Login

UK Private Health Insurance Pre-Existing Conditions

UK Private Health Insurance Pre-Existing Conditions 2025

Secure Your Cover: How to Navigate UK Private Health Insurance with Pre-Existing Medical Conditions

UK Private Health Insurance Pre-Existing Conditions – Navigating Your Best Options

The UK's healthcare landscape is a dynamic one. While the National Health Service (NHS) remains a cornerstone, providing comprehensive care to all, increasing pressures often lead to longer waiting lists for appointments, diagnostics, and elective surgeries. This reality drives many individuals and families to consider Private Medical Insurance (PMI) as a way to gain quicker access to specialists, receive diagnoses promptly, and have more choice over their treatment facilities and consultants.

However, a significant hurdle for many considering private health insurance is the often-misunderstood concept of "pre-existing conditions". Will your past health issues prevent you from getting cover? If you have a long-term condition, can you still benefit from PMI? These are common and entirely valid questions.

This comprehensive guide is designed to demystify UK private health insurance concerning pre-existing medical conditions. We'll explore exactly what insurers mean by a pre-existing condition, the various underwriting methods that dictate how your past health affects your policy, and critically, what options remain available to you. Our aim is to provide you with the insights needed to navigate this complex area effectively, ensuring you make an informed decision about your health and financial future.

Understanding Pre-Existing Conditions in Private Health Insurance

One of the most crucial aspects of private health insurance in the UK is how insurers define and manage "pre-existing conditions". This single factor can profoundly impact what your policy will, or will not, cover.

What Exactly is a "Pre-Existing Condition"?

In the context of UK private health insurance, a pre-existing condition is broadly defined as:

  • Any disease, illness, or injury that you have already had signs or symptoms of, or for which you have received medication, advice, or treatment, or have consulted a doctor or other healthcare professional about.
  • This applies whether or not the condition has been formally diagnosed.
  • The key is that the event (symptoms, treatment, consultation, diagnosis) occurred before the start date of your new private health insurance policy.

It's vital to understand that this definition is retrospective. Even if you felt well at the time of application, any historical health issue that fits this description will be considered pre-existing.

Example: If you had recurring back pain two years ago and saw a physiotherapist, even if it cleared up and you feel fine now, that back pain would be considered a pre-existing condition. Similarly, if you take medication for high blood pressure, regardless of how well controlled it is, it's a pre-existing condition.

The Rationale: Why Insurers Exclude Pre-Existing Conditions

Insurers are in the business of managing risk. Private health insurance is designed to cover new, acute medical conditions that arise after you've taken out the policy. It's not designed to pay for ongoing treatment or investigations for conditions that already exist.

Here's why this exclusion is standard practice across the industry:

  1. Risk Management: If insurers covered pre-existing conditions, they would face unpredictable and potentially overwhelming costs. People would only purchase insurance once they knew they needed expensive treatment, leading to an unsustainable business model.
  2. Actuarial Science: Premiums are calculated based on the likelihood of a policyholder making a claim for a new illness. Covering existing conditions would drastically skew these calculations, making premiums unaffordable for everyone.
  3. Adverse Selection: Without these exclusions, there would be a strong incentive for individuals with chronic or known conditions to buy insurance solely to cover their existing health issues. This phenomenon, known as 'adverse selection', would drive up costs for all policyholders, as healthy individuals would drop out, leaving a pool of high-risk claimants.
  4. Maintaining Affordability: By focusing on new, acute conditions, insurers can keep premiums more accessible, making private health insurance a viable option for a wider range of people.

Crucially, this means that private medical insurance in the UK will not cover treatment for conditions considered pre-existing or conditions that are chronic in nature. This is a fundamental principle of all individual and small group private health insurance policies.

The Two Core Underwriting Approaches and Their Impact

Understanding how insurers assess your health history – known as 'underwriting' – is paramount when considering private health insurance. There are two primary methods used in the UK, and the choice between them significantly impacts how your pre-existing conditions are treated.

Overview of Underwriting: How Insurers Assess Risk

Underwriting is the process by which an insurer evaluates your health status and medical history to decide whether to offer you cover, what premium to charge, and what, if any, conditions will be excluded from your policy.

The two main methods are:

  1. Moratorium Underwriting (Mori)
  2. Full Medical Underwriting (FMU)

Let's delve into each.

1. Moratorium Underwriting (Mori)

Moratorium underwriting is the most common and often the simplest way to get private health insurance, especially for individual policies.

  • How it Works: When you apply for a policy under moratorium underwriting, you typically won't be asked detailed medical questions upfront. Instead, the insurer applies a 'moratorium' – a waiting period, usually 12 or 24 months (2 years) – during which your pre-existing conditions are automatically excluded.

  • The Crucial Caveat: The key aspect of moratorium is that any condition for which you have experienced symptoms, received treatment, or sought advice during a specified period (e.g., the last 5 years) before your policy starts will be excluded. This exclusion continues for the duration of the moratorium period.

  • When a Condition Might Become Covered: For a pre-existing condition to potentially become covered under a moratorium policy, you must go the entire moratorium period (e.g., 2 years) without experiencing any symptoms, receiving any treatment, or seeking any advice for that specific condition. If you manage this, the condition may then become eligible for cover for new, acute episodes that arise after the moratorium period has successfully passed.

    Example Scenario: Sarah had mild eczema 3 years ago but hasn't had any flare-ups or needed treatment for the last 2.5 years. She takes out a private health insurance policy with a 2-year moratorium.

    • Year 1: Sarah has no eczema symptoms.
    • Year 2: Sarah has no eczema symptoms.
    • After 2 years: Sarah's eczema condition could potentially become covered if it flares up again, as she has successfully completed the symptom-free moratorium period.
    • What if: If Sarah experienced eczema symptoms or sought treatment during the 2-year moratorium period, the condition would remain excluded, and the moratorium period for that specific condition would essentially reset, or the condition would remain permanently excluded.

Pros of Moratorium Underwriting:

  • Simplicity: No need to disclose extensive medical history upfront, making the application process much quicker and easier.
  • Immediate Cover for New Conditions: You get immediate cover for any new acute conditions that arise after your policy starts.

Cons of Moratorium Underwriting:

  • Uncertainty: You won't know for sure if a pre-existing condition will be covered until you try to make a claim, and the insurer investigates your medical history. This can be stressful.
  • Persistent Exclusions: Many pre-existing conditions (especially chronic ones or those that recur) will likely remain excluded indefinitely because it's difficult to go the full moratorium period without symptoms or treatment.
  • Risk of Misunderstanding: Policyholders might mistakenly believe their conditions will be covered after the moratorium, even if they've had ongoing symptoms.

2. Full Medical Underwriting (FMU)

Full Medical Underwriting involves a more detailed assessment of your health history at the point of application.

  • How it Works: When applying under FMU, you will complete a comprehensive medical questionnaire. This typically asks about your past and present health conditions, symptoms you've experienced, medications you're taking, and any consultations or treatments you've received. * Process: Based on the information provided, the insurer will review your medical history before offering you a policy. They will then notify you of their decision, which could include:

    • Offering cover with no exclusions.
    • Offering cover but with specific exclusions for certain pre-existing conditions (these exclusions will be clearly listed on your policy documents).
    • Offering cover with a 'loaded' premium (a higher cost) due to a perceived higher risk, often in conjunction with exclusions.
    • Declining to offer cover in rare, high-risk cases.

    Example Scenario: David takes medication for controlled high blood pressure and has had occasional mild asthma since childhood. He applies for a policy using FMU.

    • Application: David declares his high blood pressure medication and asthma history on the medical questionnaire.
    • Insurer Review: The insurer reviews this information, potentially requesting a GP report to understand the severity and stability of these conditions.
    • Policy Offer: The insurer might offer David a policy that specifically excludes any claims related to high blood pressure or asthma. This exclusion would be explicitly stated in his policy documents from day one. Any new acute condition would still be covered.

Pros of Full Medical Underwriting:

  • Certainty: You know exactly what is and isn't covered before your policy starts. This eliminates surprises at the point of claim.
  • Tailored Policy: The policy is underwritten specifically to your health profile.
  • Potentially Fewer Future Disputes: With clear upfront exclusions, there's less ambiguity during claims.

Cons of Full Medical Underwriting:

  • Time-Consuming: The application process takes longer due to the detailed medical questionnaire and potential need for GP reports.
  • Potential for More Exclusions: Conditions that might eventually be covered under moratorium (if you remain symptom-free) will be explicitly excluded from the outset under FMU.
  • Requires Full Disclosure: You must be completely honest and thorough in your medical disclosures, as non-disclosure could invalidate your policy.

Table: Moratorium vs. Full Medical Underwriting

FeatureMoratorium UnderwritingFull Medical Underwriting (FMU)
Medical QuestionsFew to none upfront.Detailed medical questionnaire. GP reports often required.
Initial Set-upQuick and easy.More time-consuming.
ExclusionsPre-existing conditions automatically excluded for a moratorium period (e.g., 2 years). Exclusions are not explicitly listed upfront.Specific pre-existing conditions explicitly excluded from day one. Clear policy wording.
CertaintyLow upfront certainty. Becomes clear only at point of claim or after moratorium period.High upfront certainty. You know what's covered/excluded before policy starts.
What Gets CoveredNew, acute conditions. Pre-existing may become covered after symptom-free moratorium period.New, acute conditions. Pre-existing are permanently excluded from the start.
Best ForGenerally healthy individuals with few/minor past issues, or those who prefer a simpler application.Individuals who want clear, upfront understanding of their cover, or those with more complex medical histories.

When a Condition Stops Being 'Pre-Existing' (or doesn't)

For a pre-existing condition to potentially become covered under a moratorium policy, it must typically meet the insurer's criteria for being 'symptom-free' for the duration of the moratorium period (e.g., 2 years). This means:

  • No symptoms of the condition.
  • No medication for the condition.
  • No consultations with a doctor or specialist for the condition.
  • No advice received for the condition.

Even after a moratorium period, some conditions, particularly those considered chronic, will remain permanently excluded.

Chronic vs. Acute Conditions: Private Medical Insurance is designed to cover acute conditions – illnesses, injuries, or diseases that respond quickly to treatment and are likely to return the policyholder to their original state of health. Examples include appendicitis, a broken bone, or a new cancer diagnosis (once the initial treatment is complete and if it's a new occurrence).

Chronic conditions, by definition, are ongoing, recurrent, or long-term. They typically require continuous management, cannot be cured, or are likely to recur. Examples include diabetes, asthma, arthritis, long-term mental health conditions, and most heart conditions. Even if a chronic condition develops after your policy starts, it will generally not be covered by PMI. This is a fundamental exclusion across almost all policies.

So, while a past acute condition (like a one-off bout of sciatica that fully resolved) might eventually be covered under moratorium, a truly chronic condition (like Type 2 diabetes) will almost certainly remain excluded, whether it's pre-existing or develops later.

Get Tailored Quote

The way pre-existing conditions are treated can vary significantly depending on the specific condition and the underwriting method chosen. Let's look at some common examples.

Common Examples: How Conditions are Typically Treated

It’s crucial to remember that each insurer will have its own specific wording and interpretation, and your individual circumstances (severity, duration, last treatment date) will always play a role. However, here are some general guidelines:

Condition CategoryExample ConditionsTypical Treatment Under PMI (Individual Policies)
Well-Controlled, CommonHigh Blood Pressure, High Cholesterol (on medication), Mild Hypothyroidism (on medication).Almost always considered pre-existing and usually permanently excluded under FMU. Under Moratorium, highly likely to remain excluded as medication is ongoing.
Musculoskeletal IssuesBack pain, knee problems, sciatica, frozen shoulder (resolved or intermittent).Often excluded if pre-existing. Under Moratorium, could potentially be covered if completely symptom/treatment-free for 2 years. Under FMU, usually excluded.
Allergies & AsthmaHay fever (requiring medication), mild asthma.Often excluded if pre-existing and requiring ongoing medication or treatment. Under Moratorium, might be covered if symptom-free for 2 years (rare for ongoing conditions).
Mental Health ConditionsAnxiety, Depression (past episodes or ongoing medication).Often excluded if pre-existing, particularly if ongoing or requiring medication/counselling. Under Moratorium, very difficult to become covered due to recurrence.
Chronic DiseasesType 1 or Type 2 Diabetes, Crohn's Disease, Rheumatoid Arthritis, Epilepsy.Considered chronic conditions. Universally excluded if pre-existing. Will also be excluded even if developed after policy starts, as PMI does not cover chronic care.
Minor, Resolved IssuesOne-off bout of tonsillitis (resolved), minor sports injury (fully recovered).Under Moratorium, usually covered after the initial waiting period (often 3 months) if no further symptoms/treatment within the 2-year moratorium. Under FMU, often covered if fully resolved and minor.

The Importance of Full Disclosure

Regardless of the underwriting method, honesty and full disclosure are paramount. When applying for health insurance, you are legally required to answer all questions truthfully and to the best of your knowledge.

  • For FMU: If you fail to disclose a relevant medical history, your policy could be invalidated at the point of claim. This means the insurer could refuse to pay for treatment, and you could be left with significant medical bills.
  • For Moratorium: While you don't answer detailed questions upfront, the insurer will thoroughly investigate your medical history (via GP reports) if you make a claim. If it transpires that the condition was pre-existing and should have been excluded, your claim will be denied.

It's always better to be upfront, even if you think a condition is minor or irrelevant. Let the insurer decide.

Switching Insurers with Pre-Existing Conditions

If you already have private health insurance and are considering switching providers, the treatment of your pre-existing conditions can be complex.

  • Continued Medical Exclusions (CME): Many insurers offer 'Continued Medical Exclusions' (CME) or 'No Claims Underwriting' when you switch from another UK insurer without a break in cover. Under CME, your new policy will generally exclude any conditions that were excluded on your previous policy (whether explicitly or due to a moratorium period). This means you don't have to go through a new underwriting process for those existing exclusions.
  • New Moratorium Period: If you don't opt for CME (or if your previous insurer's underwriting doesn't qualify), or if there's a break in cover, your new insurer will likely treat you as a new applicant. This means you might have to go through a new moratorium period or FMU, potentially re-excluding conditions that were starting to become covered under your old policy.

Advice: Always consult with a broker like WeCovr when considering switching insurers. We can help you understand the implications for your existing conditions and ensure continuity of cover where possible.

Group Schemes vs. Individual Policies – A Different Landscape

While individual private health insurance policies are very strict on pre-existing conditions, group health insurance schemes (often provided by employers) can offer a more lenient approach.

Company Health Insurance: Medical History Disregarded (MHD)

Many company health insurance schemes, particularly for larger employers, are offered on a Medical History Disregarded (MHD) basis.

  • How it Works: With MHD, employees do not need to disclose their past medical history, and critically, pre-existing conditions are covered from day one, subject to the policy's overall terms and conditions.
  • Why Companies Offer This:
    • Employee Benefit: It's a highly attractive benefit that enhances recruitment and retention.
    • Simplicity: It removes the complexity of individual underwriting for each employee.
    • Risk Spreading: For large groups, the risk of covering pre-existing conditions is spread across a large number of employees, making it actuarially viable for the insurer.
    • Cost-Effective: Group policies are often more cost-effective per person than individual policies.

This is a significant advantage for individuals who have pre-existing conditions, as it provides a level of cover that would be almost impossible to obtain through an individual policy. However, chronic conditions, even under MHD, are still often subject to limitations or exclusions once they become long-term or ongoing.

Implications of Leaving a Group Scheme

A common concern arises when an individual leaves an employer that provided an MHD scheme.

  • Loss of MHD Cover: When you leave the company, you typically lose access to the group scheme's MHD benefits.
  • Switching to Individual Policy: If you wish to continue with private health insurance, you will need to take out an individual policy. At this point, you will face standard individual underwriting (Moratorium or FMU). Any conditions that were covered under your old MHD scheme but are now considered pre-existing (because you had them before the new individual policy starts) will likely be excluded from your new individual policy.
  • "Switch" Options: Some insurers offer a "continuation option" where you can transition from a group scheme to an individual policy with some underwriting concessions, but these are rarely as generous as the original MHD terms. You will almost certainly face exclusions for your pre-existing conditions that were covered under the group scheme.

Therefore, if you have a known pre-existing condition and are considering leaving an employer with an MHD scheme, it's crucial to understand that your private health insurance coverage for that condition will likely change dramatically.

What Private Health Insurance Does Cover (Despite Pre-Existing Exclusions)

Despite the strict rules around pre-existing and chronic conditions, private health insurance remains a highly valuable investment for many. It offers peace of mind and tangible benefits for the vast majority of health issues that arise after your policy has begun.

PMI primarily covers new, acute medical conditions – those that are sudden in onset, respond to treatment, and are likely to return you to your previous state of health.

Here's what a typical private health insurance policy does generally cover:

  • Diagnostic Tests and Scans: Quicker access to necessary scans like MRI, CT, X-rays, and other diagnostic tests, often avoiding long NHS waiting lists.
  • Consultant Fees: Appointments with specialists and consultants to get a diagnosis and treatment plan.
  • In-patient and Day-patient Treatment: Costs for hospital stays, including surgery, anaesthetist fees, and nursing care in a private hospital.
  • Out-patient Treatment: Follow-up appointments, chemotherapy, radiotherapy (for new cancer diagnoses), physiotherapy, and other treatments administered without an overnight stay.
  • Cancer Treatment: Comprehensive cover for new cancer diagnoses, including diagnosis, surgery, chemotherapy, radiotherapy, and biological therapies. This is often a significant motivation for purchasing PMI.
  • Hospital Choice: The ability to choose a private hospital and consultant that suits your preferences, offering greater comfort and flexibility.
  • Private Rooms: Enjoying a private room with en-suite facilities during hospital stays.
  • Reduced Waiting Times: A major advantage, allowing quicker access to diagnosis and treatment compared to NHS waiting lists.
  • Some Mental Health Support: Many policies now include some level of cover for acute mental health conditions (e.g., short-term counselling, psychiatric consultations), provided they are new and not pre-existing/chronic.
  • Post-Operative Care: Including rehabilitation and follow-up care as part of the overall treatment plan for a covered condition.

Why PMI is Still a Valuable Investment:

Even with pre-existing exclusions, the value proposition of PMI lies in its ability to provide rapid access to high-quality care for unforeseen health issues. Nobody can predict when a new illness or injury might occur. Having PMI means that should you develop, say, appendicitis, require a new hip replacement, or be diagnosed with a new form of cancer, you can potentially bypass NHS waiting lists, choose your specialist, and receive treatment in a private facility at a time that suits you. For many, this offers invaluable peace of mind and reduces the potential impact of health issues on their personal and professional lives.

Alternatives and Supplementary Options for Pre-Existing Conditions

If you have significant pre-existing or chronic conditions, or if private health insurance doesn't seem like the right fit for your circumstances, it's important to be aware of other avenues for managing your health.

1. The National Health Service (NHS)

The NHS remains the primary provider of healthcare for everyone in the UK, regardless of their health history.

  • Comprehensive Care: The NHS provides free at the point of use care for all conditions, including pre-existing and chronic illnesses. This includes GP services, hospital care, emergency treatment, and ongoing management of long-term conditions.
  • Reliability: It's the safety net that ensures everyone can access necessary medical attention.
  • Challenges: The main challenges with the NHS often relate to waiting times for non-emergency appointments, specialist consultations, diagnostic tests, and elective surgeries, particularly in times of high demand.

For many, particularly those with complex pre-existing conditions, the NHS will continue to be their main point of contact for healthcare. Private health insurance is designed to supplement the NHS, not replace it.

2. Self-Pay for Private Treatment

If you need quicker access to a specific specialist or diagnostic test, and you don't have PMI (or your condition is excluded by your policy), you can choose to self-pay for private treatment.

  • Process: You can directly book private appointments with consultants, diagnostic tests (e.g., MRI, blood tests), or even operations.
  • Costs: This option can be very expensive. A single private consultation might cost £150-£300, an MRI scan £400-£1,000+, and a private operation several thousands to tens of thousands of pounds.
  • Benefits: You get immediate access and choice of consultant.
  • When it's Viable: This is often a good option for a one-off consultation or a specific diagnostic test, especially if you need a quick answer or a second opinion. It's generally not sustainable for ongoing or complex treatment.

3. Health Cash Plans

It's vital not to confuse health cash plans with Private Medical Insurance. They serve entirely different purposes.

  • How They Work: Health cash plans are designed to help you budget for and reclaim money spent on routine, everyday healthcare costs. You pay a monthly premium, and in return, the plan reimburses you for a portion of the costs of things like:
    • Dental check-ups and treatment
    • Eye tests and optical wear
    • Physiotherapy, osteopathy, chiropractic treatment
    • Podiatry
    • Acupuncture, reflexology, aromatherapy (depending on plan)
    • Consultations (sometimes, up to a certain limit)
  • Pre-Existing Conditions: Many health cash plans do not exclude pre-existing conditions for these routine benefits. So, if you have chronic back pain, you could claim back costs for ongoing physiotherapy sessions (up to your annual limit).
  • Limitations: They do not cover major medical events, surgery, hospital stays, or specialist consultations for complex conditions in the way PMI does. They are essentially a budgeting tool for routine costs.
  • Complementary: A health cash plan can be a great complement to PMI, covering the smaller, everyday health costs that PMI doesn't, and often offering benefits for pre-existing conditions that PMI would exclude.

4. Critical Illness Cover

Critical illness cover is an insurance policy that pays out a tax-free lump sum if you are diagnosed with a specific serious illness (e.g., certain types of cancer, heart attack, stroke, multiple sclerosis) defined in the policy terms.

  • Purpose: It's not designed to pay for your medical treatment. Instead, the lump sum can be used for anything you wish – to cover lost income, adapt your home, pay off a mortgage, or fund private medical treatment if you choose.
  • Pre-Existing Conditions: Pre-existing conditions are typically excluded from critical illness cover at the point of application.
  • Distinction: This is a life insurance product, not a health insurance product. It offers financial security in the event of a severe illness, but it doesn't cover the ongoing costs of your medical care.

Considering these alternatives and supplementary options can provide a more holistic approach to managing your healthcare needs, especially when private medical insurance has limitations regarding pre-existing conditions.

The Indispensable Role of a Specialist Health Insurance Broker (WeCovr)

Navigating the intricacies of UK private health insurance, especially when pre-existing conditions are a factor, can feel overwhelming. The market is saturated with options from numerous providers, each with different policy terms, exclusions, and underwriting approaches. This is where a specialist health insurance broker like WeCovr becomes an invaluable partner.

Why You Need Expert Guidance

Trying to understand the subtle differences between moratorium and full medical underwriting, deciphering complex policy wordings, and comparing multiple insurers' definitions of "pre-existing" on your own can be a daunting task. Without expert knowledge, you risk:

  • Choosing the Wrong Underwriting: Opting for a moratorium when FMU would provide clearer exclusions, or vice versa, leading to surprises at claim time.
  • Missing Out on the Best Value: Not knowing which insurer offers the most suitable cover for your specific needs at the most competitive price.
  • Misunderstanding Exclusions: Believing a condition might be covered when it isn't, or vice-versa.
  • Non-Disclosure Issues: Accidentally failing to disclose something that could invalidate your policy later.

How WeCovr Helps You

At WeCovr, we pride ourselves on being modern, expert UK health insurance brokers dedicated to simplifying this complex process for you. Here’s how we can help:

  • Impartial, Tailored Advice: We take the time to understand your unique medical history, your current health concerns, and your future healthcare priorities. We then provide impartial advice on the best underwriting method for your situation. Do you have a history of intermittent back pain that has now fully resolved? We can guide you on whether moratorium or FMU offers the best chance of future cover, or at least the most clarity.
  • Comprehensive Market Scan: We have access to policies from all major UK health insurers, including AXA Health, Bupa, Vitality, Aviva, WPA, National Friendly, and more. This means we can compare a wide range of options, ensuring you don't miss out on a policy that might be perfectly suited to your needs and budget.
  • Underwriting Expertise: Our deep understanding of each insurer's underwriting rules and practices allows us to explain precisely how your pre-existing conditions will be treated. We can pre-empt potential issues and help you navigate the application process smoothly.
  • Simplifying the Process: From filling out applications to liaising with insurers, we handle the administrative burden. Should you need to make a claim, we can also provide support and guidance throughout the process.
  • Unbiased Comparisons: We provide transparent comparisons of different policies, highlighting key benefits, exclusions, excesses, and costs, so you can make an informed decision with all the facts at hand.
  • Our Service is Free to You: Crucially, our expert advice and support come at no direct cost to you. We are remunerated by the insurer if you take out a policy through us, meaning our priority is always to find the best policy for your needs, not just any policy.

By engaging with us at WeCovr, you gain a knowledgeable advocate who can cut through the complexity of pre-existing conditions, ensuring you find the most suitable and cost-effective private health insurance coverage available, empowering you to make the best decision for your health.

Making Your Best Decision: A Step-by-Step Guide

Choosing the right private health insurance, especially with pre-existing conditions, requires a thoughtful and systematic approach. Here's a step-by-step guide to help you navigate the process.

1. Assess Your Healthcare Needs and Priorities

  • What are your primary motivations for getting PMI? Is it quicker access to diagnostics, choice of consultant, or avoiding NHS waiting lists?
  • Do you have any specific health concerns that are not pre-existing? This helps determine the value proposition.
  • What's your budget? Premiums vary widely based on cover level, excess, and age.

2. Review Your Medical History Thoroughly

  • Be honest and comprehensive. List all conditions, symptoms, consultations, treatments, and medications from your past, even if they seem minor or long resolved. Note down dates.
  • Consider anything you've seen a GP for in the last 5-10 years.
  • This review is crucial regardless of whether you opt for moratorium or full medical underwriting. The more detailed you are, the better the advice you can receive.

3. Understand Your Underwriting Options

  • Moratorium (Mori): Simpler application, but uncertainty regarding past conditions. Best if you have very few or very minor historical issues, and you're confident you can remain symptom-free for the moratorium period.
  • Full Medical Underwriting (FMU): More upfront work, but clear exclusions from day one. Best if you want certainty, or if you have a more complex medical history and want to understand upfront what will be excluded.
  • Weigh the pros and cons of each based on your medical history and preference for certainty.

4. Compare Insurers and Policies

  • Don't just look at price. Compare the level of cover, excesses, and any specific benefits (e.g., mental health, therapies, cancer care).
  • Look at their definitions of 'pre-existing' and their specific underwriting rules for your known conditions. This can be challenging without expert help.
  • Consider customer service and claims reputation.

5. Consider Group Schemes (if applicable)

  • If your employer offers a health insurance scheme, especially one on an MHD basis, this is often the most advantageous route if you have pre-existing conditions. Understand what happens if you leave the company.

6. Seek Expert Advice from a Broker Like WeCovr

  • This step cannot be over-emphasised. An independent broker like WeCovr can:
    • Analyse your medical history and recommend the most suitable underwriting approach.
    • Compare policies from all major UK insurers to find the best fit.
    • Explain precisely how your specific pre-existing conditions will be treated by different insurers.
    • Handle the application process and provide ongoing support.
    • All at no cost to you.

Table: Private Health Insurance Decision Checklist

QuestionYour Answer / Consideration
What are my primary motivations for PMI?(e.g., faster access, specific treatments, peace of mind)
What is my full medical history?(List all conditions, dates, treatments – be thorough)
Do I prefer upfront certainty (FMU) or simpler application with potential later exclusions (Moratorium)?
What is my budget for monthly/annual premiums?
Does my employer offer a group scheme (MHD)?(If yes, explore this first)
What level of cover do I need?(e.g., comprehensive, basic, outpatient limits)
What excess am I comfortable paying?(Higher excess lowers premiums)
Have I sought advice from an independent broker (WeCovr)?(Crucial for navigating complexity and comparing options)

By following these steps, you can confidently navigate the world of UK private health insurance and make a decision that best supports your current and future health needs.

Conclusion

Understanding how private health insurance in the UK handles pre-existing conditions is undeniably complex, but it doesn't have to be a barrier to securing valuable cover. While it's a fundamental principle that private medical insurance is designed to cover new, acute medical conditions rather than existing or chronic ones, the various underwriting options available mean that the impact of your past health can be managed.

Whether you choose the simplicity of moratorium underwriting with its period of observation, or the upfront certainty of full medical underwriting, knowing the implications for your medical history is key. Remember, conditions that are genuinely chronic will remain largely outside the scope of individual private health insurance, but that doesn't diminish the significant benefits it offers for unforeseen health challenges.

Private Medical Insurance can provide invaluable peace of mind, offering quicker access to diagnostics, specialist consultations, and treatment for new illnesses and injuries, helping you navigate the healthcare system with greater speed and choice.

Don't let the complexity deter you. By meticulously assessing your medical history, understanding the different underwriting processes, and most importantly, leveraging the expertise of an independent broker like WeCovr, you can confidently find a policy that aligns with your specific needs and provides the best possible healthcare solutions for your future. Your health is your wealth, and making an informed decision about its protection is always a worthwhile investment.


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!

There is no need to wait until the renewal of your current policy.
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:

Our Group Is Proud To Have Issued 800,000+ Policies!

We've established collaboration agreements with leading insurance groups to create tailored coverage
Working with leading UK insurers
Allianz Logo
Ageas Logo
Covea Logo
AIG Logo
Zurich Logo
BUPA Logo
Aviva Logo
Axa Logo
Vitality Logo
Exeter Logo
WPA Logo
National Friendly Logo
General & Medical Logo
Legal & General Logo
ARAG Logo
Scottish Widows Logo
Metlife Logo
HSBC Logo
Guardian Logo
Royal London Logo
Cigna Logo
NIG Logo
CanadaLife Logo
TMHCC Logo

How It Works

1. Complete a brief form
Complete a brief form
2. Our experts analyse your information and find you best quotes
Experts discuss your quotes
3. Enjoy your protection!
Enjoy your protection

Any questions?

Life Insurance and Private Medical Insurance cover you for two different purposes, so you will need to assess your needs but may wish to consider holding the two policies. Private Medical Insurance covers you if you get sick or need treatment and want or need to go privately. Life Insurance covers you in the case of death, giving a payout to family/those left behind.

Health insurance covers conditions that develop after your policy starts. Pre-existing conditions are typically not covered, and insurers may exclude related issues. Some policies may cover symptoms of pre-existing conditions under specific circumstances. Always review your policy's exclusions. Coverage for pre-existing medical conditions may be available if you currently hold a medical insurance policy or are transitioning from a company scheme. However, if you have never had medical insurance before or if your policy is not active at the moment, pre-existing conditions will not be covered. This limitation exists because health insurance is primarily intended to protect against unexpected health issues. To simplify, it's akin to getting into a car accident and then trying to obtain insurance coverage afterward to repair the vehicle — insurance companies typically do not cover such claims. Nevertheless, there is an option to gain coverage for pre-existing conditions after a two-year waiting period, subject to specific rules and conditions.

If you prefer to get straight into treatment in the private sector without the long waiting times with the NHS, or you just prefer the private sector anyway, without having to pay it all yourself, then you would need to have Private Medical Insurance to cover it. Sometimes treatments and drugs that are not covered by the NHS can be covered by Private Medical Insurance.

It's free to use WeCovr to find health insurance - we never charge you for quotes. Health or private medical insurance is an investment that can pay for itself the first time you might need medical treatment.

It depends on your personal choice and preferences. If you are prepared to limit yourself to NHS-covered treatments only and can or want to endure long waiting times to get into treatment, then yes, NHS might work for you. Your cover there is free. If you don't want to be exposed to long waiting times or if your treatment is not covered by the NHS, then you would benefit from Private Medical Insurance.

Private Medical Insurance is an important financial product that insurance companies take a lot of care and diligence so speaking to real human beings ensures that they understand your requirements fully so that you can get the right cover.

All of our partners are carefully vetted and authorised by the FCA, which means they are held to the highest standards that the FCA expects from them and treat all customers fairly!

Our revenue comes from commissions paid by the insurance providers when a policy is taken out through us. Essentially, when you choose to secure a policy from one of the providers we work with, they compensate us for facilitating the transaction. It's important to note that this commission does not impact the premium you pay. We remain committed to providing transparent and unbiased quotes to help you find the best insurance options tailored to your needs.

The cost of private health insurance depends on several factors, including your age, location, smoking status, and the type of policy you choose. Your health insurance policy is tailored to your needs, and the cost can vary based on the level of cover you require, such as the amount of excess and specific treatment allowances.

Private health insurance covers you for conditions that arise after your policy begins. You pay a monthly fee and can make claims for private healthcare covered by your policy. One of the main benefits of private healthcare is quicker access to treatment compared to the NHS, along with access to new drugs or specialist treatments.

Most health insurance covers private hospital stays and may include outpatient treatments like scans, tests, or appointments. Policies vary in coverage, and exclusions often include emergency treatment, maternity care, cosmetic surgery, and ongoing conditions present before the policy started.

Unfortunately, you cannot pay extra to have a pre-existing condition covered as part of your health insurance policy. However, you have access to support from a nurse or digital GP. If you have questions about what is covered under your policy, please contact us for clarification.

Your health insurance policy begins once you've selected your policy and set up your payment. After setup, you'll receive your cover documents detailing what is and isn't covered. It's important to review these details carefully as policies differ.

An excess is the amount you contribute towards treatment when you make a claim. Choosing a higher excess can reduce your policy's monthly cost but requires a larger contribution when claiming. WeCovr's experts will offer you flexible excess options depending on your preferences.

To reduce health insurance costs, consider choosing a higher excess, which lowers the monthly premium. However, ensure the plan still meets your needs. Other factors affecting cost include lifestyle choices like smoking and potential savings for couples or family plans.

There is no age limit for taking out health insurance, but age influences the policy's cost. The benefits of health insurance are consistent regardless of age. If you're considering health insurance, you can get a quote from WeCovr's experts regardless of your age.

Let WeCovr's experts do the legwork for you and compare health insurance plans at no cost to you to find the best fit for your needs. Consider individual, couple, or family plans and review coverage details thoroughly before choosing. WeCovr provides transparent information on coverage options for easy comparison.

Yes, you can add your partner (if you live at the same address) or dependents to your policy at any time. The cost of couple's or family health insurance depends on factors like location, age, health, and chosen excess. Contact WeCovr or your insurer for assistance in adding someone to your policy.

While WeCovr's private health insurance plans are tailored for the UK, we offer global health insurance options for those living or working abroad. For holiday coverage, travel insurance is recommended.

Comprehensive cover provides extensive benefits, including full outpatient services such as consultations, diagnostic tests, physiotherapy, and mental health therapies. Our team at WeCovr can assist in understanding the various coverage levels available.

Private health insurance typically does not cover dental treatment. However, WeCovr's experts can guide you to dental insurance policies offered by our partner insurers. Reach out to us to explore these options.

Yes, private health insurance covers cancer treatment from diagnosis through treatment. At WeCovr, we can help you navigate the cancer cover options that suit your needs.

At WeCovr, you have flexibility in adjusting your cover. Speak to our experts within 21 days of receiving your paperwork or at policy renewal to make changes.

Accessing a private GP appointment is fast and convenient with WeCovr's services, available through your digital platform provided under your chosen insurance plan.

Yes, family members on the same policy can potentially have different levels of cover tailored to their individual needs.

WeCovr works with insurers offering a range of cover levels to accommodate different budgets and needs. Our experts can discuss these options with you.

Discovering healthcare facilities and specialists is easy with WeCovr's resources. Contact us for personalised assistance by tapping one of the buttons above or below and filling in a few details for personalised assistance.

Fee-assured consultants provides transparency and no hidden costs for clients.

WeCovr prioritises mental health support with comprehensive coverage and access to specialist advice and services.

Children up to a certain age can be included in your policy, and we offer discounts for family coverage.

Like most health insurance plans, premiums may increase annually due to factors such as age and medical cost inflation.

The cost of health insurance varies based on several factors. Connect with our experts by tapping a button below and get your own personalised quote.

Private health insurance offers quicker access to consultations, treatments, and personalised care compared to the NHS.

Yes, WeCovr's experts can guide you which health insurance plans include coverage for physiotherapy treatments.

Immediate access to certain services like our digital GP app is available upon enrolment.

You can obtain a range of suitable quotes easily by tapping one of the buttons above or below and filling in a few details for personalised assistance.

Health insurance covers new conditions that arise after the policy starts. Pre-existing conditions and certain exclusions may apply.

WeCovr's experts help you arrange health insurance that simplifies access to private healthcare services, including consultations and treatments.

Outpatient cover includes consultations, physiotherapy, and mental health therapies outside hospital admissions.

Yes, you can use your health insurance cover immediately. You have access to a nurse through your helpline and can consult with a GP using the digital GP app. If you need to make a claim right away, we may require a medical report from your GP. Health insurance is designed to cover new conditions that arise after the policy has started.

No, health insurance does not cover A&E (Accident and Emergency) visits. Private hospitals do not typically have the facilities for handling A&E cases. In case of an emergency, please dial 999 or use the NHS emergency services. However, if you require follow-up treatment after an emergency situation, your private medical insurance may be able to assist.

Yes, many insurers offer rewards in leisure, wellbeing, and health. Speak to WeCovr's experts or visit your insurer's website for more details on member rewards.

You may continue your cover or get another own personal policy. If you continue your cover, existing or ongoing medical conditions might be covered depending on the level of cover you choose. Contact our friendly experts to discuss your options and find the right option for you.

You can tap one of the buttons above or below and fill in a quick form to arrange a call with us to discuss your options.

Your cover may be similar but not identical. We will help you find the right level of cover that suits your needs, and ongoing medical conditions may be covered. Contact our friendly advisers to explore all available options.

No, the price won't be the same as before since employers often contribute to the cost of employee cover. Additionally, different cover levels and medical histories may affect the price. Contact WeCovr's experts for detailed information.

You have a few weeks or months from leaving your job to decide to continue with your insurer or change to another one. Your policy may start the day after you left your work policy, and our experts can guide you through other available options.

After leaving your job, contact WeCovr's experts with your leave date to discuss available options.

Yes, ongoing treatment may be covered on your new personal policy, although it could affect the price. Contact our experts for personalised advice on your options.

Details on paying excess fees will be provided when you contact your insurer for treatment authorisation.

No, there is no excess fee for utilising these services.

Excess adjustments can be made at specific intervals during your policy term.

No claims discounts can impact renewal costs based on claims history.

Pre-existing conditions typically aren't covered but can be discussed with our healthcare specialists.

This involves health-related questions before policy enrolment to determine coverage.

Moratorium underwriting simplifies enrolment but may require health disclosures during claims.

Claims may require additional information if under moratorium underwriting.

Pre-existing conditions refer to medical issues existing before policy inception. A pre-existing condition is anything you've previously had medical treatment for, such as diabetes, heart disease, or asthma. Most insurance providers consider any condition you've had symptoms or treatment for in the past five years as pre-existing. Our experts at WeCovr can help you understand how pre-existing conditions affect your policy options.

While some insurance providers automatically renew your private healthcare cover, it's beneficial to compare policies when yours is about to end. This ensures you're still getting the best deal for the coverage you need. Our experts at WeCovr can assist you in finding the right policy for you.

Typically, you must be over 18 to take out your own policy, but minors can usually be included in a family policy. There may also be an upper age limit for private health insurance, and premiums typically increase with age. Our experts at WeCovr can provide guidance on age-related policy aspects.

Paying for health insurance annually often results in savings compared to monthly payments. However, this depends on your insurance provider. For help determining the most cost-effective option, consider consulting our experts at WeCovr.

If your employer offers private health insurance as part of your benefits package, you likely don't need additional cover. However, there may be limits on the cover you receive, and it may not extend to your entire family. Remember, any insurance you get through work only covers you while you're employed there.

If you don't have pre-existing conditions, a medical exam is usually not required. You'll just need to complete a medical history form and select your level of cover. However, if you're older, have a pre-existing condition, or lead an unhealthy lifestyle, a medical exam may be necessary. Our experts at WeCovr can clarify the requirements of different policies.

Many private health insurance providers now offer GP services, either digitally or face-to-face. This means you can often get a private GP appointment quickly, sometimes even on the same day. Our experts at WeCovr can help you find policies that offer GP services.

With private health insurance, you can often secure a GP appointment much quicker than with traditional methods, sometimes even on the same day. Our experts at WeCovr can help you find policies that offer quick GP appointment services.

Inpatient care refers to any treatment requiring a stay in a hospital or clinic for at least one night. Outpatient care refers to treatments or tests that don't require hospital admission, such as minor diagnostic tests or physiotherapy sessions. Our experts at WeCovr can help you understand the different types of care and find a policy that suits your needs.

Private health insurance covers your medical treatment if you fall ill, while critical illness cover provides additional financial help if you develop one of the critical illnesses listed in the policy, such as covering loss of income if you're unable to work. For assistance in understanding the differences and finding the right coverage, consult our experts at WeCovr.

Health insurance policies are designed for cover in the UK. For cover abroad, consider travel insurance for short trips or international health insurance for longer stays or if you have a holiday home overseas. Our experts at WeCovr can guide you in finding the appropriate coverage for your travel needs.

If your employer provides health insurance, it's considered a 'benefit in kind' and is not tax deductible. Your employer should calculate the tax you owe for your health insurance premiums and deduct it from your pay. There are some exceptions for small companies. For more information on tax implications, consider reaching out to our experts at WeCovr.

When you purchase a policy, you choose how much excess you pay, which is your contribution to the cost of treatment if you make a claim. The higher your excess, the lower your premium is likely to be. Our experts at WeCovr can help you understand how excess works and choose the right level for you.

These are two methods of underwriting a health insurance policy, relating to how insurance providers consider your pre-existing medical conditions when you take out cover. For help understanding the differences and choosing the right option for you, consult our experts at WeCovr.

Some private health insurance providers offer a no-claims discount, similar to car insurance. Every year you don't make a claim gives you an extra year of no-claims discount, potentially reducing your premium when you renew. Our experts at WeCovr can help you find policies that offer no-claims discounts.

To find the best health insurance for you, compare various policies to find one that offers the features you need at a price you can afford. Consider your personal circumstances and what you want from your policy. Our experts at WeCovr can assist you in evaluating your options and selecting the right coverage for you.

If you need treatment, a GP referral is not always necessary. However, this depends on how you plan to pay for your treatment. Most hospitals will allow you to book appointments with a consultant without a GP referral if you are paying out-of-pocket. If you have private medical insurance, you'll need to check the terms of your policy to see whether your insurer requires you to consult with a GP first (most insurers do). Some policies offer a direct booking system without a referral for certain conditions, such as counseling for mental health issues.

Yes, you can obtain financing for a loan to cover the cost of surgery. Many private healthcare companies have partnerships with finance companies to allow you to spread the cost of private treatment over time. You could also explore getting an ordinary loan from your bank if this option proves to be more cost-effective for you.

WeCovr has conducted extensive research into the cost of private health insurance in the UK. Click the link to find out more detailed information.

Yes, you can continue to receive treatment through the NHS even if you have private health insurance and have received private treatment in the past. This could be for rehabilitation after private surgery or for treatment that is not covered by your health insurance policy. For example, some cosmetic surgeries may be available through the NHS but are generally not covered by private medical insurance.

This is a difficult question to answer definitively. There are certain services that cannot be obtained privately, such as emergency treatment at an Accident and Emergency (A&E) department. Many NHS consultants also practice privately, so you could potentially see the same consultant regardless of whether you choose private or public healthcare. However, private healthcare typically offers shorter waiting times, guaranteed private rooms, and more relaxed visiting hours. Additionally, you may have access to treatments and drugs that are not routinely available through the NHS.

Yes, you can self-refer to a private specialist without the need for a GP referral. However, the British Medical Association believes that in most cases, it is best practice to start with your GP, as they are familiar with your medical history.

Yes, if you have a health concern and pay for private tests and scans but cannot afford to have private surgery, you should be able to have your test results transferred to an NHS provider for treatment.


Learn more


...

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.

Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!

Important Information

Since 2011, WeCovr has helped thousands of individuals, families, and businesses protect what matters most. We make it easy to get quotes for life insurance, critical illness cover, private medical insurance, and a wide range of other insurance types. We also provide embedded insurance solutions tailored for business partners and platforms.

Political And Credit Risks Ltd is a registered company in England and Wales. Company Number: 07691072. Data Protection Register Number: ZA207579. Registered Office: 22-45 Old Castle Street, London, E1 7NY. WeCovr is a trading style of Political And Credit Risks Ltd. Political And Credit Risks Ltd is Authorised and Regulated by the Financial Conduct Authority and is on the Financial Services Register under number 735613.

About WeCovr

WeCovr is your trusted partner for comprehensive insurance solutions. We help families and individuals find the right protection for their needs.