3 ms·

That’s the theory. In reality, insurance policies are complex and reading them closely matters. I just re-read the pre-existing conditions clause of my employ

That’s the theory. In reality, insurance policies are complex and reading them closely matters. I just re-read the pre-existing conditions clause of my employer provided long term disability policy and I’m pretty sure that if you’ve had the policy for over a year you can’t be denied due to a preexisting condition. They offer the policy to all employees, there is no screening. Therefore, if you have a slowly progressing disease that will result in disablement more then a year out you can still get a long term disability policy that covers it.

lostcolony 5y ago
That's the case with all employer policies; health insurance is the same way. Because the employer guarantees it for all employees, and has no reason to hire only unhealthy employees, the insurer can cover all the employees at a fixed rate; the risk is balanced out. Even then, as you note, there's a year's lag on that policy (probably because the employer didn't want to cover that extra risk in premiums for every employee). Universal healthcare also works due to this assumption; everyone is paying into it, so the cost of the most expensive (the sick) is balanced by the cost of the least expensive (the healthy). As the former outpaces the latter, the premiums for everyone grow. It's also why the ACA in the US mandated participation or a fine; to make it more affordable the healthy need to also be paying into it, but the healthiest also tend to be the youngest, and the least likely to buy insurance, whereas the older and sicker would all buy in (and now have to be covered), and that would make the premiums untenable (leading the moderately healthy to decide not to buy in, causing an even bigger issue, etc etc, until it doesn't make sense for anyone). And why prior to the ACA, you needed a physical, and pre-existing conditions generally led to you being excluded. But, while the US has changed with regard to health insurance, it still is the case that if you want LTD as an individual, expect to have questions about your health, if not an actual physical, just like life insurance does, and to have it denied, or have insanely high premiums, if you are looking likely to need it.

lostcolony 5y ago

That's the case with all employer policies; health insurance is the same way. Because the employer guarantees it for all employees, and has no reason to hire only unhealthy employees, the insurer can cover all the employees at a fixed rate; the risk is balanced out. Even then, as you note, there's a year's lag on that policy (probably because the employer didn't want to cover that extra risk in premiums for every employee). Universal healthcare also works due to this assumption; everyone is paying into it, so the cost of the most expensive (the sick) is balanced by the cost of the least expensive (the healthy). As the former outpaces the latter, the premiums for everyone grow. It's also why the ACA in the US mandated participation or a fine; to make it more affordable the healthy need to also be paying into it, but the healthiest also tend to be the youngest, and the least likely to buy insurance, whereas the older and sicker would all buy in (and now have to be covered), and that would make the premiums untenable (leading the moderately healthy to decide not to buy in, causing an even bigger issue, etc etc, until it doesn't make sense for anyone). And why prior to the ACA, you needed a physical, and pre-existing conditions generally led to you being excluded. But, while the US has changed with regard to health insurance, it still is the case that if you want LTD as an individual, expect to have questions about your health, if not an actual physical, just like life insurance does, and to have it denied, or have insanely high premiums, if you are looking likely to need it.