# Insurance Question



## Maj34 (Oct 7, 2011)

Hi all, 

I'm new to investing but I'm eating up everything I can about it. One of the closely related topics, that keeps coming up, is insurance - life, ad&d, disability, etc.

My question today is about my girlfriend and a medical condition I think she's developing: Arthritis.

She's 27 and has been having symptoms of arthritis for years, particularly in her hands and feet which swell up and become stiff and sore in the winter. She's gone to a few doctors who so far have been down-playing the symptoms because "Hey you're only 27 it must be something else". But more and more it is taking on symptoms of arthritis and my research indicates that young people can get it. The type of doctors she has happened to see are reminders that "Hey, sometimes a few morons slip through med school". 

But I came here hoping someone could ask an insurance question.

She is currently working for a large company and has medical coverage. The other day, when I spoke to a family member about this, they recommended she load up on insurance now before getting properly diagnosed. I did some research and this seemed like it might be "grey" or perhaps even outright illegal (especially if asked "Do you have any existing conditions or symptoms", which you surely will be asked, and you say "no").

Another possible issue here is that she is considering leaving her job to go back to school for a couple of years. What if she is diagnosed while she doesn't have coverage for, let's say, an expensive medication that may be required to treat her ailment? Is this something that should be avoided? What sorts of things should she be thinking about here? 

This is really concerning me because she's sort of ignoring it (because for now it's easier not to admit that somethings wrong I guess) but I'm wondering if years from now she might look back and say "wow, if I could have started treating this years earlier I would have so much better a quality of life right now... 

Thoughts? 

This is an area that you never learn about in school, and even Googling is not giving me a lot of clear direction on it.

Thanks, 
M.


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## Toronto.gal (Jan 8, 2010)

Maj34 said:


> 1. I think she's developing: Arthritis.
> 2. they recommended she load up on insurance now before getting properly diagnosed.
> 3. what if she is diagnosed while she doesn't have coverage for, let's say, an expensive medication?


1. She's been suffering for years with no clear diagnosis yet? It doesn't sound right. And yes, young people can get RA, which can also affect internal organs and indeed lead to disability.

2. Most health insurance contracts have pre-existing condition exclusions for a period of time, which would depend on the type of health condition. You mentioned she has already seen a few doctors, so be very careful about lying on any medical questionnaire for increased or new coverage, as even a prescription and/or change in medication is considered treatment by insurance companies. You mentioned she has health coverage, what about LTD?

3. Universities offer health insurance with an annual [eligible] drug maximum of $5K I believe and imagine colleges and other offer similar.


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## Maj34 (Oct 7, 2011)

Toronto.gal said:


> 1. She's been suffering for years with no clear diagnosis yet? It doesn't sound right. And yes, young people can get RA, which can also affect internal organs and indeed lead to disability.


Yes, I know. My doctor tells me that people have to stop diagnosing themselves using google and I too am guilty. But it really is textbook conditions and my mother is a nurse and she is convinced. Whether it is or isn't I'm just kind of exploring the hypotheticals here...



Toronto.gal said:


> 2. Most health insurance contracts have pre-existing condition exclusions for a period of time, which would depend on the type of health condition. You mentioned she has already seen a few doctors, so be very careful about lying on any medical questionnaire for increased or new coverage, as even a prescription and/or change in medication is considered treatment by insurance companies. You mentioned she has health coverage, what about LTD?


Ok. It sounds like I should get her to dig up her insurance contract and we should do some reading up on any pre-existing condition clauses.



Toronto.gal said:


> 3. Universities offer health insurance with an annual [eligible] drug maximum of $5K I believe and imagine colleges and other offer similar.


Any idea how a policy might be moved from one company to another when you are eventually diagnosed? For example - my girlfriend currently has group benefits with Manulife through her employer. If she were diagnosed with arthritis tomorrow and then left her employer next week, wouldn't the next insurance company charge her an incredible amount because she has a diagnosed condition? It just seems to me like insurance is something you have to have (or you HOPEFULLY have) before you get a condition - which is the case for her. But if she moves to a different insurer, wouldn't they just look at her as a person with a medical condition and charge incredibly high premiums? 

Thanks for the reply.


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## MoneyGal (Apr 24, 2009)

If she's seen a doctor for the symptoms, even without diagnosis she will likely be excluded. That's why they call it a pre-existing CONDITION, not a pre-existing diagnosis. It's a medical condition that existed before the insurance coverage came into effect, whether or not there's any diagnosis or whether or not the diagnosis is correct or whether or not there's been any treatment prescribed and whether or not she's been compliant with treatment recommendations. 

She's more likely to need disability insurance than she is to need prescription drug coverage. Aren't most treatments for arthritis over-the-counter pain meds and various forms of supplementation?


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## m3s (Apr 3, 2010)

Maj34 said:


> Yes, I know. My doctor tells me that people have to stop diagnosing themselves using google and I too am guilty. But it really is textbook conditions and my mother is a nurse and she is convinced. Whether it is or isn't I'm just kind of exploring the hypotheticals here...


I've taught (young) doctors things off the internet. Not in a rude way but they looked it up and agreed. It's not like they can possibly know everything. I can see how they would be annoyed, but more often than not (old) doctors seem to have a know-it-all attitude and are annoyed by the information people have access to nowadays. If you read medical forums you see this is a common plague with many situations along with the heavy over use of prescription drugs. I've also experienced vastly different opinions from different doctors. You just have to try another one.


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## carverman (Nov 8, 2010)

Toronto.gal said:


> 1.
> 
> 2. Most health insurance contracts have pre-existing condition exclusions for a period of time, which would depend on the type of health condition. You mentioned she has already seen a few doctors, so be *very careful about lying on any medical questionnaire for increased or new coverage, as even a prescription and/or change in medication is considered treatment by insurance companies. You mentioned she has health coverage,* what about LTD?


Most insured drug plans limit you anyway in the first 2 years, so even the ManualLife "Coverme" plan has limitations on coverage, even if you don't disclose a pre-existing condition, so the part about "lying about a condition" when you haven't been diagnosed yet, doesn't make any sense, IMO.

If one doesn't know one's chronic condition because one hasn't been diagnosed yet, one cannot disclose a pre-existing condition either. 

I've had arthritis for a few years, mostly symptomatic in the right shoulder and the toes and I've been taking celebrex anti-anflammatory for it for years. Juvenile arithritis does occur and it's difficult to diagnose sometimes.


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## Toronto.gal (Jan 8, 2010)

carverman said:


> 1. Most insured drug plans limit you anyway in the first 2 years...
> 2. the part about "lying about a condition" when you haven't been diagnosed yet, doesn't make any sense, IMO.
> 3. I've had arthritis for a few years.


1. That time period applies more to a disability plan, not to the Extended Health Care portion of a *group* plan, which come with inside maximums for the majority of covered services.

2. Perhaps I should not have used the word 'lying', but I think the OP understood what I was trying to say; I meant no disrespect. 

The pre-existing condition exclusions wording is very clear, it states that benefits are not payable for a disability resulting from any illness or condition which existed when employee began employment.

As MoneyGal said, it does not matter whether there was proper and clear diagnosis.

3. I'm sorry about that, I know it can be very painful.

Slightly off topic, but not completely; there was an interesting episode last week on Marketplace that I'm sure was an eye-opener for many travellers. If you're interested, here it is:

*Tripped-Up*

http://www.cbc.ca/marketplace/2012/trippedup/


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## uptoolate (Oct 9, 2011)

Thanks for the link TG. Very informative. The many, many comments that follow are even moreso. And one of the cases in the comments section is rather on topic as the judge apparently decided that costs resulting from a case of lung cancer which had not yet been diagnosed should be covered by the travel insurance even though symptoms of the disease had previously been noted by both the individual and a doctor. Insurance company is still appealing but it looks as if the original judgement will likely hold up.


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## brocko (Apr 20, 2009)

Probably one should know that there are major differences between group insurance and indvidual Health Insurance. Group operates from the concept of "actively at work" which simply means if your working you are deemed healthy so there are no pre existing conditions for extended health. LTD does have pre existing conditions but only in the first two years of coverage and essentially it means if you have consulted a doctor you cannot claim for that condition. There are drugs that do a great job in the treatment of severe arthritis which are very expensive on an annual basis that are covered under group health plans but the key is knowing what the annual maximum is for prescriptions. Many plans will have an unlimited maximum and others will have a dollar amount such as $10,000.


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## Karen (Jul 24, 2010)

I have read similar things about travel insurance before, TG, but that video was still appalling. So what can we do to protect ourselves if we need medical travel insurance? Are there companies that are trustworthy?


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