Product Philosophy
Product Philosophy Why is it unfair to exclude the wait for unknown pre-existing conditions for VHIS?
Author Bowtie Team
Updated on 2025-06-10
Disclaimer: This article is translated with the assistance of AI.
Many insurance providers are now waiving or slashing the waiting period for unknown pre-existing conditions in premium VHIS plans to just 30 days. It’s a big draw for buyers, but here’s the catch: overly lenient waits might tip the scales of fairness among policyholders and crank up long-term premiums. At Bowtie, we strive to strike the perfect balance between irresistible product perks and wallet-friendly costs. We’ll unpack the connections and our smart approach in this read.
Why Does VHIS Include a Waiting Period for Unknown Pre-Existing Conditions?
First off, we need to understand what “unknown pre-existing conditions” really means:
The definition of unknown pre-existing conditions is a disease that the insured person was unaware of before applying for coverage, or one that hadn’t shown obvious symptoms or signs, or hadn’t been diagnosed or treated by a doctor.
In the past, medical insurance policies might not have clearly outlined how unknown pre-existing conditions are handled, which could lead to disputes between insurance companies and policyholders. When the Food and Health Bureau introduced the VHIS in 2019, they added a waiting period clause for unknown pre-existing conditions to cut down on disagreements during claims. This means the compensation amount gradually increases from 0% of the sum insured in the first year up to 100%* over a 4-year waiting period, giving both sides a clear way to handle these claims and avoid conflicts.
- * The waiting period for unknown pre-existing conditions is 0% in the first year, 25% in the second year, 50% in the third year, and 100% starting from the fourth year.
Situations that don’t count as unknown pre-existing conditions , like accidental injuries requiring hospitalization or diseases that develop after the policy starts, don’t have a waiting period with VHIS. Policyholders can claim 100% of the sum insured right away after the policy takes effect !
Does the Clause Affect Claims? What About Diseases With An Incubation Period?
Many serious illnesses like cancer have an incubation period, so you might wonder if the unknown pre-existing conditions clause in VHIS could weaken the coverage you expect. For instance, if someone buys insurance without any obvious symptoms or medical history, but then gets diagnosed with cancer within 6 months of the policy starting, could they still get compensated? Or would this clause block the claim?
In fact, cancer progression can vary widely from person to person, and it’s tough for doctors to pinpoint exactly when it began in an individual case. Without solid medical evidence, the insurance company can’t classify it as an unknown pre-existing condition and apply this clause. In other words, the policyholder wouldn’t be affected and could claim compensation for cancer treatment costs.
Why Do Most Insurance Companies Offer Shorter Waiting Periods for Unknown Pre-Existing Conditions?
You’ve probably noticed when comparing health insurance plans that many insurers offer shorter waiting periods for unknown pre-existing conditions in their VHIS Flexi Plans and premium VHIS plans — often just about 30 days or even immediate coverage.
Some insurers highlight the waiver of this waiting period as a key selling point for their plans, making it one of the factors people consider alongside premiums, coverage limits, and benefits. This is appealing because it reduces the worry of getting diagnosed with a condition during the waiting period without any coverage. By waiving it, policyholders can get 100% coverage for diseases they had before applying but showed no symptoms of .
But from a consumer’s perspective, is skipping the waiting period truly all benefits and no drawbacks in the long run? It boils down to why you’re buying health insurance in the first place. Should you sign up when you’re young and healthy, or wait until health issues pop up? And if most people wait for problems to arise before buying, could that drive up premiums over time?
A Reasonable Waiting Periods Can Reduce Policy Abuse and Ensure Fair Treatment for Policyholders
At Bowtie, we get that shorter waiting periods make plans more attractive, and there’s room for improvement with VHIS products that have a four-year wait. However, shortening it could encourage more people with existing health issues to sign up, as they might wait out the period and then claim, potentially leading to policy abuse and putting upward pressure on premiums in the long term.
Imagine a scenario where a policyholder claims for knee joint replacement due to arthritis just two or three months after their policy starts. From a medical standpoint, arthritis is a chronic condition that develops over stages, and surgery is usually considered much later when it’s advanced. Early signs like joint pain or mobility issues might prompt someone to seek insurance specifically to cover costs quickly—perhaps even choosing a plan that waives the unknown pre-existing condition waiting period. Setting a reasonable waiting period helps minimize the chances of such abuse.
As an insurer focused on improving the insurance experience, we have a responsibility to keep our products sustainable, striking the right balance between product appeal and long-term affordability of premiums. We want all our customers to enjoy affordable coverage well into the future, even as they age and need more medical support, without worrying about premiums spiraling out of control and forcing them to drop their plans.
We’re concerned that overly short waiting periods could increase the risk of abuse, leading to unfair premium hikes for most policyholders. Based on our strong performance over the past four years, Bowtie has progressively shortened the Bowtie VHIS Flexi Plan and Bowtie Pink VHIS Plan waiting periods for unknown pre-existing conditions in three stages during 2022, 2023, and 2024.
Starting from August 30, 2024, the waiting period for unknown pre-existing conditions in the Bowtie VHIS Flexi Plan and Bowtie Pink VHIS Plan has been reduced to the first 90 days from the policy start date. That means from day 91 onward, policyholders can receive 100% reimbursement for eligible hospital expenses related to unknown pre-existing conditions, up to the coverage limits .
Want to know how much it costs to get Bowtie Pink for yourself? Get an instant quote!
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