Private Medical Insurance and Pre-Existing Conditions Whats Covered
Navigating private medical insurance in the UK can feel complex, especially concerning pre-existing conditions. As an FCA-authorised expert broker that has helped arrange over 800,000 policies, WeCovr is here to provide clarity. This guide demystifies how insurers treat past medical issues and what your options are.
The latest underwriting trends and moratorium policy options
Understanding how insurers assess your health is the single most important step in choosing the right private health cover. This process, known as underwriting, determines what is and isn't covered. The method you choose—or that is chosen for you—has significant long-term implications for your policy.
Let's break down the key concepts, starting with the most fundamental question.
What is a Pre-Existing Condition in UK Private Medical Insurance?
In the simplest terms, a pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, or sought advice or treatment before the start date of your policy.
This definition is broad and can include:
- A diagnosed condition like asthma or high blood pressure.
- A specific injury, such as a knee problem you saw a physiotherapist for two years ago.
- Symptoms you've discussed with a GP, even without a formal diagnosis (e.g., recurring headaches or back pain).
- Any medication prescribed or taken for a condition.
The core principle of private medical insurance in the UK is that it is designed to cover new, eligible, acute conditions that arise after you join. It is not designed to cover the ongoing management of long-term (chronic) conditions or issues that were already present.
The Crucial Difference: Acute vs. Chronic Conditions
Understanding this distinction is key to grasping what private medical insurance (PMI) will and will not cover.
| Condition Type | Description | Examples | PMI Cover? |
|---|---|---|---|
| Acute | A condition that is sudden in onset, short in duration, and is expected to respond quickly to treatment, leading to a full recovery. | Broken bones, appendicitis, hernias, cataracts, most infections. | Yes, this is what PMI is for. |
| Chronic | A condition that is long-lasting, has no known cure, and requires ongoing management or monitoring. | Diabetes, arthritis, asthma, Crohn's disease, high blood pressure. | No, ongoing management is not covered. |
Important Note: Even if you have a chronic condition, you can still get immense value from a PMI policy. The policy would not cover your chronic diabetes management, for example, but it would cover you for an unrelated acute condition like gallbladder removal, allowing you to bypass lengthy waiting lists. According to NHS England data, the median waiting time for consultant-led elective care was over 14 weeks in mid-2024, a figure that private cover helps you avoid.
How Insurers View Pre-Existing Conditions: The Underwriting Process
Underwriting is how an insurer assesses your medical history to determine the terms of your policy. In the UK, there are two main methods.
1. Moratorium Underwriting (The "Wait and See" Approach)
This is the most common type of underwriting for individual and small business policies because it's quick and simple to set up.
- How it works: You do not need to fill out a detailed medical questionnaire. Instead, the policy automatically excludes any medical conditions you have had in the five years prior to the policy start date.
- The Two-Year Rule: This exclusion is not necessarily permanent. A pre-existing condition may become eligible for cover if, after your policy starts, you go for a continuous two-year period without experiencing any symptoms, or seeking or receiving any treatment, tests, or advice for that specific condition. This is often called a "rolling moratorium."
- The Catch: When you make a claim, the insurer will investigate your medical history to see if the issue is new or pre-existing. This can sometimes slow down the claims process.
Example: Sarah and her Eczema
Sarah took out a policy with moratorium underwriting on 1st November 2025. She had used a cream for mild eczema in 2023.
- For the first two years of her policy (until 1st November 2027), any treatment for eczema is excluded.
- Sarah doesn't need any treatment or advice for her eczema during this time.
- In December 2027, she has a significant flare-up. Because she has completed the two-year symptom-free period, her insurer now agrees to cover the consultation with a private dermatologist.
Pros of Moratorium: ✅ Fast and easy application process. ✅ Less intrusive, no need for a long medical form. ✅ Conditions you had over five years ago are typically covered from day one. ✅ The possibility for recent conditions to become covered in the future.
Cons of Moratorium: ❌ Lack of certainty. You may not know if a condition is covered until you make a claim. ❌ Claims can take longer to process due to medical history checks. ❌ "Related conditions" can be a grey area, potentially leading to disputes.
2. Full Medical Underwriting (FMU) (The "Tell Us Everything" Approach)
With FMU, the insurer gathers all your medical information at the start to make a clear and final decision on cover.
- How it works: You complete a detailed health questionnaire as part of your application, declaring your full medical history. You may also need to give the insurer permission to contact your GP.
- The Decision: Based on your answers, the insurer decides what to cover. They will either accept a condition for cover, apply a temporary exclusion, or, more commonly, apply a permanent exclusion (known as an "endorsement") to your policy for that specific condition and any related ones.
- The Certainty: Your policy documents will clearly list any and all exclusions from the outset.
Example: David and his Back Pain
David has a history of lower back pain and has seen a chiropractor a few times in the past. He chooses Full Medical Underwriting.
- He declares this on his application form.
- The insurer writes to him confirming his policy is accepted but with an exclusion: "No cover will be provided for the investigation or treatment of lumbar spine conditions."
- Two years later, David develops shoulder pain. He claims for physiotherapy with confidence, knowing it's an unrelated condition and will be covered.
Pros of Full Medical Underwriting: ✅ Complete clarity and certainty from day one. You know exactly what is and isn't covered. ✅ Faster and smoother claims process, as the underwriting is already done. ✅ No ambiguity about "related conditions".
Cons of Full Medical Underwriting: ❌ Longer, more detailed application process. ❌ Exclusions are often permanent, with no chance of being reviewed. ❌ You must have a good recall of your medical history.
Which Underwriting is Right for You? A Comparison
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple, no health form. | Detailed health questionnaire required. |
| Initial Certainty | Low. Cover for past issues is uncertain. | High. Exclusions are stated clearly in your policy. |
| Claims Speed | Can be slower as insurer investigates your history. | Generally faster as underwriting is pre-approved. |
| Pre-Existing Conditions | Excluded for 2 years, then potentially covered if you remain symptom-free. | Usually excluded permanently via an endorsement. |
| Best For... | People with few or no recent medical issues, or those who value a quick start. | People who want absolute certainty, or have a complex medical history they wish to clarify upfront. |
An expert PMI broker, like the team at WeCovr, can walk you through the pros and cons based on your personal health history, helping you choose the path that offers the best protection and value for you.
Underwriting Trends for 2025: What's Changing in the UK Market?
The private medical insurance UK market is constantly evolving. Here are the key trends we are seeing in how insurers underwrite policies.
1. The Growth of Simplified Switching (CPME)
For the 7 million+ people in the UK with some form of private health cover, switching providers used to be a major headache. If you had developed and claimed for a condition with your old insurer, a new insurer would treat it as a pre-existing condition and exclude it.
Now, most major insurers offer Continued Personal Medical Exclusions (CPME) underwriting. This allows you to switch to a new provider on equivalent terms, carrying over the cover for conditions you've already had. It's a game-changer for ensuring a competitive market and is something a good broker can manage for you seamlessly.
2. Enhanced Mental Health Pathways
Insurers have recognised the growing need for mental health support. While pre-existing and chronic mental health conditions (like bipolar disorder or long-term depression) remain largely excluded from cover for treatment, many policies are now including:
- Generous cover for new mental health issues: Policies from leading providers often include cover for a set number of therapy sessions (e.g., CBT) or even in-patient psychiatric care for acute conditions that arise after joining.
- Enhanced support services: Most plans now include 24/7 access to mental health helplines, stress counselling sessions, and digital tools as standard, regardless of your underwriting.
3. The Rise of "Added Value" Benefits
PMI is no longer just about paying for surgery. Insurers are competing to be a holistic health partner. This means your policy is likely to include a suite of benefits designed to keep you healthy, such as:
- 24/7 Digital GP: Get a GP appointment via video call in hours, not days.
- Wellness Programmes: Discounts on gym memberships, fitness trackers, and healthy food.
- Health and Wellbeing Apps: Access to tools for mindfulness, nutrition, and fitness.
As a WeCovr client, you get complimentary access to our AI-powered nutrition app, CalorieHero, to help you manage your diet and achieve your health goals. We also offer discounts on other insurance products, such as life or income protection, when you purchase a PMI policy.
Living with Chronic Conditions: How PMI Can Still Be Your Safety Net
A common misconception is that if you have a chronic condition, PMI is not for you. This is incorrect. While your policy won't pay for the routine management of your diabetes, arthritis, or asthma, it provides an invaluable safety net for everything else.
Imagine you have well-managed high blood pressure (a chronic condition). One day, you develop severe abdominal pain and your GP suspects a hernia.
- Without PMI: You join the NHS waiting list. Latest data shows thousands wait over a year for certain procedures.
- With PMI: You use your Digital GP service for a quick referral. You see a private specialist within a week and have surgery scheduled for the following week at a time and hospital of your choice.
Your PMI policy works in parallel with the NHS, giving you control, speed, and choice when you are diagnosed with a new, acute condition, regardless of any chronic conditions you may already live with.
A Practical Wellness Tip
Managing a chronic condition effectively not only improves your quality of life but can also reduce the risk of developing new, acute complications. For example, individuals with diabetes can significantly lower their risk of related cardiovascular events through regular physical activity. Even 30 minutes of brisk walking, five days a week, can make a substantial difference. Combine this with a balanced diet—something our CalorieHero app can help you track—to maintain a healthy weight and support your overall wellbeing.
Making a Smart Choice: Your Step-by-Step Guide to Getting Covered
- Be Honest and Thorough: The single biggest mistake you can make is withholding information. Under the Consumer Insurance (Disclosure and Representations) Act 2012, you have a duty to take "reasonable care" to answer all questions accurately. Failing to do so can lead to a claim being rejected or even your entire policy being cancelled.
- Review Your Medical History: Before you apply, think back over the last five years. What have you seen a doctor or other medical professional for? What medication have you been prescribed? Having this information to hand makes the process much smoother.
- Decide on Your Underwriting Preference: Use our comparison table above. Do you value speed of application or long-term certainty? If you have had no medical issues at all in the last five years, a moratorium policy is often the quickest and easiest choice. If you have a few past problems, FMU can provide welcome clarity.
- Speak to an Independent Broker: This is the most important step. The UK PMI market is vast, with dozens of policies from providers like Bupa, AXA Health, Aviva, and Vitality. Each has different rules on underwriting, different hospital lists, and different benefits.
An independent, FCA-authorised broker like WeCovr works for you, not the insurer. Our service costs you nothing. We take the time to understand your needs and budget, compare the entire market, and recommend the policy that provides the best possible cover for you. Our high customer satisfaction ratings reflect our commitment to finding the right solution for every client.
Real-Life Scenarios: Underwriting in Action
| Scenario | The Situation | Underwriting Choice | The Outcome |
|---|---|---|---|
| Amelia, 28 | Fit and healthy, but had physiotherapy for a running-related ankle sprain 3 years ago. | Moratorium | Her ankle is excluded for the first 2 years. She remains symptom-free. After 2 years, her ankle becomes eligible for cover. A year later, she develops a new knee problem, which is covered immediately. |
| Ben, 52 | Has a history of gout and has taken medication for high cholesterol for several years. He wants no surprises. | Full Medical Underwriting (FMU) | He declares both conditions. The insurer applies permanent exclusions for "gout and hypercholesterolemia". Ben is happy with this, as he knows any other new, unrelated condition (like a future need for a cataract operation) will be covered without question. |
| Chloe, 45 | Has a PMI policy with Insurer A. She had a claim for sinus surgery two years ago. She sees a better deal with Insurer B. | Continued Personal Medical Exclusions (CPME) | Her broker, WeCovr, arranges a CPME switch. Insurer B takes her on, honouring the cover she had with Insurer A. This means any future sinus issues will still be covered, and she benefits from a lower premium. |
Do I need to declare symptoms I've had but haven't seen a doctor for?
What happens if I honestly forget to mention a minor condition?
Is pregnancy considered a pre-existing condition?
Can I get private health cover if I have cancer?
Choosing the right private health cover is one of the best investments you can make in your future wellbeing. While the rules around pre-existing conditions can seem strict, they are navigable with the right expert advice.
Take the next step today. Get a free, no-obligation quote from WeCovr and let our friendly experts compare the UK's leading insurers to find the perfect private medical insurance for you.
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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Who Are WeCovr?
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.
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