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What is considered a pre-existing condition?
What is considered a pre-existing condition?
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Written by Dajana
Updated over 5 months ago

When considering signing up to a new insurance policy, you may have seen that pre-existing conditions or issues are not covered.

But what does this mean exactly, and why is this the case?

What is a pre-existing condition?

A pre-existing condition or issue is something that was already known, treated or diagnosed before an insurance policy commences.

Further to this, if you were aware of the issue before your insurance policy started, and there is an intent to get this treated after your insurance policy commences, then this would be also be considered pre-existing.

Examples of a pre-existing condition include:

  • It has undiagnosed symptoms, whether recognised or not.

  • It has been diagnosed.

  • It has needed medical treatment (including drugs, medication that can be purchased without a prescription, special diets, injections or other procedures or investigations).

  • Medical advice has been sought including routine medical examinations and check-ups.

Example 1: You have had a chronic back issue for 2 years, which has required medical treatment and physical therapy, and this occurred before your insurance policy commenced. This would be considered pre-existing.

Example 2: You have had abdominal pain for 6 months but have not been to any medical professional for this issue. However, you intend to purchase an insurance product and then go to a medical professional to get this treated. Since the issue was known before the insurance policy started and there was an intent to get it treated after an insurance policy was contracted, this would also be considered pre-existing.

Why don't insurers cover pre-existing conditions?

Think of insurance like a big shared pool where everyone chips in by paying premiums. The idea is that more people are contributing to the pool than taking from it, so that there’s enough for those who need it.

Pre-existing conditions can make this tricky because people with these conditions are more likely to need medical care, which means they take more from the pool.

If insurance covered pre-existing conditions without any limits, there’s a risk that:

  • People might only buy insurance when they need it

  • This would mean too many people would be taking from the pool and not enough would be putting into it, leading to a shortage of funds.

To handle this, insurance costs would have to go up a lot, which isn’t a great solution.

Example: Let's take a look at this in the context of our expat health insurance. This policy does not cover pre-existing conditions, and whilst this does create limitations in the coverage, it is also the reason why this insurance is one of the most affordable health insurance options in Germany (starting at €72 per month).

By keeping the risk pool lowered, it also allows for the price of this policy to be accessible and affordable for a wide range of people.

Which insurances cover pre-existing conditions?

In general, government funded/state based insurances will typically offer the most broad range health insurance that would include coverage for pre-existing conditions.

In Germany, public health insurance will provide coverage for pre-existing conditions, so this would be the best option from a health insurance perspective if you would like to have broad-range coverage.

To learn about public health insurance and the eligibility requirements to sign up, feel free to use our recommendation tool, or learn more in our public health FAQ.

If you are eligible and would like to sign up, you can sign up here.

If you have any further questions, please feel free to reach out to us via our support page.

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