TL;DR
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr is frequently asked if private medical insurance (PMI) is available for UK residents with pre-existing conditions. This guide provides a clear, comprehensive answer, explaining the crucial underwriting rules that every potential policyholder needs to understand. WeCovr explains underwriting rules for pre-existing illnesses One of the most common questions we hear is: "Can I get private health cover if I already have a medical condition?" It's a vital question, and the answer is nuanced.
Key takeaways
- Symptoms: Even if you never saw a doctor (e.g., recurring back pain or occasional shortness of breath).
- Advice: A consultation with a GP, physiotherapist, or specialist.
- Medication: Any prescribed drugs for a condition.
- Treatment: A course of therapy, a surgical procedure, or diagnostic tests.
- Sudden or recent onset.
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr is frequently asked if private medical insurance (PMI) is available for UK residents with pre-existing conditions. This guide provides a clear, comprehensive answer, explaining the crucial underwriting rules that every potential policyholder needs to understand.
WeCovr explains underwriting rules for pre-existing illnesses
One of the most common questions we hear is: "Can I get private health cover if I already have a medical condition?" It's a vital question, and the answer is nuanced. While you can certainly get a policy, the fundamental principle of standard UK private medical insurance is that it's designed to cover new, acute medical conditions that arise after your policy begins.
Unfortunately, this means that pre-existing conditions and long-term, chronic illnesses are generally excluded from cover.
Understanding why this is the case requires a look at how insurers assess risk. This process is called "underwriting," and it determines the terms of your policy, including what is and isn't covered. Let's break down these key concepts.
What is a Pre-Existing Condition?
Insurers have a standard definition for a pre-existing condition. It generally means any disease, illness, or injury for which you have experienced symptoms, or for which you have sought or received medication, advice, or treatment, within a set period before your policy starts (typically the last five years).
This definition is broad and covers more than just diagnosed illnesses. It includes:
- Symptoms: Even if you never saw a doctor (e.g., recurring back pain or occasional shortness of breath).
- Advice: A consultation with a GP, physiotherapist, or specialist.
- Medication: Any prescribed drugs for a condition.
- Treatment: A course of therapy, a surgical procedure, or diagnostic tests.
Examples of Common Pre-Existing Conditions:
| Condition Category | Specific Examples |
|---|---|
| Musculoskeletal | Sciatica, historic knee injuries, arthritis, recurring back pain |
| Respiratory | Asthma, Chronic Obstructive Pulmonary Disease (COPD) |
| Cardiovascular | High blood pressure (hypertension), high cholesterol, angina |
| Gastrointestinal | Irritable Bowel Syndrome (IBS), Crohn's disease |
| Mental Health | Anxiety, depression, stress-related disorders treated in the past |
| Endocrine | Diabetes (Type 1 or 2), thyroid disorders |
| Dermatological | Eczema, psoriasis |
It's crucial to realise that whether a condition has been formally diagnosed or not is often irrelevant to the insurer. If you've had symptoms, it can still be classed as pre-existing.
The Crucial Difference: Acute vs. Chronic Conditions
To fully grasp what private medical insurance UK covers, you must understand the distinction between acute and chronic conditions. PMI is built to handle the former, while the latter is typically managed within the NHS.
What is an Acute Condition?
An acute condition is an illness, injury, or disease that is likely to respond quickly to treatment and from which you are expected to make a full recovery. It's short-term and curable.
Hallmarks of an Acute Condition:
- Sudden or recent onset.
- Has a known, effective treatment path.
- The treatment aims to return you to your previous state of health.
- It is not expected to last for the long term.
Think of it as a medical problem with a clear beginning, middle, and end.
| Examples of Acute Conditions Covered by PMI |
|---|
| Cataract surgery |
| Hernia repair |
| Appendectomy (removal of the appendix) |
| Treatment for a broken bone |
| Gallstone removal |
| Joint replacement (e.g., hip or knee) |
| Diagnosis and treatment of new cancer |
What is a Chronic Condition?
A chronic condition is an illness that is long-lasting, has no known cure, and needs ongoing management. Treatment for chronic conditions aims to control symptoms and manage the illness, rather than cure it.
Hallmarks of a Chronic Condition:
- Continues indefinitely.
- May require lifelong medication or monitoring.
- Often involves flare-ups and periods of remission.
- Has no recognised cure.
Standard private health cover in the UK does not cover the routine management of chronic conditions. This is a fundamental exclusion across the market. The NHS is structured to provide this long-term care.
Acute vs. Chronic: A Quick Comparison
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Duration | Short-term | Long-term, lifelong |
| Treatment Goal | Cure, full recovery | Management of symptoms |
| PMI Cover | Yes (if it's a new condition) | No (for routine management) |
| Example | Breaking your arm | Living with diabetes |
Important Note: PMI may cover an acute flare-up of a chronic condition, but this is policy-dependent and can be a grey area. For example, a policy might cover a short hospital stay to stabilise a severe asthma attack, but it won't cover the cost of your regular inhalers or GP check-ups for asthma management.
How Do Insurers Find Out About My Health? The Two Types of Underwriting
Underwriting is the risk assessment process insurers use to decide if they can offer you cover and on what terms. For private medical insurance in the UK, there are two main methods. Choosing between them is one of the most significant decisions you'll make.
1. Moratorium (MORI) Underwriting
This is the most common and popular type of underwriting because it's quick and doesn't require you to fill out a lengthy medical questionnaire.
- How it works: You don't declare your medical history upfront. Instead, the policy automatically excludes any condition for which you've had symptoms, treatment, or advice in the 5 years before the policy start date.
- The "Rolling" Moratorium Rule: Here's the key feature. If you join a moratorium policy and then go for a continuous 2-year period without seeking any advice, treatment, or medication for that pre-existing condition, it may become eligible for cover in the future.
- The Catch: The decision is made at the point of claim. When you need treatment, the insurer will investigate your medical history to see if the issue is new or related to a pre-existing condition from the last 5 years.
Example of Moratorium Underwriting in Action:
- Meet Ben: Ben takes out a moratorium policy on 1st October 2025.
- His History: In 2023, he saw a GP for shoulder pain and was given some painkillers.
- The Exclusion: This shoulder pain is a pre-existing condition and is automatically excluded from his new policy.
- The Future: Ben has no further shoulder pain, symptoms, or treatment. On 1st October 2027 (after 2 years on the policy), his shoulder becomes eligible for cover for any new problems. If his shoulder pain had flared up in 2026, any claim would have been rejected.
| Moratorium Underwriting: Pros & Cons |
| :--- | :--- |
| Pros | ✅ Fast and simple application process.
✅ No intrusive medical forms.
✅ Pre-existing conditions can become eligible for cover after 2 years. |
| Cons | ❌ Lack of certainty. You don't know for sure what's covered until you claim.
❌ The claims process can be slower due to medical history checks.
❌ Any symptom, however minor, can "reset the clock" on the 2-year waiting period. |
2. Full Medical Underwriting (FMU)
This is the more traditional method of underwriting. It involves a detailed look at your health from day one.
- How it works: You complete a comprehensive health questionnaire, declaring all your past and present medical conditions. You may also be asked to provide access to your medical records.
- The Outcome: The insurer's underwriting team assesses your application. They will then offer you a policy with a clear list of specific exclusions. These exclusions are usually permanent.
- The Certainty: You know exactly what is and isn't covered from the moment your policy starts. There are no surprises at the point of a claim.
Example of Full Medical Underwriting in Action:
- Meet Priya: Priya applies for an FMU policy.
- Her History: On her form, she declares she had treatment for anxiety 3 years ago and has mild eczema.
- The Insurer's Decision: The insurer offers her a policy with two specific exclusions: "No cover for any treatment related to anxiety or any psychiatric conditions" and "No cover for any treatment related to eczema or any dermatological conditions."
- The Benefit: A year later, Priya develops gallstones. She can claim with confidence, knowing this is a new, unrelated condition and is fully covered.
| Full Medical Underwriting: Pros & Cons |
| :--- | :--- |
| Pros | ✅ Complete clarity and certainty from day one.
✅ You know precisely what is excluded.
✅ The claims process is generally faster and smoother. |
| Cons | ❌ The application process is longer and more intrusive.
❌ Exclusions are typically permanent and will never be covered.
❌ You must have a good memory of your medical history. |
Which Underwriting is Right for Me?
The choice depends on your personal preference and medical history.
- Choose Moratorium if: You are in good health, have few or no recent medical issues, and prefer a quick, simple application.
- Choose Full Medical Underwriting if: You have a more complex medical history, want absolute certainty about your cover, and don't mind the initial paperwork.
An expert PMI broker like WeCovr can walk you through the pros and cons for your specific situation, helping you choose the underwriting style that best suits your needs at no cost to you.
Can a Pre-Existing Condition Ever Be Covered?
While the general rule is "no," there are specific circumstances where a pre-existing condition might gain cover:
-
Under a Moratorium Policy: As explained, if you remain completely free of symptoms, treatment, and advice for the condition for a continuous 2-year period after your policy starts, it may become eligible. This is the most common way for a past condition to be covered.
-
Switching Insurers with "CPME": If you already have private medical insurance and want to switch providers, you may be able to do so on "Continued Personal Medical Exclusions" (CPME) terms. This means the new insurer agrees to carry over the same exclusions as your old policy, rather than applying new ones. This is a valuable option for people who have developed conditions while insured and want to keep them covered.
-
Very Minor or Historic Conditions: Under Full Medical Underwriting, if a condition was very minor, happened a long time ago, and is highly unlikely to recur (e.g., a broken wrist from 15 years ago), the insurer may decide not to apply an exclusion for it.
It's vital to be realistic. A chronic condition like diabetes or a serious past illness like cancer will almost certainly be permanently excluded from a new standard PMI policy.
The Absolute Importance of Honest Disclosure
It can be tempting to omit a past health issue from an application form, especially if it feels minor. This is a mistake.
Under the Consumer Insurance (Disclosure and Representations) Act 2012, you have a duty to take "reasonable care not to make a misrepresentation." In plain English, you must be honest.
What happens if you don't disclose a condition?
- Claim Rejection: If you claim for something related to the undisclosed condition, the claim will be rejected.
- Policy Cancellation: The insurer can void your policy from the start, meaning you never had cover. They may or may not refund your premiums.
- Future Insurance Problems: Having a policy cancelled for non-disclosure can make it much harder and more expensive to get any type of insurance in the future.
Insurers have the right (with your consent, given at the claims stage) to check your medical records. Any discrepancies will be found. The best policy is always full honesty.
Beyond Insurance: Taking Control of Your Health and Wellbeing
While PMI is a fantastic tool for handling new health problems, the best strategy is always proactive health management. Living a healthy lifestyle can help manage existing conditions and reduce the risk of developing new ones.
At WeCovr, we believe in a holistic approach to health. That's why customers who purchase PMI or Life Insurance through us receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app. We also offer discounts on other insurance products to help you build a complete protection portfolio.
Here are some tips endorsed by UK health bodies like the NHS:
- A Balanced Diet: Follow the principles of the NHS Eatwell Guide. Aim for at least five portions of fruit and vegetables a day, lean proteins, whole grains, and healthy fats. Good nutrition is fundamental to managing conditions like high blood pressure and diabetes.
- Regular Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or tennis) a week. This strengthens your heart, manages weight, and boosts mental health.
- Prioritise Sleep: Most adults need 7-9 hours of quality sleep per night. Poor sleep is linked to a range of health issues, including weakened immunity and higher stress levels.
- Manage Stress: Chronic stress can exacerbate many health conditions. Techniques like mindfulness, yoga, spending time in nature, or engaging in hobbies can have a powerful positive impact.
How WeCovr Can Help You Find the Right PMI
Navigating the world of private medical insurance, especially with a pre-existing condition, can feel overwhelming. That's where we come in.
As an independent, FCA-authorised broker, WeCovr works for you, not the insurers.
- We Listen: We take the time to understand your health history and your priorities.
- We Explain: We demystify the jargon, clearly explaining the difference between moratorium and FMU and what it means for you.
- We Compare: We use our expertise and technology to compare policies from the UK's best PMI providers, finding the most suitable options for your circumstances.
- We Support: Our service is completely free, and we are here to help you every step of the way, from application to claim.
Even if you have pre-existing conditions, there is immense value in a PMI policy. It can provide fast access to specialists, diagnostics, and treatment for all the new health issues that might arise in the future, giving you peace of mind and control over your healthcare.
Will my PMI premiums be higher if I have pre-existing conditions?
Is pregnancy considered a pre-existing condition for health insurance?
Can I switch my PMI provider if I have developed a condition while insured?
Do I need to declare a condition if I haven't seen a doctor for it?
Ready to find the right private health cover for your needs?
The expert team at WeCovr is here to provide clear, independent advice. Get a free, no-obligation quote today and let us help you compare options from the UK's leading insurers, ensuring you get the peace of mind you deserve.
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.
