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Health insurance customers are often unsure of what private medical insurers classify as a chronic condition, and also of whether chronic conditions will be covered on their policy. ActiveQuote has provided a comprehensive guide to chronic conditions to clear up some of the common misconceptions surrounding this topic.
What is a chronic condition?
A chronic condition is any condition that falls under the following categories:
- The condition needs ongoing or long-term monitoring though examinations, consultations, check-ups and/ or tests
- The condition needs ongoing or long-term control or relief of symptoms
- The condition requires your rehabilitation or for you to be trained to cope with it
- The condition continues indefinitely
- The condition has no known cure
- The condition comes back or is likely to come back
How will insurers deal with a chronic condition?
If you have already sought medical advice for your chronic condition, it will be dealt with as a pre-existing condition. This means:
- Policies with full medical underwriting will probably apply a specific exclusion for that condition.
- Moratorium policies will only cover a pre-existing condition if the patient has gone treatment and advice free for two years. It is unlikely that this will apply to a person with a chronic condition.
If the chronic condition develops after the start of the policy, cover will be provided to stabilise the condition. This means:
- Your insurer will pay for any treatment to stabilise the condition.
- If a condition is declared chronic, no further cover will be available for the ongoing management of the condition.
- However, if there is a sudden deterioration of the condition (an acute flare-up), the policy will cover its stabilisation.
Can you give me an example?
Susan had been with her current insurer for over two years, when she begins to have problems with her breathing. She visits her GP, who refers her to a specialist. After a number of tests, Susan is diagnosed with asthma. Her insurer will pay for the cost of the initial consultation, as well as the diagnostic tests.
Susan is given a course of medication to control the condition, and the specialist recommends that she has a follow-up consultation a few months later. Her insurer will cover the cost of the follow-up consultation as it was part of the initial treatment. However, her insurer will not pay for her medication since it forms part of the ongoing management of her condition.
Susan needs check-ups every 6 months. These would also not be covered by her insurer, as they are part of the ongoing management of her condition.
A year later and Susan has a bad asthma attack. This would be considered an acute flare-up, and her insurer will pay for the stabilisation of the condition. Once the asthma has stabilised, the insurer will no longer cover her regular check-ups or medication.
Please note that for all policies, there may be limitations in the amount the insurer will pay for certain treatments.
If you need more help and advice about chronic conditions, compare health insurance quotes online now, or call one of our advisors for free on 0800 862 0373.