PMI for Pre-Existing Conditions What Are My Options
Navigating the world of private medical insurance (PMI) in the UK can feel daunting, especially if you have a health history. As an FCA-authorised expert that has arranged over 900,000 policies, WeCovr understands your concerns. This guide explains exactly how PMI treats pre-existing conditions, helping you find clarity and the right cover.
WeCovr guides you through exclusions, moratoriums, and alternatives
Understanding private health cover when you have past or current medical issues is one of the most common challenges for UK consumers. The fundamental principle of private medical insurance is to cover unforeseen, acute conditions that arise after your policy begins. It is not designed to cover conditions that already exist or are chronic in nature.
This might sound restrictive, but don't be discouraged. There are different ways insurers assess your health, and understanding them is the key to finding a policy that works for you. In this guide, we will break down:
- What insurers classify as a "pre-existing condition".
- The critical difference between acute and chronic illnesses.
- The two main methods of underwriting: Moratorium and Full Medical Underwriting.
- Whether a pre-existing condition can ever be covered.
- Viable alternatives if standard PMI isn't the right fit.
- Practical tips for getting the best possible outcome.
Let’s demystify the process, so you can make an informed decision about your health.
What is a Pre-Existing Condition in an Insurer's Eyes?
In the context of private medical insurance, a "pre-existing condition" is any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment before the start date of your policy.
It's a broad definition. It doesn't matter if you've had a formal diagnosis from a specialist or just a brief chat with your GP. If it's in your medical records, or if you've had symptoms (even undiagnosed ones), an insurer will consider it pre-existing.
Common examples include:
- A historical injury: Knee pain from playing football five years ago that required physiotherapy.
- A diagnosed condition: Asthma, eczema, or high blood pressure diagnosed at any point in your life.
- Mental health support: A course of counselling for anxiety or a prescription for antidepressants two years ago.
- Symptoms and investigations: Experiencing recurring headaches or stomach issues that you've seen a doctor about, even if no definitive cause was found.
The Crucial Distinction: Acute vs. Chronic Conditions
Understanding this difference is fundamental to understanding UK PMI.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. PMI is designed specifically to cover the costs of treating these conditions. Think of things like broken bones, appendicitis, hernias, or cataracts.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, requires palliative care, has no known cure, or is likely to recur.
Standard private medical insurance in the UK does not cover the ongoing management of chronic conditions. This includes common long-term illnesses such as diabetes, arthritis, Crohn's disease, and multiple sclerosis. The NHS remains the primary provider for managing these conditions.
The Golden Rule of UK PMI: Why Aren't Pre-Existing and Chronic Conditions Covered?
This isn't an arbitrary rule; it's central to how insurance works. PMI operates on the principle of risk pooling. A large group of people pay premiums to cover the unexpected, high-cost medical bills of the few who fall ill in the future.
Covering conditions that already exist would be like trying to buy car insurance after you've had an accident. The event is no longer a risk; it's a certainty. If insurers covered pre-existing and chronic conditions, the cost of claims would skyrocket, making premiums unaffordable for everyone.
The UK's healthcare system is built on a partnership:
- The NHS: Provides comprehensive, universal care for everyone, acting as the safety net for all conditions, especially chronic and pre-existing ones.
- Private Medical Insurance: Offers a supplementary service, providing faster access to diagnosis and treatment for new, acute conditions, giving you more choice over your care.
Think of PMI as a way to bypass NHS waiting lists for eligible procedures, not as a replacement for the NHS itself. According to the latest NHS England data, the median waiting time for consultant-led elective care was 14.5 weeks in April 2024, highlighting why many seek the speed and convenience of private care.
How Insurers Assess Pre-Existing Conditions: The Two Main Underwriting Methods
When you apply for PMI, the insurer needs to understand your medical history to determine what they will and won't cover. This process is called underwriting, and there are two main approaches in the UK.
1. Moratorium Underwriting (The "Wait and See" Approach)
This is the most common type of underwriting for individual PMI policies because it's simple and fast.
- How it works: You don't need to complete a detailed medical questionnaire upfront. Instead, the policy automatically excludes any medical condition for which you have had symptoms, treatment, or advice in the five years leading up to your policy start date.
- The "Rolling" Period: These exclusions aren't necessarily permanent. If you then go for a continuous two-year period after your policy has started without needing any treatment, advice, or having any symptoms of that specific condition, the insurer may lift the exclusion and cover it in the future.
- The Catch: If you have a flare-up or need a consultation for that condition during the two-year moratorium period, the "clock" resets, and you must complete another two years symptom-free before it can be considered for cover.
Example: Maria took out a moratorium policy in January 2025. She saw a physiotherapist for back pain in 2023. Her back is therefore excluded from cover. If she remains completely free of back pain symptoms and seeks no advice or treatment for it until January 2027, her policy may then cover new, acute back problems from that point on. However, if she sees her GP for back pain in 2026, the two-year clock resets from that date.
2. Full Medical Underwriting (FMU) (The "Declare Everything" Approach)
This method is more detailed but provides complete clarity from day one.
- How it works: You are required to complete a comprehensive health questionnaire, disclosing your entire medical history. The insurer's underwriting team will review this information.
- The Outcome: Based on your disclosures, the insurer will issue a policy with a clear and explicit list of personal exclusions. These are typically permanent and will not be reviewed in the future.
- Certainty is Key: You know from the very beginning exactly what is and isn't covered. There are no grey areas or "wait and see" periods.
Example: John has a history of mild gout, with his last flare-up being four years ago. He opts for Full Medical Underwriting. He declares this on his application form. The insurer writes back confirming his policy is active but will permanently exclude any investigations or treatment related to gout or elevated uric acid levels. John now has peace of mind, knowing exactly where he stands.
Comparison: Moratorium vs. Full Medical Underwriting
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple. No medical forms. | Detailed health questionnaire required. |
| Initial Speed | Very fast to set up. | Slower, as history must be assessed. |
| Certainty of Cover | Lower. Ambiguity until a claim is made. | High. Exclusions are listed in writing. |
| Exclusions | Automatic 5-year look-back. Exclusions can potentially be lifted after 2 years. | Specific, named exclusions. Usually permanent. |
| Claim Process | Can be slower, as insurer may need to check your medical history at the point of claim. | Generally faster, as underwriting is done upfront. |
| Best For... | People with a clean bill of health or very minor past issues who want a quick start. | People with a complex medical history who want absolute clarity on their cover from day one. |
Choosing the right underwriting method is a crucial decision. An expert PMI broker, like WeCovr, can discuss your personal health history and help you decide which approach is more suitable for your needs.
Can I Ever Get a Pre-Existing Condition Covered by PMI?
While the general rule is "no," there are specific scenarios where cover might be possible.
-
Through a Moratorium Policy: As explained above, if you remain symptom-free for the two-year waiting period, a historical condition may become eligible for cover. This is the most common path to getting a past issue covered.
-
On a "Continued Personal Medical Exclusions" (CPME) Basis: This is a vital option for those who already have PMI and are looking to switch providers, perhaps for a better price or enhanced benefits.
- How it works: Instead of applying as a new customer, you can ask for a "CPME switch". A new insurer agrees to take you on with the same underwriting terms and exclusions as your previous policy.
- The Benefit: If a condition was covered under your old policy (for example, it developed after you originally took out cover), it will remain covered by your new insurer, even though it's technically now a "pre-existing condition" for them.
- Important: This is a complex area. You must switch without any gap in cover, and not all insurers offer this option. Using a broker like WeCovr is highly recommended to ensure a smooth and successful transfer.
-
For Very Minor, Historic Conditions (under FMU): In some rare cases, if a condition was extremely minor, happened many years ago, and is certified by your GP as fully resolved with no chance of recurrence, an underwriter might choose not to apply an exclusion. This is at the insurer's discretion and is not common.
What About Chronic Conditions? The Uninsurable Reality
It is essential to be direct and clear about this: Standard UK private medical insurance does not cover the management of chronic conditions.
This includes, but is not limited to:
- Diabetes (Type 1 and Type 2)
- Hypertension (High Blood Pressure)
- Arthritis (Rheumatoid and Osteoarthritis)
- Crohn's Disease and Ulcerative Colitis
- Asthma
- Multiple Sclerosis (MS)
- Chronic Obstructive Pulmonary Disease (COPD)
The reason is purely financial and structural. These conditions require predictable, ongoing care for life. Insuring them would make PMI prohibitively expensive. The NHS is structured and funded to provide this long-term care.
However, having a chronic condition does not mean you cannot get PMI. You absolutely can. The policy will simply exclude the chronic condition itself.
Crucial Nuance: An acute condition that is unrelated to your chronic illness will still be covered.
- Example: You have well-managed diabetes, which is excluded from your PMI policy. You then fall and suffer a serious fracture in your arm. Your PMI policy would cover the orthopaedic surgery, hospital stay, and physiotherapy for your broken arm because it is a new, acute condition.
Exploring Your Alternatives and Complements to PMI
If you find that PMI won't cover your main health concerns, or if you're looking for different types of support, several excellent options are available.
1. Maximising the NHS
The National Health Service remains one of the most comprehensive healthcare systems in the world. It provides high-quality care for all conditions, free at the point of use. For chronic disease management and pre-existing conditions, the NHS is your primary and most reliable source of care.
2. Health Cash Plans
These are often confused with PMI but are a different product entirely.
- What they are: Health cash plans are low-cost insurance policies that help you budget for everyday healthcare expenses.
- How they work: You pay a monthly premium. When you pay for a treatment (like a dental check-up, eye test, or physiotherapy session), you claim a percentage of that cost back, up to an annual limit.
- Relevance to Pre-Existing Conditions: Cash plans often have much more lenient rules. Many will cover routine appointments and therapies that can help you manage a pre-existing condition, even if PMI won't cover the specialist treatment for it.
3. Self-Funding (Pay-as-you-go Private Treatment)
For those who want private treatment for a specific condition excluded by insurance, paying for it directly is a growing option. This gives you control over when and where you are treated. The costs can be high, but for one-off procedures, it can be a viable path.
| Private Procedure | Estimated UK Cost Range (2025) |
|---|---|
| MRI Scan | £300 – £800 |
| Cataract Surgery (per eye) | £2,500 – £4,000 |
| Hip Replacement | £12,000 – £15,000 |
| Knee Replacement | £13,000 – £16,000 |
| Hernia Repair | £3,000 – £5,000 |
| Note: Costs are estimates and vary significantly by hospital and location. |
Practical Tips for Navigating the PMI Application Process
- Be Completely Honest: When applying for a policy (especially with FMU), you have a legal duty to provide a "fair presentation of risk". Hiding or omitting information about your health can lead to your policy being cancelled and claims being denied, precisely when you need it most.
- Speak to an Expert Broker: This is the single most effective step you can take. An independent, FCA-authorised broker like WeCovr works for you, not the insurer. We can:
- Listen to your health concerns in confidence.
- Explain the different approaches of leading UK insurers.
- Advise on whether Moratorium or FMU is better for you.
- Manage complex applications or CPME switches on your behalf.
- All of this comes at no extra cost to you.
- Embrace the Added Value: Modern PMI is more than just paying for claims. Most policies include a suite of wellness benefits available to all members, regardless of their medical history. These often include:
- 24/7 Digital GP: Get a remote appointment with a GP via phone or video, often within hours.
- Mental Health Support: Access to counselling or therapy helplines without needing a GP referral.
- Wellness Programmes: Discounts on gym memberships, fitness trackers, and health screenings.
- At WeCovr, we enhance this further by providing our PMI and Life Insurance clients with complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, and exclusive discounts on other types of cover.
The Bigger Picture: Proactive Health and Wellbeing
While insurance focuses on what happens when you get sick, the best strategy is to stay healthy. A balanced diet, regular physical activity, sufficient sleep, and managing stress are the cornerstones of good health.
Engaging with the wellness benefits included in your PMI policy can be a powerful motivator. Using the digital GP for early advice, taking advantage of gym discounts, or tracking your nutrition with an app like CalorieHero are all proactive steps you can take to manage your wellbeing and potentially reduce the risk of future acute conditions.
Navigating private medical insurance with a pre-existing condition requires careful thought, but it is entirely possible to find a valuable policy. The key is to be informed, be honest, and seek expert guidance.
Do I need to declare a medical condition that my GP says is fully resolved?
What happens if I develop a chronic condition after my PMI policy starts?
Can I switch my PMI provider if I have a pre-existing condition?
Will my premiums be higher if I have pre-existing conditions?
Navigating the world of PMI and pre-existing conditions can feel complex, but you don't have to do it alone. The expert, FCA-authorised advisors at WeCovr specialise in the UK market. We can compare policies from leading insurers to find the right fit for your circumstances, completely free of charge.
Get your no-obligation PMI quote today and gain clarity on your private health cover options.
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?
👉 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.
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