TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr understand the nuances of the UK market. This guide provides an authoritative look at private medical insurance for individuals with epilepsy, clarifying what is and isn't covered, and how a policy can still offer immense value. Does PMI cover seizures and neurological disorders?
Key takeaways
- Prevalence (illustrative): According to Epilepsy Action UK, around 1 in 100 people in the UK have epilepsy. This translates to over 630,000 individuals living with the condition.
- New Diagnoses: Approximately 87 people are diagnosed with epilepsy every day in the UK.
- Age Groups: Epilepsy can start at any age, but it is most commonly diagnosed in children and people over the age of 65.
- Impact: While many people with epilepsy lead full and active lives with treatment, the condition can have a significant impact on daily activities, employment, and mental wellbeing.
- It needs long-term or ongoing monitoring, consultations, check-ups, or examinations.
As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr understand the nuances of the UK market. This guide provides an authoritative look at private medical insurance for individuals with epilepsy, clarifying what is and isn't covered, and how a policy can still offer immense value.
Does PMI cover seizures and neurological disorders?
This is the most critical question, and the answer requires understanding a fundamental principle of UK private medical insurance (PMI). In short, standard PMI policies are designed to cover acute conditions that arise after your policy begins. They do not cover the ongoing management of chronic conditions, and epilepsy is defined as a chronic condition.
If you already have a diagnosis of epilepsy before taking out a policy, it will be considered a pre-existing condition and will be excluded from cover.
However, the story doesn't end there. Private health insurance can still provide significant benefits for someone with epilepsy, from covering other unrelated medical issues to offering access to valuable wellness services. This guide will explore all these aspects in detail.
Understanding Epilepsy in the UK: Key Facts and Figures
To appreciate how insurers view epilepsy, it's helpful to understand its prevalence and nature. Epilepsy is not a single condition but a term for a group of neurological disorders characterised by recurrent seizures.
- Prevalence (illustrative): According to Epilepsy Action UK, around 1 in 100 people in the UK have epilepsy. This translates to over 630,000 individuals living with the condition.
- New Diagnoses: Approximately 87 people are diagnosed with epilepsy every day in the UK.
- Age Groups: Epilepsy can start at any age, but it is most commonly diagnosed in children and people over the age of 65.
- Impact: While many people with epilepsy lead full and active lives with treatment, the condition can have a significant impact on daily activities, employment, and mental wellbeing.
These statistics highlight that epilepsy is a long-term condition requiring ongoing care, which is precisely what insurers define as "chronic".
The Critical Distinction: Chronic vs. Acute Conditions in PMI
Understanding the difference between chronic and acute conditions is the key to unlocking how private medical insurance works. Insurers build their policies around this distinction to manage risk and keep premiums affordable for the majority.
What is a Chronic Condition?
Insurers typically define a chronic condition as an illness, disease, or injury that has one or more of the following characteristics:
- It needs long-term or ongoing monitoring, consultations, check-ups, or examinations.
- It has no known cure or is likely to come back.
- It requires palliative care or management to alleviate symptoms.
- It is a long-term condition that requires rehabilitative treatment.
Epilepsy fits this definition perfectly. It requires long-term management with medication (e.g., anti-epileptic drugs or AEDs), regular consultations with a neurologist, and ongoing monitoring.
What is an Acute Condition?
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and from which you are expected to make a full recovery.
The table below illustrates the difference clearly:
| Condition Type | Characteristics | Examples | Covered by PMI? |
|---|---|---|---|
| Acute | Short-term, curable, fast response to treatment | Broken arm, appendicitis, cataract, hernia repair, new joint pain requiring a single course of physiotherapy | Yes (if it arises after the policy starts) |
| Chronic | Long-term, no known cure, requires ongoing management | Epilepsy, diabetes, asthma, high blood pressure, arthritis | No (ongoing management is not covered) |
This distinction is the bedrock of the UK private health insurance market. PMI provides a way to bypass NHS waiting lists for eligible, acute conditions, offering fast access to specialists and private hospitals. It is not a replacement for the comprehensive, cradle-to-grave care provided by the NHS for chronic conditions.
How UK Private Health Insurance Treats Pre-existing Conditions
Because epilepsy is a chronic condition, if you have been diagnosed, sought advice, or received treatment for it before buying a policy, it will be treated as a "pre-existing condition". Insurers handle pre-existing conditions in two main ways, known as underwriting.
1. Moratorium Underwriting
This is the most common type of underwriting because it's simple and doesn't require you to fill out a long medical questionnaire.
- How it works: The policy automatically excludes any medical condition for which you have had symptoms, treatment, or advice in the 5 years leading up to the policy start date.
- The "Two-Year Rule": An exclusion might be lifted if you go for a continuous 2-year period after your policy starts without experiencing any symptoms, or seeking any treatment, medication, or advice for that condition.
- For Epilepsy: Given that epilepsy requires continuous management and medication, it is extremely unlikely that it would ever become eligible for cover under a moratorium policy. The condition will remain a permanent exclusion.
2. Full Medical Underwriting (FMU)
This method involves a more detailed application process but offers greater clarity from day one.
- How it works: You complete a comprehensive health questionnaire, declaring your full medical history, including your epilepsy. The insurer's underwriting team assesses your application and then offers you a policy with specific, named exclusions.
- For Epilepsy: With FMU, your policy documents will state explicitly that "epilepsy and any related conditions" are not covered. This provides absolute certainty about what you can and cannot claim for.
Comparing Underwriting for Someone with Epilepsy
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and easy, no health forms. | Detailed health questionnaire required. |
| Exclusions | Blanket exclusion for conditions from the last 5 years. | Specific, named exclusions listed on your policy. |
| Clarity | Can be uncertain what's covered until you make a claim. | Completely clear from the start. |
| Epilepsy Cover | Excluded as a pre-existing chronic condition. | Explicitly excluded in writing. |
| Best For | People who want a quick start and have few recent health issues. | People with known conditions who want certainty. |
An expert broker like WeCovr can help you decide which underwriting method is better for your personal circumstances, ensuring there are no surprises when you need to use your policy.
So, When Could Private Health Insurance Help Someone with Epilepsy?
Even though the ongoing management of epilepsy itself is not covered, a private medical insurance policy can be incredibly valuable in several key scenarios.
1. Cover for New, Unrelated Acute Conditions
This is the primary reason to have PMI if you have a pre-existing chronic condition. Having epilepsy does not stop you from developing other health problems. With PMI, you can get fast-track access to private treatment for a huge range of new, acute conditions that might develop, including:
- Orthopaedic Surgery: Bypassing long NHS waits for a hip or knee replacement.
- Cancer Treatment: Access to specialist consultants, therapies, and drugs not always available on the NHS (provided cancer is not a pre-existing condition).
- Diagnostic Procedures: Quickly getting an MRI scan for a new joint injury or an endoscopy for digestive issues.
- Common Surgeries: Hernia repair, cataract removal, gallbladder surgery.
Example: Sarah, who has managed her epilepsy for 10 years, develops severe knee pain. Her GP suspects a torn meniscus and refers her for an MRI scan. The NHS waiting list is 18 weeks. With her PMI policy, Sarah gets a private MRI within a week, sees a consultant three days later, and has keyhole surgery scheduled for the following week, getting her back on her feet quickly. Her epilepsy is irrelevant to this new, acute knee problem.
2. Initial Diagnosis of Neurological Symptoms
This is a crucial nuance. If you take out a PMI policy before you have ever had a seizure or any related symptoms, the policy could cover the initial diagnostic process.
Example: David, 40, has a PMI policy. He unexpectedly has his first-ever seizure. His GP refers him to a neurologist. His PMI policy would likely cover:
- The initial private consultation with the neurologist.
- Diagnostic tests like an MRI scan and an EEG to find the cause.
- Follow-up consultations to discuss the results.
If these tests lead to a diagnosis of epilepsy (a chronic condition), the insurer's responsibility for that condition ends there. The ongoing management, medication, and future care for the epilepsy would then be passed to the NHS. However, the policy will have provided immense value by delivering a fast diagnosis, which can reduce anxiety and lead to quicker implementation of an NHS treatment plan.
3. Access to Valuable Added Benefits
Modern PMI policies are more than just hospital cover. They come packed with benefits that are available to all policyholders, regardless of their pre-existing conditions. For someone managing epilepsy, these can be particularly helpful:
- 24/7 Digital GP: Get a virtual GP appointment by phone or video call, often within hours. This is perfect for non-urgent advice, getting prescriptions, or discussing medication side effects without waiting for a local GP appointment.
- Mental Health Support: Living with a chronic condition can take a toll on mental health. Most policies now include access to a set number of counselling or therapy sessions, which can be accessed without a GP referral.
- Wellness and Health Support: Many insurers offer a wealth of resources, including:
- Discounts on gym memberships and fitness trackers.
- Nutritional advice and support.
- Health and wellbeing apps. As a WeCovr client, you get complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping you manage your diet effectively.
- Expert Second Opinion Services: If you have concerns about an NHS diagnosis or treatment plan (even for your epilepsy), some policies allow you to get a second opinion from a world-leading expert.
Comparing Top UK PMI Providers
While no standard provider will cover chronic epilepsy, they differ in their underwriting flexibility, added benefits, and overall value proposition. A specialist broker can compare the entire market, but here’s a look at some leading providers.
| Provider | Key Features & Benefits | Best For... |
|---|---|---|
| Bupa | Strong hospital network, comprehensive cancer cover, good digital GP service. Well-regarded and established brand. | Those seeking a trusted brand with a robust and extensive network of hospitals and specialists. |
| AXA Health | Flexible policy options, excellent mental health support (often a core benefit), strong focus on practitioner access. | Individuals prioritising mental wellbeing support and flexible cover that can be tailored to a budget. |
| Aviva | "Expert Select" hospital list can lower premiums, strong digital tools including the Aviva DigiCare+ app, good value for money. | Cost-conscious buyers who are happy with a slightly more guided choice of hospitals in return for lower premiums. |
| Vitality | Unique wellness programme that rewards healthy living with discounts and perks like cinema tickets and coffee. | Proactive and engaged individuals who want to be rewarded for staying active and managing their health. |
Navigating these options and their subtle differences is where an independent PMI broker like WeCovr provides a crucial service, ensuring you get the right policy for your needs and budget at no extra cost to you.
Lifestyle Management and Support for Living with Epilepsy
Managing epilepsy effectively often involves a holistic approach that goes beyond medication. A healthy lifestyle can play a significant role in reducing seizure frequency and improving overall quality of life.
1. Diet and Nutrition
While most people with epilepsy don't need a special diet, some evidence suggests certain dietary therapies can help, particularly for children with hard-to-control seizures.
- Ketogenic Diet: A strict high-fat, low-carbohydrate diet that should only be undertaken with medical supervision.
- General Healthy Eating: A balanced diet rich in vitamins and minerals supports overall brain health. Regular meal times are also important to avoid low blood sugar, which can be a seizure trigger for some.
2. The Importance of Sleep
Sleep deprivation is one of the most common seizure triggers.
- Consistent Schedule: Aim for 7-9 hours of quality sleep per night and try to go to bed and wake up at the same time every day, even on weekends.
- Sleep Hygiene: Create a relaxing bedtime routine. Avoid caffeine and screens before bed. Ensure your bedroom is dark, quiet, and cool.
3. Stress Management
Stress is another well-known seizure trigger. Finding effective ways to manage it is vital.
- Mindfulness and Meditation: Apps like Calm or Headspace can teach valuable techniques.
- Physical Activity: Gentle exercise like walking, swimming, or yoga can be a great stress reliever. Always consult your doctor before starting a new exercise regime.
- Support Groups: Connecting with others who have epilepsy can reduce feelings of isolation. Organisations like Epilepsy Action and the Epilepsy Society have local groups and online forums.
4. Travel and Epilepsy
You can travel the world with epilepsy, but it requires some planning.
- Medication: Carry more than enough medication for your trip in your hand luggage with a doctor's letter.
- Time Zones: Speak to your doctor about how to adjust your medication schedule when crossing time zones.
- Travel Insurance: Standard travel insurance may not cover epilepsy. You will need to declare it and may need a specialist policy. This is separate from PMI.
The Role of an Expert PMI Broker
Trying to find the right private health insurance policy when you have a pre-existing condition can feel overwhelming. This is where an independent broker adds immense value.
An expert broker like WeCovr:
- Understands the Market: We work with all the leading UK insurers and understand the subtle differences in their policies and underwriting philosophies.
- Provides Personalised Advice: We take the time to understand your health, your budget, and your priorities to recommend the most suitable options. We can explain the pros and cons of moratorium versus full medical underwriting for your specific situation.
- Saves You Money: Our expertise and relationships with insurers mean we can find the most competitive premiums. Furthermore, clients who purchase PMI or Life Insurance through us may be eligible for discounts on other types of cover.
- Offers the Service for Free: Our service is paid for by the insurer you choose, so you get expert, impartial advice at no cost.
- Builds Trust: We are authorised and regulated by the Financial Conduct Authority (FCA), and our high customer satisfaction ratings reflect our commitment to finding the best outcomes for our clients.
Do I need to declare my epilepsy when applying for private health insurance?
Can my private medical insurance be cancelled if I develop epilepsy after my policy starts?
Is it worth getting private health insurance if I already have epilepsy?
Can I get private health insurance for my child who has epilepsy?
Your Next Step
Navigating private medical insurance with a condition like epilepsy is complex, but you don't have to do it alone. The right policy can provide invaluable peace of mind and rapid access to care for many of life's other health challenges.
Contact WeCovr today for a free, no-obligation quote. Our expert advisors will help you understand your options and find a policy that provides the best possible value for you and your family.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.
