The most frequent question asked by Canadian travellers of all ages is “Can I get insurance for my pre-existing condition?” And for most, the answer is Yes. But you have to know the rules set in the policy, and you have to understand what you are buying.
No insurer will ever give you blanket coverage for pre-existing conditions, no matter how much you pay.
There are always limitations. It’s up to you to understand them; and if you don’t, ask your insurer and be prepared to go to your doctor and ask his or her help too.
Any policy that says it covers pre-existing conditions will usually stipulate that a pre-existing condition (or its symptoms—the condition does not necessarily have to be diagnosed) must have been stable and controlled for a specified period: some require 90 day stability, some longer. And stability is not what you think it is or your doctor says it is. The policy defines stability, and that is usually a condition that has not revealed symptoms, or been treated, or required medication, or a change in type of dosage or medication, or investigations or tests, or referrals to specialists for a given period. The language differs from policy to policy, so make sure you understand it.
If you have one or several conditions, or are in an elderly age group, you may have to complete a medical questionnaire or answer medical questions put to you by an insurance agent. It’s critical that you answer these questions accurately and in full knowledge of what you are being asked. Some questionnaires use too much medical language that may not be clear to you. In that case ask the agent to be specific and explain the questions, and if you are unsure of your medical history—why you are taking certain medication, why you have been referred for tests—ask your doctor to clarify. And demand that your doctor tell you everything that is in your medical record.
Too often, doctors don’t tell their patients everything in their record because they think they don’t need to know, or the condition doesn’t warrant treatment at the time, or they don’t want to worry them. That does not help the patient.
We know of many patients who have complained that their doctor didn’t tell them they had a 2nd degree heart block, or atrial fibrillation, or a small kidney stone, and they completed a medical application without that knowledge and subsequently had their claim for emergency services denied. The insurer has a right to expect that when you apply for $5 million of coverage, you provide accurate information about your medical status. It’s up to you to do it right.
Take control of your medical record. Make sure you know what’s in it. Make sure you read the key parts of your policy and, if necessary, discuss anything you don’t understand with your agent or the insurer directly, and be absolutely sure the information you provide on your medical record is complete and accurate.
Coverage of pre-existing conditions is possible and widely available: but you need to understand the rules.