A pre-existing condition is any health issue known, diagnosed, or treated before an insurance policy starts or intended to be treated after the policy begins. Insurance companies usually exclude these conditions to keep costs affordable and prevent adverse selection. Government or public health insurance plans generally offer coverage for pre-existing conditions, while private or expat health insurance often do not.
What is considered a pre-existing condition in insurance?
A pre-existing condition is a medical issue or health problem that existed before the start of an insurance policy. This includes conditions that were diagnosed, treated, or showed symptoms before the policy began. It also includes health issues you knew about before buying insurance and planned to get treated after the policy started.
Examples of pre-existing conditions include:
Symptoms that were present but undiagnosed.
Diagnosed illnesses or disorders.
Medical treatments previously received, such as medications, special diets, injections, or medical procedures.
Medical advice or routine check-ups sought before the insurance policy began.
Why do insurance companies exclude pre-existing conditions from coverage?
Insurance works by pooling money from many people who pay premiums to cover medical costs for those who need it. Covering pre-existing conditions without restrictions can cause financial imbalance because:
Individuals may buy insurance only when they need treatment for existing conditions.
This leads to more claims than contributions in the pool.
The imbalance would force insurance costs to increase significantly.
Excluding pre-existing conditions helps keep insurance affordable by managing risk and maintaining a balanced pool.
Can you provide examples of pre-existing conditions?
Example 1: Having a chronic back problem treated with physical therapy for two years before starting insurance is a pre-existing condition.
Example 2: Experiencing abdominal pain for six months without seeing a doctor but intending to get treatment after buying insurance is also a pre-existing condition.
Which types of insurance plans typically cover pre-existing conditions?
Government-funded or state-based health insurance plans usually provide broader coverage that includes pre-existing conditions. For example, in Germany, public health insurance covers pre-existing conditions and is suitable
for those seeking comprehensive health coverage.