Private Health Insurance Pre-Existing Conditions What Gets Covered
Navigating the world of private medical insurance (PMI) in the UK can feel complex, especially when you have existing health concerns. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we believe in clarity. This guide demystifies how insurers treat pre-existing conditions, helping you find the right cover.
Navigating coverage for existing health conditions, moratorium periods, full medical underwriting options, and strategies for maximizing pre-existing condition coverage
One of the most common questions we hear is: "Will my private health insurance cover my pre-existing condition?"
The simple, direct answer is this: Standard UK private medical insurance is designed to cover new, acute medical conditions that arise after your policy begins. It does not typically cover pre-existing conditions or long-term, chronic illnesses that require ongoing management.
This might sound restrictive, but it’s the fundamental principle of how PMI works in the UK, complementing the brilliant care provided by our NHS. The NHS remains your primary provider for managing chronic conditions, handling emergencies, and treating any pre-existing issues. PMI is your key to accessing prompt private diagnosis and treatment for new eligible health problems.
In this guide, we'll break down everything you need to know, from how insurers define a pre-existing condition to the different ways they assess your health, so you can make an informed decision.
The Core Principle: Acute vs. Chronic Conditions
Understanding the difference between "acute" and "chronic" conditions is the first and most crucial step in grasping how private health insurance works. Insurers build their policies around this distinction.
Acute Conditions An acute condition is a disease, illness, or injury that is short-lived. It's likely to respond quickly to treatment, returning you to the state of health you were in before it started.
- Characteristics: Sudden onset, temporary, curable.
- Examples:
- Broken bones
- Appendicitis
- Hernias
- Cataracts
- Infections requiring hospitalisation
- Joint replacement (e.g., a new hip or knee)
Private medical insurance is built to cover the diagnosis and treatment of acute conditions.
Chronic Conditions A chronic condition is a health problem that is long-lasting, has no known cure, and needs continuous management.
- Characteristics: Persistent, long-term, requires ongoing monitoring or treatment.
- Examples:
- Diabetes
- Asthma
- Arthritis
- High blood pressure (hypertension)
- Crohn's disease
- Eczema or psoriasis
Private medical insurance does not cover the routine management of chronic conditions. Your GP and the NHS are your partners in managing these long-term illnesses. While some policies may offer limited cover for an acute flare-up of a chronic condition, the underlying condition itself remains excluded.
What Exactly Does "Pre-Existing Condition" Mean to an Insurer?
Insurers have a broad definition of a pre-existing condition. It isn't just about diagnosed illnesses. It generally includes any ailment or symptom for which you have:
- Sought medical advice from a GP or specialist.
- Experienced symptoms, whether you saw a doctor or not.
- Received treatment or medication.
This applies to a set period before your policy start date, which is typically the last five years.
Let's look at some examples:
| Scenario | Is it a Pre-Existing Condition? | Why? |
|---|---|---|
| You were diagnosed with asthma 10 years ago and use an inhaler daily. | Yes | You have a diagnosed chronic condition requiring ongoing treatment. |
| You had physiotherapy for a sore shoulder 3 years ago. | Yes | You sought advice and treatment for the condition. |
| You've had occasional knee pain for the last year but haven't seen a GP. | Yes | You have experienced symptoms, even without a formal diagnosis. |
| You were treated for a kidney infection 4 years ago and have been fine since. | Yes | You received treatment for the condition within the last 5 years. |
| You broke your arm 7 years ago, and it healed perfectly. | No | It happened more than 5 years ago and has not required further advice or treatment. |
The key takeaway is that insurers look at your recent medical history. Any health issue you've been aware of or had treated in the past few years will likely be considered pre-existing.
How Insurers Assess Your Health: The Two Underwriting Options
When you apply for private health cover, the insurer needs to understand your health status to determine what they can cover. This process is called "underwriting," and there are two main types in the UK: Moratorium Underwriting and Full Medical Underwriting (FMU).
1. Moratorium Underwriting: The "Wait and See" Approach
This is the most common and straightforward way to get a policy started.
- How it works: With a moratorium policy, you don't have to provide a full medical history upfront. Instead, the insurer applies a general exclusion for any condition you've had symptoms, advice, or treatment for in the five years before your policy began.
- The "Moratorium Period": The policy includes a waiting period, typically two continuous years. If you remain completely free of any symptoms, advice, medication, or treatment for a specific pre-existing condition during those first two years of your cover, that condition may become eligible for cover in the future.
- The "Clock" Can Reset: If you experience symptoms or seek advice for that condition during the two-year period, the "clock" resets, and a new two-year, trouble-free period would need to begin.
Real-Life Example: Sarah's Knee Pain Sarah took out a moratorium policy in January 2025. Two years prior, in 2023, she had seen her GP for knee pain. This knee pain is therefore a pre-existing condition and is automatically excluded from her cover.
- Scenario A: Sarah's knee is fine for two full years. In February 2027, she injures her knee playing tennis. Because she has passed the two-year moratorium period without any issues related to her knee, she can now make a claim, and the insurer will likely cover her treatment.
- Scenario B: In June 2026 (18 months into her policy), Sarah's old knee pain returns, and she visits a physiotherapist. This visit resets the clock. Her knee condition will now remain excluded until she completes a new two-year period with no symptoms, advice, or treatment for it.
2. Full Medical Underwriting (FMU): The "Upfront Clarity" Approach
This method involves a more detailed application process but provides complete certainty from day one.
- How it works: You complete a comprehensive health questionnaire, declaring your full medical history. The insurer's underwriting team assesses your information and may request further details from your GP (with your permission).
- The Outcome: Based on your history, the insurer provides you with a policy that clearly lists any specific conditions or body parts that will be permanently excluded from cover. These are called "personal exclusions."
- Certainty from Day One: You know exactly what is and isn't covered before you even pay your first premium. There are no grey areas or waiting periods for eligibility.
Real-Life Example: David's Shoulder Injury David is applying for a policy with FMU. He declares that he dislocated his left shoulder five years ago and had a recurrence two years ago. The insurer reviews his application and offers him a policy with a specific exclusion: "Any treatment related to the left shoulder joint." David accepts this. Six months later, he develops a new problem with his right elbow. This is fully covered because it's an unrelated, new condition, and he knows his policy will pay for it. He has complete peace of mind.
Comparison: Moratorium vs. Full Medical Underwriting
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple. No medical forms. | Longer. Requires a detailed health questionnaire. |
| Upfront Certainty | Low. You don't know what's covered until you claim. | High. Exclusions are clearly stated from the start. |
| Claim Process | Can be slower, as the insurer investigates your history at the point of claim. | Generally faster, as underwriting was done at the start. |
| Cover for Pre-Existing | Possible to gain cover after a 2-year trouble-free period. | Pre-existing conditions are usually excluded permanently. |
| Best For... | People with a clean bill of health or very minor past issues who want a quick start. | People who want absolute clarity on their cover, or have a complex history they wish to declare upfront. |
Working with an expert broker like WeCovr is invaluable here. We can explain the pros and cons of each option based on your personal health history and help you decide which path is right for you.
Strategies for Maximising Your Health Cover
Even with the rules around pre-existing conditions, you can take steps to get the most suitable and comprehensive cover possible.
1. Be Completely Honest The golden rule is to be 100% truthful, whether you choose a moratorium or FMU policy. Failing to disclose a condition (non-disclosure) is a serious issue. If an insurer discovers you withheld information, they have the right to cancel your policy, refuse your claim, and you will have wasted your premiums.
2. Choose the Right Underwriting for You
- If you had a minor condition many years ago (e.g., a single bout of physiotherapy for a sprain 4 years ago), a moratorium policy might be perfect. You're likely to pass the two-year period and gain cover for it.
- If you have a more significant history (e.g., a recurring back problem or a history of heart issues), FMU provides the certainty you need. You'll know upfront that your back is excluded, but you'll also know that a new, unrelated issue like a hernia will be covered without question.
3. Review Your Exclusions Periodically If you have an FMU policy with a specific exclusion, it doesn't always have to be for life. If you have been symptom-free for several years, you can ask the insurer to review the exclusion. They may agree to remove it, especially if your GP can provide a supporting letter.
4. Leverage Company Health Insurance If your employer offers a group private medical insurance scheme, the underwriting rules are often far more generous. Many company schemes cover pre-existing conditions, especially larger schemes with "Medical History Disregarded" (MHD) underwriting. If this is an option for you, it's often the best way to get cover for existing issues.
5. Talk to an Independent Broker This is perhaps the most important strategy. The private medical insurance UK market is vast, and every insurer has a slightly different appetite for risk and different underwriting philosophies. An independent, FCA-authorised broker like WeCovr works for you, not the insurer.
- We understand the nuances of each provider.
- We can advise which insurer is likely to offer the most favourable terms for your specific history.
- Our service is free to you, as we are paid by the insurer.
- We save you the time and stress of comparing complex policy documents.
Common Health Conditions and How Insurers Typically View Them
Here's a general guide to how insurers might approach some common conditions. This is for illustrative purposes only; the final decision always rests with the insurer's underwriting team.
| Condition | Typical Moratorium Approach | Typical Full Medical Underwriting (FMU) Approach |
|---|---|---|
| Mild, infrequent asthma | Excluded. Cover may be gained after 2 trouble-free years. | May be covered with a small premium loading, or may be excluded. |
| High Blood Pressure (Hypertension) | Excluded as a chronic condition. | Always excluded. Related conditions (heart, stroke) will also be excluded. |
| Anxiety or Depression (single past episode) | Excluded. Cover may be gained after 2 trouble-free years (no treatment/advice). | May be covered, but more likely to have a mental health exclusion applied. |
| Recurring Back Pain | Excluded. Gaining cover is difficult as even minor twinges can reset the 2-year clock. | A clear exclusion for the spine or a specific section of the spine will be applied. |
| Joint Pain (e.g., knee/hip) | Excluded if advice was sought in the last 5 years. | A specific exclusion for that joint will be applied. |
| Cancer (in remission for 5+ years) | May be covered under moratorium if no advice/treatment has occurred in the last 5 years. | Will be assessed on a case-by-case basis. An exclusion is likely but not guaranteed. |
Enhancing Your Health and Your Cover
While PMI focuses on treating new problems, the best strategy is always prevention. Leading a healthy lifestyle can reduce your risk of developing new conditions and can help you manage existing ones, potentially making you a more attractive applicant to insurers.
- Balanced Diet: Focus on whole foods, fruits, vegetables, and lean proteins. Good nutrition is the foundation of health.
- Regular Activity: Aim for at least 150 minutes of moderate-intensity exercise per week, as recommended by the NHS. This could be brisk walking, cycling, or swimming.
- Quality Sleep: Prioritise 7-9 hours of quality sleep per night. It's vital for physical and mental recovery.
- Stress Management: Techniques like mindfulness, yoga, or simply spending time in nature can have a powerful positive impact on your overall health.
To support our clients on their wellness journey, WeCovr provides complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app. Furthermore, clients who purchase private medical or life insurance through us are eligible for valuable discounts on other types of insurance cover we offer. It's part of our commitment to your holistic wellbeing.
Your NHS Safety Net
It is vital to remember that private medical insurance works in partnership with the National Health Service. The NHS is and will remain your safety net for:
- Accident & Emergency services.
- Management of all pre-existing and chronic conditions.
- Any condition that your PMI policy excludes.
With NHS waiting lists for elective treatment in England reaching 7.54 million in September 2023, according to NHS England data, a PMI policy gives you a valuable choice. It allows you to bypass these queues for eligible new conditions, giving you fast access to specialists, diagnostic scans, and private hospital treatment.
What happens if I forget to declare a pre-existing condition?
Is pregnancy considered a pre-existing condition?
Can I switch PMI providers if I have pre-existing conditions?
Why won't my PMI cover my diabetes?
Take the Next Step with Confidence
Understanding how private health insurance treats pre-existing conditions is the key to finding a policy that offers real value and peace of mind. While cover for existing issues is limited, PMI remains an incredibly powerful tool for accessing fast, high-quality healthcare for new problems that may arise.
The market is complex, but you don't have to navigate it alone. The team of experts at WeCovr has helped thousands of people just like you find the right cover. We compare policies from all the leading UK providers to find the best fit for your needs and budget. Our advice is independent, our service is highly-rated by customers, and it costs you nothing.
Ready to find out your options? Get your free, no-obligation quote today and let us help you secure your health and peace of mind.
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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