Getting health insurance with as yet undiagnosed condition

adocholiday

Hi all,

Just wondering if anyone knows what the situation is here. A friend has identified a possible health issue that may turn out to be nothing. He's been to his GP and had blood tests done which have turned up nothing. The GP is currently looking at making an appointment for him with a specialist for further tests, which could possibly take months on the public system.

He is starting a new job in a few weeks that provides employees with private health insurance, or a contribution to a policy at least. What is the situation regarding this person getting health insurance? I've heard, possibly mistakenly, that it you can't get covered for previously existing conditions. My friend hasn't yet been diagnosed with anything so technically doesn't have a 'pre-existing condition'.

I know the obvious answer to this is ring and ask, but he wants to be prepared for them should the issue come up. Does anyone have any experience with or insight into a situation like this?

blindside88

If your friend is under 55 the waiting period for pre existing conditions is 5 years. It doesn't matter if the condition has been diagnosed or not, a pre existing condition is determined by the onset date of the condition rather than by the diagnosis date. Therefore if a person has an underlying cardiac condition for example, they may not be aware of it but it is still pre existing. The onset date is determined by your consultant on the claim form and not by the insurer or you. Hope that answers it. Any questions just ask

adocholiday

Thanks for that Blindside. Is it possible for a person to get covered in a situation like this? Or is it purely at the discretion of the insurer?

Edit: I've found the information on the VHI site here: https://www.vhi.ie/info/products/info.jsp
Seems that the answer to my friend's question is no, he can't get insurance at this time for a condition that he may or may not have. Fair enough I suppose!

blindside88

adocholiday wrote: »

Thanks for that Blindside. Is it possible for a person to get covered in a situation like this? Or is it purely at the discretion of the insurer?

It would all come down to the consultants opinion and the insurer really. The waiting periods for those under 55 are 26 weeks for new conditions and 5 years for pre existing. If your friend is joining a large company they sometimes wave the waiting periods for new members. Waving the pre existing condition is usually only done for very large organisations

NuMarvel

It's also worth remembering that the pre-existing year waiting period only applies to hospital or surgical treatment for that condition. Treatment for unrelated conditions is covered after the other waiting periods are served, and the out-patient cover (for GPs, x-rays, consultant visits, etc) isn't subject to a pre-existing waiting period (but might be subject to other waiting periods).

adocholiday

NuMarvel wrote: »

It's also worth remembering that the pre-existing year waiting period only applies to hospital or surgical treatment for that condition. Treatment for unrelated conditions is covered after the other waiting periods are served, and the out-patient cover (for GPs, x-rays, consultant visits, etc) isn't subject to a pre-existing waiting period (but might be subject to other waiting periods).

I'm not quite sure what you mean by this? My friend hasn't had hospital or surgical treatment yet so he isn't affected by the waiting period, is that it? I want to put it in context here. Just say my friend suspects that the symptoms may be indicative of the onset of a long term illness (good chance it isn't). He has been to the doctor who has done some initial basic tests and blood work, and is now being referred to a consultant with a public waiting list of months. No appointment has been confirmed as yet. That's as far as it has gone.

LostArt

Basically it doesn't matter if the condition has not been diagnosed yet. A pre existing condition is determined by approx start date of the condition rather than date it's diagnosed. So if your friend takes out insurance for example today and the diagnosis gives a start date of before today then they'll have a 5 year waiting period

donfers

LostArt wrote: »

Basically it doesn't matter if the condition has not been diagnosed yet. A pre existing condition is determined by approx start date of the condition rather than date it's diagnosed. So if your friend takes out insurance for example today and the diagnosis gives a start date of before today then they'll have a 5 year waiting period

but would I be correct in saying if the friend did have a series of tests done and there was found to be nothing wrong then the insurer would pay up

whereas if the tests found a condition that the consultant said started before the start of the health insurance policy then the person would be fully liable

in other words, because we don't know until the tests are conducted if there is a pre-existing condition, then we don't know if we are liable or not - seems a strange way to do things, and difficult to budget for as we won't know the results of the tests

hurray my tests are clear so health insurance covers me = double joy

boo my tests reveal a pre-existing condition and on top of that I now have to pay for all the tests

Is that a correct analysis or am I missing something?