Genetic Conditions and Private Health Insurance
Navigating private medical insurance in the UK can feel complex, especially with a family history of illness. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, we believe in clarity. This guide explains how your genetic background interacts with private health cover.
What to know if you have a family history of illness
If you have a family history of conditions like heart disease, certain cancers, or dementia, it's natural to worry about your own future health and how it might affect your ability to get insurance. You might wonder: "Will my father's heart attack make my premiums skyrocket?" or "Do I have to tell an insurer about my mother's breast cancer diagnosis?"
The good news is that the UK has robust regulations designed to protect you. For private medical insurance (PMI), the focus is almost always on your current health and symptoms, not the health of your relatives.
This guide will walk you through everything you need to know, from the rules governing genetic tests to how underwriters view family history, ensuring you can make an informed decision about your health cover.
Understanding the UK's Stance: The Code on Genetic Testing & Insurance
The UK has a long-standing agreement between the Government and the Association of British Insurers (ABI) to prevent genetic discrimination. This is known as the Code on Genetic Testing and Insurance. It sets clear boundaries on how insurers can use genetic test information.
This Code is fundamental because it provides a protective shield for consumers, ensuring that taking a predictive genetic test won't automatically penalise you when you apply for most types of insurance, including private medical insurance.
What is the Code on Genetic Testing and Insurance?
First established in 2001 and updated regularly, the Code is a voluntary agreement that almost all UK insurers sign up to. Its primary purpose is to allow people to have a genetic test to understand their health risks without fearing that the result will be used against them by an insurer.
For policies like PMI, life insurance, critical illness cover, and income protection, the rules are very clear. The Code ensures that for the vast majority of policies, you do not have to disclose the result of a predictive genetic test.
Key Principles of the Code: What Insurers Can and Cannot Ask
The Code distinguishes between two types of genetic tests:
- Predictive or Presymptomatic Tests: These tests predict the likelihood of you developing a condition in the future when you have no current signs or symptoms. An example is a test for the BRCA1 or BRCA2 gene mutation, which increases the risk of breast and ovarian cancer.
- Diagnostic Tests: These tests are used by a doctor to confirm or rule out a diagnosis when you are already showing symptoms of a condition.
For Private Medical Insurance, the rules are simple and powerful:
- Insurers CANNOT ask you to take a genetic test.
- Insurers CANNOT ask about or use the result of a predictive genetic test for a PMI policy of any size.
This means that if you've taken a 23andMe test out of curiosity or a specific NHS predictive test for a condition that runs in your family, you do not have to declare the result when applying for PMI.
The table below summarises the position for PMI applicants.
| Question | Can an Insurer Ask This for PMI? |
|---|---|
| "Have you had a predictive genetic test?" | No |
| "What were the results of your predictive test?" | No |
| "Do any of your family members have a genetic condition?" | No |
| "Are you currently experiencing symptoms of a condition?" | Yes |
| "Have you been diagnosed with a medical condition?" | Yes |
| "Are you receiving treatment or monitoring for a condition?" | Yes |
Crucial Point: The protection of the Code applies to the test result itself. It does not apply if you have already been diagnosed with or are showing symptoms of the condition. In that case, the condition itself would be considered pre-existing.
The Crucial Distinction: Pre-existing vs. New Acute Conditions
This is the single most important concept to understand in UK private health insurance. PMI is designed to cover acute conditions that arise after your policy begins. It is not designed to cover conditions you already have.
Let's break down these terms.
What is a Pre-existing Condition?
A pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment before your policy start date. This includes conditions you are aware of, even if you haven't had a formal diagnosis.
- Example: If you've been taking medication for high blood pressure for the last two years, high blood pressure and related complications are pre-existing conditions.
What is a Chronic Condition?
A chronic condition is an illness that is long-lasting, often has no known cure, and needs ongoing management. Examples include diabetes, asthma, arthritis, and multiple sclerosis. Standard PMI policies do not cover the routine management of chronic conditions, although they may cover acute flare-ups.
- Example: Your policy won't cover your monthly diabetic check-ups or insulin, but it might cover an unexpected hospital admission for a sudden complication of your diabetes (depending on your policy's specific terms).
How PMI Handles These Conditions
Insurers use a process called underwriting to decide what they will and will not cover. There are two main types for PMI:
- Moratorium Underwriting (Most Common): This is the simpler option. You don't have to fill out a detailed medical questionnaire. Instead, the insurer applies a general exclusion for any condition you've had in the last five years. However, if you go for a set period (usually two years) without any symptoms, treatment, or advice for that condition after your policy starts, the exclusion may be lifted.
- Full Medical Underwriting (FMU): With FMU, you complete a detailed health questionnaire, declaring your medical history. The insurer then assesses your application and states upfront what will be excluded from your cover. This provides certainty from day one but can be more complex.
| Underwriting Type | How It Works | Pros | Cons |
|---|---|---|---|
| Moratorium | Automatically excludes conditions from the last 5 years. Cover may be added after a 2-year trouble-free period. | Quicker application, less paperwork. | Less certainty upfront; claims can take longer to process as checks are made then. |
| Full Medical | You declare your full medical history upfront. The insurer gives you a list of specific exclusions. | Certainty from day one about what is and isn't covered. | Longer application process; exclusions are often permanent. |
Understanding this framework is key. Your family history doesn't define what's pre-existing; your own personal medical history does.
How Your Family History Affects Your PMI Application
So, if the Code on Genetic Testing protects you and insurers are focused on pre-existing conditions, where does family history fit in?
For private medical insurance, it largely doesn't.
The Application Process: What Questions Will You Be Asked?
When you apply for PMI, the questions will centre on you. They will ask about:
- Your age, occupation, and lifestyle (e.g., smoker status).
- Any symptoms you are currently experiencing.
- Any diagnoses, treatments, or medical advice you have received in the past (usually the last 5 years for moratorium underwriting).
You will not find a question on a standard PMI application form that says: "Does your mother, father, or sibling have a history of cancer or heart disease?"
This is a fundamental difference compared to some life insurance or critical illness cover applications, which may ask about the health history of your immediate biological relatives (parents and siblings).
Example Scenarios: Putting Theory into Practice
Let's look at some real-life examples to see how this works.
Scenario 1: Family history of breast cancer
- The situation: Sarah is 35. Her mother and aunt both had breast cancer in their 40s. Worried, Sarah had a predictive genetic test and found she carries the BRCA2 gene mutation. She has no symptoms and has not been diagnosed with cancer.
- Applying for PMI: Sarah applies for a policy with moratorium underwriting. She is not required to declare the BRCA2 test result. She is not asked about her mother's or aunt's health. As she has no pre-existing conditions herself, she is accepted for cover with standard terms.
- What happens next? A few years later, Sarah finds a lump. Her PMI policy would cover the consultation with a specialist, diagnostic scans (like a mammogram and biopsy), and if it turns out to be cancer, the subsequent treatment (surgery, chemotherapy, radiotherapy) as it is a new, acute condition that arose after the policy began.
Scenario 2: Family history of heart disease
- The situation: David is 50. His father had a heart attack at 55. David is overweight and has been told by his GP his cholesterol is slightly high, but he is not on medication for it, just receiving advice to improve his diet and exercise.
- Applying for PMI: David applies for a policy with full medical underwriting. He declares the advice he received from his GP regarding diet and his cholesterol levels. The insurer might place an exclusion on his policy for cardiovascular conditions because he has already received medical advice related to it. His father's heart attack is not a factor in the underwriting decision itself, but the advice David received is.
- The lesson: It's David's own health status and medical advice that matter, not his father's.
Scenario 3: Family history of Huntington's disease
- The situation: Emma is 28. Her father was diagnosed with Huntington's disease, a degenerative genetic condition. The Code on Genetic Testing & Insurance has a single exception for life insurance policies over £500,000, where an insurer can ask for the result of a predictive test for Huntington's.
- Applying for PMI: This exception does not apply to private medical insurance. Emma can apply for PMI and she will not be asked if she has taken a test for Huntington's, nor what the result was. As long as she is asymptomatic, she can get cover. If she were to develop symptoms later, the condition would likely be classified as chronic and its ongoing management would not be covered, but initial diagnostic tests could be.
Can Private Health Insurance Cover Genetic Testing?
This is a common question. If you have a family history of an illness, you might want to get tested. Can PMI help?
The answer again comes down to the "diagnostic vs. predictive" and "acute vs. chronic" principles.
- PMI may cover diagnostic genetic testing: If you develop symptoms and your specialist believes a genetic test is needed to confirm a diagnosis for an acute condition, this is often covered as part of the diagnostic process.
- PMI does not typically cover purely predictive or screening tests: If you are healthy and have no symptoms but want a genetic test simply because of your family history, this is considered screening and is not usually covered by standard PMI policies.
The NHS has excellent screening programmes for many conditions, and this is often the most appropriate route for predictive testing.
| Type of Genetic Test | Typically Covered by PMI? | Reason |
|---|---|---|
| Diagnostic Test (to find cause of new symptoms) | Yes | Part of the pathway to diagnose a new, acute condition. |
| Predictive Test (to check future risk, no symptoms) | No | This is considered screening, not treatment for an active condition. |
| Direct-to-Consumer Test (e.g., 23andMe) | No | These are not considered medically necessary diagnostic procedures. |
Proactive Health Management: Beyond Insurance
While insurance is a valuable safety net, knowledge about your family history gives you a powerful tool: the ability to be proactive about your health. Many genetically influenced conditions, such as type 2 diabetes and certain heart diseases, are significantly impacted by lifestyle.
Knowledge is Power: Understanding Your Risk
Knowing you have a family history of a particular illness is an opportunity. It allows you to focus your efforts on prevention and early detection.
- Engage with NHS screening programmes (e.g., bowel cancer screening, mammograms).
- Talk to your GP about your family history and ask what preventative steps are right for you.
- Be vigilant for early signs and symptoms.
Lifestyle Choices that Make a Difference
Many studies show that lifestyle can mitigate genetic risk. The British Heart Foundation, for example, highlights that even with a high genetic risk for heart disease, a healthy lifestyle can cut the danger significantly.
- Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can reduce the risk of many conditions. Minimising processed foods, sugar, and saturated fats is key. As a WeCovr client, you get complimentary access to our AI-powered app, CalorieHero, which makes tracking your nutrition simple and effective.
- Exercise: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, or swimming. Regular activity helps manage weight, lower blood pressure, and improve mental health.
- Sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep is linked to a higher risk of conditions like obesity, diabetes, and cardiovascular disease.
- Smoking and Alcohol: Quitting smoking is the single best thing you can do for your health. Limiting alcohol intake to within recommended guidelines also reduces your risk of several cancers and liver disease.
Choosing the Right Private Medical Insurance UK Policy
With the reassurance that your family history won't bar you from cover, the next step is finding the right policy. The private medical insurance UK market is diverse, with many providers offering different levels of cover.
Key Factors to Consider When Comparing Policies
- Level of Cover: Do you want a basic plan that just covers in-patient treatment, or a comprehensive plan that includes out-patient consultations, therapies, and mental health support?
- Hospital List: Insurers have different lists of eligible hospitals. Check that your local private hospitals are included.
- Excess: This is the amount you agree to pay towards a claim. A higher excess will lower your monthly premium.
- No-Claims Discount: Many policies feature a no-claims discount that rewards you for not making a claim, similar to car insurance.
- Added Benefits: Look for extras like virtual GP services, wellness programmes, and mental health support lines.
To illustrate, here's a look at how features can vary between different types of plans.
| Feature | Basic Plan Example | Comprehensive Plan Example |
|---|---|---|
| In-patient Cover | Full Cover | Full Cover |
| Out-patient Cover | Not covered / Low limit (£500) | Full Cover / High limit (£1,500+) |
| Cancer Cover | Full cover for surgery, chemo | Full cover, plus experimental drugs |
| Therapies (Physio etc.) | Not covered | Covered up to a limit |
| Mental Health Cover | Limited or not covered | Covered up to a limit |
| Virtual GP | Included | Included |
How a Specialist PMI Broker Like WeCovr Can Help
Trying to compare all these variables across multiple providers can be overwhelming. This is where an independent PMI broker like WeCovr becomes invaluable.
As an FCA-authorised broker, our role is to represent you, not the insurance companies. We specialise in the UK private health cover market and can:
- Understand Your Needs: We take the time to listen to your specific concerns, including any worries about family history, and what you want from a policy.
- Compare the Market: We use our expertise and technology to compare policies from a wide range of the best PMI providers, saving you hours of research.
- Explain the Jargon: We cut through the complex terminology of underwriting, exclusions, and policy limits to give you clear, straightforward advice.
- Find the Best Value: Our service is provided at no cost to you. We find the right policy for your needs and budget, and our high customer satisfaction ratings reflect our commitment to this.
- Offer Extra Value: When you arrange a PMI or Life Insurance policy through WeCovr, we can often provide discounts on other types of cover you might need, such as home or travel insurance.
Navigating the nuances of private medical insurance with a family history of illness is much simpler with an expert on your side.
Do I have to declare my family's medical history when applying for private medical insurance?
Will taking a predictive genetic test affect my ability to get private health insurance?
What happens if I develop a genetic condition *after* I take out my policy?
Can I get cover for a condition I'm already being monitored for due to family history?
Ready to find the right health cover with confidence? Let our friendly experts at WeCovr help you compare quotes from leading UK insurers in minutes. Get your free, no-obligation quote today and gain peace of mind for your future health.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
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Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
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