Pre-existing Medical Conditions

You can find affordable life insurance if you have a pre-existing medical condition. If you’ve been putting off looking into buying insurance because you have doubts due to your health concerns, follow our 7 steps to guide you toward finding the right cover.

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Definition of pre-existing condition

A pre-existing condition medical condition is a condition which you are currently receiving treatment for or you have been diagnosed with in the past by a medical practitioner/professional.

An example of pre-existing condition may be:

  • Diabetes
  • High Blood Pressure
  • Asthma
  • Chronic Disease
  • Any other conditions diagnosed by a medical practitioner/professional

If you have a pre-existing medical condition, there may be a number of steps you need to follow:

Step 1: Speaking to your adviser

In order to gain cover, the first step is to fully disclose to your adviser any pre-existing medical conditions. This includes a FULL medical history from the time of your birth.

Not only is it a legal and essential requirement to disclose any pre-existing medical condition, it also allows your adviser to find the most appropriate cover for you and your circumstances.

By not disclosing, you are not giving your adviser every opportunity to find you an insurer who will cover you.

Please note that technically your adviser will only need to know all pre-existing medical conditions which would reasonably affect the insurer’s decision to provide cover, however the more details you disclose the better. To be safe, if you are unsure whether a previous medical condition is relevant, ask your adviser.

Generally, you will need to provide your full and complete medical file history if available; or if that is unavailable, you will need to provide answers to the following questions around your relevant previous medical conditions:

  • Your diagnosed condition
  • The severity of your condition
  • Who you have consulted regarding the condition
  • The date of diagnosis
  • Your treatment to date
  • The outcome of the treatment
  • The current status of the condition
Step 2: Pre-assessment option

If your medical history is complicated, ask your adviser to complete an anonymous pre-assessment around your specific medical history and submit the anonymous enquiry to a number of life insurance companies so they can establish what their view is around your particular medical history.

A pre-assessment is an informal way to find out how an insurer might rate / view your risk, without it influencing your insurance history.

Such an assessment is generally done by people who:

These people don’t want to be penalised because of their unique situation. So, instead of formally applying for insurance at the start, they make use of a pre-assessment to glean what their premiums or offer from an insurer or insurers might be. The assessment generally don’t affect your insurance history because these are predominantly completed anonymously (This is the best way to ensure this is the case).

A pre-assessment gives you the advantage of assessing your risk discreetly, so you are more prepared when applying formally. You can turn risk into value by getting that extra edge when choosing and selecting an insurer.

The following will help you make the most of your pre-assessment.

  1. The more detailed, accurate and complete the information you provide, the more precise the pre assessment results will be.
    It gives you valid insight into your formal application, should you apply for one. Therefore, it’s important that you provide as much information as possible during the pre-assessment stage.
  2. A Pre assessment is not binding to an insurer.
    While it is a great way to get insight into their views, it doesn’t mean they have to honour it. That being said, in our experience, we have found that if you provide honest, detailed information from the start, then generally the insurers’ final assessment will be more consistent with their original pre-assessment.

However, the results of your pre-assessment should never be a reason to leave out pertinent information when you formally apply. It is essential that you fully disclose to the insurer your entire situation when applying formally.

General Information you can expect to provide in your pre-assessment:

  • Date of birth
  • Height
  • Weight
  • Smoking and drinking habits
  • Your health history
  • Your current health
  • Your family’s health history
  • Your annual income
  • Pastimes

If you’re looking for an insurance policy and you suspect you might be a higher risk than a standard adult, then add additional information to your pre-assessment. You can and should use our expertise to see if we can help you find an affordable policy that provides you with adequate coverage / terms that meet your requirements.

We’ve compiled a list of information we recommend you attach, if applicable.

If you have a complex medical history:

  • The medical condition you’ve been diagnosed with
  • The date of diagnoses
  • Treatment and medications
  • Results
  • The contact details of the doctor treating you

When your occupation could be perceived as dangerous:

  • Title
  • Duties
  • Hours per week
  • Income
  • Education
  • Location

When you partake in dangerous past times:

  • The type of activity
  • Hours spent participating in said activity
  • Qualification and license
  • Locations
  • Activity specific information. For example, type of vehicle you race with, the depth you dive to and the heights you jump of off

Financials, if you’re self-employed and want to apply for income protection insurance:

  • Business profits and loss statements for the last 2 years
  • Business balance sheet for the last 2 years
  • Your income (group certificate)
  • Tax assessment notice
  • Tax return (personal)
  • Income splitting (spouse)

*Note: Remember to black-out your name in the copies you send with your pre-assessment.

It’s important to know that not all insurers’ view pre-existing conditions the same. If you want the best possible premiums, you need to shop around and send them your pre-assessment.

Step 3: Outcome of Pre-assessment

Following the outcome of your pre-assessment, you can then make a decision on whether or not you wish to formally apply for a life insurance policy and who would be the first insurer to approach.

Step 4: Formal lodgment of application to a life insurance company

Once you decide to proceed with an application, your adviser will formally lodge the above information to the life insurer who provided the best available terms based on the pre-assessment. The formal application will involve providing the insurer with the above medical information as well as a number of other personal details as per a normal full application.

Step 5: Providing further information

Once the relevant life insurance company has received your application, including details of your pre-existing medical history, they may request additional information and may require you to:

  • Obtain further information from your doctor (you will need to sign a medical authority form to allow the insurer to access your files and/or
  • Undergo a medical examination; and/or
  • Undergo further blood tests; and/or
  • Undergo additional medical tests
Step 6: Underwriting

When your life insurance company believes they have all the relevant information, including your pre-existing medical history, medical files and results from any other additional tests, your application will be assessed and go through a process called underwriting, where your life insurer will assess your risk to the company.

Step 7: Outcome

Once this process is completed, they will generally decide on the following:

  • Accept you at standard rates; or
  • Apply a loading to your policy; or
  • Apply an exclusion to your policy; or
  • Decline your application

If you are not happy with the outcome the insurer has provided, it is important to ask the life company or your adviser when the outcome is reviewable or you should possibly consider other insurers.

However it is important to know that life companies may hold very similar views on certain medical conditions.

Published: March 24, 2017

Ask an Expert?

20 Comments

  • John |

    I have Bipolar2 (Bi polar II) and was diagnosed 10 years ago. I am 56 now and want to know if an insurer would penalise me or disqualify me from taking out a life insurance policy.

    Thanks

    • Russell SPECIALIST
      Russell |

      Hi John

      Generally, having Bi polar II (2) alone doesn’t mean you will automatically be disqualified by an insurer for life insurance cover, however your eligibility will generally be based on a number of factors about you and your control of your Bipolar II such as:

      • Number of episodes
      • Date of last episode
      • Response to treatment
      • Any hospitalisation
      • Suicidal idealisations or attempts
      • Any drug or alcohol abuse

      For Life or Critical Illness (Trauma) cover it may be possible to get full cover without any additional premiums (loading’s) or exclusions however the number of episodes would have to be very low, with the last episode being a few years + ago and you will need to be responding well to medication and have no other risk factors.

      However if this is not the case you may still be possible to get cover however at a higher premium to take into consideration the greater risk posed to the insurer, worst case scenario you may not be able to get full Life or Critical Illness cover, it may have an exclusion or you may only be able to accidental death cover only.

      Please note Total & Permanent Disablement cover can be harder to obtain as life insurers generally have tighter eligibility criteria than the above types of cover.

      Every persons situation is different and I would suggest talking to a specialist such as us to allow us to get a better understanding of your situation which would allow us to then complete a Pre Assessment (where we take that information about you & your past medical history and anonymously propose your cover / situation to a number of insurance companies to then get their feedback before you lodge a formal application). This gives you an understanding of which insurer may provide you with a better offer or not and can save you a lot of time.

      It can also lead to a better outcome as insurers often have different views on certain medical conditions therefore one companies response / view can be very different to another therefore it often pay for people with complex medical situations to engage in a specialist such as us to find an appropriate outcome that works for you.

      I hope this helps.

  • Paul |

    Hi Team

    I am looking for a quote for life insurance. I am a 60 year Australia male who has never smoked. My problems is that I have had open heart by-pass surgery. I have fully recovered and have returned to full-time work.

    I have a wife and two daughters one 18 yrs and one 14 yrs. Is there any chance of obtaining life insurance at a reasonable cost? or what is the best type of insurance cover to get?

    Regards

    Paul

    • Russell SPECIALIST
      Russell |

      Hi Paul
      Thank you for your question, in order for me to help you as much as I possibly can in answering your question could you please provide me with the following additional information:

      1. Date of the Surgery
      2. Diagnosis (That lead to the requirement for Surgery)
      3. What Treatment / Surgery was completed – the details of the area / type of treatment.
      4. Are you on any type of ongoing treatment?
      5. Do you suffer from any other medical conditions?

      This information is key for a us to undertake a pre-assessment which is where we informally ask an underwriter from an insurer their views on if they are able to offer cover (and if so on what terms / premium) for someone who has had heart / Bypass surgery.

      Once we have this information we will be able to assist further.

      Regards
      Russell Cain

  • lynn |

    Hi, my husband has connective tissue disease, he is currently taking medicine and seeing his specialist once a three month. He is 31 this year. Does he qualify to have life insurance cover? Will the cover price be higher than normal?

    • Russell SPECIALIST
      Russell |

      Hi Lynn

      I would need more information to assist you with this question as my brief research has highlighted there are a number of connective tissue conditions therefore please can you provide the following information to assist:

      1. Which Connective tissue condition does he have
      2. When was it diagnosed
      3. What treatment has he had
      4. What medication / treatment & dosage is he currently taking
      5. Any other medical conditions
      6. Is he a smoker / none smoker

      Once I have this information I will be able to find out more around the life insurance options that may be available and the potential premiums should the insurers we have access to be able to offer cover to your husband. If you prefer to call us to provide this information please call us on 1300 135 205.

  • Rakesh |

    Hi
    My wife is going through a dialysis program. She is lot stronger and energetic ever since she started on it about 2 months ago. She doesn’t have anything major other than that. Does she qualify to hold a life insurance?

    • Brett Lenertz SPECIALIST
      Brett Lenertz |

      Thanks for your question Rakesh. Each Life Insurance company assesses a persons health based on many factors. This can include the severity or frequency of certain medical conditions. The most practical way to approach this for your wife is to make contact with us and we can take her through a pre-assessment on her condition with the Life Insurers and then we will provide further information to both of you before we take her through the application process. You are welcome to contact us on 1300 135 205 and one of our specialists can help you with this.

  • Bronwen |

    Hi,
    I would like to find out if there are any Insurance Companies that would insure me for both Life Insurance and Income Protection without excessive loading. I am a 52 y.o female. I am a registered nurse who works in an outpatient type setting so no lifting, night shifts etc. Much of my work is either computer/phone related and venepuncture. My BMI is around 40 which seems to be a stumbling block for most insurers much to my irritation. I have normal blood pressure, normal sugar and cholesterol levels and normal liver and thyroid function. I do have generalized anxiety which is well controlled on meds and has been for years. I also have osteoarthritis in my knees and have recently had surgery on one of these (lateral release and tibial tendon transfer). Many years ago I had muscular related back issues but have not had any issues for a couple of decades . Whilst I realize this all sounds terrible I would like it noted that I have not had any sick leave for anxiety issues. Similarly I have not had any time off for osteoarthritis and have only had 6 days off work following the recent surgery. On a family history level. My father died at age 85 having had congestive heart failure for several years which subsequently led to several falls resulting in acquired dementia. My mother is currently living and is 83 and aside from osteoporosis and high cholesterol is well. My paternal grandmother was a large woman like myself and lived to 95. I would be grateful if you could find a company that is prepared to insure me without just looking at their BMI charts and throwing their hands up in the air and saying she is un-insurable and if we do insure her we will tack on an excessive loading. Thanks

    • Brett Lenertz SPECIALIST
      Brett Lenertz |

      Thanks for contacting us Bronwen and your question has plenty of content which is great. I appreciate the effort you have gone to and I can definitely sense the importance that you place on having these covers to protect you and your family. I can see that you have already spoken to one of our Specialists and you have already provided the additional information that we require so thank you. It is important to understand that all Insurers treat each application on a case by case basis but generally when people have pre-existing medical conditions the Insurers will often assess on date of diagnosis, severity of the condition, current treatment and any recent changes to the condition or outcomes. With regards to the Family History information, the Insurers will only look at Family History to immediate first degree blood related family members for example mother, father, brother and sister up to the age of 65, hence this does not extend to Grandparents. I can see that our Life Insurance Specialist has contacted 6 x Insurers to have you pre-assessed at this stage and they will be getting back to you in the next 24 hours to provide some outcomes and discuss your options. Thank You.

  • Alan |

    Hi Team,
    I am about to turn 66 and have been retired for afew years. I also take medication for PTSD which is a result of both War Service (Vietnam) and years of working in the emergency services. My previous insurance company has just informed me that my Life Policy has expired and as such they say I can be insured with them if I pay a premium that is absolute extortion! The premium has been increased because of my age to 2 1/2 times what is has been, with NO change in my medical condition. I still need life insurance to protect my family. Is there a company that will provide insurance without the highway robbery?

    • Brett Lenertz SPECIALIST
      Brett Lenertz |

      Hi Alan, Thanks for contacting us and am sorry to hear about those circumstances around the new premium you have been asked to pay to retain your cover. I hope I can provide you with some good information here that will be beneficial to you. I can probably presume that this cover was held inside superannuation and possibly provided by your previous employer in the form of a Group Insurance Product? The reason I say this is that often these types of policies do expire at age 65 or 70.

      We can offer a choice of up to 11 x Insurance Providers here and our Life Insurance Specialists can pre-assess your situation with these companies so that you can hopefully find a policy the meets your needs. The Life Insurance Providers will ask questions around the severity of your PTSD but that can be explained to you following the pre-assessment. It does not cost you any money for us to research this for you and to present you with options so that you know where you stand. Please call us on 1300 135 205 and we can start the process for you. Thanks

  • Chris Roberts |

    Hi There,

    My husband had Hodgkin’s Lymphoma 15 years ago.

    He has had nil re-occurrences and still he can’t get an average life insurance coverage.

    What can we do?

    • Brett Lenertz SPECIALIST
      Brett Lenertz |

      Thanks for contacting us Chris with your very relevant question. Life Insurance for cancer survivors can often be difficult to obtain but it is most definitely not impossible. Typically, a Life Insurance Provider looks at the Type of Cancer, Age at Diagnosis, Staging based on a Histology Report and the type of treatment undertaken when they assess life insurance for people who have had cancer. When these factors are considered, the Life Insurer then during the underwriting process decides if the risk to them to insure this person can be considered at standard or normal rates or they may wish to apply a ‘loading’ to the premiums which means they will offer cover but apply a higher premium based on the risk to accept the insurance cover.

      Based on your question, I suspect that you have found that the premiums being offered have been with a ‘loading’ or are higher than you thought? One of the benefits of our service is that we can offer your husband a pre-assessment with up to 11 x Life Insurance Providers that we compare and thus all these Insurers may provide a different outcome in relation to the Life Cover and you can subsequently choose the best for your needs, whether this be the lowest premium or the included features and benefits of a policy. This is a free service for one of our Life Insurance Specialists to conduct the pre-assessment and provide an outcome for you to consider. You are welcome to contact us on 1300 135 205 and we can help you and your husband further in this regard.
      Thank You

  • Sabrina |

    I have been diagnosed with a incidental finding of a small meningioma no treatment is required only follow up scan in 12 months

    • Russell SPECIALIST
      Russell |

      Hi Sabrina

      I would suggest you contact the team on 1300 135 205 to let them know the type and level of cover you are looking for. Please also provide them with any test results you may have had completed for your meningioma and we will be able to complete an anonymous pre-assessment with a number of insurers for you to let you know the best outcome we can find for you.

  • Mark |

    I am interested in income protection insurance. Here is a short synopsis:

    I am an airline pilot currently unable to fulfil my role as a pilot due to being diagnosed in Jan 2016 with an autoimmune disease called Granulomatosis with polyangiitis (Wegener’s disease). I am currently working part time on the ground however it is highly unlikely I will be able to get my medical back to fly again. I am also concerned about not being able to work on the ground either due to the possibility of disease relapses.

    If you are able to assist I would greatly appreciate it.

    • Russell SPECIALIST
      Russell |

      Hi Mark

      If you are already suffering from a medical condition that is preventing you from doing your original occupation it would be very difficult to find an insurer willing to cover you for a different occupation for the same condition for full income protection cover. However you may be able to get personal accident insurance that would cover you for accidents that prevent you from being able to work.

      If you would like to discuss your situation in detail please and for us to complete a no obligation pre-assessment for full income protection or if you would like personal accident insurance please contact us.

  • Chris |

    Hey I have a Knee replacement fitted a number of years ago and not expecting any issues with it. I was wondering if I had an accident (ie feel down stairs and broke my knee replacement) is there any insurance out there that would cover for accident only for pre – existing medical conditions?

    Regards
    Chris

    • Russell SPECIALIST
      Russell |

      Hi Chris

      While I can’t comment of all insurance policy type’s, however I will be able to comment with the income protection policies we currently have access to from the 10 insurers we use. In general their view is that if you have had a structural issue in the past that was treated by fusion (eg spine fusion), replacement (eg knee replacement) or pinned (where the pins are still present eg broken leg).

      Then in general if you were to take out a policy after this medical event now becoming a pre-existing medical condition of this nature, this will generally be excluded from the policy as their general is that as you have had this type of previous condition and treatment it is more likely to reoccur or have related conditions as a result of this.

      However each person’s scenario is reviewed on a case by case basis by insurers therefore it would be worth your time completing a pre-assessment to get their actual view based on your particular scenario to be certain.

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