Medical Condition
A medical condition refers to any illness, injury, disease, disorder, or ongoing health issue that affects a person’s physical or mental well-being. In the context of insurance, the term includes both acute and chronic conditions, whether diagnosed, treated, or undiagnosed at the time of application or claim. Examples include high blood pressure, diabetes, asthma, depression, or past surgeries.
How It Works
Insurers use information about your medical conditions and medical history during underwriting and claims assessment to determine eligibility, premium rates, and coverage terms. With personal health insurance, underwriting typically does not require invasive medical exams such as bloodwork, urine tests, or vitals, though some plans require medical questions, and plans with medical questionnaires tend to offer higher coverage maximums and lower premiums. When a plan requires a medical questionnaire and coverage is not approved as applied for, three common outcomes can occur: an exclusion for a pre-existing condition, a premium adjustment where the policy is rated at a higher cost, or declined coverage. A pre-existing condition is any injury, sickness, or condition that exists before the date a policy takes effect, with examples including asthma, diabetes, anxiety, depression, high blood pressure, and high cholesterol. More than four in 10 Canadians over the age of 20 have at least one of 10 common chronic conditions. Medically underwritten plans may exclude coverage for pre-existing medical conditions or impose waiting periods before related claims are covered, while guaranteed issue plans typically cover pre-existing conditions after a defined stability period or at reduced benefit levels. For travel insurance to cover a pre-existing condition, the condition must be stable for a period defined in the contract that varies by age, meaning during that period the insured did not receive a new prescription or treatment, change medication dosage, or await treatment, surgery, or examination results.
Example:
If a Canadian has been treated for asthma, that is considered a medical condition. When applying for personal health insurance, the insurer uses that information to evaluate the application and decide whether asthma-related expenses are covered. A plan with a medical questionnaire might exclude that condition while still offering higher overall coverage limits.
What to Watch For:
Disclose all known medical conditions and treatments when applying for insurance. Failure to disclose may result in denied claims or cancellation of coverage. Insurers may request medical reports or test results during underwriting or when reviewing a claim.
