Insurance For Pre-Existing Conditions

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Health Insurance for
Pre-Existing Conditions

Pre-existing conditions are an unfortunate part of life. They are also an extremely important aspect of your health insurance throughout South East Asia. Without the right advice and the right timing, you could end up paying out-of-pocket medical expenses that are not covered by your health insurance plan.  

That’s a situation we’d like you to avoid. In this article, you’ll learn how pre-existing conditions affect your health insurance. So let’s get started:

Health Insurance for Pre-existing conditions

How To Avoid Worrying About Pre-Existing Conditions

1.Get health insurance when you don’t need it. Getting health insurance when you’re healthy may seem counterintuitive, but insurance is all about covering future unknown medical conditions, accidents and treatments. If you get health insurance when you’re healthy, then you do not have anything to worry about.  Seeking health insurance for pre-existing conditions, like after an accident or diagnosis has happened, is like asking for car insurance after you’ve been in a crash. 

2. Stay insured. Preferably with the same insurer who is a safe long-term insurer. If you have gaps in insurance or are always changing providers, you expose yourself to the risk of having your policy affected by a pre-existing condition. Anytime you’re starting a policy from new, there’s a risk you could be denied claims for a pre-existing condition. If you limit the number of times you’re starting a policy from scratch, then you limit your risk.

Health Insurance for Pre-existing conditions

How Providers Handle Pre-Existing Conditions When Applying

If you want a pre-existing covered from the inception of the policy, then you’ll need to declare that condition on the application. This will go to the underwriting department, who may request supporting medical documents. They will then decide to:

1. Accept the condition with no special terms – this is done if it’s not a very serious condition, without the likelihood of high future claims.

2. Accept the condition with a premium loading – they agree to accept the risk of a condition & chance future claims if you agree to pay more on your annual premium. For example, we’ll cover condition XYZ for a 20% loading on your premium.

3. Exclude the condition – if it’s too risky, an exclusion will apply

4. Reject your application – this will happen if you fall outside of that provider’s risk tolerence. If so, they’ll just reject you and won’t allow you join their plans, even with exclusion(s). 

If the insurer requests supporting medical documents and you’re not able to provide them, then an exclusion will usually apply. Please note all providers handle pre-existing conditions differently. Some providers basically do not accept anything & some are better at considering them. This will depend on how they do their underwriting & the terms of their policy.

Speak a Tenzing agent if you’d like to find out more about this.

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If You Have an Exclusion, What Gets Excluded?

If you have an exclusion as part of your health insurance policy, then the exclusion will apply to your condition AND related treatments to that condition. So if your primary condition also leads to other issues, then the other issues will also be excluded.  You can see how there’s a lot of grey area and discretion has to be used. This is why it’s so important to get health insurance when you’re healhty, so this isn’t a factor. 

This can be an issue if you have a serious condition that causes many related conditions, treatments, and claims.


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How Providers Handle Pre-Existing Conditions at Renewal

This is without a doubt one of the most overlooked aspects of a policy. Far too frequently a buyer only looks at the upfront price and doesn’t think about the renewal, especially after high or serious claims. THIS is the true test of a health insurance provider:

  • How do they handle large claims for serious accidents?
  • How do they handle serious dianosis?
  • How do they treat you at the renewal date if #1 or #2 happens?

If you are with a provider that does experience rating then you could expect a substantial increase in your premium at renewal. Worse yet, they don’t necessairly have to even renew your plan.  For people living in South East Asia, this is how most local health insurance providers operate. In addition, you could have other terms:

  1. Install a maximum benefit payable for your condition
  2. Co-pays
  3. Deductibles installed

If you are with a provider that does community rating, then you’ll have a fixed annual increase regardless of how much you claim or don’t claim, usually 5-10% per year which is based on medical inflation and the claims ratio of their portfolio.  These increases can be offset with:

Community rated providers are significantly more stable over the long-term as they only increase your rate by the same fixed rate, they won’t kick you off or do other liability control methods.  All that being said, both styles still have a place in the market still and are suitable for different people with different profiles, budget and risk appetites.  


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Transferring Policies With Pre-Existing Conditions

If you have pre-existing conditions that you want to be covered continuously, there is a Continuing Personal Medical Exclusions (CPME) application. With CPME applications, a new provider will agree to accept your policy under the same terms as your previous insurer. You usually have to have:

  • No break in coverage
  • Similar level of benefit
  • Provide a certificate of insurance
  • Have a copy of full medical questionnaire from previous insurer

Very few providers offer CPME policies, please ask your Tenzing insurance specialist if you’d like to know more.

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What’s the Best Health Insurance for Pre-Existing Conditions?

Great question, we’re happy to oblige. We usually consider a range of private health insurers for when we have clients who would like to see if they’re condition can be covered. The thing to keep in mind is that you can only get an official offer by applying and providing any further medical information, medical reports, etc.  That being said, we recommend speaking to broker, so you’re not running around like a headless chicken. Here are some good health insurance providers for pre-existing conditions: 

  • Aetna
  • Allianz
  • Cigna
  • IPH
  • PassportCard
  • April
  • Swiss Global
  • IntegraGlobal



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Group Policies

If you’re with a company that has enough employees, your plan may qualify to be a Medical Health Disregarded (MHD) plan. Very simply put, if your company has enough employees in the group, the insurer will agree to accept all pre-existing conditions.

The MHD number varies by provider, some offer it as low as 5 employees, most modern international providers will do MHD plans at 10 employees. Most local providers do MHD at 50+ lives.

Health Insurance tip: Ask your potential employer to see the details while you’re negotiating a contract.  Many expats living in South East Asia are given inadequate plans as part of their employee benefits package.  This lures you into a false sense of security and can have negative consequences. Ask to see the provider and benefit details. If you’re not satisfied, you can negoatiate or request to be given a stipend instead, so you can get something you want. 

Learn more about Employee Benefits


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What pre-existing condtions are covered? What are excluded?


Each provider has a different amount of risk they’ll accept, which means they accept, exclude or premium load different types of health conditions differently.  That being said, there is an overall theme: 

Can be considered: Minor conditions, things from a long time ago, not on major joints, not likely to reoccur, don’t have large medical bills associated with them.  Things like asthma, acute injury in non-joint from your past. 

Accepted by some: chronic conditions that can be easily managed with medication, healhty lifestyle changes. Example, hypertension, acid reflux, etc. 

Usually excluded:  Diabetes or other chronic conditions that lead to a variety of health problems. Injuries that have just recently happened. Diagnosis that have recently happened. Things that require ongoing monitoring and treatments.

Always excluded: costs for immediate treatments, surgeries, serious chronic conditions, cancers, anything on the list of exclusions like cosmetic treatments, not medically required treatments, etc. 


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Final Thoughts

Hopefully from reading this blog, you’ll increase your chances of this being a non-factor for you and your family. Just remember, the point of insurance is to cover you for future unknowns. If a provider knows they’ll have guaranteed losses throughout the future, then they will take liability cutting measures: exclusion, premium loading or application rejection. 

Pre-existing conditions are handled on a case-by-case basis and depend on the severity of the condition & risk to the insurer for future claims. The only way to get an official offer is to fill out an application & have it be underwritten.

By following our advice, hopefully the pitfalls can be avoided. If this is a serious consideration, we highly recommend speaking to an experienced broker like Tenzing.  What we do is guide you to the most likely providers to accept a condition with the most favorable outcome. 


Contact us below and we’d be happy to have a confidential conversation. 


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    Patrik Shore Tenzing Pacific Services

    Patrik Shore

    Senior Advisor
    From Sweden & New Zealand
    7 years' insurance experience
    Joined Tenzing in 2019
    Crim Science
    Speaks English and Swedish

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