Dealing with pre-existing conditions in health insurance

If you’re thinking about buying or switching health insurance, the term “pre-existing conditions” might come to the forefront. But what exactly is meant by pre-existing conditions and how do they affect your insurance decision?

What are pre-existing conditions?

A pre-existing condition, as the name implies, is a condition that occurred before you purchased health insurance. These could be chronic diseases such as diabetes, lupus or various cancers. But mental illnesses, such as depression, are also included.

How do pre-existing conditions affect your insurance?

Pre-existing conditions are not relevant for mandatory basic insurance. Here, health insurance companies must accept all policyholders regardless of their health status and insure them in accordance with KVG coverage requirements.

However, the situation is different with supplementary health insurance, which offers benefits that go beyond the basic insurance – be it preferential hospital treatment or special therapies. Pre-existing conditions are very much a factor in these supplementary insurances.

During the application process for supplemental insurance, prospective customers are usually required to complete a health questionnaire. Health insurance companies use this information to form a picture of the interested person’s current health status. If a relevant pre-existing condition is identified, the health insurer may:

  1. Possibly exclude cost sharing for certain pre-existing conditions.
  2. In some cases, even deny coverage altogether.

An important note: The health questionnaire must always be filled out completely and truthfully. Otherwise, you risk that the health insurance company will refuse to cover the costs in the event of a claim.

Our tip

The sooner you purchase supplemental health insurance, the better! Ideally, as long as there are no pre-existing conditions. But with so many choices, the decision-making process can be complicated.

This is where simply comes in: as your insurance partner, we help you find supplemental health insurance that meets your needs. Exciting supplementary insurances for outpatient services, for hospital stays or explicitly for children are offered, for example, by KPT.

Let’s work together to find the best solution for your health and safety.

Published On: 10. August 2023Categories: All about health insurance