TL;DR
Navigating the world of private medical insurance (PMI) in the UK can feel complex, especially when you have a past or current health issue. At WeCovr, where we've helped arrange hundreds of thousands of policies, the most common question we hear is: "Can I get private health insurance that covers pre-existing conditions?" This guide provides a clear, realistic, and authoritative answer. What private health insurance that covers pre existing conditions may offer, and the common limitations to expect The straightforward answer is that standard UK private health insurance is designed to cover new, treatable (acute) conditions that arise after your policy begins.
Key takeaways
- The fundamental rules of UK PMI.
- What insurers define as a "pre-existing condition".
- The different ways insurers assess your health history (underwriting).
- The specific circumstances where a pre-existing condition might become eligible for cover.
- Practical steps and expert advice for getting the most suitable cover for your situation.
Navigating the world of private medical insurance (PMI) in the UK can feel complex, especially when you have a past or current health issue. At WeCovr, where we've helped arrange hundreds of thousands of policies, the most common question we hear is: "Can I get private health insurance that covers pre-existing conditions?" This guide provides a clear, realistic, and authoritative answer.
What private health insurance that covers pre existing conditions may offer, and the common limitations to expect
The straightforward answer is that standard UK private health insurance is designed to cover new, treatable (acute) conditions that arise after your policy begins. As a general rule, it does not cover conditions you had before you took out the policy, nor does it cover long-term, incurable (chronic) conditions.
However, the situation is more nuanced than a simple "no". Certain types of underwriting can allow for pre-existing conditions to be covered eventually, after a specific waiting period without symptoms or treatment. Understanding this distinction is the key to finding the right policy and avoiding disappointment when you need to make a claim.
This article will explore:
- The fundamental rules of UK PMI.
- What insurers define as a "pre-existing condition".
- The different ways insurers assess your health history (underwriting).
- The specific circumstances where a pre-existing condition might become eligible for cover.
- Practical steps and expert advice for getting the most suitable cover for your situation.
The Fundamental Rule of UK Private Medical Insurance
Before diving into pre-existing conditions, it's vital to grasp the core purpose of PMI in the United Kingdom.
Private medical insurance is for acute conditions, not chronic ones.
This is the single most important principle to understand.
- An Acute Condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, joint pain requiring a replacement, or appendicitis. PMI is designed to provide prompt diagnosis and treatment for these issues.
- 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 drugs or check-ups, it has no known cure, or it is likely to recur. Examples include diabetes, asthma, arthritis, high blood pressure, and most forms of eczema.
UK PMI does not cover the ongoing management of chronic conditions, regardless of whether they started before or after your policy began. The NHS remains the primary provider for chronic care management. An insurer might pay for the initial diagnosis of a chronic condition (e.g., tests to confirm you have Crohn's disease), but they would then pass your ongoing care back to the NHS.
Acute vs. Chronic Conditions at a Glance
| Feature | Acute Condition | Chronic Condition |
|---|---|---|
| Onset | Usually sudden | Can be gradual or sudden |
| Duration | Short-term | Long-term or lifelong |
| Outcome | Curable, leads to recovery | Incurable, requires management |
| PMI Cover | Yes (if it arises after policy start) | No (for ongoing management) |
| Examples | Broken bones, appendicitis, gallstones | Diabetes, asthma, hypertension |
What is a "Pre-Existing Condition" in Health Insurance?
Insurers have a broad and consistent definition of a pre-existing condition.
A pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, sought advice, or had treatment before the start date of your policy.
This applies whether you have a formal diagnosis or not. For example, if you experienced recurring back pain and mentioned it to your GP two years ago, but never had a scan or formal diagnosis, insurers will still class it as a pre-existing condition.
Common examples of pre-existing conditions:
- A knee injury you suffered playing football three years ago.
- Occasional migraines for which your GP prescribed medication.
- Anxiety or depression you received therapy or medication for.
- A skin condition like psoriasis that has flared up in the past.
- Tests or investigations for unexplained symptoms, even if they led to no diagnosis.
Insurers will typically look at your medical history from the five years immediately preceding your policy start date.
How Insurers Assess Pre--Existing Conditions: Underwriting Explained
"Underwriting" is the process an insurer uses to review your application, assess your health risk, and decide on the terms of your policy—specifically, what they will and won't cover. For personal PMI policies, there are two main types of underwriting.
1. Moratorium Underwriting
This is the most common type for new personal policies. It's often described as the "wait and see" approach.
- How it works: You do not need to fill out a detailed medical questionnaire when you apply. Instead, the policy automatically excludes any condition you have had symptoms, treatment, or advice for in the five years before the policy began.
- The "Two-Year Rule": A pre-existing condition may become eligible for cover if you serve a continuous two-year period after your policy start date during which you are completely free of symptoms, treatment, medication, or advice for that specific condition.
- At the Point of Claim: The insurer will investigate your medical history when you make a claim to see if it's related to a pre-existing condition.
Practical Scenario: Sarah and her Shoulder Pain Sarah takes out a policy with moratorium underwriting on 1st March 2026. She saw her GP for shoulder pain in 2024.
- This shoulder pain is a pre-existing condition and is excluded from cover.
- In 2027, her shoulder flares up again. She cannot claim for it, as she has not yet gone two full years without symptoms or advice. The two-year "clock" resets.
- If, however, she remains completely symptom-free until April 2028 (more than two years after her policy started), and the pain returns, she may now be able to claim for diagnosis and treatment, as she has satisfied the moratorium period.
| Moratorium Underwriting | |
|---|---|
| Pros | ✅ Fast application process, no upfront medical forms. ✅ Pre-existing conditions can become eligible for cover over time. |
| Cons | ❌ Lack of certainty; you only discover if a claim is valid when you make it. ❌ The two-year clock can reset easily. ❌ Unsuitable for those who want absolute clarity from day one. |
2. Full Medical Underwriting (FMU)
This is the "full disclosure" approach, offering complete transparency from the outset.
- How it works: You complete a detailed health questionnaire as part of your application, declaring your full medical history.
- The Insurer's Decision: The underwriting team reviews your information and may contact your GP for more details. They then issue your policy documents with a clear list of specific, named exclusions. These exclusions are often permanent.
- At the Point of Claim: The process is generally smoother, as the insurer already knows what is excluded. There are fewer surprises.
Practical Scenario: David and his Back Problems David applies for an FMU policy. He declares on his form that he had a slipped disc five years ago and occasionally gets back stiffness.
- The insurer assesses this and writes back, offering him a policy that "excludes any treatment related to the lumbar spine".
- David now knows with 100% certainty that he can never claim for his lower back problems on this policy.
- However, if he later develops an unrelated issue, like knee pain, he knows it will be covered (subject to his policy terms).
| Full Medical Underwriting (FMU) | |
|---|---|
| Pros | ✅ Complete clarity and certainty from day one. ✅ You know exactly what is and isn't covered. ✅ Smoother claims process for non-excluded conditions. |
| Cons | ❌ Slower, more intrusive application process. ❌ Exclusions are usually permanent and cannot be removed. ❌ You may be declined cover altogether if your history is complex. |
An expert broker, such as WeCovr, can help you decide which underwriting method is best for your personal circumstances and risk appetite.
Can a Pre-Existing Condition Ever Be Covered?
Yes, but only in specific circumstances. Here are the realistic pathways:
-
Satisfying a Moratorium Period: This is the most common route for individuals. If you have a policy with moratorium underwriting and go for two continuous years without any symptoms, treatment, or advice for a past condition, it may become eligible for cover. Crucially, this generally only applies to acute conditions. A chronic condition like asthma will almost certainly remain excluded even if you are symptom-free for two years, because its underlying nature is chronic.
-
Switching with Continued Personal Medical Exclusions (CPME): If you already have a PMI policy and want to switch to a new insurer, you can often do so on a "CPME" basis. This means the new insurer agrees to match the terms of your old policy, carrying over your existing exclusions without adding new ones. This is hugely valuable, as it protects cover you've already earned for conditions that developed while you were insured.
-
Joining a 'Medical History Disregarded' (MHD) Group Scheme: This is the "gold standard" for covering pre-existing conditions and is almost exclusively available through company health insurance schemes. On an MHD policy, the insurer agrees to cover eligible conditions regardless of your prior medical history. These policies are expensive and typically only available to larger businesses. If your employer offers one, it's a significant benefit.
Switching Health Insurance with a Pre-Existing Condition
This is a critical area where many people make costly mistakes. If you already have health insurance, you may have developed conditions while covered. These are not "pre-existing" relative to your original policy. But if you switch insurers incorrectly, they will become pre-existing.
The Golden Rule of Switching: Always aim to switch on a Continued Personal Medical Exclusions (CPME) basis.
Let's look at an example:
- Scenario: You bought a policy in 2023. In 2025, you develop gallstones and have them treated privately. In 2026, you want to switch to a cheaper insurer.
- Good Switch (CPME): You work with a broker like WeCovr to find an insurer offering CPME terms. Your new policy continues your cover seamlessly. If your gallstone issue recurs, you are still covered.
- Bad Switch (New Underwriting): You simply cancel your old policy and buy a new one on a moratorium basis. Your gallstones are now a "pre-existing condition" from 2025 and will be excluded by your new insurer for at least two years.
Expert Tip: Never cancel your existing policy until your new one is fully in force on a CPME basis. An independent broker is invaluable for managing this process, ensuring you don't lose precious cover.
A Practical Look: How Major UK Insurers Approach Pre-Existing Conditions
While the core principles are the same, each insurer has a slightly different approach. All the major providers below offer both Moratorium and Full Medical Underwriting, as well as options for CPME switching.
| Provider | Underwriting Options Offered | Typical Stance on Pre-Existing Conditions |
|---|---|---|
| Bupa | Moratorium, FMU, Switch (CPME) | Standard 5-year lookback with a 2-year rolling moratorium. A globally recognised brand with extensive experience. |
| Aviva | Moratorium, FMU, Switch (CPME) | Follows the standard 5-year/2-year moratorium rule. Known for clear policy documents and flexible cover options. |
| AXA Health | Moratorium, FMU, Switch (CPME) | Standard moratorium underwriting is common. Highly regarded for their customer service and comprehensive cancer care pledge. |
| Vitality | Moratorium, FMU, Switch (CPME) | Standard 5/2 moratorium rules apply. Unique for its wellness programme, which rewards healthy living. |
| The Exeter | Primarily FMU, some Moratorium | As a Friendly Society, they specialise in providing cover for those with some medical history, meaning they often favour the clarity of FMU from the start. |
Disclaimer: The exact terms depend on the specific policy chosen. This table is a general guide.
What Are Your Options if You Have Pre-Existing Conditions?
If you're looking for cover and have a medical history, don't be discouraged. You have several sensible options:
- Choose a Moratorium Policy: This is a great choice if you want cover for new, unforeseen medical issues and are happy to accept that your past conditions won't be covered, at least for the first two years.
- Opt for a Full Medical Underwriting Policy: If you value certainty above all else, an FMU policy will give you a black-and-white list of what's excluded. This can provide great peace of mind.
- Prioritise Employer Schemes: If you are changing jobs, a company's private medical insurance benefits—especially if it's an MHD scheme—can be more valuable than a small salary increase.
- Use PMI Alongside the NHS: Remember, PMI is not a replacement for the NHS. You can use your PMI for new, eligible conditions while relying on the NHS for any pre-existing or chronic issues. They are designed to work together.
- Speak to an Independent Broker: This is the most effective step. An expert advisor can assess your specific health history, explain the nuances of each insurer's rules, and compare the entire market to find the most suitable and cost-effective policy for you. This service is provided at no cost to you.
WeCovr's Expert Verdict on Covering Pre-Existing Conditions
For UK consumers buying a new personal policy, it is unrealistic to expect immediate cover for pre-existing conditions. The system is built to protect against future, unknown risks.
The most realistic path to gaining cover for a past acute condition is by taking out a moratorium policy and serving the two-year trouble-free period. For those with more complex histories who desire absolute clarity, Full Medical Underwriting is the superior choice.
The best possible outcome is to be part of a 'Medical History Disregarded' company scheme, which is a powerful employee benefit.
Ultimately, navigating this landscape requires professional guidance. At WeCovr, we demystify the jargon and provide transparent advice tailored to your personal situation. We'll help you find the right balance between cost, coverage, and peace of mind. Plus, our clients get complimentary access to our AI-powered nutrition app, CalorieHero, and can unlock discounts on other insurance products, adding even more value.
Don't let confusion stop you from securing the benefits of private healthcare.
Do I need to declare a condition if I haven't been officially diagnosed?
Is high blood pressure a pre-existing condition?
Can I get health insurance if I have cancer?
What's the difference between a pre-existing condition and a chronic condition?
How can a broker like WeCovr help me with pre-existing conditions?
Ready to explore your options with clarity and confidence? Contact our friendly team of experts at WeCovr for a free, no-obligation quote and personalised advice. Let us help you find the right protection for your health and wellbeing.
