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Changing health insurance providers can be a daunting task. Understanding how your pre-existing medical conditions affect your ability to switch providers is key to ensuring you receive all the coverage needed for your particular situation, without unnecessary complications.
If you’re considering making this switch, read on: below we discuss pre-existing medical conditions, their effect on your choices of policy, and how to change providers while maintaining complete coverage.
What Constitutes a Pre-Existing Medical Condition?
A pre-existing medical condition is any condition for which you consulted a doctor, received treatment, or experienced symptoms before the start date of your new health insurance policy. This includes both diagnosed and undiagnosed conditions such as:
- Genetic or hereditary illnesses that may have been passed on within the family but have not yet been certified.
- Uninvestigated symptoms that point to an underlying medical condition, even without a diagnosis.
- Pending medical examinations where you have yet to receive results from tests or screenings for a possible health condition.
Knowing whether your medical history contains such conditions is vital when changing insurance companies, as they will affect the terms of your new policy.
Typical Examples of Pre-Existing Medical Conditions
Pre-existing medical conditions are well cataloged and will determine if you can switch to another insurance company or not depending on its nature. Here’s a list of the most common conditions:
- Chronic Illnesses: Diabetes (Type 1 and 2), Hypertension, Asthma, Chronic kidney disease, Heart disease
- Neurological Disorders: Parkinson’s disease, Epilepsy, Multiple sclerosis, Alzheimer’s disease, Stroke
- Mental Health Conditions: Major depression, Bipolar disorder, Schizophrenia, Anxiety disorders
- Autoimmune Diseases: Rheumatoid arthritis, Crohn’s disease
- Respiratory Conditions: Chronic obstructive pulmonary disease (COPD), Emphysema
- Cancer: Any previous diagnosis, including those that are now in remission.
Other major medical conditions include HIV/AIDS, organ transplants, and hepatitis B or C. It is crucial to disclose any pre-existing medical conditions when applying for new insurance; failure to do so could result in denied claims or policy cancellations.
What Doesn’t Count as a Pre-Existing Condition?
Not all health issues are considered pre-existing conditions. Minor injuries, seasonal colds, and short-term illnesses like the flu do not need to be declared when applying for new coverage. Additionally, COVID-19 is not considered a pre-existing condition unless you’ve had long-term complications from it (often referred to as “long COVID”).
How to Switch Health Insurance Companies With a Pre-Existing Condition
There are three main ways to switch health insurance companies while managing pre-existing medical conditions. Which option is best for you depends on your current health status, the history of your policy, and the level of coverage you require.
1. Switching With Continued Personal Medical Exclusions (CPME)
CPME allows you to switch insurance companies without creating a coverage gap and with nearly equivalent protection. You can carry over any medical exclusions from the previous policy without undergoing fresh medical underwriting.
- Ensure your present policy is fully medically underwritten or has a moratorium approach.
- Apply to the new carrier, including your certificate of insurance and benefits table from your current carrier.
- The new carrier will process your application and transfer your coverage without further medical checks.
Benefits of CPME:
- No coverage gap; your new policy starts immediately after your old one ends.
- No new medical underwriting is required.
- Waiting periods for benefits are dropped.
- Maintains similar levels of coverage to your previous plan.
Notes on CPME:
- Your existing insurer must be a recognized international private healthcare insurer.
- Ensure there are no gaps in coverage between your policies.
- If you are over 50, CPME may be your only option, and your last policy must have started in the last five years.
- Some major health conditions may disqualify you from CPME.
2. Switching With Full Medical Underwriting (FMU)
FMU is required if you:
- Have been diagnosed with a new condition since your last policy started.
- Have had a major illness in the past.
- Need to take out new health insurance after a break in coverage.
- Are disqualified from CPME.
How to Switch With FMU:
- Fill out a detailed application form regarding your medical history and lifestyle.
- The insurer will review your application and determine if exclusions or premium increases are necessary.
Advantages of FMU:
- You can upgrade your level of coverage.
- Your premium is tailored to your needs.
- Approval may be quick if you have no current health issues.
To follow this process properly, you must also disclose all pre-existing conditions.
3. Switching With Moratorium
If you have not suffered from non-serious or non-chronic conditions in the past and do not qualify for CPME, using a moratorium approach may be suitable.
- With Moratorium underwriting, a pre-existing condition can be covered only if:
- You have not consulted a doctor.
- You have not taken prescribed medicines.
- There have been no symptoms for at least two years.
How to Switch With Moratorium:
Fill in a simple application form. Moratorium is available only if you are under 39 and opting for a coverage level just above the lowest.
Advantages of Moratorium:
After two years, pre-existing conditions can be covered and the application process is faster than FMU.
Final Notes Before Switching Health Insurance
Switching health insurance providers isn’t overly complicated. Once you understand your options and their implications regarding pre-existing conditions, you can make the change with ease—much like signing new rental agreements in college while ensuring old ones are canceled.
If you have questions, a health insurance expert can help guide you through every decision and locate the best policy for your needs.
