TL;DR
Navigating the world of private medical insurance (PMI) in the UK can feel complex, especially when you have a pre-existing medical condition. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands your concerns. This guide demystifies the costs, exclusions, and options available to you.
Key takeaways
- Pre-Existing Condition: Any illness, disease, or injury for which you have experienced symptoms, received medication, advice, or treatment before the start of your policy.
- Chronic Condition: A condition that is long-lasting, has no known cure, and requires ongoing management. Examples include diabetes, asthma, and arthritis.
- Years 1 & 2 of your policy: Your knee is automatically excluded. If it flares up, you cannot claim for treatment.
- After 2 years: If you have had absolutely no pain, symptoms, check-ups, or advice related to your knee for two full years, your policy may then cover new issues with that knee.
- What if it flares up? If you see your GP about knee pain 12 months into your policy, the two-year waiting period for that condition resets from that date.
Navigating the world of private medical insurance (PMI) in the UK can feel complex, especially when you have a pre-existing medical condition. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands your concerns. This guide demystifies the costs, exclusions, and options available to you.
What exclusions apply and how much premiums can vary
Understanding how private health insurance works with pre-existing conditions starts with one fundamental principle: standard UK private medical insurance is designed to cover acute conditions that arise after your policy begins. It is generally not designed to cover pre-existing or chronic conditions.
This single point is the most common source of confusion, so let's break it down.
- Pre-Existing Condition: Any illness, disease, or injury for which you have experienced symptoms, received medication, advice, or treatment before the start of your policy.
- Chronic Condition: A condition that is long-lasting, has no known cure, and requires ongoing management. Examples include diabetes, asthma, and arthritis.
Insurers exclude these conditions to keep premiums affordable for the wider population. If policies were to cover long-term, pre-diagnosed issues, the cost of insurance would become prohibitively expensive for everyone. The premium you pay is based on the risk of you needing new eligible treatment in the future, not the cost of treating an existing condition.
Understanding Underwriting: The Key to Pre-Existing Conditions
The process an insurer uses to assess your health and decide what it will and will not cover is called 'underwriting'. When it comes to pre-existing conditions, there are two main types of underwriting in the UK. The one you choose will have a significant impact on your cover.
Moratorium Underwriting (The 'Wait and See' Approach)
Moratorium underwriting is the most common type offered in the UK. It's simpler and quicker to set up because you don't need to provide your full medical history upfront.
How it works: A moratorium policy automatically excludes any pre-existing medical conditions you've had in the five years leading up to your policy start date. However, this exclusion isn't necessarily permanent.
If you then serve a continuous period (usually two years) after your policy starts without having any symptoms, treatment, medication, or advice for that specific condition, it may become eligible for cover. This is often called a 'rolling moratorium'.
Real-Life Example: Knee Pain
Imagine you had physiotherapy for knee pain 18 months before you took out a moratorium policy.
- Years 1 & 2 of your policy: Your knee is automatically excluded. If it flares up, you cannot claim for treatment.
- After 2 years: If you have had absolutely no pain, symptoms, check-ups, or advice related to your knee for two full years, your policy may then cover new issues with that knee.
- What if it flares up? If you see your GP about knee pain 12 months into your policy, the two-year waiting period for that condition resets from that date.
| Moratorium Underwriting: Pros & Cons | |
|---|---|
| Pros ✅ | Cons ❌ |
| Quicker and easier to set up. | Lack of certainty at the start of the policy. |
| No lengthy medical questionnaires. | Claim process can be slower as underwriting happens at the point of claim. |
| Pre-existing conditions can become eligible for cover over time. | Any symptom or check-up can reset the two-year waiting period. |
| Less intrusive application process. | Can lead to disputes if what constitutes 'advice' or 'symptoms' is unclear. |
Full Medical Underwriting (FMU) (The 'Upfront Declaration' Approach)
With Full Medical Underwriting, you provide your complete medical history to the insurer via a detailed questionnaire when you apply. The insurer's underwriting team then reviews this information and makes a clear decision from day one.
How it works: Based on your declarations, the insurer will state precisely what is and isn't covered in your policy documents. Any pre-existing conditions will typically be listed as specific exclusions. These exclusions are often permanent, but you can sometimes ask for them to be reviewed after a number of years if the condition has fully resolved.
Real-Life Example: A Past Skin Condition
Suppose you had treatment for eczema five years ago but it hasn't returned since. You declare this on your FMU application.
- The insurer might decide the risk is low and agree to cover you for any new dermatological issues.
- Alternatively, they might apply a permanent exclusion for "eczema and related conditions".
- The key benefit is that you know exactly where you stand from the very first day of your policy.
| Full Medical Underwriting: Pros & Cons | |
|---|---|
| Pros ✅ | Cons ❌ |
| Complete clarity on what is covered from day one. | Application process is much longer and more detailed. |
| Faster claims process as your medical history is already assessed. | You must remember and declare your full medical history accurately. |
| No ambiguity about cover when you need to make a claim. | Exclusions are often permanent. |
| Better for individuals who prefer certainty. | May feel more intrusive than a moratorium. |
Which Underwriting is Right for Me?
Choosing between moratorium and FMU depends entirely on your personal circumstances and preferences.
- Choose Moratorium if: You have had few or no recent health issues, you're generally healthy, and you prefer a quick and simple application.
- Choose Full Medical Underwriting if: You have a complex medical history, you want absolute certainty about what is covered before you commit, or you've had a condition many years ago that has fully resolved.
This is where an expert PMI broker like WeCovr provides immense value. Our specialists can discuss your health history and help you decide which underwriting method best suits your needs, ensuring there are no nasty surprises down the line.
The Crucial Distinction: Acute vs. Chronic Conditions
We've mentioned this before, but it's worth dedicating a section to it as it is the bedrock of how private medical insurance UK works. Insurers cover acute conditions but exclude chronic ones.
- An Acute Condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. It's a short-term, curable event.
- A Chronic Condition is a disease, illness, or injury that has one or more of the following characteristics:
- It needs ongoing or long-term monitoring.
- It requires management through check-ups, examinations, medication, or tests.
- It has no known cure.
- It is likely to recur.
Here’s a table to make the difference clear:
| Condition Type | Examples | Is it Covered by PMI? |
|---|---|---|
| Acute Conditions | Cataracts, hernia repair, joint replacement (e.g., hip/knee), appendicitis, broken bones, new cancer diagnosis (post-policy). | Yes, these are the primary focus of PMI. Treatment aims to return you to your previous state of health. |
| Chronic Conditions | Diabetes, asthma, arthritis, hypertension (high blood pressure), Crohn's disease, epilepsy. | No, the long-term, ongoing management of these conditions is not covered. It remains under the care of your NHS GP. |
It's important to note that while the management of a chronic condition isn't covered, an acute flare-up or a new, related acute condition might be. This is a grey area and depends heavily on the specific insurer and policy wording. For example, a person with well-managed asthma (chronic) would not be covered for their inhalers or routine check-ups. However, if they developed a severe, acute chest infection requiring a hospital stay, that treatment might be covered.
How Much Do Premiums Vary with Pre-Existing Conditions?
This is the million-dollar question. Counter-intuitively, having a pre-existing condition doesn't usually make your premium more expensive. Instead, it results in an exclusion for that condition.
Your premium is calculated based on a range of other factors that assess your overall risk of needing new, eligible medical treatment in the future.
Key Factors That Actually Determine Your PMI Premium
- Age: This is the single biggest factor. The older you are, the higher the statistical likelihood of needing medical care, so premiums increase with age.
- Location: Medical treatment costs vary significantly across the UK. Living in Central London, where hospital costs are highest, will result in a higher premium than living in a rural part of Scotland.
- Level of Cover:
- Basic: Covers in-patient and day-patient treatment only.
- Mid-Range: Includes out-patient cover up to a certain limit (e.g., £1,000 per year) for consultations and diagnostics.
- Comprehensive: Offers extensive out-patient cover, plus options for mental health, dental, and optical benefits.
- Excess (illustrative): This is the amount you agree to pay towards the cost of a claim. A higher excess (e.g., £500) will lower your monthly premium, while a lower excess (e.g., £100) will increase it.
- Hospital List: Insurers offer different tiers of hospitals. A policy with a nationwide list including prime London hospitals will cost more than one with a more restricted local network.
- No-Claims Discount: Similar to car insurance, you build up a discount for every year you don't make a claim. Making a claim will typically reduce this discount and increase your premium at renewal.
- Lifestyle: Some insurers offer lower premiums for non-smokers.
Illustrative Monthly PMI Premiums (2025)
To give you a clearer idea of costs, the table below shows example monthly premiums for a non-smoker with a £250 excess. These are illustrative figures and your actual quote will depend on the factors above.
| Age | Basic Cover (In-patient only) | Mid-Range Cover (+ £1,000 Out-patient) | Comprehensive Cover (Full Out-patient) |
|---|---|---|---|
| 30-year-old | £35 - £50 | £55 - £75 | £80 - £110 |
| 40-year-old | £45 - £65 | £70 - £95 | £100 - £140 |
| 50-year-old | £65 - £90 | £95 - £130 | £140 - £200 |
| 60-year-old | £100 - £145 | £140 - £190 | £200 - £280 |
Disclaimer: These are estimated costs for illustrative purposes only. For a precise quote based on your personal circumstances, it is essential to speak with a PMI broker.
Navigating Specific Pre-Existing Conditions
How insurers view your health history can vary. Here’s a look at some common conditions and how they are typically handled.
Mental Health Conditions (e.g., Anxiety, Depression)
Mental health is becoming a more prominent part of private health cover, but pre-existing conditions are still a key consideration.
- Moratorium: If you've received therapy or medication for anxiety in the last 5 years, it will be excluded for the initial 2-year period.
- FMU: You would declare the history. The insurer might apply an exclusion for "anxiety, depression, and related conditions". If it was a single, brief episode many years ago, they may disregard it. Many policies now offer access to a limited number of therapy sessions or a mental health support line as a standard benefit, even if you have a mental health exclusion for specialist treatment.
Musculoskeletal Issues (e.g., Back Pain, Joint Problems)
This is one of the most common reasons for claims.
- Moratorium: A history of back pain or a dodgy knee will be excluded. If you go two years symptom and treatment-free, you could become eligible for cover for that body part again.
- FMU: You will likely receive a specific exclusion for the affected area (e.g., "lumbar spine" or "right knee"). This provides clarity but removes the possibility of it being covered later.
Cancer
A history of cancer is treated with significant caution by insurers.
- FMU: If you have had cancer, it will almost certainly be a permanent exclusion on your policy.
- Moratorium: The situation is more nuanced. The previous cancer would be excluded. However, if you remained cancer-free and then, after the 2-year moratorium period, were diagnosed with a new, completely unrelated primary cancer, it would likely be covered. This is a key advantage of moratorium underwriting for those with a cancer history.
High Blood Pressure (Hypertension) & High Cholesterol
These are generally considered chronic conditions by insurers. The ongoing monitoring, GP check-ups, and medication (e.g., statins, blood pressure tablets) are managed by the NHS and are not covered by PMI. However, if you were to suffer an acute event that may be linked to these conditions, such as a heart attack or stroke, the subsequent acute treatment in a private hospital could be covered, provided it's not deemed a direct consequence of a long-term, unmanaged condition.
Can I Ever Get a Pre-Existing Condition Covered?
Yes, it is possible, primarily through moratorium underwriting. Let's revisit the rule as it's so important:
The 2-Year Rule (Moratorium): If you take out a moratorium policy, a pre-existing condition you've had in the last 5 years can become eligible for cover if, and only if, you spend a continuous 2-year period after your policy starts where you:
- Have no symptoms of the condition.
- Receive no treatment for it.
- Take no medication for it.
- Seek no advice from a doctor or specialist about it.
If you meet these criteria, the condition is no longer considered pre-existing, and you can claim for it.
Warning about Switching Insurers: If you are part-way through a 2-year moratorium period and switch to a new insurer, the clock resets. You will have to start a new 2-year waiting period with the new provider. This is why it's crucial to get expert advice before switching.
The Role of an Expert PMI Broker
Trying to compare policies, underwriting terms, and pricing from a dozen different insurers is a daunting task. This is where an independent, specialist private health cover broker adds enormous value.
An expert broker like WeCovr works for you, not the insurance companies.
- We Understand the Market: We know the intricate underwriting philosophies of each major UK provider. We know which insurers are more lenient with certain conditions.
- Personalised Advice: We take the time to understand your medical history and priorities, helping you choose between moratorium and FMU and finding a policy that offers the best possible terms for your situation.
- 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.
- Hassle-Free Process: We handle the paperwork and comparisons, presenting you with clear, simple options. Our team has helped arrange policies for over 750,000 people and has exceptionally high customer satisfaction ratings.
Enhancing Your Wellbeing: Added Benefits with WeCovr
Modern private medical insurance is about more than just treating you when you're ill; it's also about helping you stay healthy. Most top-tier policies now include a wealth of wellness benefits, such as:
- Digital GP services (24/7 access to a GP via phone or video call).
- Mental health support lines and access to therapy sessions.
- Discounts on gym memberships, fitness trackers, and health screenings.
- Nutrition consultations and physiotherapy support.
At WeCovr, we believe in a proactive approach to health. That’s why, as a thank you to our clients, we provide complimentary access to CalorieHero, our proprietary AI-powered calorie and nutrition tracking app, to help you manage your diet and achieve your wellness goals.
Furthermore, when you arrange your PMI or Life Insurance with us, you can also benefit from exclusive discounts on other types of cover you may need, providing even greater value.
Do I have to declare a condition I had many years ago?
What counts as 'treatment' or 'advice' for a moratorium?
Can I get private health insurance if I have a chronic condition like diabetes?
Will my premiums go up if I claim for a newly covered pre-existing condition?
Ready to Find the Right Cover?
Finding the best private health cover when you have a pre-existing condition requires expert guidance. Don't navigate the complexities alone.
Contact WeCovr today for a free, no-obligation quote. Our friendly, expert team will compare the leading UK insurers to find a policy that fits your needs and your budget, giving you peace of mind and fast access to the best care.
Sources
- Department for Transport (DfT): Road safety and transport statistics.
- DVLA / DVSA: UK vehicle and driving regulatory guidance.
- Association of British Insurers (ABI): Motor insurance market and claims publications.
- Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.












