Which PMI Policy Is Best for Pre-existing Conditions in 2026
Navigating the world of private medical insurance (PMI) in the UK can feel daunting, especially when you have a health history. As FCA-authorised experts who have helped arrange over 900,000 policies, our team at WeCovr is here to bring you clarity. This guide demystifies how insurers view pre-existing conditions.
Side-by-side review and guide to underwriting, exclusions, and leading providers
Finding the right private health cover is about understanding the rules of the game. The single most important rule is this: standard UK private medical insurance is designed to cover new, unforeseen, acute medical conditions that arise after your policy begins. It is not designed to cover pre-existing conditions or the ongoing management of chronic illnesses.
However, the way insurers define and handle these conditions varies. Understanding this is the key to finding the best possible policy for your unique circumstances. This guide will walk you through everything you need to know, from the types of underwriting to how the top providers approach your medical history.
What Exactly Is a "Pre-existing Condition" in 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, advice, or treatment before the start of your PMI policy.
This definition is broad and includes:
- Conditions you've been formally diagnosed with (e.g., asthma, diabetes, high blood pressure).
- Injuries you've had (e.g., a recurring knee problem from a past sports injury).
- Symptoms you've seen a doctor about, even without a firm diagnosis (e.g., unexplained joint pain, occasional migraines).
- Even symptoms you haven't seen a doctor about. If you were aware of the issue, an insurer will likely consider it pre-existing.
Example: You experienced occasional back pain a year before taking out a policy but never sought treatment. If that back pain flares up after your policy starts, the insurer will almost certainly classify it as a pre-existing condition and exclude cover for its investigation and treatment.
Acute vs. Chronic Conditions: The Critical Difference
Insurers make a crucial distinction between 'acute' and 'chronic' conditions. This distinction determines what PMI will and will not cover.
| Condition Type | Description | Is it Covered by PMI? | Examples |
|---|---|---|---|
| Acute | A condition that comes on suddenly, has a limited duration, and is expected to be cured with treatment. | Yes. This is what PMI is for. | Appendicitis, a broken bone, a cataract, a hernia, most infections. |
| Chronic | A condition that is long-lasting, has no known cure, and requires ongoing management or monitoring. | No. The long-term management is not covered. | Diabetes, asthma, arthritis, high blood pressure, Crohn's disease, eczema. |
The Grey Area: What about an acute flare-up of a chronic condition? For example, a severe asthma attack that requires hospitalisation. Some policies may cover the cost of stabilising you in a private hospital. However, they will not cover the ongoing management of your asthma, such as inhalers, routine check-ups, or consultant appointments to monitor the condition. The specifics depend entirely on your policy's terms and conditions.
The Crucial Role of Underwriting: How Insurers Assess Your Health History
'Underwriting' is the process an insurer uses to evaluate your health and medical history to decide if they can offer you cover and on what terms. For individual private medical insurance in the UK, there are two main types of underwriting. Your choice between them will have a huge impact on how your pre-existing conditions are treated.
1. Moratorium Underwriting
This is the most common type of underwriting for new individual PMI policies. It's often quicker to set up because you don't need to complete a full medical questionnaire.
- How it works: The insurer applies a 'waiting period', typically two years, to any conditions you had in the five years before your policy began. If, during a continuous two-year period after your policy starts, you remain completely free of any symptoms, treatment, medication, or advice for that specific pre-existing condition, it may become eligible for cover in the future.
- The process: You don't declare specific conditions upfront. When you make a claim, the insurer will then investigate your medical history to see if the issue is new or pre-existing.
| Pros of Moratorium | Cons of Moratorium |
|---|---|
| ✅ Quick and simple application – no lengthy forms. | ❌ Lack of certainty – you don't know for sure what's covered until you claim. |
| ✅ Possibility of cover – old conditions can become eligible for cover over time. | ❌ Slower claims process – the insurer needs to check your history at the point of claim. |
| ✅ Less intrusive – no need to recall your entire medical history at the start. | ❌ The "rolling" nature – if a condition reoccurs, the two-year clock resets. |
Real-life Example: Sarah had physiotherapy for a sore shoulder 3 years before buying a moratorium policy. For the first two years of her policy, she is symptom-free. In year three, she develops a new, unrelated shoulder pain. Because she has passed the two-year clear period for the original issue, her new shoulder problem will likely be covered (subject to a claims assessment).
2. Full Medical Underwriting (FMU)
With FMU, you provide your full medical history upfront by completing a detailed health questionnaire.
- How it works: The insurer's underwriting team reviews your application and decides what they will and will not cover from day one. Any pre-existing conditions you declare will typically be listed as specific exclusions on your policy documents.
- The process: You must be honest and thorough when filling out the forms. The insurer makes a final decision before your policy even starts.
| Pros of Full Medical Underwriting | Cons of Full Medical Underwriting |
|---|---|
| ✅ Total clarity – you know exactly what is and isn't covered from the outset. | ❌ More paperwork – requires filling in a detailed health declaration. |
| ✅ Faster claims process – as exclusions are pre-agreed, there's less investigation needed. | ❌ Exclusions are often permanent – it's rare for an insurer to review an exclusion later. |
| ✅ Potential for negotiation – sometimes a broker can discuss a specific exclusion with the insurer on your behalf. | ❌ Can be a slower application process – the insurer may need to request more medical information. |
Which Underwriting is Right for You?
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Fast, no medical questionnaire. | Slower, requires a detailed health questionnaire. |
| Clarity on Cover | Uncertain until a claim is made. | Clear from day one. Exclusions are listed on your certificate. |
| Claims Process | Can be slower as insurer investigates medical history. | Generally faster as cover is pre-defined. |
| Cover for Pre-existing Conditions | Can be covered after a 2-year symptom-free period. | Usually excluded permanently. |
| Best for... | People with minor or no recent medical history who want a quick start. | People who want absolute certainty about their cover, especially if they have a complex medical history. |
Can You Ever Get Cover for Pre-existing Conditions? The Nuances
While the general rule is "no," there are specific situations where cover for pre-existing conditions might be possible.
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Passing the Moratorium Period: As explained above, this is the most common way a pre-existing condition can become eligible for cover on an individual policy. You must complete a continuous 24-month period without symptoms, treatment, or advice for that condition.
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Switching Insurers with CPME Underwriting: If you already have a PMI policy, you might be able to switch to a new insurer on a 'Continued Personal Medical Exclusions' (CPME) or 'Switch' basis. This means you carry your original underwriting terms across to the new provider. If your old policy was set to cover a condition after a moratorium, a new insurer may honour that. This is a complex area where advice from a specialist PMI broker like WeCovr is invaluable.
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Medical History Disregarded (MHD) Underwriting: This is the 'gold standard' of underwriting, as it ignores your past medical history and covers pre-existing conditions (excluding chronic ones). However, MHD is almost exclusively available only to members of large corporate group schemes. It is extremely rare to find it offered on an individual or small business policy.
Side-by-Side Review of Leading UK PMI Providers for 2026
All major UK insurers operate on the same principle: they cover new, acute conditions and exclude pre-existing and chronic ones. The key differences lie in their underwriting flexibility, customer service, and the additional benefits they offer.
Here’s how the leading providers compare:
| Provider | Underwriting Options Offered | Typical Approach to Pre-existing Conditions | Key Features & Wellness Benefits |
|---|---|---|---|
| Bupa | Moratorium, Full Medical Underwriting (FMU), Switch (CPME). | Standard moratorium and FMU rules apply. Exclusions are clearly stated on FMU policies. | Strong hospital network, Bupa from Home (remote access to specialists), comprehensive cancer cover. |
| AXA Health | Moratorium, Full Medical Underwriting (FMU), Switch (CPME). | Follows industry-standard practices. Known for clear communication on what is and is not covered. | Doctor@Hand (24/7 online GP), strong mental health support pathway, access to their 'Health Gateway'. |
| Aviva | Moratorium, Full Medical Underwriting (FMU), Switch (CPME). | Standard underwriting. They have a reputation for a straightforward claims process and clear policy documents. | Aviva Digital GP, good cancer cover with options for enhanced treatment, access to the Aviva Line support service. |
| Vitality | Moratorium, Full Medical Underwriting (FMU), Switch (CPME). | Standard underwriting rules, but their model is unique. They focus heavily on rewarding healthy behaviour. | Rewards programme (Apple Watch, cinema tickets, coffee) for staying active. This proactive approach can help members manage their overall health. |
A Closer Look at the Providers
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Bupa: As one of the most established names in UK health insurance, Bupa offers robust and comprehensive policies. Their approach to pre-existing conditions is standard, but their extensive network of hospitals and consultants is a major draw. They are a reliable choice for those seeking traditional, high-quality cover.
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AXA Health: AXA is a global insurance giant with a strong UK presence. They are known for their customer-centric approach and excellent digital tools, like their Doctor@Hand virtual GP service. Their underwriting is clear and fair, making them a popular choice for families and individuals who value both cover and service.
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Aviva: Another household name, Aviva provides dependable and well-structured PMI policies. Their 'Expert Select' hospital option can help manage premiums. For pre-existing conditions, their FMU process is thorough, providing clients with the certainty they need before committing.
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Vitality: Vitality has disrupted the market by linking insurance with wellness. While their underwriting on pre-existing conditions is the same as others, their philosophy is different. They actively encourage and reward you for healthy living—tracking activity, eating well, and having regular health checks. For someone with a manageable pre-existing condition, this proactive model can be highly appealing, as it supports your overall wellbeing even if the condition itself isn't covered.
Strategies for Managing Your Health and Finding the Right Cover
If you have a pre-existing condition, don't be discouraged. A PMI policy can still provide enormous peace of mind and fast access to treatment for any new health concerns you may face. Here’s how to approach it:
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Be Honest and Thorough: When applying for a policy with Full Medical Underwriting, disclose everything. Failing to declare a condition, however minor you think it is, can be classed as 'non-disclosure'. In a worst-case scenario, this could lead to your policy being cancelled and your claims denied.
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Understand Your NHS Care Pathway: Your PMI policy is designed to work alongside the NHS, not replace it. Your GP remains your first point of contact, and the NHS will continue to provide management for any chronic conditions. PMI gives you a choice for new, eligible conditions.
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Focus on Wellness and Prevention: Take control of your health. Many insurers now offer fantastic wellness benefits. Vitality leads the way, but others also provide access to digital GPs, mental health support, and discounts on gym memberships. At WeCovr, we support this by giving our PMI and Life Insurance clients complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help them achieve their health goals.
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Embrace Healthy Habits:
- Diet: A balanced diet rich in fruits, vegetables, and whole grains can help manage weight and reduce the risk of many conditions.
- Activity: Aim for at least 150 minutes of moderate-intensity activity per week, as recommended by the NHS. Even a brisk daily walk can make a huge difference.
- Sleep: Prioritise 7-9 hours of quality sleep per night. It is vital for both physical and mental recovery.
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Speak to an Independent Broker: This is the single most effective step you can take. An expert broker, like the team at WeCovr, works for you, not the insurer. We can:
- Explain the subtle differences in each insurer's policy wording.
- Advise on whether Moratorium or FMU is better for your specific history.
- Help you compare quotes from the whole market to find the best value.
- Assist with the application process to ensure it's completed correctly.
- Our service is provided at no cost to you.
How WeCovr Can Help You Navigate the Complexities of PMI
Choosing a PMI policy with a pre-existing condition requires specialist knowledge. At WeCovr, we provide that expertise, simplifying the process and empowering you to make the best choice.
- Impartial, Expert Advice: As an FCA-authorised broker, our priority is you. We don’t favour any single insurer; we find the right policy for your needs.
- Whole-of-Market Comparison: We have access to policies from all the UK's leading providers, saving you the time and effort of comparing them yourself.
- Clarity on the Fine Print: We'll help you understand exactly how your medical history will be treated under each policy option.
- Added Value: When you arrange a policy through us, you not only get expert advice but also unlock extra benefits, such as complimentary access to our CalorieHero app and potential discounts on other insurance products you may need, like life or home insurance. Our clients consistently give us high satisfaction ratings for our friendly and professional service.
Do I need to declare pre-existing conditions I had years ago?
Is asthma considered a pre-existing condition for health insurance?
What happens if I don't declare a pre-existing condition?
Can I get private health insurance if I have cancer?
Finding the right health cover is about protecting yourself against the unexpected. While pre-existing conditions are a key consideration, they shouldn't stop you from securing the peace of mind that PMI offers for future health concerns.
Ready to find the right private medical insurance for your needs? Get a free, no-obligation quote from our WeCovr experts today and let us help you navigate your options with confidence.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
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