Pre-existing conditions in health insurance: what is covered and what isn't?

We explain what is considered a pre-existing condition, if they are covered by the insurance and which illnesses or treatments may be excluded.

Las pre-existing conditions in health insurance are one of the most important aspects to take into account before taking out a health insurance policy.
 

What are pre-existing conditions in health insurance?

Pre-existing conditions are understood as illnesses, medical conditions or injuries affecting the insured person that existed before the policy is taken out. This includes:

• Previously diagnosed chronic illnesses (diabetes, high blood pressure, asthma, etc.).

• After-effects of previous surgery or accidents.

• Inherited conditions known to the insured person.

Insurance companies usually request a prior health declaration from the customer. Depending on the information provided, they may accept, limit or exclude certain cover.
 

Do health insurance policies cover pre-existing conditions?

In general, health insurance does not cover pre-existing conditions, especially if they have not been declared in the initial questionnaire. However, some companies may offer partial cover, apply waiting periods, or accept certain illnesses for a surcharge on the premium.

Therefore, it is essential to be completely transparent when filling in the health form. Withholding prior medical information can result in treatments being excluded, or even the policy being cancelled in the event of a claim.
 

What exclusions do insurers usually apply?

In addition to pre-existing conditions, insurers may also establish general exclusions. These may vary, but usually include:

• Treatment related to alcohol or drug addiction.

• Sexually transmitted diseases such as HIV/AIDS.

• Consequences of criminal acts or self-harm.

• Injuries derived from high-risk sports or dangerous activities.

• Occupational accidents (in some policies).

• Voluntary termination of pregnancy.

• Aesthetic surgeries not justified for health reasons.

Each insurer has its own list of exclusions, which must be clearly indicated in the contract. The law requires these exclusions to be clearly and simply explained to the customer before signing the policy.
 

What happens if I have a pre-existing illness?

If you have a disease diagnosed before taking out the insurance, the insurer can:

• Include it in the policy (uncommon).

• Apply a waiting period before offering cover.

• Completely exclude this condition from the insurance.

In some cases, an additional medical assessment will be required to determine the status of the condition and decide whether it is insurable.
 

Recommendations before taking out health insurance

To avoid future problems with pre-existing conditions in health insurance, follow these tips:

• Carefully read the general terms and conditions and exclusions.

• Fill in the health questionnaire honestly.

• Ask in writing what cover applies to your specific situation.

• Consider a policy with cover for pre-existing illnesses, if any.

Taking out a health insurance policy with all the information you need is the best way to protect yourself and avoid unpleasant surprises when you need it most.