Navigating Health Declarations and Underwriting with Pre-existing Conditions: How to Pass Underwriting Successfully?

Health Insurance Applications with Pre-existing Conditions: What You Need to Know When purchasing health insurance (e.g., critical illness or medical insurance), insurers require a health declaration to assess the applicant's medical history. But what if you have pre-existing conditions like hypertension, thyroid nodules, or diabetes? Can you still get coverage? And if you've previously undisclosed a condition, how can you rectify it? This guide provides a systematic approach to help those with pre-existing conditions: ✔ Understand underwriting outcomes (approval, surcharge, exclusions, or denial). ✔ Learn strategies to improve approval chances (e.g., smart underwriting, multi-company applications). ✔ Remediate past non-disclosures through supplemental declarations or policy adjustments. Key Takeaway: Even with health issues, coverage is often possible—but transparency is critical to avoid claim rejections. Plan wisely to secure protection without pitfalls!

1. Core Principles of Health Declaration

1.1 What is a Health Declaration?

A health declaration is the insurer’s written inquiry about the policyholder’s health status during application, typically covering:

Current or past illnesses (e.g., cancer, heart disease).
Recent abnormal test results (e.g., nodules, irregular blood work).

1.2 The "Three No’s" Rule for Health Declarations

No unsolicited disclosures: Only answer the insurer’s specific questions.
No omissions: Disclose all asked-for conditions truthfully.
Medical records prevail: Only diagnosed conditions (not self-assessed symptoms) must be reported.

2. How to Pass Underwriting with Pre-existing Conditions?

2.1 Common Underwriting Outcomes

Results vary by condition and insurer:

Underwriting Decision	Meaning	Example Conditions
Standard Approval	Normal coverage, no restrictions	Recovered acute appendicitis, mild colds
Premium Surcharge	Higher premiums, full coverage	Hypertension, high cholesterol
Exclusion Clause	Specific condition excluded	Thyroid nodules, hepatitis B carrier
Postponed Decision	Underwriting deferred for review	Recent surgery, undiagnosed symptoms
Declined	Application rejected	Severe heart disease, advanced cancer

2.2 Strategies for Common Conditions

① Thyroid/Breast Nodules

Medical Insurance: Likely excludes thyroid/breast-related claims.
Critical Illness Insurance:
- Grade 1–2 (benign): Possible standard approval or exclusion.
- Grade 3+: Likely declined or postponed.
Tip: Get an ultrasound to confirm grading before applying.

② Hypertension

Stage 1 (140–159/90–99 mmHg): Possible surcharge.
Stage 2+ (≥160/100 mmHg): Likely declined.
Tip: Use "smart underwriting" or opt for lenient products (e.g., cancer-only insurance).

③ Hepatitis B (HBsAg+)

HBeAg-negative (normal liver function): Possible surcharge or liver disease exclusion.
HBeAg-positive: Likely declined; consider cancer-only insurance.

④ Diabetes

Medical/Critical Illness Insurance: Usually declined; explore "diabetes-specific" policies.
Cancer/Accident Insurance: Often approved.

2.3 Tips to Improve Approval Odds

✅ Use Smart/Pre-Underwriting:

Platforms like Alipay’s Good Doctor or Ping An’s eLife offer no-record pre-assessments.
✅ Apply to Multiple Insurers:
Compare underwriting outcomes (standards vary by company).
✅ Wait for Stable Conditions:
E.g., delay application for 6 months if recent lung nodules show no changes.

3. Consequences of Non-Disclosure & Remedies

3.1 Risks of Hiding Conditions

Policy cancellation + claim denial: Insurers may void contracts if omissions are discovered.
No premium refunds: Deliberate concealment may forfeit paid premiums.
Blacklisting: Future applications with other insurers could be impacted.

Case Example:
A client hid thyroid nodules during application. Upon thyroid cancer diagnosis, the insurer denied the claim and terminated the policy after reviewing medical records.

3.2 How to Fix Incomplete Disclosures?

Supplemental Declaration:
- Submit missing health details for re-underwriting.
- Outcomes: Policy upheld, surcharged, excluded, or cancelled.
Reapply After Cancellation:
- If unsatisfied (e.g., exclusion clauses), switch to another product.
- Key: Ensure new coverage is active before cancelling the old policy.

4. Key Takeaways for Insuring with Pre-existing Conditions

🔹 Pre-underwrite first: Use smart underwriting tools to test eligibility.
🔹 Choose lenient products: E.g., cancer-only insurance or inclusive local plans (like Hui Min Bao).
🔹 Never hide conditions: Insurers cross-check医保 (healthcare) and体检 (medical exam) records.
🔹 Improve health metrics: Some conditions (e.g., fatty liver) may requalify after control.

Remember: Even coverage with exclusions or surcharges beats no protection. Plan early to mitigate risks effectively!