One of the most common sources of confusion in private medical insurance is pre-existing conditions. Are they covered? Can you still get a policy? And what does it mean for your options?
In this guide, we explain what counts as a pre-existing condition, how insurers treat them, and how to find the right cover, even if you have a health condition.
What Are Pre-Existing Conditions in Health Insurance?
A pre-existing condition refers to any medical issue you’ve experienced before starting your private health insurance policy. This includes, but is not limited to:
- Diagnosed conditions such as asthma, diabetes, high blood pressure, or depression
- Chronic or ongoing health issues like eczema, joint pain, or back problems
- Past medical treatment or surgery, even if you’ve fully recovered
- Unexplained symptoms, even if you haven’t seen a doctor yet
When you apply for private medical insurance, insurers may check your medical history to assess risk and determine what’s eligible to be covered. Being honest and informed at policy inception can help you avoid claim rejections or coverage exclusions down the line.
What’s the difference between acute and chronic conditions in insurance?
Private health insurance usually covers acute conditions which are medical issues that arise suddenly and are expected to improve with treatment. Chronic conditions, on the other hand, are ongoing and typically require long-term management, such as diabetes or arthritis. Most insurers limit or exclude cover for chronic conditions, although some offer support services or treatment for flare-ups. It’s important to compare policies carefully.
How Insurers Assess Pre-Existing Conditions Health Insurance
Private health insurance is designed to cover new and unexpected medical issues. The way pre-existing conditions are treated depends on the type of underwriting used in your policy:
1. Moratorium Underwriting
This is the most common choice for new applicants.
- How it works: Any condition you’ve had treatment, advice, medication, or symptoms for in the five years before your policy starts is excluded automatically.
- Cover may resume: If you go two continuous years after your policy starts without any symptoms, treatment, or medical advice for that condition, it may become eligible for cover.
- No medical history required at application.
- Best for: People who want a fast and easy application process without disclosing their full medical history.
2. Full Medical Underwriting
A more detailed and transparent approach.
- How it works: You provide your complete medical history upfront. The insurer reviews this to decide which conditions will be excluded or covered.
- Requires: Medical questionnaires and, in some cases, GP or hospital reports.
- Best for: Applicants with complex medical histories or those who want certainty about what’s covered from the start.
3. Medical History Disregarded (MHD) Underwriting
Typically, only available on corporate or group schemes (not individual policies).
- How it works: All pre-existing medical conditions are disregarded. The policy will usually provide full cover, regardless of your past medical history.
- Why it’s not available to individuals: MHD underwriting spreads the risk across a larger group of people, which allows insurers to offer broader cover without assessing each person’s medical history.
- No underwriting process required for each individual.
- Best for: Employers offering health insurance to staff, particularly in larger businesses.
These are three of the most commonly used underwriting methods. For a full list with a more detailed breakdown of each type and how they could affect your policy, read our blog on Understanding Medical Underwriting.
What if I don’t disclose pre-existing conditions?
If you’re asked to provide details about your medical history, it’s important to answer honestly. Not disclosing a pre-existing condition could lead to a claim being declined if the insurer determines the condition existed before your policy started. Being transparent at the application stage helps ensure your policy remains valid and gives you peace of mind.
Can I still get cover with a health condition?
Yes, having a pre-existing condition doesn’t mean you can’t take out private health insurance. However, the condition may not be covered straight away, or at all, depending on how the policy is underwritten.
Here are the main options available:
- Cover with exclusions: Your pre-existing condition may be excluded from the policy, but you’ll still be covered for new, unrelated medical issues that arise after your policy begins.
- Limited or future cover: Some insurers may offer cover for certain pre-existing conditions after a certain period with no symptoms, treatment, or advice, often under moratorium underwriting.
If you’re unsure what’s possible, it’s a good idea to speak with a health insurance broker who can offer unbiased advice on your health insurance policy. At UK Health Insurance, our FCA-regulated advisers can offer guidance based on your individual circumstances. This blog provides general information and should not be taken as personalised financial advice.
It’s important to remember that even if you’re accepted for a policy, cover for certain conditions or treatments may be limited, subject to waiting periods, or declined entirely.
Can I switch providers if I have pre-existing conditions?
You can switch providers, but pre-existing conditions covered by your current policy may not be included in the new one. Some insurers offer continuation of cover if you’re moving from a similar policy without a gap in cover. Always review the underwriting terms before switching. A health insurance broker can guide you through the process and help ensure nothing is missed.
If you’re considering switching, our top tips for switching health insurance can help you navigate the process with confidence and avoid common mistakes.
Final Thoughts
Understanding how pre-existing conditions affect your health insurance gives you more control over your choices and costs. Whether you’re applying for the first time or thinking about switching providers, being informed helps you make the right decision.
Tips for Choosing the Right Health Insurance Policy
- Be honest – always disclose your full medical history to avoid issues with claims
- Understand exclusions – ask questions about anything you are unsure of
- Think long term – the cheapest policy might not give you the protection you need. For more guidance, read our article on what to consider before buying medical insurance
- Review excess and limits – these affect how much you pay when making a claim and can impact value for money
- Understand the health insurance terminology – it’s important to understand key terms like underwriting, exclusions and chronic conditions. If you’re unsure, our guide to private health insurance terms explains them in simple language.
Have questions about your policy or thinking about taking out cover? Get in touch with our friendly team today or get a free health insurance quote using our quick and easy quote tool.
Disclaimer: Health insurance policies vary between providers and are subject to underwriting. Cover for pre-existing conditions is assessed on a case-by-case basis. For personalised guidance, please get in touch with UK Health Insurance. Our advisers can help you find a policy that best suits your health insurance needs.