How the health questionnaire and pre-existing conditions work

Key rules

• Answer what is asked: Answer every question truthfully, but you do not have to mention conditions the form does not ask about.
• Look-back period: There is no single legal look-back, so check the period on each question of your form.
• Written terms: If you declare a condition, the insurer must offer its terms in writing before the contract, and you can decline.
• Proof: The insurer must prove you concealed something.

What the questionnaire is for

The cuestionario de salud is the basis of the insurer's decision. It uses your answers to decide whether to accept you, on what terms, or whether to refuse. You must answer truthfully the questions it asks. You do not have to volunteer what it does not ask.

What it asks

Forms differ by insurer, but most ask for:

• Personal data, height and weight, smoking, alcohol and drug habits.
• Current and past diagnoses: heart, cancer, diabetes, respiratory, neurological, mental health, bones and muscles, digestive, kidney, and infectious diseases including HIV.
• Regular medication and ongoing treatments.
• Surgeries and hospital stays.
• Pending or recent tests and results, planned procedures, disabilities and pregnancy.
• Sometimes family history.

Some policies ask for fewer items.

How far back it looks

No single legal period applies. Each form sets its own. Many ask about conditions, treatments and hospital stays over the last 5 years. Some ask about tests and consultations over the last 2 or 3 years. Serious or chronic conditions such as cancer, heart disease, diabetes or HIV are often asked about at any time in your life. Read the periods on your form before you answer. If you are unsure of a date or diagnosis, ask your doctor for a copy of your records.

How pre-existing conditions are treated

A condition you had before the policy started is called pre-existing. Declaring one does not automatically mean refusal. The insurer judges the type, severity, how recent it is, the treatment and your age. It can:

1. Accept you on standard terms. Controlled high blood pressure is a typical example.
2. Accept you with an exclusion, so the declared condition and related complications are not covered. This is common in health insurance.
3. Add a surcharge (recargo) to the premium. This is more common in life insurance.
4. Impose a longer carencia, a waiting period before some services such as childbirth or surgery are covered.
5. Refuse the application. A previous cancer, for example, may be refused or excluded.

If you declare a condition, the insurer must give you its terms in writing before the contract. You can accept or decline. If you decline, you can compare other insurers. Some insurers sell policies with no questionnaire, but these usually come with longer waiting periods or exclude pre-existing conditions.

What happens if an answer is wrong

If the insurer finds an omission or inaccuracy in your answers, it has one month to propose a change or end the policy.

If you make a claim before the insurer corrects things, it pays only part of the claim. The share is based on the premium you paid compared with the premium your true risk would have required. If you answered with intent or serious negligence, the insurer can refuse to pay and keep the premiums for the current period.

The insurer must prove you hid something. Vague questions or general health clauses are not enough, and the insurer is expected to ask specific questions. Even so, never leave out something you know the form asks about.

Before you sign

Use the checklist below, answer only what is asked, and keep a copy of the signed form.

Choosing between options

What should you do once the insurer replies to a condition you declared?

• Accept the insurer's terms: The offer is standard terms, or covers you with only your declared condition excluded, or adds a surcharge or longer waiting period you can live with.

• Decline and compare other insurers: The exclusion, surcharge or waiting period removes the cover you bought the policy for, or the application is refused.

• Look at a policy without a questionnaire: You are refused or the terms are poor, and you accept longer waiting periods or exclusions of pre-existing conditions instead.

The insurer sets its terms in writing before the contract, based on the type, severity, recency and treatment of your condition and your age. You then choose whether to accept or decline them.

Timeline and deadlines

• Answer the insurer's questionnaire with every known circumstance it asks about: before the contract is concluded

• The insurer proposes a change to the contract or ends it after finding an omission or inaccuracy: within one month of learning of it

• The insurer pays only part of a claim made before the wrong answer was corrected: if a claim happens before the declaration is corrected

Documents you need

• The health questionnaire (cuestionario de salud), issued by the insurer and answered and signed by you before the contract is concluded.

• The insurer's written offer of terms, which it must give you before the contract if you declare a condition, so you can accept or decline.

Checklist for answering the health questionnaire accurately

Before you answer the health questionnaire

• Read the whole questionnaire (cuestionario de salud) first and note the period each question covers.

• List current conditions and diagnoses, plus treatments and hospital stays over the last 5 years, or whatever period the form states.

• Include serious or chronic conditions such as cancer, heart disease, diabetes or HIV if the form asks about them at any time in life.

• Write down your regular medication, ongoing treatments, surgeries and hospital admissions.

• Check your height, weight, smoking, alcohol and drug habits, and add family history if the form asks.

• Answer every question truthfully and only what is asked, then keep a copy of the signed form.

• Agree to a medical report or exam only if the insurer asks, and ask who pays before you consent.

Warning that an inaccurate questionnaire can void your cover

Inaccurate answers can void your cover

• Wrong answers can cut or cancel your cover: If your answers leave out or misstate something you knew, the insurer has one month from finding out to propose a change or end the policy. If you claim before that, it may pay only part of the claim, in proportion to the premium you paid against what your true risk required. If you acted with intent or serious negligence, it can refuse to pay and keep the premiums for the current period. Answer every question fully and truthfully. You do not have to volunteer what was not asked, and the insurer must prove you hid something.

Frequently asked questions

Do I have to mention a condition the questionnaire does not ask about?

No, you do not have to mention a condition the questionnaire does not ask about, because you only answer the questions the insurer puts to you. Courts expect specific questions, so a vague general health clause is not enough for the insurer.

Who has to prove that I hid something on the questionnaire?

The insurer has to prove that you hid something, not you. If a dispute follows, the outcome depends on the exact questions asked and how they were worded.

What happens if I have a claim before the insurer notices a wrong answer?

The insurer pays only part of the claim, in proportion to the premium you paid compared with the premium your true health would have required.

Can I buy health insurance without answering a questionnaire?

Yes, some insurers sell policies without a questionnaire, but these usually have longer waiting periods (carencias) or exclude pre-existing conditions. Compare what is excluded before choosing one.