Enrolling when you have a pre-existing medical condition

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Enrolling when you have a pre-existing medical condition

  • This term refers to current or recent treatments and any health problems existing at the time when you apply for coverage
  • Any pre-existing conditions must be declared in the health questionnaire
  • If they are not declared, they will be excluded
  • A false declaration will invalidate the policy

Why do insurers take into
account existing medical conditions?

Expatriate health insurance is optional. You are free to purchase any plan you wish, and you can cancel (or renew) the plan after one year. It isn't like a French Social Security, plan which everyone is required to have and which cannot not be canceled when you have finished using it.

This flexibility may sound attractive, but it also comes with a drawback: some people only purchase an expatriate health insurance plan when they know they will incur expenses that need reimbursement. This is like buying car insurance after you have an accident.

Even though such cases are rare, they can be extremely expensive for the insurer and therefore indirectly expensive for the other insureds.

Insurers therefore practice this medical selection process in order to protect their financial interests, as well as the interests of their existing policyholders. Otherwise, they would risk having to regularly and significantly increase their premiums. As a result, many policyholders would be dissatisfied and would decide to cancel their plans. Unlike a French Social Security fund, expatriate insurers cannot prevent people from canceling and cannot force them to pay their premiums.

The premiums offered by the insurer would then quickly become too high to attract new policyholders and the rates would increase until they would no longer be acceptable to anyone.

This health questionnaire therefore makes it possible to cover the interests of all policyholders based on to two founding principles of insurance:
- Risk pooling: for insurers, there are two types of customers - those that cost them money, and those that make them money. Without customers who make them money, insurers would be able to provide coverage to any of their policyholders.
- Unforeseen circumstances: the purpose of insurance is to cover the costs of an unexpected event. If this event already has already occurred at the time of enrollment, the concept of unforeseen circumstances no longer exists or is almost non-existent and the insurer must therefore either exclude the risk or increase the rate accordingly.

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How do I report pre-existing
medical conditions?

Each insurer has its own rules for accepting or refusing enrollment. A condition that is problematic for one insurer may be accepted by another. The decision may also depend on the type of policy, the country of expatriation and the foreseeable medical costs for this condition in this country.

Because they work with insurers every day, our advisors understand their procedures and can anticipate their decisions. If you have a medical history, health concerns or receive regular treatments, our advisors will be able to direct you to the insurer who can best meet your expectations.

To save time, you should try to provide as much information as possible from the start (medical reports, current treatments, test results, etc.) because your file will be examined by the insurer's medical advisor. If the advisor is unable to properly assess your application with the information provided, you will be asked to submit additional information. If you are moving in a few days, this may add an extra stress (see the section on "When to Apply").

Depending on the application, the insurer may:
- Agree to cover you under the terms of the quote.
- Offer to insure you for a higher premium.
- Exclude coverage for a specific medical condition.
- Refuse to insure you at all.


What if the insurer has
special conditions?

If the insurer proposes a rate increase:

This is both good and bad news.

The bad news is obvious:

The cost is no longer within your budget. Your International Health advisor can quickly present you with solutions from other insurers. They can also suggest that you review your choice of plan to try to stay within your budget while maintaining adequate coverage for essential expenses.

The good news is less obvious but very important:

French policies are subject to French law, and this is good for you, even if you are not French. After you are accepted, the insurer will no longer be able to individually modify the conditions of the policy and must reimburse all expenses related to the declared medical condition, whether a simple consultation, a long-term treatment or hospitalization. And the insurer will not be able to increase the rate individually. This is an exclusive advantage.

In policies which are not subject to this regulation, the insurer can do whatever it wants on the anniversary date of the policy, even if it is an automatically renewable policy. The insurer can increase the rate, it can exclude a medical condition from one year to the next, or it can refuse to renew the policy.

At the request of the policyholder, this rate increase can be reviewed after two or three years by filling out a new health questionnaire. The insurer can then reduce the rate or cancel the policy, but it will not be allowed to increase the rate.

If the insurer offers a partial exclusion:

Again, this is both good and bad news.

The bad news:

The insurer will not cover all expenses related to the pre-existing medical condition, such as treatments, medical exams or visits.
These exclusions are limited, however, and may not apply to specific conditions, such as accidents. For example: lower back pain is excluded, except in the case of hospitalization following an accident.

The insurer does not provide your advisor with the text of this exclusion in the Medical Confidentiality application. However, you can talk to your advisor about it if you would like a detailed explanation. See the rules on Medical Confidentiality.

There is also good news:

At the request of the policyholder, the rate increase can be reviewed after two or three years by filling out a new health questionnaire. The insurer may cancel the policy, but it will not be allowed to increase the rate or make any other changes.

What should I do if the insurer refuses to cover me?

It is rare for an insurer to completely refuse a file, but it can happen. The most difficult conditions to insure are:
- Progressive medical conditions which may require lengthy treatments, since most insurers are obliged to cover you for an unlimited period of time, regardless of the evolution of your health.
- Recent illnesses or accidents, because the Medical Examiner may have difficulty assessing the recovery time, and therefore, it may be difficult to estimate the foreseeable short-term or medium-term care. In such cases, the insurer often prefers to refuse coverage than to risk mistaking its assessment of the risk.

Chronic conditions that require long-term but inexpensive treatment and regular monitoring are usually covered for a higher premium.

If the insurer refuses to cover you, your International Health advisor will help you find another insurer who may be able to offer a partial exclusion for the existing condition and then add it to your CFE coverage. This will allow you to be partially covered for this condition and to be fully covered for everything else.

To avoid wasting time when you enroll, feel free to discuss these issues with your International Health advisors. They will direct you as quickly as possible to the best solution.

Please note: unlike their medical services, even though insurers are subject to an ethical rule that requires them to maintain professional discretion, insurers aren't subject to medical confidentiality. It's up to you what information you wish to share with them.

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