PMI for Pre-Existing Conditions What You Need to Know
Navigating the world of private medical insurance (PMI) in the UK can feel daunting, especially if you have a pre-existing health condition. At WeCovr, an FCA-authorised broker that has helped arrange over 800,000 policies, we believe everyone deserves clarity. This guide demystifies how PMI works with existing health issues.
How to secure cover if you have existing health issues, and which providers are most inclusive
Finding private health cover when you have a medical history is one of the most common challenges faced by UK consumers. The fundamental principle of private medical insurance is to cover unexpected, acute conditions that arise after your policy begins. It is not designed to cover the ongoing management of long-term (chronic) illnesses or treatment for health issues you already have.
However, this doesn't mean you can't get a valuable policy. The key lies in understanding how insurers assess your health history—a process known as underwriting. By choosing the right underwriting method and the right provider, you can secure a policy that gives you peace of mind for new, eligible conditions, even if certain past issues are excluded.
This guide will walk you through:
- The crucial difference between moratorium and full medical underwriting.
- How insurers define "pre-existing" and "chronic" conditions.
- Which leading UK providers offer the most flexible approaches.
- How an expert broker can help you find the best possible terms.
Understanding "Pre-Existing" and "Chronic" in the Eyes of an Insurer
Before diving into how to get cover, it's vital to speak the same language as the insurers. These two terms are the bedrock of any PMI policy decision.
What is a Pre-Existing Condition?
From an insurer's perspective, a pre-existing condition isn't just a formal diagnosis. It is any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment before the start of your policy.
This is a broad definition. It could include:
- A diagnosed condition like asthma or eczema.
- A joint injury from playing sports five years ago.
- Symptoms like recurring headaches or back pain, even if you never received a formal diagnosis.
- Mental health conditions for which you've sought therapy or medication.
Insurers exclude these conditions to manage risk. A core principle of insurance is to protect against the unknown. Covering conditions that are already known, and likely to require treatment, would make premiums prohibitively expensive for everyone. Think of it like trying to buy car insurance after you've had an accident—the policy is designed to cover future events, not past ones.
What is a Chronic Condition?
A chronic condition is a long-term health issue that is likely to continue indefinitely. These conditions cannot be cured but can be managed through monitoring, check-ups, and medication.
Examples of common chronic conditions include:
- Diabetes
- Arthritis
- Hypertension (high blood pressure)
- Crohn's disease
- Asthma
- Most types of heart disease
Standard UK private medical insurance does not cover the routine management of chronic conditions. This is because their treatment is ongoing and predictable, falling outside the scope of insurance for acute, short-term illnesses. While your PMI policy won't cover your regular diabetes check-ups or asthma inhalers, it would cover an eligible acute condition that arises separately from your chronic illness.
The Two Gates to Cover: Moratorium vs. Full Medical Underwriting
When you apply for PMI, the insurer needs to understand your medical history to decide what they will and won't cover. They do this using one of two methods: Moratorium or Full Medical Underwriting (FMU). Choosing the right one for your circumstances is the single most important decision you'll make.
1. Moratorium (MORI) Underwriting
This is the most common and quickest way to get a policy.
- How it works: You do not complete a detailed medical questionnaire. Instead, the policy automatically excludes any pre-existing conditions you've had in the five years leading up to your policy start date.
- The "Two-Year Rule": The magic of a moratorium policy is that these exclusions can be lifted. If you go for a continuous two-year period after your policy starts without having any symptoms, treatment, medication, or advice for that specific condition, it may become eligible for cover in the future.
- Pros:
- Fast and Simple: No lengthy forms to fill out.
- Less Intrusive: You don't have to disclose your entire medical history upfront.
- Potential for Future Cover: Conditions can become eligible for cover over time.
- Cons:
- Lack of Certainty: You won't know for sure if a condition is covered until you make a claim. The insurer will investigate your medical history at that point.
- The "Clock" Can Reset: If you have a flare-up or even a GP check-up for an old condition during the two-year waiting period, the clock resets, and you must start another two-year symptom-free period.
Example: Jane had physiotherapy for knee pain three years before buying a moratorium policy. For the first two years of her policy, any treatment related to her knee is automatically excluded. If she remains completely symptom-free and needs no advice or treatment for her knee during those two years, a new knee problem in her third year could be covered.
2. Full Medical Underwriting (FMU)
This method involves a more detailed, upfront assessment of your health.
- How it works: You complete a comprehensive health questionnaire, declaring your medical history. The insurer's underwriting team reviews this information and may ask for more details or access to your medical records (with your consent).
- The Outcome: The insurer provides you with a policy document that explicitly lists any specific exclusions. These exclusions are usually permanent.
- Pros:
- Complete Certainty: You know exactly what is and isn't covered from day one. There are no surprises at the point of a claim.
- Potentially Fewer Exclusions: Sometimes, if a condition was very minor or a long time ago, an underwriter might choose not to apply an exclusion, which wouldn't be possible with a moratorium's blanket approach.
- Cons:
- Slower Process: The application can take several weeks.
- More Intrusive: You have to provide detailed personal health information.
- Exclusions are Often Permanent: Once an exclusion is on your policy, it's very unlikely to be removed.
Example: David has a history of mild IBS. He declares this on his FMU application. The insurer reviews his case and applies a permanent exclusion for any investigations or treatment related to irritable bowel syndrome. David is disappointed but is glad to know exactly where he stands. All other new, acute conditions are covered as normal.
Which Underwriting Option is Right for You? A Comparison
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple, no health forms. | Slower, requires a detailed health questionnaire. |
| Initial Exclusions | Automatically excludes conditions from the last 5 years. | Exclusions are based on your specific medical history. |
| Clarity of Cover | Can be uncertain until a claim is made. | Crystal clear from the start. |
| Future Cover | Pre-existing conditions may become eligible after a 2-year clear period. | Exclusions are typically permanent. |
| Best For... | People with minor or no recent health issues who want a quick start. | People with a complex medical history who want certainty above all else. |
A specialist PMI broker like WeCovr can be invaluable here, helping you decide which path is better suited to your personal medical history and preferences.
A Comparative Look at UK PMI Providers and Their Approaches
While all UK insurers exclude pre-existing conditions on standard policies, their underwriting flexibility, digital health tools, and member benefits can vary significantly. This can make a real difference to customers with existing health concerns.
Bupa
A household name in UK health insurance, Bupa is known for its extensive hospital network and comprehensive cover options.
- Underwriting: Offers both Moratorium and Full Medical Underwriting, providing flexibility for applicants.
- Health Management: Bupa provides strong support for managing ongoing health through its 'Bupa Touch' app and direct access to services like mental health support, often without needing a GP referral. This proactive approach helps members stay on top of their wellbeing.
- Focus: Bupa's scale means they have well-established processes for handling claims and queries, which can be reassuring.
AXA Health
AXA Health is a major global insurer praised for its innovative approach and strong emphasis on member wellbeing.
- Underwriting: Provides a clear choice between Moratorium and FMU. They also have well-regarded 'switch' terms, making them a popular choice for those looking to move from another insurer without losing cover for conditions that developed under their old policy.
- Digital Health: AXA's 'Doctor at Hand' service provides 24/7 access to a virtual GP, which can be a lifeline for quick advice, helping to avoid issues escalating.
- Inclusivity: They have a strong focus on mental health, with dedicated pathways and support that are often available without impacting your core policy benefits.
Aviva
As one of the UK's largest insurers, Aviva brings a reputation for reliability and a wide range of products.
- Underwriting: Aviva's underwriting is known for being thorough and clear. They offer both MORI and FMU options. Their FMU process is often seen as very precise, giving customers total clarity.
- Value-Adds: The Aviva 'Wellbeing' app includes a wealth of resources. They are also noted for their 'Cancer Pledge,' which promises to cover cancer treatment beyond any initial limits on their core policies, although this applies to cancers that develop after joining.
- Mental Health: Like AXA, Aviva has invested heavily in its mental health proposition, understanding that mental and physical health are interlinked.
Vitality
Vitality has disrupted the UK private medical insurance market with its unique model that rewards healthy living.
- Underwriting: Vitality applies the same principles of Moratorium and FMU. Pre-existing and chronic conditions are still excluded.
- The Vitality Difference: Their programme encourages members to manage their health through exercise, healthy eating, and regular check-ups. By tracking your activity via a wearable device, you can earn points that lead to lower premiums, cinema tickets, and coffee vouchers.
- Relevance for Pre-Existing Conditions: While Vitality won't cover your existing condition, its rewards programme can provide a powerful incentive to manage your overall health, which can be particularly beneficial if you have a chronic illness.
The Exeter
A smaller, specialist insurer, The Exeter is a Friendly Society known for its more personal approach and flexibility.
- Underwriting: The Exeter is often praised by brokers for its considered and individual approach to Full Medical Underwriting. They are sometimes willing to consider applicants that other, larger insurers might decline.
- Target Audience: They have a strong reputation for offering cover to older applicants and those with more complex health backgrounds.
- Simplicity: Their policies are often designed to be straightforward and easy to understand, cutting through some of the jargon that plagues the industry.
| Provider | Typical Underwriting Options | Key Strengths for Managing Health |
|---|---|---|
| Bupa | Moratorium, Full Medical Underwriting | Extensive network, comprehensive cancer cover, Bupa Touch app. |
| AXA Health | Moratorium, FMU, 'Switch' terms | Excellent 'Doctor at Hand' virtual GP, strong mental health pathways. |
| Aviva | Moratorium, Full Medical Underwriting | Reliable, strong cancer pledge, good digital wellbeing support. |
| Vitality | Moratorium, Full Medical Underwriting | Unique wellness programme rewards healthy behaviour, lowering future premiums. |
| The Exeter | Moratorium, Full Medical Underwriting | Specialist approach, often more flexible for older applicants or complex cases. |
The Indispensable Role of a Specialist PMI Broker
Trying to compare these options and underwriting nuances on your own can be overwhelming. This is where an independent, FCA-authorised broker like WeCovr becomes your most valuable asset.
- Expert Market Knowledge: We understand the fine print of each insurer's policy. We know which providers have more lenient underwriting for certain conditions and who offers the best 'switch' terms if you're already insured.
- Tailored, Personal Advice: We take the time to understand your specific medical history and what you need from a policy. We can then recommend the most suitable underwriting method and insurer for you, not for a generic customer.
- Application Support: On an FMU application, declaring your history correctly is vital. We guide you through the process to ensure it's accurate and complete, maximising your chances of getting the best possible terms.
- No Extra Cost: Our service is free to you. We are paid a commission by the insurer you choose, so you get expert, unbiased advice without paying a penny more than going direct. In fact, brokers often have access to deals not available to the public.
With high customer satisfaction ratings, WeCovr specialises in helping individuals and families, including those with pre-existing conditions, find their way to the right private medical insurance in the UK.
Beyond Insurance: A Proactive Approach to Your Wellbeing
While PMI focuses on treating new conditions, taking control of your overall health is the best investment you can ever make. Many insurers now actively support this, but the power lies in your daily habits.
- Nutrition: A balanced diet is fundamental to managing many conditions. The NHS Eatwell Guide is an excellent resource for building healthy meals. As a WeCovr client, you also get complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help you stay on track.
- Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, or swimming. Regular exercise helps manage weight, blood pressure, and blood sugar levels, and is a powerful mood booster.
- Quality Sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep can worsen inflammation and impact your immune system. Creating a relaxing bedtime routine and a dark, quiet environment is key.
- Mental Resilience: Stress can trigger or worsen many physical health conditions. Practices like mindfulness, meditation, or simply spending time in nature can have a profound impact. Most PMI providers now offer access to mental health support lines or apps as part of their standard package.
Purchasing a PMI or Life Insurance policy through WeCovr can also unlock discounts on other types of cover, helping you protect your family's broader financial wellbeing.
Real-Life Scenarios: How Underwriting Plays Out
Let's look at how these rules apply in practice.
Scenario 1: Sarah and her Sore Shoulder (Moratorium) Sarah had physiotherapy for shoulder pain caused by a gym injury in 2022. In 2025, she takes out a PMI policy with moratorium underwriting.
- The Situation: For the first two years of her policy (until 2027), any medical care related to her shoulder will be excluded because it was a pre-existing condition within the last 5 years.
- The Outcome: Sarah is careful and has no further shoulder trouble. In 2028, she develops a completely new pain in the same shoulder. Because she has completed the two-year symptom-free period, her insurer agrees to cover the investigations and potential treatment.
Scenario 2: Mark and his Medical History (Full Medical Underwriting) Mark has a history of gout and high cholesterol, both managed by medication. He wants absolute clarity on what will be covered.
- The Situation: He opts for an FMU policy and declares both conditions on his application form.
- The Outcome: The insurer issues his policy with two specific, permanent exclusions: one for "gout and related conditions" and another for "management of high cholesterol." Mark is fully covered for any other new, acute condition, from a hernia repair to cancer treatment, and is happy knowing there will be no grey areas if he needs to claim.
Scenario 3: Fatima and Switching Insurers (Continued Medical Exclusions) Fatima has been insured with Provider A for six years. During that time, she developed asthma, which Provider A has covered. She finds a cheaper policy with Provider B.
- The Situation: If she simply cancels and takes out a new policy, her asthma will now be a pre-existing condition and will be excluded by Provider B.
- The Solution: She speaks to a broker at WeCovr, who finds an insurer that offers "Continued Medical Exclusions" (CME) or "Switch" terms. Provider B agrees to take on Fatima's underwriting from Provider A, meaning they will continue to offer cover for her asthma on the same terms. She successfully switches providers without losing her valuable cover.
Do I need to declare every single cold or minor GP visit on a PMI application?
What happens if I don't declare a pre-existing condition?
Can I get private medical insurance if I have a history of cancer?
Is high blood pressure (hypertension) a pre-existing condition?
Navigating the complexities of private medical insurance with a pre-existing condition doesn't have to be a solo journey. The right advice can make all the difference, ensuring you get a policy that provides genuine value and security.
For clear, independent advice tailored to your personal circumstances, get a free, no-obligation quote from the experts at WeCovr today.
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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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!