High-End Medical Plans: Do They Cover Pre-Existing Conditions?

For insurance companies, a pre-existing illness before application refers to situations where the condition has already been diagnosed, obvious symptoms have appeared, or medical advice or treatment for the condition has been received. Traditionally, if the applicant had such a pre-existing illness before applying, regardless of whether it was ‘known’ or ‘unknown’, it would be listed as an exclusion in medical insurance by the insurance company, known as an exclusion .

As mentioned earlier, ‘pre-existing conditions’ can be ‘known’ or ‘unknown’. So, what is an unknown pre-existing condition ? It generally refers to a disease that the insured was unaware of before application, or one that had not shown obvious symptoms, or for which no doctor was consulted or treatment sought.

In the past, unknown pre-existing conditions were excluded from most medical insurance policies. This tradition changed with the introduction of VHIS . VHIS requires all approved plans to cover unknown pre-existing conditions at the time of application, and all plans on the market must comply with this rule. However, to prevent adverse selection, insurers are allowed to include a certain waiting period in their policies. The minimum requirements for coverage of unknown pre-existing conditions are as follows:

For example, with Bowtie, the waiting period for unknown pre-existing conditions in our VHIS products is set as follows:

With the introduction and growing popularity of the VHIS Scheme, “unknown pre-existing conditions” can now receive a certain degree of medical coverage. So, can “known pre-existing conditions” be covered by medical insurance policies?

If the applicant is already aware of certain diseases, the insurance company will handle the medical insurance application based on the type and severity of the “pre-existing condition”.

If the risk of complications is low or the condition is mild, the insurance company may exclude the “pre-existing condition” from coverage and/or charge an additional premium (commonly known as Loading ); if the risk of complications is high or the condition is severe, the insurance company is likely to reject the application outright.

Some might think that when applying for insurance and filling out the health declaration questionnaire, they can withhold or conceal the history of “pre-existing conditions” to successfully get insured.

However, if the applicant violates the principle of utmost good faith by deliberately hiding medical history or misrepresenting their health status, it could lead to claim denials or even policy invalidation. Insurance companies have the right to request medical records from public and private healthcare institutions, so any existing medical history will eventually be discovered.

There are two types of policies in the market that provide such coverage for those with a higher budget.

The first type is certain high-end medical insurances that cover “pre-existing conditions”, though these plans are rare in the market. For example, a high-end medical insurance plan offered by Bank C includes “pre-existing condition coverage”, but applicants must opt for the highest tier of the three plan levels to enjoy this benefit.

Additionally, there is a 36-month waiting period (during which no treatment for the condition is received or claims made from other policies), but the payout per claim is very limited (only $100,000), with a lifetime maximum of three claims, each followed by another 36-month waiting period.

The second type is group medical insurance . Group medical insurance is provided by employers to employees, and employers typically renew it annually. For administrative convenience, and because insurance companies can adjust premiums and re-underwrite during renewal, the underwriting process for group medical insurance is generally more lenient than for individual plans, and employees usually do not need to declare their health status or medical history individually.

Therefore, even if an employee has been diagnosed with certain diseases, they can still receive coverage under the group medical insurance.

However, as an employee, you cannot choose the plan or coverage level yourself, so it may not fully meet personal needs. Moreover, the coverage amounts for general employees are often limited (unless you are in senior management).

With annual inpatient and surgical benefits possibly only amounting to tens of thousands of dollars, it may not be sufficient for serious illnesses.

“Pre-existing conditions” are typically excluded from most medical insurances, and even if some policies offer coverage, the levels are often inadequate with many restrictions.

The smartest move is to secure suitable medical coverage as early as possible while you are young, healthy, and free from illness. For instance, with guaranteed renewable VHIS , once the policy takes effect, you can continue to receive coverage as long as you maintain renewal, even if you are unfortunately diagnosed with a disease or health issues arise.

• Medical insurance: In a reimbursement form , it provides compensation for eligible medical expenses
• Critical illness insurance: In the event that the insured unfortunately suffers from a specified serious illness, it provides a lump sum payment to cover the insured’s living expenses during the period of absence from work due to illness, allowing the insured to focus on treatment and recovery

Therefore, if you unfortunately suffer from a critical illness, having only medical insurance may cover your medical expenses but may not address your long-term challenges. In fact, when you are diagnosed with a critical illness, even if it is not life-threatening, you may be forced to stop working and lose income, which could affect your quality of life and disrupt your existing plans.

Since medical insurance and critical illness insurance provide non-overlapping coverage, a reliable critical illness insurance policy can replace your lost income during your absence from work, providing financial support and reducing the impact on your family, while maintaining your original quality of life.

Critical illness insurance is absolutely an essential form of protection. In addition to medical insurance, the importance of critical illness insurance cannot be overlooked. In any situation, as long as you have a stable income, you should actively consider purchasing a critical illness policy to give yourself an extra layer of protection.

Bowtie Pink VHIS Plan offers several key features to serve as your health safety net:

• Individuals aged 15 days to 80 years can apply
• Coverage worldwide ^{^} applicable
• Global emergency support services
• Full reimbursement ¹ for any hospital, any surgery
• Annual limit: Up to HK$2,000,000 (reset annually)
• Monthly premium as low as HK$168 ^#