Health insurance for pre-existing conditions

Murray Joiner
Many people who have a pre-existing medical condition think insurance companies won’t want to provide them with health insurance. But that’s not always the case. This article is designed to help you understand what might be possible, so that you can shop around or get professional advice from someone like an insurance broker.

What is a pre-existing condition?

When it comes to applying for health insurance, a pre-existing condition is something you’ve had medical advice or treatment for in the past. It can also be a medical ‘sign, symptom or event’ that you’re aware of or reasonably should have been aware of.

Not everything will affect the cover you’re offered, but certain conditions or treatments will suggest you’re more likely to make a claim in the future. Pre-existing conditions that are often of particular interest include things like heart disease, high blood pressure, high cholesterol, cancer, knee and hip conditions, back problems and respiratory illnesses.

It’s essential that you disclose all pre-existing conditions and let the insurer decide which ones will affect your cover. If you don’t tell them about a pre-existing condition, your policy could be cancelled or a claim refused when you need treatment, even though you’ve been paying premiums for some time.

How would an insurer know I have a pre-existing condition?

When you apply for health insurance you normally answer and sign a medical questionnaire. The insurer may also access a national database to see what medications have been prescribed for you. The people that assess insurance application risks are known as underwriters. They’re very experienced at recognising conditions that are indicated by particular prescribed medicines. Finally, an insurer may sometimes request your medical records.

Can I apply for medical insurance with a pre-existing condition?

The short answer is yes. The best way to confirm what an insurer is prepared to offer is to make an application with full disclosure of your pre-existing conditions. Several outcomes are possible:

  • Their policy may cover your condition anyway
  • They may agree to cover treatments related to that condition if you pay a higher premium
  • They may agree to cover the condition after a wait period, provided it doesn’t get worse or re-occur
  • They may exclude treatments related to that condition

Good insurance brokers represent most of the main health insurance providers and know their policy details inside out. They can often identify insurers that typically cover your condition in some way. This can save you a lot of time spent shopping around and the frustration of being turned away.

What are my options if I’m turned down for health insurance?

If a pre-existing condition is preventing you from getting the health insurance cover you want, there may be some other options to consider and get advice about.

Join a group scheme

Some organisations offer health insurance to their staff or members as part of a group scheme with a health insurance company. Many of these schemes provide cover regardless of each person’s pre-existing conditions. If you leave that organisation, some insurers let you take your policy with you; others don’t. If you can’t access a group scheme, check whether your partner can. They’re sometimes available as family cover, not just for individuals.

Self-insure

As you get older, health insurance premiums become more and more expensive. In your 50s and 60s they rise quite quickly and become unaffordable for many people. If you think your condition is unlikely to need treatment, or at least not for some time, you could choose to pay the equivalent of your premium into a savings account or term investment instead. You’d have the public system to rely on if needed, albeit with potentially long waiting times, but eventually you might be able to cover your own private health treatment if required. Keep in mind that something like a knee replacement can cost around $27,000 and heart bypass surgery around $48,000, based on 2023 prices. The costs will steadily increase with annual inflation. Self-insuring is also a risky option because many people struggle to leave the money alone when faced with other financial challenges.

Look at other types of insurance

The New Zealand public health system provides nearly all the treatments you can get privately with health insurance. The main difference is that the public system has wait times for non-acute ‘less-urgent’ treatments. Sometimes you’re not able to continue working while you wait, which can create financial problems. It’s unlikely, but you might find that other types of personal insurance – such as income protection cover or mortgage repayment cover – are prepared to provide some financial cover despite your pre-existing condition. It’s certainly worth looking into with the help of a financial adviser or insurance broker.

Next steps

To learn more about health insurance and the other types of personal insurance mentioned above, see our series of health and wealth insurance guides.

DISCLAIMER: The information contained in this article is general in nature. While facts have been checked, the article does not constitute an insurance advice service. It is only intended to provide education about the New Zealand insurances sector. Nothing in this article constitutes a recommendation that any type of insurance cover is suitable for any specific person. We cannot assess anything about your personal circumstances, all of which are unique to you. Before making insurance decisions, we recommend you seek assistance from an insurance adviser or expert.

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