Personal Health Insurance and Pre-Existing Conditions

By Ian Baker, Inc.

Toronto, ON (July 31, 2014) – It is very common for Canadians who apply for an individual health insurance plan to have one or more existing health problems or medical issues.

This article explains the options available to Canadians who find themselves in this situation.

Guaranteed Issue versus Medically Underwritten Health Insurance

Canadian private health insurance plans are either medically underwritten or they are guaranteed issue in nature.

Guaranteed issue plans are issued automatically with no medical questions to be answered.

There are also special guaranteed issue plans called “group conversion” plans, available if you have lost employee benefits coverage in the last 60 days.

Medically underwritten plans are “underwritten” by the insurance company. The applicant must answer medical questions that form part of the health insurance application. Additionally the applicant must give the insurance company permission to access their medical history and records.

It is important to know that medically underwritten plans offer more coverage (especially drug coverage) compared to guaranteed issue plans!

Possible Underwriting Results

When a health insurance plan is underwritten there are 3 possible results:

  • Accepted: There is an offer of coverage with no exclusions.
  • Counter offer: There is a counter offer of coverage with one or more exclusions regarding a pre-existing condition. In this case prescription drug coverage for that specific condition is excluded.
  • Declined: The insurance carrier declines to cover you.

What Type of Health Insurance Plan is Best for You?

If you currently have one or more health conditions that require prescription medication then the important question is how much you are currently paying (and are willing to continue to pay) for those medications.

If you must have your current medication covered than the only option available to you is a guaranteed issue plan.

However, if your current prescription drug costs are relatively low then you might want to consider going for an underwritten plan. Your current medications will be excluded from coverage, but if accepted you will have larger prescription drug maximums available to you if needed at a later time.

If your application is declined then you may be able to submit an application for a guaranteed issue health insurance plan. Note, however, that some carriers will exclude you from applying for a guaranteed issue plan once you have been turned down by them for a medically underwritten health insurance plan.

About the Author

Ian Baker has been helping Canadians get the right health insurance for over 30 years now. Ian is also the President of Inc., a nationally licensed, family-run Canadian insurance brokerage.

About Inc. has been insuring Canadians since 1981. is constantly upgrading their online technology to make it as easy as possible for clients to get health and travel insurance that is just right for them.

Source: Inc.