Private insurance and pre-existing conditions

I am actually a US Citizen, but I have been in Germany long enough to get a Permanent Residence - EU. I am now in the process of moving to Spain, and applying to transfer my residency there. It's proving to be a real pain (I don't speak Spanish yet), but it is in process. I will be working remote lon term for my german company.

In the meantime I am trying to get private insurance, as I want to be able to cancel my health insurance in Germany, which is currently costing me a small fortune (paying the whole thing myself until I can prove insurance in Spain).

I had everything lined up with Sanitas, only to find out they don't cover pre-existing conditions.

I am youngish (33), but have had for instance:

An umbelical hernia in may this year.

Diagnosed with ulcerative colitis in april of this year (I have a prescription now for a suppository)

And long term have been taking cortisteroids (8 years) due to adrenal insufficiency (not addisons).

I asked about this in regards to filling out the form, to which they said these conditions would not be covered. Now I read online that in the future with claims a company could link this to my condition and deny me.

This is a new world for me, and am looking for advice before I commit myself to paying for nothing. For my Ulcerative Colitis, I will likely need checkups, regular medicine, and the odd colonoscopy. I would be scared to think of paying for that myself.

I understand that if you are working in Spain, not sure about particular situation, then you and your employer have to pay the social security each month and with that you are covered by the state medical system.  

When a person applies for Residencia (as a non EU Citizen) or EU registration as an EU Citizen, if one is working then one does not have to produce evidence of full medical  cover or financial means.

PS    http://europa.eu/youreurope/citizens/residence/documents-formalities/eu-nationals-permanent-residence/index_en.htm 

If you negotiate a bit around that page you will find a question area where you can ask any question about Rights etc. in the EU. I have used it a couple of times and had personalised replies within a few days.

Yes I will be working, but as self employed (consulting for my German firm). Then my conditions should be covered under the public system, but I was hoping to not have to rely solely on it.

Best example, when my hernia started I was on vacation in Ibiza with my GF. I went to the hospital there with my EHIC card, only the end to have them refuse to operate. They said to get such an operation under the public system can sometimes be months. The pain I had was awful, but they said it doesn't matter. I would not have been able to work for 2 monthes waiting for such a thing. They said patients simply stop working and subside on government subsidies.

Therfore since my salary is decent, I figured why not get a private policy as well, but now I find that if such a thing were to happen again, I would simply be denied.... what a mess. Makes me feel powerless.

My GF (who is Spanish), says just lie about my conditions and don't tell. I can't evaluate at all if such a thing is possible.

Well Kita,  Of course you could lie, but if they later discovered it then not only might you be left with the full bill for any, or even all the procedures which the insurance had paid for or which you hoped they would,  you could also be prosecuted in a criminal court for fraud.

I have lived in Spain for around 30 years and on several occasions I have used the public health system.  About 10 years ago my private insurance premiums had climbed so high and I had so many exclusions I decided to discontinued it.

The Social Security system:   To mention just one instance.  A couple of months ago I was going through the procedure required for cataract operations which the state health system had decided I needed.  Part of that required  an ECG.  Upon checking that result the surgeon suggested I should have a pacemaker fitted.  Within 10 day I had been admitted and the pacemaker had been fitted.    My condition was not serious. Since 1973 I have been involved in regular fitness training, originally running and latterly cycling  (around 21 kms in 50 mins, averaging 25 kph, 3 or 4 days a week).   Although there were no overt signs of heart probelms, the doctor thought that as I was 76 and engaged in such exercise it would be advisable that the pacemaker was fitted. He said if I became dizzy when riding fast I might crash and incur a severe injury. 

My point is that I have found the State Health System, whilst not perfect, is more than adequate. I suspect your holiday experience might have been different had you been resident in Spain.

PS When I had insurance I am sure I had a couple of procedures which were for 'financial reasons' rather than my medical condition. Financial,  in that had the private consultations not resulted in procedures the doctor would not have earned so much !  On the Social Secuity system I know I will only have procedures which are really required.

Can't you just register as autonomo, pay the subscription, and then you're in the same boat as any Spaniard?

I assume autonomo means self employed and paying into the public system?

Sure that is my plan regardless. Short term it doesn't matter I guess, I can get travel insurance it sounds like until the process is done.

I guess my GF just scared the shit out of me that the system isn't enough on it's own and you need private to help cover you.

However, I don't see a point if they can just exclude my condition(s) and then link things to it as they want. It would be paying for nothing.

GUY  Can't you just register as autonomo, pay the subscription, and then you're in the same boat as any Spaniard?

But his point was I think, that he was concerned that he would not get good service from the Social Security system.  It was to try and reassure him that I made the rather full explanation of how good that service was in my case.  

johnzx Yup that was more or less the point. Thanks for your story btw.

Can anyone comment to how bad the private firms are about attempting to link things to your excluded pre-existing conditions?

The private medical firms do vary in whether they decide to cover a pre-existing condition, so definitely shop around : suggest going through an insurance broker..many speak English and will do the medical questionnaire in English, if that would be useful.

The broker will have a view on which companies tend to be more lenient on existing conditions.. I went through this, and was surprised that although the first company excluded both my conditions, the second one only excluded one of them, and the premium was the same. And I gave the same information to both.

Johnzx gave some good advice.. If you lie, obviously on top of legal problems, paying full whack etc, you will have also lost all the premiums you have paid in, and you would probably be denied any insurance in the future too.

If the private medical company are faced with a big payout, they would obviously check all the information you have supplied.. When you last visited your doctor, what conditions you have vs what you declared etc.

When you apply for insurance, each company will want a sentence on each condition you have, treatments etc, then when they have accepted you in principle, they will usually go through a very detailed phone call.. 30mins, going through everything in detail.. They will tell you it is being recorded, but you won't have the luxury of recording it too, unless you plan for that in advance.

Who knows if medical companies share information on applications? Surely some data protection act would prevent that, but who knows. It's in their financial interest to do so. There's probably some small print where you give them permission to contact other companies, doctors etc, to verify your claims.

So if you are going to lie, at least be consistent :-) .. But your doctor will give you away anyway.

Even if a condition is accepted in principle, and they begin paying out, on renewal they can either whack up the premiums to make the unaffordable, cancel the policy, or, as some companies claim they guarantee not to cancel your policy, but when pressed they say that they can 'ask you to leave'. The insurance company couldn't give a coherent explanation as to he difference. So definitely check renewal and termination conditions on continued payout for existing conditions before you hand over your money.

Without boring you with all the details everytime I have had to use the Spanish state system I have found the service excellent and of a very high standard 

@mrkita. I suspect their evasiveness with your EHIC had more to do with their inability to decide whether you could wait til you went home, etc. It would have been easier to pass the buck. But as most people say, the Spanish state medical care.... such as you would be entitled to as a dues paying autonomo....is very good and wouldn't involve disqualification for pre-existing conditions. Out of curiosity, you say you are paying a small fortune for private insurance in Germany...while at the same time you sound as if you qualify for German state medical care??

Only through June, technically I could extend it for part of July, as I haven't officially registered in Spain yet. I am stuck in limbo at the moment, as I wait on everyone. Long term it's not an option though.

Kita.  I have thought a little more about your Ibiza experience.  Had you required immediate treatment that would have been covered.    However, if as it seems they considered your condition did not warrant immediate attention, then you were treated exactly as they would have a person registered in the system. 

Had they carried out any medical service,  that would have been charged back to the country of origin of your EHIC.  Thus there is no reason of avoiding costs the the Spanish system that you were not treated,

 PS  Just to clarify.  If one  moves to Spain (not here as a visitor) i.e. start work, live permanently, etc.  then you are resident and tax resident immediately. The 3 months / 183 days rule does not apply in such cases.

Johnzx: Thanks for the clarification. That's why I was a bit rattled, because the surgeon basically told me since I wouldn't die I could wait a few months. But waiting in that case would have destroyed my career, as I was in constant pain. The surgeon clarified that people simply go on government subsidies, but to me that's impractical at best, a disaster at worst.

Mrkita.  In the situation you describe without private cover, which included the condition, the only option if you could not wait would be to pay privately for the treatment.

I was going to pay for a friend to have reconstructive surgery, just a kind gesture but was advised against it by the surgeon for that reason.  Fortunately my friend was called by Social Security shorty after and they did the work.   I suspected, but did not know, that surgeon may have had a finger in that pie.

Can't you just remain resident in germany for the time being?

You are OK for the first (upto) 6 months and (I am not sure you need to check if it is calendar years, but I think it is,) you may be OK for the start of next year.

Not telling you to be dishonest but there are plenty of foreign nationals in Spain that create a paper chain that shows they are not resident in Spain.

You have to be careful with health insurance. My lot suddenly put in the renewal letter last year (I almost did not notice it) 'no notified illnesses'. This was totally wrong as we were scrupulously honest 5 years ago when we took it out. With my wife being under medical investigation I decided that I could not risk it and commented. This eventually led to our policy being heavily loaded because of my past history, but they were ot interested in my wife's investigations!

I just happened on this. It might be helpful for some, not only Brits.

https://www.gov.uk/guidance/healthcare-in-spain

Extract:

Purchasing public health insurance

If you are not covered for state-run healthcare through any other means, the Spanish regional health authorities offer a special pay-in scheme (convenio especial). This is a public health insurance scheme available nation-wide where you pay a monthly fee to access state-run healthcare. The scheme is managed by each autonomous region.

Policy holders pay on an individual basis for access to public healthcare, regardless of pre-existing conditions, anywhere in Spain. Children do not have to join the Convenio Especial as they are protected under Spanish law and can access state healthcare for free.

The basic monthly fee is 60€ for the under 65s and 157€ for those aged 65 and above. However, prescriptions are not subsidised at this rate so you would pay 100% of prescription costs. This form of cover doesn’t give holders the right to an EHIC at this time, so if you wish to travel, you will need to take out private travel insurance

tteed  Not telling you to be dishonest but there are plenty of foreign nationals in Spain that create a paper chain that shows they are not resident in Spain.

I know some people think the authorities  are incompetent and so suggest that others might give being illegal a go.

The easiest way to know about someone is to ask their neighbours. “How often is your neighbour here?”    “Does your neighbour let his property?” etc. 

Elementary Dr Watson !

The good thing in theory is I have an appointment in a week for my residency. I am not sure anyone that speaks Spanish can come with me which scares me, but oh well.

The bad thing is, I had no idea this pre-existing condition stuff was. Before Germany I never needed much help from my health insurance, and in Germany I never had to worry. I asked by two global insurers, one rejected me outright, the other with exclusions. Makes me scared to ever go back to the US now....

John

Most do not even try to create the evidence that they are not resident. I know of none who have been caught up with.

Further most of their neigbours would deny enough familiarity to know. But again I have heard no reports of anyone ever ever being asked.