Getting life insurance with pre-existing conditions

Essentially, any medical condition you currently have or previously had that affects your health and could potentially result in a claim could be classified as pre-existing. Some common examples of pre-existing conditions include:

• Heart disease.
• High blood pressure.
• High cholesterol.
• Musculoskeletal conditions.
• Strokes.
• Cancer.
• Mental health conditions (including depression and anxiety).
• Sleep apnoea.
• Kidney or liver disease.
• Diabetes.

In some cases, medical conditions you had in the past may not be considered pre-existing under your life insurance policy. These can include conditions that were successfully treated and no longer require medical tests, or conditions that haven’t required treatment for a specific time.

Definitions regarding pre-existing conditions can vary, so it’s always worth reading the relevant Product Disclosure Statement (PDS).

While you may be able to find a life insurance provider that can cover your pre-existing condition, there are some things that many providers will not cover. Common exclusions can be:

• Self-inflicted injuries and suicide. A lot of policies won’t pay claims for death resulting from self-inflicted injuries and suicide within the first 13 months of cover.
• Reckless behaviour. Claims for injuries or death caused by reckless activities (like dangerous driving) or anything else where safety precautions and warnings were disregarded may be excluded from your policy.
• Criminal activity. If a claim is made for an injury or death that occurred while committing a criminal activity or breaking the law, it may not be covered by your policy.

Other exclusions for specific types of life insurance may include:

• Life insurance: You may not be covered for claims if you’re in a country that has a ‘do not travel’ warning. You can find out which countries have this warning on Smartraveller.
• Trauma cover: Within the first 90 days of cover, some trauma events (such as heart attacks, strokes and cancer) may be excluded. Low grade, generally non-life-threatening cancers may also be excluded.
• Total and permanent disability (TPD) cover: Given the name of this policy, temporary injuries and disabilities are usually excluded.
• Income protection: Pregnancy-related ailments may be excluded from income protection policies, provided it’s a regular pregnancy without complications.

You should always read the PDS to understand the exclusions and limits that are applicable to any policy you are considering.

Maybe. If you are able to take out cover with your pre-existing condition, you may pay more for life insurance with a pre-existing condition, which is known as a loading, to cover the additional risk to the insurer. Alternatively, the insurer may exclude the pre-existing condition from cover. These are known as alternative terms. Where the insurer offers insurance with alternative terms, they will also let you know how long they are intended to apply for and how you can review these.

However, it’s important to keep in mind that there are a wide variety of other factors that can affect how much you pay for life insurance, including:

• Your occupation.
• Whether you participate in high-risk hobby or sport.
• How much alcohol you drink.
• If you smoke cigarettes or cigars.

The cost of life insurance progressively increases as we age, partly due to the higher likelihood that you’ll need to make a claim as you get older.

A life insurance pre-assessment is a process that can help you gain a better understanding of what policies may be available to you before you lodge a formal application for insurance. This is done with the help of an insurance consultant before you purchase a policy to give you an idea of potential conditions and/or loadings that would apply to a life insurance policy based on your disclosed medical history and pastimes.

It involves answering a series of questions about your pre-existing medical conditions and pastimes, along with your general details (e.g. age, height and weight) and other information regarding your current lifestyle and occupation. The more information you provide, the more comprehensive the pre-assessment can be.

Pre-assessments are not compulsory, but your insurance consultant may recommend you complete one if you disclose a pre-existing condition or participation in hazardous activities.

The information you may need to provide can vary between providers but may include the following types of information:

• General information like date of birth, gender, height, weight, home address and personal contact information.
• Lifestyle details such as smoking status and average alcohol consumption, hobbies, work activities, extreme sport or pastimes you participate in.
• Health status information about pre-existing conditions, former surgeries and any information about current medical conditions.
• Family history of health issues or medical conditions, including the current and former health status of your parents.
• Occupation details like what your current occupation is, the requirements of your role and what industry or field you work in.

It’s important to note that the results of your pre-assessment aren’t conclusive; rather, they’re a guide to give you an idea of what kind of cover and prices you can get. If you can’t be covered by a standard policy due to your pre-existing condition (or other factors), your life insurance provider may offer a policy with alternative terms tailored to your needs. These terms may include:

• Loadings. You would still be covered for all insured events, as outlined within the Product Disclosure Statement, but charged a loading (higher premium). A loading might be added on to your premium if you have a pre-existing condition like diabetes or if you’re a smoker.
• Exclusions. Certain benefits may be excluded from your policy due to your pre-existing condition or other circumstances. For example, if you have a heart condition, benefits based on heart attacks might be excluded.