There are a number of reasons why your insurance application may have been rejected and this varies among different companies and types of policies. For insurance policies providing life cover, dread disease or disability benefits as well as physical impairment and income protection, certain medical tests would be required. The results of these tests in conjunction with your profile (determined by your age, gender and family history) may led to your insurance policy being declined.
Most insurance providers will require one or more the the following tests. Restrictions may vary among different companies so it is best to speak to your insurance broker about any eventuality which may lead to your policy being declined.
If your HIV test is positive, most insurance companies will refuse to provide the cover for policies like life cover, dread disease, disability or physical impairment. Some insurance companies have special policies for persons living with HIV but further testing may be required. Based on your CD4 count and viral load, some companies may be prepared to cover you. In these instances, you will have to pay more for your insurance cover.
A random glucose test may be done so you will not need to fast before the test. This random sample will give the provider some indication of your glucose tolerance. If you are considered at high risk for diabetes, then a glucose tolerance test (GTT) may be necessary. Most companies will not refuse you cover if your are suffering with diabetes or impaired glucose tolerance but you can expect to have the policy ‘loaded’.
A random cholesterol test is conducted so fasting is not necessary. The total cholesterol should ideally be lower than 5 mmol/L but most insurance companies will accept you without ‘loading’ the policy if your blood cholesterol is below 6 mmol/L. This varies among companies but some are prepared to accept applicants with a total cholesterol level of up to 7 mmol/L if they are on medication and younger than 35 years of age.
Gamma-Glutamyl Transferase (GGT)
This test is done to check the level of the liver enzyme known as gamma-glutamyl transferase (GGT). It is common to see this enzyme raised as a result of excessive alcohol consumption, long term use of scheduled drugs and narcotic abuse. It may also be raised in liver failure and other serious medical conditions. It is now known that certain vitamin and mineral supplements as well as herbal supplements may raise your GGT level. You should discuss this with your insurance broker or doctor. If you are concerned about this liver enzyme level, you should talk to your doctor about doing a full liver function test (LFT) before you draw any conclusions.
This test is necessary to check the nicotine levels. If you have admitted to being a smoker, then the insurance company may not require a cotinine test. However non-smokers are often required to do this blood test. Most insurance companies will consider you as a smoker unless you have quit more than 2 years before the inception of the policy. Do not try to make false claims about your cigarette smoking or tobacco use. Qualitative and quantitative cotinine tests can to some degree differentiate between active smokers, passive (second hand) smokers and tobacco use other than cigarette smoking.
Apart from these tests, each insurance company may look at your profile differently. Depending on your previous medical history, family history, chronic conditions, body weight, age and gender, you may be considered as a high risk applicant and your policy will be declined. These restrictions should not apply to medical aids in South Africa. While there may be certain medical aid exclusions based on pre-existing conditions, in most cases a medical aid cannot refuse you membership on these grounds.