Know The Pre-Existing Condition Before Joining Insurance


Know The Pre-Existing Condition Before Joining Insurance – Having insurance is considered by some people to be very important as an effort to protect themselves. But before becoming an insurance customer, it would be nice to know in detail the agreement or clause contained in the insurance.


One of them is the pre-existing condition clause in insurance. Insurance Observer Kapler Marpaung said that a pre-existing condition is a health condition that existed before the insurance policy took effect.


“Usually, this pre-existing condition is an exception to the protection provided. For example, if a customer already has congenital heart disease that he has suffered from before buying an insurance policy. Then when submitting a Life Insurance or Health Insurance Application Letter, the congenital disease is not conveyed to the insurance company. So if after the policy takes effect and he submits a claim for his heart disease, the claim can be canceled by the insurance company,” said Kapler quoted on Thursday (14/10/2021).


According to the man who also serves as Chairman of the Wealth Management Standard Board Indonesia (WMSBI), the cancellation of claims due to the imposition of a pre-existing condition clause can be avoided by providing information about the prospective customer’s medical and medical history openly and transparently.

For a recently growing issue that led to an actress’ complaint, according to Kapler when a customer decides to buy a health insurance policy, for example, he should have put forward all the medical data he has on the insurance protection application letter.

“So that the insurance company can determine or decide, whether the insurer will accept the application, or whether the company will accept with several conditions, or instead the insurance company will refuse. So that if there is a claim in the back of the day, there will be no problems around its legality,” he said.

“So the prospective customer must put forward all his medical history. Openness must be done,” he added.

Kapler also said that certain insurance companies may set policies so that customers can still get the protection programs provided. He regretted that if the customer turns out to have a medical trace of a certain severe illness, the insurance company may prepare a contract with a clause that the claim benefit can only be received by the customer after a certain period after the policy is issued.

“There are insurance companies that are willing to cover certain risks that have occurred before the policy took effect. It’s just that claims can only be served after two years of the policy being in effect, for example. Or some are valid after three years of the policy. It depends on the type of critical illness,” said the Member of the Advisory Board of the Indonesian Insurance and Reinsurance Brokers Association (ABAI).

Disclosure of Information

However, this clause that can lead to a win-win solution for customers and insurance companies, according to Kapler, can only be realized if, from the beginning, information disclosure from customers to insurance companies has been implemented.

“This is a kind of good faith on the part of the company in providing insurance protection to the public,” he said. 

Kapler also said that on the other hand, the insurance industry must be able to provide very detailed education to prospective customers, to avoid mis-spelling. Furthermore, Kapler also urged customers to read each clause of the insurance agreement carefully, so that they can raise objections or rectifications if there are articles that are considered unfavorable.


“What is not well understood by the public as prospective customers, they have a free look period or free look provision. This means that prospective policyholders have time to first examine their policies, or re-study, them to make a final decision. If the contents of the policy climax are deemed to be inconsistent with what is desired, the policy can be canceled and the premiums paid will be refunded,” Kapler said.

Generally, this free look provision period is 14 days long since the prospective customer receives the policy, and all life and health insurance products apply the clause in good faith from the insurance company, so that there is no prejudice that the insurance company only pursues the policy sales target.

“So, before buying a policy, understand the desired product. Carefully read the articles of agreement in the policy, and provide all information about yourself transparently and honestly. The realtor does not know the true condition of his prospective customer, only the person of the prospective customer knows,” said Kapler.

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