TL;DR
It’s the single most common question we hear at WeCovr: "Can I get private medical insurance if I already have a health condition?" As FCA-authorised brokers who have arranged cover for thousands of UK families, we know this is the biggest source of confusion in the private health market. The short answer is nuanced, but this guide will give you the complete picture. Private medical insurance is designed for new, unexpected health issues.
Key takeaways
- Acute Condition: A condition that is short-lived and responds to treatment, ultimately leading to a cure or full recovery. Insurers love covering these. Examples include cataracts, joint replacements, hernias, and most infections.
- Chronic Condition: A long-term condition that can be managed but not cured. The NHS is the primary provider for chronic care in the UK. Standard PMI policies do not cover the routine management of chronic conditions. Examples include diabetes, asthma, arthritis, and high blood pressure.
- How it works: The insurer automatically excludes any medical condition for which you have had symptoms, treatment, or advice in the 5 years before your policy began.
- The 2-Year Rule: Here’s the clever part. If you then complete 2 continuous years on the policy without seeking any treatment, advice, or experiencing symptoms for that specific condition, the exclusion may be lifted. The insurer may then agree to cover you for it in the future.
- The Clock Reset: If you do have a flare-up or need advice for that condition during the initial 2-year moratorium period, the clock resets, and you must go another 2 years symptom-free before it can be considered for cover.
It’s the single most common question we hear at WeCovr: "Can I get private medical insurance if I already have a health condition?" As FCA-authorised brokers who have arranged cover for thousands of UK families, we know this is the biggest source of confusion in the private health market. The short answer is nuanced, but this guide will give you the complete picture.
Private medical insurance is designed for new, unexpected health issues. However, getting cover after a diagnosis is possible, and you may even be able to cover future flare-ups of a past condition. It all comes down to a crucial process called underwriting.
Can you switch to private insurance after a diagnosis? We explain Moratorium underwriting and how to get covered for future flare-ups
Yes, you can absolutely switch to a private health insurance policy after a diagnosis. The critical detail, however, is how that existing condition will be treated by your new insurer. It will be classed as "pre-existing," and its coverage depends entirely on the type of underwriting you choose.
This guide will demystify the rules, explain your options, and show you how to secure the best possible cover, even with a medical history.
What Is a Pre-Existing Condition in Health Insurance?
In the world of UK private medical insurance (PMI), a pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, or sought advice from a medical professional before your policy start date.
This definition is broad. It includes everything from a diagnosed chronic illness like diabetes to experiencing back pain, even if you never received a formal diagnosis.
The Golden Rule of PMI: Private health insurance in the UK is designed to cover acute conditions that arise after your policy begins. It is not designed to cover the ongoing management of long-term (chronic) conditions or issues you already had.
The Crucial Difference: Acute vs. Chronic Conditions
Understanding this distinction is fundamental to understanding what PMI will and won't cover.
- Acute Condition: A condition that is short-lived and responds to treatment, ultimately leading to a cure or full recovery. Insurers love covering these. Examples include cataracts, joint replacements, hernias, and most infections.
- Chronic Condition: A long-term condition that can be managed but not cured. The NHS is the primary provider for chronic care in the UK. Standard PMI policies do not cover the routine management of chronic conditions. Examples include diabetes, asthma, arthritis, and high blood pressure.
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Duration | Short-term | Long-term, often lifelong |
| Outcome | Curable, leads to recovery | Manageable, but not curable |
| PMI Coverage | Generally covered (if it arises after the policy starts) | Generally not covered (for routine management) |
| Examples | Broken bones, appendicitis, gallstones, hernias | Asthma, diabetes, eczema, hypertension |
Insider Tip: While PMI doesn't cover the day-to-day management of chronic illness, some policies may cover an acute flare-up. For example, routine insulin for diabetes isn't covered, but emergency hospital treatment for a sudden complication might be. An expert adviser at WeCovr can help you find policies with these valuable nuances.
How Insurers Handle Pre-Existing Conditions: The Two Types of Underwriting
When you apply for health insurance, the provider assesses your health risk. This process is called "underwriting." There are two main methods used in the UK, and your choice has a massive impact on how your pre-existing conditions are treated.
1. Moratorium Underwriting (The "Wait and See" Approach)
This is the most common and popular type of underwriting in the UK. It's fast and requires no initial medical declaration.
- How it works: The insurer automatically excludes any medical condition for which you have had symptoms, treatment, or advice in the 5 years before your policy began.
- The 2-Year Rule: Here’s the clever part. If you then complete 2 continuous years on the policy without seeking any treatment, advice, or experiencing symptoms for that specific condition, the exclusion may be lifted. The insurer may then agree to cover you for it in the future.
- The Clock Reset: If you do have a flare-up or need advice for that condition during the initial 2-year moratorium period, the clock resets, and you must go another 2 years symptom-free before it can be considered for cover.
Real-World Scenario:
- Meet Priya: Priya had physiotherapy for shoulder pain 18 months ago. She takes out a moratorium policy today.
- The Exclusion: Her shoulder is automatically excluded from cover.
- The Path to Coverage: If Priya goes 2 full years from her policy start date with no shoulder pain, consultations, or treatment, her policy may then cover future shoulder problems. If her shoulder hurts in the first year, the 2-year clock starts again from the date of that flare-up.
| Moratorium Underwriting | Pros | Cons |
|---|---|---|
| Application | ✅ Fast and simple, no medical forms | ❌ Initial uncertainty about what's covered |
| Privacy | ✅ Less intrusive, no deep dive into your history | ❌ Potential for disputes at the point of claim |
| Coverage | ✅ A clear path to get past conditions covered | ❌ Flare-ups can reset the 2-year waiting period |
2. Full Medical Underwriting (FMU) (The "Full Disclosure" Approach)
This is the traditional method, offering complete clarity from day one.
- How it works: You complete a detailed health questionnaire, disclosing your entire medical history. The insurer's underwriting team reviews your application and provides a decision.
- The Outcome: The insurer will come back with clear terms. They will explicitly state any conditions that are permanently excluded from your policy. There is no ambiguity.
- Certainty is Key: With FMU, you know exactly what you are and are not covered for from the moment your policy starts. There are no "wait and see" periods.
Real-World Scenario:
- Meet Tom: Tom has a history of recurring back issues and has seen a specialist. He chooses Full Medical Underwriting.
- The Declaration: He discloses this on his application form.
- The Decision: The insurer reviews his case and offers him a policy with a specific, written exclusion for "any treatment related to the lumbar spine." Tom knows he can't claim for his back, but he is secure in the knowledge that everything else is covered.
| Full Medical Underwriting | Pros | Cons |
|---|---|---|
| Clarity | ✅ Complete certainty on what is covered from Day 1 | ❌ Long application process with detailed forms |
| Claims | ✅ Smoother claims process as exclusions are pre-agreed | ❌ Exclusions are often permanent |
| Honesty | ✅ No risk of future disputes over non-disclosure | ❌ Requires you to remember and declare your full history |
Switching Health Insurance with a Pre-Existing Condition
This is where many people make costly mistakes. If you already have a private medical insurance policy and want to switch to a new provider for a better price or better benefits, it's crucial you do it the right way.
Simply cancelling your old policy and starting a new one is rarely the best idea. A new insurer will treat all your past medical issues as pre-existing, and you will lose any continuity of cover you have built up.
Instead, you should use a special switching method.
Continued Moratorium Underwriting (CMORI)
If you are currently on a moratorium policy, you can switch to a new provider on a "Continued Moratorium" basis.
- What it does: This transfers your original moratorium start date to the new policy. You don't have to start your 2-year waiting periods all over again.
- Example: You have been on a Bupa moratorium policy for 18 months. An old knee issue has been symptom-free this whole time. You only have 6 months left until it might become eligible for cover. If you switch to AXA on a CMORI basis, you still only have 6 months to wait, rather than starting a fresh 2-year period.
Continued Personal Medical Exclusions (CPME)
If your current policy was taken out with Full Medical Underwriting, you can switch on a "Continued Personal Medical Exclusions" basis.
- What it does: Your new insurer agrees to accept the same specific exclusions that were applied to your original policy. They won't add new ones unless you have developed a new condition since your first policy began.
Broker Insight: Managing a CMORI or CPME switch requires careful coordination between insurers. This is a core service provided by expert brokers like WeCovr. We handle the paperwork and liaise with the providers to ensure a seamless transition, protecting the cover you've worked hard to maintain, all at no extra cost to you.
Getting the Best Cover with a Pre-Existing Condition: An Adviser's Guide
Navigating the market with a medical history can feel daunting, but following a few simple rules will put you in the strongest position.
- Always Be Honest: The single biggest mistake is failing to disclose a condition. Insurers view this as non-disclosure, which can lead to your policy being cancelled and claims being rejected. It is never worth the risk.
- Understand Your Underwriting Choice: For minor issues from many years ago, a moratorium policy is often the quickest and easiest option. For more significant or recent conditions, the certainty of Full Medical Underwriting might be more reassuring.
- Use an Independent Broker: Insurers have different appetites for risk. Some are more lenient with musculoskeletal issues, while others might be more flexible with mental health history. An independent broker knows these intricate differences and can match you to the most suitable provider.
- Review Annually: Your health and the insurance market change. A yearly review with a broker ensures your policy remains competitive and appropriate for your needs. It's the perfect time to see if switching could save you money or enhance your benefits.
- Focus on Value, Not Just Price: The cheapest policy is not always the best. Look at the details, such as outpatient limits, cancer cover, and hospital lists. As a WeCovr client, you also get complimentary access to our AI-powered nutrition app, CalorieHero, and can receive discounts on other policies like life insurance when you take out PMI.
Insurer Spotlight: How Major UK Providers Approach Pre-Existing Conditions
While every application is judged on its own merits, insurers do have general approaches to underwriting. An adviser can give you specific guidance, but here is a brief overview.
| Insurer | Typical Underwriting Options | General Approach & Key Features |
|---|---|---|
| Bupa | Moratorium, FMU, CMORI, CPME | A market leader with a very established and clear process for underwriting and switching. Their Bupa Health Trust is known for funding medical research. |
| AXA Health | Moratorium, FMU, CMORI, CPME | Renowned for excellent customer service and clear policy documents. They offer a guided option for choosing a specialist, which can simplify the claims process. |
| Vitality | Moratorium, FMU, CMORI, CPME | Famous for its wellness programme that rewards healthy living. The underwriting rules for pre-existing conditions are standard, but engagement with the wellness programme can lower future premiums. |
| Aviva | Moratorium, FMU, CMORI, CPME | Often very competitive on price and offers a strong core product. Their "Expert Select" hospital option can be a cost-effective choice. |
Disclaimer: This is a general guide. Insurers' underwriting criteria are complex and can change. The final decision on cover always rests with the provider based on your individual circumstances.
Your Next Step to Getting Covered
The rules around pre-existing conditions are the most complex part of private medical insurance, but they shouldn't be a barrier to getting the peace of mind you deserve. Whether you are buying for the first time or looking to switch, the key is to get expert, independent advice.
At WeCovr, our specialist advisers can compare the entire market for you in minutes, explain your options in plain English, and manage the entire application or switching process on your behalf. We ensure you get the right cover for your needs, with no nasty surprises.
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What if I had symptoms but never got a diagnosis?
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.
