TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the nuances of private medical insurance in the UK. The rise of genetic testing has brought new questions for those considering private health cover. This guide clarifies the rules, your rights, and how your genetic information interacts with your PMI policy.
Key takeaways
- Curiosity: Exploring ancestry or wellness traits with a direct-to-consumer (DTC) kit.
- Family Planning: Checking if they are a "carrier" for a genetic condition they could pass to their children.
- Symptom Diagnosis: Helping doctors confirm a diagnosis when a genetic condition is suspected.
- Risk Assessment: Understanding their future risk of developing a condition that runs in their family, like certain cancers or Huntington's disease.
- Sarah's Situation: Sarah is 35 and healthy. Her mother had breast cancer at 45, so her GP recommends a predictive genetic test. The result shows she has the BRCA1 gene mutation, giving her a high lifetime risk of developing breast and ovarian cancer.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the nuances of private medical insurance in the UK. The rise of genetic testing has brought new questions for those considering private health cover. This guide clarifies the rules, your rights, and how your genetic information interacts with your PMI policy.
Rules on disclosures, impact on cover, and the latest on genetic risk assessments
The world of genetics is advancing at lightning speed. From home DNA kits revealing your ancestry to clinical tests assessing your risk for serious illness, we can now access more information about our genetic makeup than ever before. But with this knowledge comes a pressing question for many in the UK: will a genetic test result affect my ability to get private medical insurance (PMI)?
The short answer, for the vast majority of people, is a reassuring no.
The UK has a robust framework in place designed specifically to prevent "genetic discrimination" by insurers. However, the details matter. Understanding the rules around disclosures, the type of test you've had, and the nature of your insurance application is crucial. In this comprehensive guide, we'll break down everything you need to know about PMI and genetic testing, ensuring you can make informed decisions about your health and your cover with confidence.
Understanding Genetic Testing: A Simple Breakdown
Before we dive into the insurance rules, let's clarify what we mean by "genetic testing". It's not one single thing; it's a broad term for various medical tests that identify changes in your genes, chromosomes, or proteins.
People undertake genetic testing for many reasons:
- Curiosity: Exploring ancestry or wellness traits with a direct-to-consumer (DTC) kit.
- Family Planning: Checking if they are a "carrier" for a genetic condition they could pass to their children.
- Symptom Diagnosis: Helping doctors confirm a diagnosis when a genetic condition is suspected.
- Risk Assessment: Understanding their future risk of developing a condition that runs in their family, like certain cancers or Huntington's disease.
Here are the main types of genetic tests and what they do:
| Type of Genetic Test | Purpose | Example |
|---|---|---|
| Predictive & Pre-symptomatic | To find gene mutations that increase your risk of developing a condition in the future. You have no symptoms at the time of the test. | Testing for the BRCA1 or BRCA2 gene mutation, which increases the risk of breast and ovarian cancer. |
| Diagnostic | To confirm or rule out a specific genetic condition when you are already showing symptoms. | Testing to confirm a diagnosis of cystic fibrosis in a child with respiratory issues. |
| Carrier | To see if you and your partner carry a gene for a condition you could pass on to your children. You typically have no symptoms. | Testing to see if you are a carrier for sickle cell anaemia or Tay-Sachs disease. |
| Pharmacogenomic | To determine how your body will respond to certain medicines, helping doctors choose the most effective drug and dose. | Testing to see if a specific chemotherapy drug will be effective for your type of cancer. |
| Direct-to-Consumer (DTC) | Sold online directly to the public, offering ancestry, wellness (e.g., caffeine sensitivity), and sometimes health risk information. | A 23andMe or AncestryDNA kit. |
The most important distinction for insurance purposes is between predictive tests (taken when you're healthy) and diagnostic tests (taken when you have symptoms). This difference is central to the UK's rules.
The Code on Genetic Testing and Insurance: Your Shield Against Discrimination
The cornerstone of consumer protection in this area is the Code on Genetic Testing and Insurance. This is a voluntary agreement between the UK government and the Association of British Insurers (ABI), which virtually all UK insurers, including every major PMI provider, adhere to.
First established in 2001 and last updated to run until 2025 (with reviews planned), the Code sets out clear rules on how insurers can (and, more importantly, cannot) use genetic test information.
For Private Medical Insurance (PMI), the rule is simple and absolute:
Insurers will NOT ask for or use the result of a predictive or pre-symptomatic genetic test when you apply for PMI, regardless of the level of cover.
This is a powerful protection. It means you can take a predictive test to understand your future health risks without fearing that it will prevent you from getting private health cover or lead to higher premiums.
What You Must Declare vs. What You Are Protected From Declaring
Confusion often arises between a genetic test result and a diagnosed condition. The Code protects you from having to declare the former, but you must always be honest about the latter.
Let's make this crystal clear:
| Item | Do I Need to Declare This for PMI? | Why? |
|---|---|---|
| A predictive genetic test result (e.g., you have the BRCA gene) | NO | The Code on Genetic Testing and Insurance explicitly forbids PMI insurers from asking for or using this information. |
| A diagnosed medical condition (e.g., a doctor has diagnosed you with breast cancer) | YES | This is part of your medical history. Insurers need to know about diagnosed conditions to assess your application. It doesn't matter if a genetic test helped confirm the diagnosis; the diagnosis itself is what must be declared. |
| Family medical history (e.g., your mother had early-onset bowel cancer) | YES | Insurers have always asked about family history for certain conditions. This is separate from your personal genetic test results. |
| A direct-to-consumer (DTC) test (e.g., from 23andMe) | NO | These are considered predictive or wellness-related tests and are fully covered by the Code's protections for PMI. |
Critical Point: Standard UK private medical insurance is designed to cover acute conditions (illnesses that are curable and short-term) that arise after your policy begins. It does not cover pre-existing conditions (ailments you had before taking out the policy) or chronic conditions (long-term illnesses that require ongoing management, like diabetes or asthma).
Does a Predictive Genetic Test Result Count as a Pre-Existing Condition?
This is a common and understandable fear, but the answer is a firm no.
A pre-existing condition is a disease, illness, or injury for which you have already received medication, advice, or treatment, or have experienced symptoms.
A predictive genetic test result that shows an increased risk of a future illness is not a condition. It's a risk factor, just like having high cholesterol or a family history of heart disease. You are still healthy.
Let's look at an example:
- Sarah's Situation: Sarah is 35 and healthy. Her mother had breast cancer at 45, so her GP recommends a predictive genetic test. The result shows she has the BRCA1 gene mutation, giving her a high lifetime risk of developing breast and ovarian cancer.
- Applying for PMI: A month later, Sarah decides to get private medical insurance. When filling out the application, she is asked about her medical history. She does not need to mention the BRCA1 test result. The insurer is not allowed to ask.
- The Outcome: Sarah is approved for PMI at a standard rate. Her premium is based on her age, location, and the level of cover she chose—not her genetic risk.
- Future Scenario: Five years later, a routine scan finds early-stage breast cancer. Because the cancer is a new, acute condition that developed after her policy started, her private medical insurance UK policy will cover her diagnosis and treatment in a private hospital.
The key takeaway is that PMI is there for the "what ifs." The fact that you know you have a higher "what if" chance does not disqualify you from getting cover for it, as long as the condition itself has not yet materialised.
How Your Underwriting Choice Interacts with Genetic Information
When you apply for PMI, the insurer "underwrites" your policy, meaning they assess the risk and decide on the terms of your cover. There are two main ways this is done in the UK.
1. Moratorium Underwriting
This is the most common and simplest route.
- How it works: You don't complete a detailed medical questionnaire. Instead, the policy automatically excludes treatment for any medical conditions you have had symptoms, advice, or treatment for in the five years before your policy starts.
- The "rolling" part: If, after your policy begins, you go for a continuous two-year period without needing any treatment, advice, or having symptoms for that condition, the insurer may then cover it in the future.
- Genetic Angle: This method doesn't involve any deep dive into your medical history, so your genetic test results are completely irrelevant. The focus is purely on conditions that have been present in the last five years.
2. Full Medical Underwriting (FMU)
This is a more detailed, upfront approach.
- How it works: You complete a comprehensive health questionnaire, declaring your full medical history. The insurer assesses this and tells you from day one exactly what is and isn't covered. Any pre-existing conditions you declare will be permanently excluded.
- Genetic Angle: Even with FMU, the insurer cannot ask you about predictive genetic tests. However, you must declare any actual diagnosed conditions. If a genetic test led to a doctor diagnosing you with a condition (e.g., hypertrophic cardiomyopathy), you must declare that diagnosis. The condition would then be excluded, but your policy would be accepted for all other future, unrelated acute conditions.
For most people, choosing between these underwriting types depends on their medical history and preference for clarity. A specialist PMI broker like WeCovr can explain the pros and cons for your specific situation, helping you make the right choice at no extra cost to you.
The Wellness Revolution: A Positive Spin on Health Data
While the focus is often on the risks, it's worth noting how genetic information and health data are being used positively by insurers. Many leading UK PMI providers now offer sophisticated wellness programmes that reward you for living a healthy lifestyle.
These programmes encourage activities like:
- Hitting daily step counts
- Regular gym visits
- Mindfulness and meditation
- Healthy eating
- Annual health checks
By engaging with these platforms, you can earn rewards like free coffee, cinema tickets, and even discounts on your renewal premium.
This is where some of the "wellness" reports from direct-to-consumer genetic tests can be personally useful. Knowing you have a genetic predisposition to slow caffeine metabolism might encourage you to cut back on coffee. Finding you have a gene associated with endurance muscle performance might motivate you to take up running.
This information is for you—it helps you tailor your lifestyle. It is not used by your insurer to penalise you. In fact, by acting on it and improving your health, you could end up lowering your future premiums through a wellness-linked policy.
Furthermore, as a WeCovr client, you get complimentary access to our AI-powered nutrition app, CalorieHero, to help you on your wellness journey. We also offer discounts on other types of insurance, such as life or home cover, when you take out a PMI policy with us, rewarding you for taking a holistic approach to your protection.
Case Studies: Genetic Testing and PMI in the Real World
Let's walk through a few more scenarios to see how the rules apply in practice.
Scenario 1: Mark and a Family History of Heart Disease
- The Situation: Mark, 42, has a strong family history of heart disease. He uses a direct-to-consumer test which reports he has several genetic markers associated with a higher risk of high cholesterol. He is otherwise healthy with no symptoms.
- His Action: Concerned, Mark visits his GP. His GP notes the test but tells him the evidence for these markers is weak. However, as a precaution, they do a blood test, which reveals Mark does have borderline high cholesterol. The GP advises dietary changes.
- Applying for PMI: When Mark applies for PMI, he does not have to declare the genetic test. However, on a Full Medical Underwriting application, he would need to declare that he has been diagnosed with "borderline high cholesterol" and has received "medical advice" (dietary changes) for it. This may lead to a specific exclusion for cholesterol-related heart conditions or a small premium loading, depending on the insurer. The genetic test itself played no role in the underwriting decision.
Scenario 2: Chloe and Pharmacogenomics
- The Situation: Chloe, 50, is diagnosed with an acute condition covered by her PMI policy. Her specialist recommends a course of treatment with a powerful new drug.
- Her Action: Before prescribing, the specialist runs a pharmacogenomic test. The test shows Chloe's genetic makeup means the standard drug would be ineffective and cause severe side effects. The test identifies an alternative, more expensive drug that will work well for her.
- The PMI Outcome: This is a huge benefit. The insurer covers the cost of the pharmacogenomic test as part of the diagnostic process. They also cover the cost of the more effective, personalised drug. Here, genetic testing has led to a better, safer, and more efficient health outcome, all funded by her PMI.
Scenario 3: Tom and Huntington's Disease
- The Situation: Tom's father was diagnosed with Huntington's Disease, a degenerative neurological condition. At 25, a pre-symptomatic Tom takes a test and discovers he carries the Huntington's gene. He has no symptoms.
- Applying for PMI: Tom can get PMI and does not have to declare the test result. His cover is approved at standard rates.
- A Note on Chronic Conditions: Years later, if Tom begins to develop symptoms, the initial diagnosis and investigations would be covered by his PMI as a new condition. However, Huntington's is a chronic, long-term disease with no cure. PMI does not cover the long-term management of chronic conditions. So, after the initial acute phase, Tom's ongoing care would transition to the NHS. This highlights the fundamental purpose of PMI: to diagnose and treat acute conditions quickly, complementing the NHS's role in chronic care.
What Does the Future Hold?
The landscape of genetics and insurance is constantly evolving. The Code on Genetic Testing and Insurance is a "living document," periodically reviewed to keep pace with science and public policy. The current agreement is widely expected to be renewed beyond 2025, as it has served both consumers and the industry well.
We are likely to see a greater use of pharmacogenomics, leading to more personalised and effective medicine. This is a positive development that private medical insurance is well-placed to support, funding tests that guide doctors to the best treatment pathway from the outset.
The high level of customer satisfaction reported by clients of brokers like WeCovr often stems from the peace of mind that comes from having an expert demystify these complex topics. The UK's framework is one of the most robust in the world, and it is designed with a single goal: to allow you to explore your genetic health information without jeopardising your access to insurance.
Do I need to declare a 23andMe or AncestryDNA test to my PMI provider?
Will a genetic test result increase my private medical insurance premium?
What if a genetic test leads to a diagnosis? Do I have to declare that?
Can an insurer ask my GP for my genetic test results?
Take the Next Step with Confidence
Feeling clearer about genetic testing and PMI? The rules can seem complex, but protecting your future health shouldn't be. The UK's framework is designed to give you peace of mind.
At WeCovr, our expert advisors offer free, no-obligation advice to help you compare the best PMI providers in the UK. We'll find a policy that fits your needs and budget, ensuring you understand every aspect of your cover.
Get your free, personalised quote from WeCovr today and secure your health's future.
