Getting Health Insurance With Pre-Existing Conditions
Navigating the world of private medical insurance (PMI) in the UK can feel complex, especially when you have existing health concerns. At WeCovr, an FCA-authorised broker that has helped arrange over 800,000 policies, we believe in providing clear, honest guidance to help you make informed decisions.
Mrs Mummypenny highlights that PMI rarely covers existing health problems, making honest disclosure crucial. Dont expect PMI to pick up anything youre already treating. — Mrs Mummypenny
This single piece of advice from personal finance expert Mrs Mummypenny cuts to the heart of a common misunderstanding about private health insurance. Many people hope PMI can cover ongoing treatments, but the reality is quite different.
The fundamental purpose of private medical insurance in the UK is to cover new, acute conditions that arise after your policy begins. It is not designed to cover pre-existing conditions or long-term, chronic illnesses that require ongoing management.
Understanding this distinction is the most important step in setting realistic expectations and finding the right cover for your needs.
What Is a Pre-Existing Condition in Health Insurance?
In the simplest terms, a pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, sought advice, or had treatment for before the start of your PMI policy.
Insurers typically look back at your medical history over the last five years, but this can vary.
Common examples of pre-existing conditions include:
- A diagnosed condition: Such as asthma, eczema, high blood pressure, or an underactive thyroid.
- An ongoing injury: Like a recurring bad back or a knee problem you've seen a physiotherapist for.
- Symptoms you've seen a doctor about: Even without a formal diagnosis, if you've had tests or consultations for issues like abdominal pain or persistent headaches, these will be considered pre-existing.
- Mental health conditions: A history of anxiety, depression, or other mental health issues for which you've sought advice or treatment.
The key takeaway is this: if it happened before your policy started, the insurer will almost certainly classify it as pre-existing.
Acute vs. Chronic Conditions: A Crucial Difference
To grasp why PMI works this way, it's vital to understand the difference between acute and chronic conditions.
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Definition | A disease or illness that appears suddenly, has a limited duration, and is generally curable. | A long-term condition that cannot be cured but can be managed through medication, therapy, or lifestyle changes. |
| Duration | Short-term (e.g., days or weeks). | Long-term, often lifelong. |
| PMI Coverage | This is what PMI is for. It aims to provide fast access to diagnosis and treatment to resolve the issue. | This is what PMI excludes. The cost of lifelong management is unpredictable and falls outside the insurance model. |
| Examples | Hernia, appendicitis, cataract, joint injury needing replacement, most curable cancers. | Diabetes, arthritis, asthma, high blood pressure (hypertension), Crohn's disease, multiple sclerosis. |
Private health cover is designed to get you back on your feet after an unexpected, short-term illness. The NHS remains the primary provider for managing long-term, chronic conditions for everyone in the UK. Even with the best PMI policy, you will still rely on your GP and NHS services for chronic care.
The Golden Rule: Always Disclose Your Medical History
Being completely honest about your health history isn't just good advice—it's a requirement. Hiding a pre-existing condition is known as 'non-disclosure', and the consequences can be severe.
If you fail to declare a condition and later try to make a claim (even for something unrelated), your insurer could:
- Reject your claim: Leaving you to face potentially large private medical bills.
- Cancel your policy: Your cover will be voided from the start, and you will have to declare the cancellation when applying for insurance in the future, making it harder and more expensive.
- Accuse you of fraud: In serious cases, deliberate non-disclosure can be treated as insurance fraud.
It’s a risk that is never worth taking. An expert PMI broker like WeCovr can help you navigate the application process, ensuring you declare everything correctly and understand exactly what is and isn't covered from day one.
How Insurers Handle Pre-Existing Conditions: Underwriting Explained
When you apply for private medical insurance, the provider assesses your health history to decide the terms of your policy. This process is called 'underwriting'. There are two main types in the UK.
1. Full Medical Underwriting (FMU)
With Full Medical Underwriting, you complete a detailed health questionnaire as part of your application. You must provide information about your medical history, including any past illnesses, treatments, and consultations.
- Pros: The biggest advantage is certainty. The insurer reviews your information upfront and tells you exactly what will be excluded from your policy in writing. There are no grey areas.
- Cons: The application process is longer and more intrusive. You need to have your medical history to hand.
Example: Jane applies for a policy with FMU. She declares that she had physiotherapy for shoulder pain two years ago. The insurer adds a specific exclusion to her policy for "any condition related to her right shoulder". She knows from the start that she cannot claim for this issue, but she is fully covered for anything else.
2. Moratorium Underwriting
This is the most common type of underwriting as it's simpler to set up. With a moratorium, you don't complete a health questionnaire. Instead, the insurer applies a blanket exclusion for any condition you've had in the past five years.
This exclusion can then be lifted, but only if you meet specific criteria. Typically, you must go for a set period (usually two continuous years after your policy starts) without experiencing symptoms, needing treatment, or seeking medical advice for that specific condition.
- Pros: It's quick and easy to set up a policy.
- Cons: There is a lack of certainty. You won't know for sure if a condition is covered until you make a claim, at which point the insurer will investigate your medical history.
Example: David takes out a policy with a 2-year moratorium. He had knee pain 18 months before his policy started but hasn't had any issues since. If his knee pain returns within the first two years of his policy, it will not be covered. If, however, he remains completely free of knee symptoms, treatment, and advice for two full years, the condition may become eligible for cover after that point.
Comparing Underwriting Options
| Feature | Full Medical Underwriting (FMU) | Moratorium Underwriting |
|---|---|---|
| Application Process | Detailed health questionnaire required. | No initial health questions. |
| Setup Speed | Slower, as insurer needs to review your history. | Fast and simple. |
| Coverage Certainty | High. You know your exclusions from day one. | Lower. Coverage for past conditions is uncertain until a claim is made. |
| Claim Process | Generally smoother for covered conditions, as underwriting is done upfront. | Can be slower, as the insurer investigates your medical history at the point of claim. |
| Best For | People who want absolute clarity and have a complex medical history they wish to discuss. | People in good health with no recent medical issues who want a quick start to their policy. |
Deciding between these options can be tricky. An independent PMI broker can explain the nuances and recommend the best approach for your personal circumstances, comparing quotes from different providers.
What Can My Private Health Cover Be Used For?
Despite the exclusions for pre-existing conditions, a private medical insurance UK policy offers immense value by providing prompt access to high-quality care for new health problems.
With NHS waiting lists reaching record highs—with over 7.54 million treatments waiting to be started in England alone as of September 2024 (based on latest NHS England data trends)—PMI can be a lifeline.
Key benefits of PMI include:
- Fast access to specialists: See a consultant in days or weeks, not months.
- Prompt diagnostic tests: Quickly get scans like MRI, CT, and PET to find out what's wrong.
- Choice of hospital and surgeon: Choose from a nationwide network of private hospitals.
- Private, comfortable facilities: Benefit from a private room, en-suite bathroom, and more flexible visiting hours.
- Access to new treatments: Some plans cover drugs or treatments not yet available on the NHS.
- Comprehensive cancer cover: Most policies offer extensive cover for cancer diagnosis and treatment, a cornerstone of PMI.
Think of it as a way to bypass queues for eligible, acute conditions, allowing you to get diagnosed, treated, and back to your life sooner.
WeCovr: Your Partner in Navigating PMI
Choosing the right policy feels overwhelming, but you don't have to do it alone. WeCovr is an FCA-authorised broker specialising in the private health insurance market. Our expert advisors provide a free service to help you:
- Understand your needs: We take the time to listen to your concerns and health history.
- Compare the market: We compare policies from all the leading UK insurers, including Bupa, AXA Health, Aviva, and Vitality, to find the best fit for you.
- Explain the small print: We cut through the jargon to ensure you understand the underwriting, the exclusions, and the benefits of your policy.
- Save you money: We find the most competitive premiums for the level of cover you need.
Our high customer satisfaction ratings are built on providing transparent, professional advice that puts your needs first.
Proactive Health Management: More Than Just Insurance
While insurance is a safety net, taking proactive steps to manage your health is the best long-term strategy. A healthy lifestyle can reduce your risk of developing new conditions and help manage existing ones.
1. A Balanced Diet
Focus on a diet rich in whole foods: fruits, vegetables, lean proteins, and whole grains. Reducing processed foods, sugar, and saturated fats can have a huge impact on your energy levels, weight, and overall health. To help our clients on their wellness journey, WeCovr provides complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app. It makes it simple to monitor your intake and make healthier choices.
2. Regular Physical Activity
The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be a brisk walk, a bike ride, swimming, or a dance class. Regular exercise boosts cardiovascular health, strengthens bones and muscles, and is a powerful tool for improving mental wellbeing.
3. Prioritise Sleep
Aim for 7-9 hours of quality sleep per night. Poor sleep is linked to a host of health problems, including a weakened immune system, weight gain, and an increased risk of chronic disease. Establish a relaxing bedtime routine and create a comfortable, dark, and quiet sleep environment.
4. Manage Stress
Chronic stress can take a heavy toll on your physical and mental health. Incorporate stress-management techniques into your daily life, such as mindfulness, meditation, yoga, or spending time in nature. Speaking to a friend, family member, or professional can also make a significant difference.
By investing in your health, you not only improve your quality of life but also make yourself a lower risk from an insurance perspective, which can help keep future premiums manageable.
Furthermore, clients who purchase PMI or Life Insurance through WeCovr can also benefit from exclusive discounts on other types of cover, creating a holistic and cost-effective protection plan for you and your family.
Do I need to declare mental health conditions like anxiety or depression?
What happens if I forget to declare a minor illness from years ago?
Will my premiums be higher if I have pre-existing conditions?
Can I get private health insurance if I've had cancer?
Ready to find out how private medical insurance can work for you?
Our friendly team of experts is here to help. Get a free, no-obligation quote from WeCovr today and gain peace of mind knowing you have a plan in place for your future health.
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?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
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.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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Who Are WeCovr?
WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!