TL;DR
Navigating the UK private medical insurance market can feel complex, especially with a pre-existing condition. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands your concerns. This guide explains how insurers approach medical history and helps you find the best path forward.
Key takeaways
- Symptoms
- Medication or treatment
- Diagnostic tests or consultations
- Medical advice
- Asthma diagnosed a decade ago, even if you only use an inhaler occasionally.
Navigating the UK private medical insurance market can feel complex, especially with a pre-existing condition. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands your concerns. This guide explains how insurers approach medical history and helps you find the best path forward.
Review of underwriting and leading providers
Finding the "best" private medical insurance (PMI) when you have a pre-existing medical condition isn't about finding a policy that covers everything from day one. Instead, it's about understanding how insurers assess your health history—a process called underwriting—and choosing the right approach for you.
This definitive 2026 guide will demystify the process, review the UK's leading providers, and show you how to secure valuable health cover, even with a medical background.
What Exactly is a Pre-existing Condition in PMI?
Before we dive in, let's be crystal clear on the definition. From an insurer's perspective, a pre-existing condition is any disease, illness, or injury for which you have experienced:
- Symptoms
- Medication or treatment
- Diagnostic tests or consultations
- Medical advice
...in a set period before your policy start date. This period is typically the five years leading up to your application.
Real-life examples of pre-existing conditions:
- Asthma diagnosed a decade ago, even if you only use an inhaler occasionally.
- Joint pain in your knee for which you saw a GP two years ago.
- Anxiety or depression for which you received counselling or medication.
- High blood pressure or high cholesterol managed with diet or pills.
- A benign skin lesion removed three years prior.
The key takeaway is that it doesn't matter if the condition was minor, fully resolved, or undiagnosed at the time. If you sought advice or had symptoms, it counts.
The Golden Rule of UK PMI: Acute vs. Chronic Conditions
This is the most critical concept to grasp in UK private medical insurance.
-
Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a broken bone, appendicitis, cataracts, or a hernia. PMI is designed to cover acute conditions that arise after you take out your policy.
-
Chronic Condition: A condition that is long-lasting, has no known cure, and requires ongoing management. Examples include diabetes, arthritis, asthma, Crohn's disease, and multiple sclerosis. Standard UK PMI policies do not cover the management of chronic conditions.
Why this distinction? PMI is structured to help you bypass NHS waiting lists for specific, curable treatments. Covering long-term, ongoing chronic care would make premiums unaffordable for the vast majority of people. The NHS remains the cornerstone of care for chronic conditions in the UK.
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Duration | Short-term | Long-term, often lifelong |
| Prognosis | Curable, full recovery expected | Incurable, requires ongoing management |
| Treatment Goal | To cure the condition | To manage symptoms and prevent progression |
| PMI Cover | Yes (if it arises after the policy starts) | No (for long-term management) |
| Example | Cataract surgery, joint replacement | Diabetes management, asthma medication |
How UK Insurers Handle Pre-existing Conditions: Underwriting Explained
Underwriting is the process an insurer uses to evaluate your health and determine the terms of your policy. When it comes to pre-existing conditions, you generally have two main choices. Understanding them is the single most important step in your journey.
1. Moratorium (MORI) Underwriting
This is the most common and popular type of underwriting in the UK, chosen by over 80% of new individual policyholders.
How it works: A moratorium policy automatically excludes any pre-existing conditions you've had in the five years before your policy begins. However, these exclusions are not necessarily permanent.
The condition may become eligible for cover later if you meet specific criteria, often called the "2-5-2 rule":
- You had the condition in the 5 years before the policy started.
- You must then go for a continuous 2-year period after your policy start date without any symptoms, treatment, medication, or medical advice for that specific condition.
- After that 2-year "clear" period, the condition may become eligible for cover under your policy's terms.
Example:
- Scenario: David had physiotherapy for a bad back in 2024. He takes out a moratorium PMI policy in January 2026.
- Exclusion: His back problem is automatically excluded from cover.
- Path to Cover: If David remains completely free of back pain and needs no check-ups, medication, or advice for it until January 2028 (two full years), his back will then be eligible for cover for any new episodes of trouble.
- Resetting the Clock: If he gets a twinge in June 2027 and sees his GP, the two-year moratorium clock for his back resets from that date.
| Moratorium Underwriting: Pros & Cons | |
|---|---|
| Pros ✅ | Cons ❌ |
| Quick and simple application process | Lack of certainty at the start of the policy |
| No lengthy medical questionnaires needed | Claims process can be slower as underwriting happens then |
| Possibility for conditions to become covered over time | Conditions that require regular check-ups will never be covered |
| Ideal for those in good health with minor past issues | Ambiguity can lead to disputes if medical history is complex |
2. Full Medical Underwriting (FMU)
With Full Medical Underwriting, you provide your complete medical history upfront by filling out a detailed health questionnaire.
How it works: The insurer's underwriting team reviews your answers. Based on your health history, they will then offer you a policy with specific, named exclusions written into your contract. For example, your policy documents might explicitly state, "Cover excludes any treatment related to asthma and associated respiratory conditions" or "No cover for the right knee".
These exclusions are typically permanent and will not be reviewed unless you specifically request it and can provide medical evidence of a significant change in your health status.
Example:
- Scenario: Sarah has a history of endometriosis and wants a PMI policy. She chooses FMU.
- Process: She declares her endometriosis diagnosis, treatments, and consultations on her application form.
- Outcome: The insurer offers her a policy with a clear, written exclusion: "All conditions related to endometriosis and pelvic pain are excluded from cover." She knows from day one exactly what is and isn't covered.
| Full Medical Underwriting: Pros & Cons | |
|---|---|
| Pros ✅ | Cons ❌ |
| Complete clarity and certainty from day one | A long and detailed application process |
| You know exactly which conditions are excluded | Exclusions are usually permanent |
| Faster claims process as your history is already known | May result in more exclusions than a moratorium policy |
| May be possible to negotiate an exclusion with the insurer | Can be intrusive for those who value privacy |
Comparison: Moratorium vs. Full Medical Underwriting
| Feature | Moratorium (MORI) | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick, no health forms | Detailed health questionnaire |
| Initial Underwriting | None. Done at the point of claim. | Done upfront before the policy starts. |
| Exclusions | Blanket exclusion on recent pre-existing conditions. | Specific, named exclusions listed on your policy. |
| Clarity | Can be ambiguous. "Will my knee be covered?" | Crystal clear from the start. |
| Path to Cover | Yes, after a 2-year trouble-free period. | No, exclusions are usually permanent. |
| Best For | People with minor or no recent medical history. | People with a known, complex medical history who want certainty. |
An expert PMI broker, like WeCovr, can discuss your personal medical history and help you decide which underwriting method is the most suitable for your circumstances at no cost to you.
What About Switching Insurers? Continued Personal Medical Exclusions (CPME)
If you already have a PMI policy and want to switch to a new provider, a third option called "Continued Personal Medical Exclusions" (CPME) underwriting may be available.
This allows you to switch insurers while keeping the same underwriting terms you had on your previous policy. Essentially, the new insurer agrees to continue covering what your old insurer covered, without adding new exclusions for conditions that developed while you were insured. This is an excellent way to shop around for a better price without losing valuable cover.
Review of Leading UK PMI Providers & Their Approach
While all major providers use the underwriting methods above, they differ in their flexibility, customer service, and added benefits. Here’s a look at some of the best PMI providers in the UK.
| Provider | Key Features & Underwriting Approach | Ideal For |
|---|---|---|
| AXA Health | Offers both Moratorium and FMU. Known for its extensive hospital lists and strong focus on mental health support through its "Stronger Minds" pathway. Their customer service is highly rated. | Individuals and families looking for comprehensive cover with a strong emphasis on mental wellbeing support. |
| Bupa | A household name offering Moratorium, FMU, and CPME. Bupa provides direct access to services (no GP referral needed for some conditions like cancer and mental health). They have a vast network of hospitals and clinics. | Those wanting a trusted brand with direct access pathways that can speed up diagnosis and treatment. |
| Aviva | Provides a full range of underwriting options. Their "Expert Select" hospital list can offer lower premiums. Known for their digital tools, including the Aviva DigiCare+ app which offers health checks and digital GP access. | Cost-conscious buyers who are happy with a guided hospital list and value digital health tools. |
| Vitality | Unique approach combining Moratorium or FMU with a wellness programme. Policyholders are rewarded with discounts and perks (like free coffee or cinema tickets) for staying active. This can make premiums more manageable. | Active individuals who are motivated to engage with a wellness programme to lower their long-term costs. |
Important Note: No provider is universally "best." The right choice depends entirely on your personal health, your budget, and the level of cover you need.
Strategies for Getting Health Cover with a Medical History
- Be Honest and Thorough: The single biggest mistake you can make is withholding information. Whether on an FMU form or when speaking to a claims team on a moratorium policy, be completely transparent. Non-disclosure can lead to your policy being cancelled and claims being rejected.
- Understand Your Exclusions: Read your policy documents carefully. With FMU, the exclusions will be listed. With a moratorium, assume anything you've had issues with in the last five years is excluded until proven otherwise.
- Think Long-Term: A moratorium policy can be a great strategic choice if your pre-existing conditions are minor and unlikely to recur. It offers a pathway to future cover.
- Speak to an Expert Broker: This is where true value lies. A specialist private medical insurance UK broker like WeCovr works for you, not the insurer. We can:
- Listen to your medical history in confidence.
- Explain which underwriting type is likely to give you the best outcome.
- Compare policies from across the market to find the right cover at the right price.
- Assist you with the application process, ensuring it's completed correctly.
Wellness, Lifestyle, and Making the Most of Your Policy
Even with exclusions for pre-existing conditions, a PMI policy offers immense value. Most top-tier policies now come bundled with benefits designed to keep you healthy and provide support when you need it.
- Digital GP Services: Get a virtual GP appointment 24/7, often within hours. This is perfect for getting quick advice, prescriptions, or referrals without waiting weeks to see your NHS GP.
- Mental Health Support: Most policies include access to a set number of counselling or therapy sessions without needing a GP referral. This is invaluable for managing stress, anxiety, or low mood.
- Wellness Programmes: Providers like Vitality actively reward healthy living. But even others offer gym discounts, health screening offers, and access to wellness apps.
- WeCovr's Added Benefits: When you arrange your PMI with WeCovr, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help you manage your diet and health goals. Furthermore, our clients often receive discounts on other insurance products, such as life or income protection cover.
Managing your overall health through good diet, regular activity, and sufficient sleep can have a powerful impact. The NHS recommends at least 150 minutes of moderate-intensity activity a week. Small changes, like tracking your nutrition or taking a brisk daily walk, can improve your long-term wellbeing and potentially reduce the risk of future acute conditions.
The Bottom Line: Can You Get PMI with Pre-existing Conditions?
Yes, you absolutely can.
The crucial point is that your private medical insurance policy will not cover those specific pre-existing conditions from the outset, and it will not cover the ongoing management of any chronic conditions.
It will give you peace of mind and fast access to private medical care for new, eligible acute conditions that may arise in the future. For many, this is the primary reason for investing in private health cover—to bypass long waiting lists for diagnostics and surgery when something new and unexpected occurs. According to 2025 NHS England data, the median wait time for non-urgent treatment can be several months, a period that PMI can dramatically reduce.
Choosing the right underwriting method is the key. It's the difference between having clarity from day one (FMU) and having a potential path to cover for a condition in the future (Moratorium).
Do I need to declare a minor illness I had years ago?
What is the difference between a pre-existing and a chronic condition?
Can I get cover for cancer if I've had it before?
Is moratorium underwriting better than full medical underwriting?
Take the Next Step with Confidence
Understanding how private medical insurance works with pre-existing conditions is the first step. The next is finding a policy that fits you perfectly.
At WeCovr, our team of independent, experienced insurance specialists is here to provide friendly, no-obligation advice. We will help you compare the UK's leading insurers and find the most suitable and cost-effective plan for your unique needs.
[Get Your Free, No-Obligation PMI Quote Today]
Sources
- NHS England: Waiting times and referral-to-treatment statistics.
- Office for National Statistics (ONS): Health, mortality, and workforce data.
- NICE: Clinical guidance and technology appraisals.
- Care Quality Commission (CQC): Provider quality and inspection reports.
- UK Health Security Agency (UKHSA): Public health surveillance reports.
- Association of British Insurers (ABI): Health and protection market publications.
