TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr knows that one of the biggest questions people have about private medical insurance in the UK is how it treats past health issues. This guide provides a definitive answer, breaking down the complex rules in simple, clear terms. WeCovr explains the rules around exclusions and waiting periods Understanding what private medical insurance (PMI) does and doesn't cover is the single most important step in choosing the right policy.
Key takeaways
- Asthma diagnosed in childhood.
- Back pain for which you saw a physiotherapist last year.
- Anxiety or depression for which you've taken medication.
- A knee injury from playing football five years ago.
- Eczema that you manage with occasional cream.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr knows that one of the biggest questions people have about private medical insurance in the UK is how it treats past health issues. This guide provides a definitive answer, breaking down the complex rules in simple, clear terms.
WeCovr explains the rules around exclusions and waiting periods
Understanding what private medical insurance (PMI) does and doesn't cover is the single most important step in choosing the right policy. A common misconception is that you can buy insurance to cover an existing illness. In the UK, this is not the case.
The fundamental principle of private health cover is that it’s designed to protect you against new, unforeseen, acute medical conditions that arise after your policy has started. It is not designed to cover conditions you already have (pre-existing) or long-term, incurable illnesses (chronic conditions).
Let's dive into the details.
What Exactly Is a Pre-Existing Condition?
In the world of health insurance, a "pre-existing condition" is any disease, illness, or injury for which you have experienced symptoms, received medication, sought advice, or undergone treatment before the start date of your policy.
It doesn't matter whether you received a formal diagnosis from a doctor. If you've had symptoms or sought advice for something, an insurer will consider it pre-existing.
Common Examples of Pre-Existing Conditions:
- Asthma diagnosed in childhood.
- Back pain for which you saw a physiotherapist last year.
- Anxiety or depression for which you've taken medication.
- A knee injury from playing football five years ago.
- Eczema that you manage with occasional cream.
- High cholesterol discovered during a routine check-up.
Insurers typically look back at your medical history for the last five years, but this can vary. The key takeaway is that if it happened before your policy began, it's likely considered pre-existing.
Understanding the Difference: Acute vs. Chronic Conditions
This distinction is vital, as it sits at the core of what UK private medical insurance will cover.
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Definition | A condition that appears suddenly, progresses rapidly, and has a limited duration. It is typically curable. | A condition that develops slowly, is long-lasting or recurrent, and cannot be fully cured. It can be managed but not resolved. |
| Examples | Appendicitis, broken bones, hernias, cataracts, joint replacement, most infections. | Diabetes, arthritis, asthma, high blood pressure, Crohn's disease, multiple sclerosis. |
| PMI Coverage | This is what PMI is for. It covers diagnosis and treatment to return you to your previous state of health. | This is not covered. PMI does not cover the routine, long-term management of chronic illnesses. |
Crucial Point: Standard private medical insurance policies in the UK do not cover the management of chronic conditions. Some policies may offer limited cover for an acute flare-up of a chronic condition (for example, a severe asthma attack requiring a short hospital stay), but the day-to-day management, medication, and routine check-ups will be excluded.
How Insurers Assess Pre-Existing Conditions: The Two Types of Underwriting
When you apply for a PMI policy, the insurer needs to understand your medical history to determine what they can cover. They do this through a process called "underwriting." There are two main methods used in the UK.
1. Moratorium Underwriting
This is the most common and straightforward method. It's often described as the "wait and see" approach.
- How it works: You don't have to provide your full medical history upfront. Instead, the insurer applies a general exclusion for any condition you've had in the five years before your policy starts.
- The Waiting Period: This exclusion is subject to a "moratorium period," which is typically two years from your policy start date.
- What happens during the waiting period? If, during this two-year period, you remain completely free of any symptoms, treatment, medication, or advice for that specific pre-existing condition, it may become eligible for cover after the two years have passed.
- What if symptoms return? If you experience symptoms or need advice for that condition during the two-year moratorium, the clock resets. You would need to go another two continuous years without any issues before it could be considered for cover.
Real-Life Example: Sarah and her Back Pain Sarah had some lower back pain 18 months before taking out a moratorium PMI policy. This is a pre-existing condition.
- Scenario A: For the first two years of her policy, she has no back pain symptoms and doesn't see a doctor or physio for it. After the two-year mark, if she develops a new back problem, it will likely be covered.
- Scenario B: Six months into her new policy, her old back pain flares up. She sees a GP. This visit resets the two-year clock for her back condition. She will now have to go another two full years from this point without any back trouble before it can be covered.
Moratorium Underwriting: Pros and Cons
| Pros | Cons |
|---|---|
| Quick and Easy Application: No lengthy medical forms to complete. | Lack of Initial Certainty: You don't know for sure what's covered until you make a claim. |
| Potentially Covers Past Issues: Old conditions can become eligible for cover over time. | The "Rolling" Moratorium: The two-year clock can reset, causing confusion. |
| Most Popular Option: Offered by nearly all major UK PMI providers. | Claims Can Be Slower: The insurer will investigate your medical history at the point of a claim. |
2. Full Medical Underwriting (FMU)
This method is more detailed and provides complete clarity from day one.
- How it works: You are required to complete a comprehensive medical questionnaire as part of your application. You must disclose all your past and present health conditions.
- The Assessment: The insurer's underwriting team reviews your medical history. They may also ask for your permission to contact your GP for more information.
- The Outcome: Based on your disclosures, the insurer will issue your policy documents with a list of specific, named exclusions. For example, it might state, "Treatment relating to asthma and any associated respiratory conditions is excluded from cover."
- Clarity from the Start: You know exactly what is and isn't covered from the moment your policy begins. These exclusions are typically permanent.
Real-Life Example: David and his Heart Palpitations David had investigations for heart palpitations three years ago. He discloses this on his FMU application.
- The insurer reviews his history and decides to place a permanent exclusion on his policy for "any investigation or treatment related to cardiac or cardiovascular conditions."
- David knows he can't claim for anything heart-related. A year later, he develops a hernia. He can claim for this without any issue, as it's an unrelated, new, acute condition.
Full Medical Underwriting: Pros and Cons
| Pros | Cons |
|---|---|
| Complete Clarity: You know exactly what is excluded from day one. | Lengthy Application Process: Requires detailed forms and full disclosure. |
| Faster Claims Process: As exclusions are pre-agreed, there's less need for investigation during a claim. | Exclusions are Permanent: The conditions excluded will never be covered by that policy. |
| Potentially Lower Premiums: If you are in good health, the upfront clarity can sometimes result in a slightly cheaper premium. | Intrusive: Requires you to share your full medical history. |
Which Underwriting Type is Right for Me? A Comparison
Choosing between Moratorium and Full Medical Underwriting depends on your personal circumstances and preferences. A specialist PMI broker like WeCovr can talk you through the options to find the best fit.
| Feature | Moratorium Underwriting | Full Medical Underwriting |
|---|---|---|
| Application Process | Simple, no health forms. | Detailed health questionnaire. |
| Speed of Setup | Very fast. | Slower, may require GP reports. |
| Certainty of Cover | Less certain initially; depends on claims. | 100% certain from the start. |
| Cover for Past Issues | Possible after a 2-year clear period. | Never. Conditions are permanently excluded. |
| Claims Process | Can be slower as history is checked. | Usually faster as exclusions are known. |
| Best For... | People who haven't had recent medical issues and want a quick setup. | People who want absolute clarity on their cover from day one, or have a complex medical history. |
Can I Switch Insurers if I Have Pre-Existing Conditions?
This is a common worry. Many people develop conditions while covered by a PMI policy and fear they will be "trapped" with their current insurer, unable to switch without losing cover for those new conditions.
Thankfully, there is a solution: Continued Personal Medical Exclusions (CPME) Underwriting.
CPME is a special type of underwriting designed for people who already have a private medical insurance policy and want to switch to a new provider.
- How it works: Your new insurer agrees to match the terms of your old policy. They will continue to cover the conditions you were already covered for, and they will carry over any exclusions you had on your previous policy.
- The Benefit: It allows you to shop around for a better price or better benefits without the risk of new exclusions being added for conditions that have developed while you were insured.
This is a key area where an expert broker is invaluable. At WeCovr, we specialise in helping clients switch providers seamlessly using CPME underwriting, ensuring continuous cover and often finding significant cost savings.
Why Do Insurers Exclude Pre-Existing and Chronic Conditions?
The logic behind these exclusions is based on the fundamental principle of insurance: to provide financial protection against unforeseen future events.
- Managing Risk: Insuring a known, existing problem is like buying car insurance after you've crashed your car. It removes the element of uncertainty, which is what insurance is based on.
- Keeping Premiums Affordable: If insurers were to cover all pre-existing and chronic conditions, the cost of claims would skyrocket. This would force them to charge extremely high premiums, making PMI unaffordable for the vast majority of people.
- Focusing on Acute Care: The UK private healthcare sector is designed to complement the NHS by providing fast access to diagnosis and treatment for acute conditions. It helps alleviate pressure on NHS waiting lists for elective procedures.
According to the latest NHS England data, the median waiting time for consultant-led elective care was around 15 weeks as of April 2025, with over 300,000 patients waiting more than a year. PMI is designed to bypass these waits for eligible, acute conditions.
Beyond the Exclusions: What PMI Does Cover
While the rules on pre-existing conditions are strict, it's important to remember the vast range of benefits a good PMI policy provides. Cover is designed to get you diagnosed and treated quickly when a new health problem strikes.
Typical Inclusions in a Private Medical Insurance UK Policy:
- In-patient and Day-patient Treatment: Covers costs if you are admitted to a hospital for surgery or treatment, including surgeons' fees, hospital accommodation, and anaesthetics.
- Out-patient Consultations: Access to specialist consultations without a long wait.
- Advanced Diagnostics: Fast access to MRI, CT, and PET scans.
- Cancer Care: Comprehensive cover for chemotherapy, radiotherapy, surgery, and pioneering new treatments. This is often a core reason people take out PMI.
- Mental Health Support: Cover for consultations with psychiatrists and psychologists, and in-patient psychiatric care.
- Therapies: Physiotherapy, osteopathy, and chiropractic treatment.
- Digital GP Services: 24/7 access to a GP via phone or video call.
Proactive Health: Wellness Benefits and Extra Value
Modern private health cover is evolving. The best PMI providers now include benefits designed to keep you healthy, not just treat you when you're ill. This proactive approach can help reduce the risk of future health problems.
Look for policies that include:
- Discounted gym memberships.
- Rewards for healthy living (e.g., tracking steps).
- Access to mental health support apps and services.
- Nutrition consultations.
At WeCovr, we champion this holistic approach to health. That's why every client who takes out a PMI or Life Insurance policy with us receives complimentary lifetime access to our AI-powered calorie and nutrition tracking app, CalorieHero. We also offer discounts on other insurance products, like income protection or life insurance, when you buy your health cover through us.
Final Thoughts: Navigating the Rules with Expert Help
The rules around pre-existing conditions are the most complex part of private medical insurance. While the basic principle is simple—new, acute conditions are covered, but past and chronic ones are not—the nuances of underwriting can be confusing.
- Always be honest. Whether on a full medical underwriting form or when speaking to an insurer during a moratorium claim, honesty is the best policy. Non-disclosure can invalidate your cover.
- Understand your underwriting type. Know whether you are on a moratorium or FMU policy and what that means for you.
- Don't assume. If you're unsure whether an old condition will be covered, don't guess.
The best way to navigate this landscape is with impartial, expert advice. A specialist broker works for you, not the insurer. They can compare the entire market, explain the different underwriting policies of each provider, and ensure you get a policy that meets your needs and budget, with no nasty surprises down the line.
Do I need to declare every single cold or minor illness I've ever had?
Is pregnancy considered a pre-existing condition?
Can I get private health insurance if I already have cancer?
What happens if I forget to declare a condition on a Full Medical Underwriting application?
Ready to find the right health cover for you? The team at WeCovr is here to help. We provide free, independent advice, comparing policies from all the leading UK insurers to find the perfect fit for your needs and budget.
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Sources
- Department for Transport (DfT): Road safety and transport statistics.
- DVLA / DVSA: UK vehicle and driving regulatory guidance.
- Association of British Insurers (ABI): Motor insurance market and claims publications.
- Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.
