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Why you must disclose pre-existing ailments or critical illnesses before buying health insurance

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While buying health insurance, individuals should provide accurate information.

The last one and a half year, driven by the ongoing COVID-19 pandemic and its implications, has made people realise that they can’t predict health emergencies. The only option left is to become more cautious and aware about securing their lives with an appropriate health cover policy. In the UAE, compulsory health insurance was introduced a few years back. Expats must be aware that in case they have a history of any illness/medical condition, they are advised to combat the disease with a proper and timely check-up without any delay. Not to forget, while buying individual health insurance, expats should tell the truth, give accurate information, and make sure to read the proposal form holding all the terms and conditions of the policy. Make it a thumb rule – when in doubt, do disclose!

A few months ago, a 40-year-old person was advised knee surgery. He applied for a claim against his health cover to his insurer. In addition to the employer-provided health insurance, he also had private health insurance. There were no claims on the cover in the last three years. While assessing the claim, the insurer found a doctor’s note stating that this person had an accident four years ago and had undergone minor surgery. This was not disclosed by the person while purchasing the health cover. The insurance company rejected the claim on the grounds of non-disclosure of pre-existing medical conditions.

The burden of lifestyle-related disease in the UAE is higher, but the care provided is undoubtedly the best. That’s why health insurance plays a massive role in providing a high level of care and treatment, which is necessary for expats living in Dubai. False information constitutes a breach of trust, as the insurer relies on the individual to provide true information. Expats must reveal and read all details asked in the application form for a smooth claim settlement. The reason behind laying more emphasis on reading the policy document is because the declarations in the proposal form are the basis on which the insurance companies underwrite policies, assess the risk, and calculate the premium to cover that risk.

Here are a few essential things you must know before buying an individual health insurance policy if you suffer from a pre-existing or chronic condition:

Complete Disclosure: Health insurance companies consider the full medical history while pricing the policy. All medical conditions, medicines taken, hospital stays, surgeries, test reports, current treatment plans are always relevant to the insurer. Sharing this information safeguards the policy buyers from denial of claims.

We highly recommend members to pay a visit to their treating doctors to get complete medical history with the above-requested information and any future treatment plans, if any, to be covered in the report. We also request members to be forthcoming in sharing every report and medical information and let the insurance company decide the relevance of it than the policy buyer themselves.

Premium Determination: If a policy buyer has a pre-existing disease or chronic condition, then the policy premium would be slightly higher than otherwise. However, one must not hide their illness due to the fear of high premiums, as not disclosing might lead to claim rejection later. Also, this premium keeps on reducing later with time when the policy is renewed continuously over the years, and conditions are controlled.

Thus, it is recommended to always disclose crucial information about pre-existing ailments before taking a health insurance policy. This will ensure complete transparency for the individual and the insurer, reducing the possibilities of claim denials and/or policy cancellations.

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Neeraj Gupta

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

TAGS: Insurance
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