What is a pre-existing condition in Canada? (2026 Guide)

A pre-existing condition is any illness, injury, or medical issue you had before your insurance policy took effect. Understanding pre-existing condition insurance in Canada is important because insurers review your medical history to assess risk, determine premiums, and decide whether to approve coverage, apply ratings, or impose exclusions.

In this guide, you’ll learn what counts as a pre-existing condition in Canada, how it affects approval, pricing, and claims, and what to do if an application or claim is denied.

What counts as a pre-existing condition in Canada?

In Canada, a pre-existing condition means any medical problem, diagnosis, or injury you had before your policy came into effect. Insurers review your medical history, including diagnoses, symptoms, treatments, tests, and medications.

Insurers consider a condition pre-existing if you:

• Experienced symptoms or sought medical advice
• Received treatment or specialist referrals
• Took prescription medication (including as‑needed)
• Received a diagnosis before coverage began

Now that you know how insurers determine whether a condition is pre-existing, here are the types of medical issues insurers most often review during underwriting.

What are some common pre-existing conditions?

Common pre-existing conditions include chronic illnesses, metabolic disorders, mental health conditions, and any medical issue you were diagnosed with or treated for before your policy started. Even fully healed conditions (like a previous fracture or concussion) may still be reviewed, depending on your policy terms. Let’s take a look at some common pre-existing conditions.

1. Chronic and serious illnesses

• Cancer
• HIV/AIDS
• Coronary artery disease
• Congestive heart failure
• Stroke
• Alzheimer’s disease
• Parkinson’s disease
• Kidney disease
• Liver disease or cirrhosis

2. Metabolic and lifestyle-related conditions

• Diabetes
• High blood pressure
• Obesity (including Class III obesity)

3. Mental health conditions

• Anxiety
• Depression
• Bipolar disorder
• Mood disorders
• Eating disorders (anorexia, bulimia)

4. Other medical conditions

• Post-transplant conditions
• Chronic pain disorders
• Long-term or recurring injuries

These conditions play a direct role in how insurers assess your risk. Here’s how pre-existing conditions affect your life insurance application in Canada.

How do pre-existing conditions affect life insurance in Canada?

Insurers assess how your condition affects risk, then decide your eligibility, pricing, and any exclusions. While each insurer has its own underwriting guidelines, your application is reviewed individually based on your age, coverage amount, medical history, lifestyle, and the stability of your condition.

As part of underwriting, insurers collect information about your current health, lifestyle, and family history. They may do this through a health questionnaire or tele-interview and can request a paramedical exam (vitals and lab work), an attending physician statement (APS), or medical records with your consent. These details help insurers assess hereditary risks and verify your medical history. The method varies by insurer, age, coverage amount, and distribution channel.

Based on this assessment, insurers assign your risk category:

• Preferred risk: Lower premiums for very healthy applicants
• Standard risk: Typical premiums for average risk
• Rated/Substandard risk: Higher premiums due to elevated risk; sometimes temporary if stability improves

This risk classification affects your coverage eligibility, premium rates, and potential exclusions.

How pre-existing conditions affect other types of insurance?

Pre-existing conditions increase the likelihood of exclusions, higher premiums, or modified coverage for living benefit insurance, such as critical illness and disability insurance.

These products pay a lump sum or monthly benefit while you are still alive, triggered by a covered illness, injury, or disability. Since insurers view the risk of developing a serious illness or disability as higher than the risk of premature death, they apply stricter underwriting to your medical history. This closer review often results in more exclusions, limited benefits, or declines for applicants with pre-existing conditions.

Can you get insurance with a pre-existing condition?

You can qualify for insurance with pre-existing conditions. After underwriting is complete, your application typically results in one of these categories:

1. Declined: Coverage is refused if the insurer finds the risk too high at this time
2. Rated: Approved with higher premiums. Ratings may be temporary or permanent. Temporary flat extras often apply to recent medical events, high-risk activities, or specific risks and usually last 1-2 years (varies by insurer). Permanent ratings remain unless new medical evidence supports reconsideration
3. Exclusion: Benefits related to the excluded condition will not be paid. Exclusions are rare for life insurance, but common in critical illness, disability insurance, and some travel insurance
4. Standard/preferred: Approved at typical or lower premiums when the condition is stable, well-controlled, or not considered risky
5. Postponed: The insurer delays a decision pending further stability or medical evidence. Reapply intervals vary by condition, commonly 6–12 months, but can range from 3 to 24+ months depending on surgeries, diagnostic tests, or medication changes.

You still have options, even if approval isn’t straightforward. You may qualify for coverage with a rating or, in some cases, an exclusion (more common for critical illness or disability insurance). You can also consider non-medical policies that don’t require detailed health information.

Tips to get coverage if you have a pre-existing condition

You can still get coverage with a pre-existing condition. Here’s what improves your approval chances and pricing during underwriting in Canada.

• Be honest on your application: Disclose all symptoms, tests, diagnoses, and treatments. Non-disclosure can lead to denied claims or policy cancellation, especially during the two-year contestability period
• Work with an experienced advisor: PolicyAdvisor’s licensed advisors review each insurer’s underwriting rules for your condition and find the policy that offers the best fit and price for you, at no extra cost
• Consider non-medical or simplified issue policies: These options ask fewer medical questions and require no exam, which can make approval easier if you have certain conditions. Just note that they come with smaller coverage amounts and higher premiums than fully underwritten plans
• Maintain documentation of your health: Keep recent test results, physician notes, and treatment records handy. Insurers may request them to assess your risk
• Improve controllable risk factors: Manage conditions like high blood pressure, diabetes, or obesity. Stable results can reduce ratings over time
• Review multiple insurers: Underwriting rules differ across insurers. Comparing options can turn a decline into an approval, or reduce a rating to standard pricing
• Consider  policy with a waiting period: Some insurance products have waiting or look-back periods. Guaranteed issue life often has a 2-year non-accidental death waiting period. Disability insurance includes elimination periods of 30-180 days before benefits start. Critical illness policies may have a 30-day survival period or condition-specific waiting periods. Travel insurance commonly applies pre-existing stability look-backs of 90-365 days. Periods vary by product, insurer, and condition

Beyond the application process, pre-existing conditions can also affect claims. Here are the most common reasons insurers deny claims related to pre-existing conditions.

Common reasons claims related to pre-existing conditions are denied

Claims involving pre-existing conditions often get denied for predictable reasons, many of which you can avoid by understanding your policy and providing complete information.

• Material misrepresentation or omission: Insurers can deny a claim or rescind a policy if you provide incomplete or inaccurate information about symptoms, diagnoses, or treatments, and the misstatement is material within contestability rules. Life insurance is generally incontestable after two years, except in cases of fraud. For accident and sickness coverage, remedies depend on timing and applicable provincial laws
• Condition outside policy coverage: Insurers may exclude conditions based on the product. Travel insurance often applies pre-existing stability clauses. Many group accident and sickness plans limit coverage for pre-existing conditions. Individual life insurance rarely has general exclusions but may include suicide, contestability, or activity-specific exclusions. Individual critical illness policies cover defined conditions with survival or waiting periods, while group critical illness plans may impose pre-existing condition limitations
• Incomplete medical records: Insurers may delay claim decisions if required documents are missing. Denial usually occurs only if you cannot provide proof that meets the policy’s definitions within the contract or limitation timelines. For life insurance, a death certificate often suffices, while critical illness and disability claims require detailed medical evidence
• Policy lapse or unpaid premiums: Insurers may deny claims if the policy lapses or premiums are unpaid. Most life and accident & sickness policies provide a grace period, usually 30-31 days. Claims occurring during this period are typically paid minus overdue premiums. After a lapse, you can often reinstate coverage by submitting evidence and paying premiums
• Lifestyle-related risks: Insurers handle lifestyle factors differently by product. Life insurance charges higher premiums for smokers rather than excluding them. Hazardous or extreme activities may be excluded or rated. Disability and critical illness policies may exclude certain activities or conditions. Travel insurance may exclude high-risk sports or claims related to intoxication
• Late reporting of claims: Filing after the required timeline can affect claim approval. Accident and sickness policies usually require notice within 30 days and proof within 90 days, though extensions are allowed for reasonable cause. Travel policies may have different timelines. Late notice can prejudice a claim, but many laws and contracts provide flexibility. Life insurance claims are rarely denied solely for late notice if it does not cause prejudice and is within the limitation periods
• Mismatch with policy type: Claims can be denied if filed under the wrong product type. For example, submitting a critical illness claim for a condition excluded under your plan, such as a pre-existing heart condition, may result in denial

What to do if you are denied life insurance coverage for health reasons

If you’re declined or heavily rated due to health issues, you still have options. Non-medical policies can provide coverage without full underwriting.

• Non-medical (simplified issue) life insurance: You answer a few health questions instead of completing a medical exam or interview. Approval is faster, but premiums are higher and coverage amounts are limited
• Guaranteed issue life insurance: No medical questions or underwriting required. Approval is guaranteed regardless of health. Premiums are the highest, and coverage is usually capped at around $50,000

Which is the best life insurance company for pre-existing conditions?

No single insurer is “best” for every condition. Licensed experts from PolicyAdvisor help you compare offers from Canada’s top companies. Our experience shows that some insurers like iA and Beneva offer greater risk tolerance and more accommodating underwriting.

We work directly with underwriters to find your best rates. We also work with non-medical carriers such as Industrial Alliance, Canada Protection Plan, Humania, and Assumption Life for faster coverage options.