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What is an Unknown Pre-existing Condition?

For instance, if an applicant named Iris is diagnosed with stage IV breast cancer in the second year after purchasing traditional health insurance, and her doctor states that the cancer existed before her application but she was unaware of it at the time, the insurance company may refuse her claim on the grounds of "unknown pre-existing conditions." This situation can be frustrating which leads many to believe that purchasing health insurance earlier is more advantageous.

However, if Iris had Voluntary Health Insurance Scheme, she could avoid this issue.
In simple terms, "unknown pre-existing conditions" refer to health conditions or symptoms that were present at the time of application but not recognized by the applicant. Under Voluntary Health Insurance Scheme, if you face this situation, you may be covered. For example, if Iris had enrolled in Cigna VHIS Series - Flexi Plan (Superior), she would be eligible for 100% coverage for her "unknown pre-existing condition" from the first day of policy effective date.

How is a Pre-existing Condition Defined?

In contrast to "unknown pre-existing conditions," the following situations are considered as conditions that the applicant was aware of before applying:

• The condition has been diagnosed.

• Clear and obvious symptoms of the condition have appeared.

• Medical advice or treatment for the condition has been sought or received.

In these cases, coverage is generally not available under either Voluntary Health Insurance Scheme (VHIS) or traditional health insurance Plan.

Congenital Conditions: Coverage Available for Conditions Diagnosed After Age of 8

Cigna VHIS Seriesaccepts applicants aged from 15 days to 80 years old, including congenital conditions diagnosed after the age of 8. The coverage includes congenital conditions that are typically not covered by traditional health insurance , such as Down syndrome, leukemia, and heart conditions, but only if they are diagnosed or manifest after the age of 8.

Examples Voluntary Health Insurance Scheme Claims

Here are three simple examples to illustrate the coverage provided by Voluntary Health Insurance Scheme:

• Case

  Scenario

  If an individual is enrolled in Cigna VHIS Series - Flexi Plan (Superior), will they be covered for their medical condition?

  Reason

• Case 1

  An applicant discloses a diagnosis of diabetes before applying for insurance. The insurance company lists diabetes and related conditions (e.g., heart disease) as exclusions in the policy

  Not covered

  As the condition is listed as an exclusion in the policy

• Case 2

  An applicant does not undergo a medical examination before applying but is diagnosed with stage III colon cancer six months after the policy starts.

  Fully covered

  As it qualifies as an "unknown pre-existing condition," eligible for 100% coverage from the first day of policy activation.

• Case 3

  An applicant shows no symptoms at application but is diagnosed with stage II lung cancer in the fourth policy year    Fourth policy year

  Fully covered

  As it qualifies as an "unknown pre-existing condition," eligible for 100% coverage from the first day of policy activation.

What is the Principle of Utmost Good Faith?

Insurance contracts are based on the principle of "utmost good faith." The applicant has the responsibility to proactively and truthfully disclose their health status and medical history to the insurance company, which enables the insurance company to assess risk and make decisions regarding coverage and premiums.

If an applicant violates this principle by misrepresenting or failing to disclose health information, the insurance company may ultimately refuse compensation. It is crucial to pay close attention during the application process.

Cigna VHIS Series - Flexi Plan (Superior) offers 100% compensation for "unknown pre-existing conditions" from the first day of coverage, providing greater health security. The annual coverage limit is up to HKD 30 million, with all medical expenses covered without itemization. Cigna Healthcare ensures you are truly "protected," "affordable," and "predictable."