In this post, we explain what a pre-existing medical condition is and how it can affect health insurance in the UK.
All of the UK's medical insurance providers describe pre-existing conditions differently and provide varying information levels on their websites.
Broadly speaking, a pre-existing condition is defined as a medical condition that you had before you took out your health insurance. It could be a health condition you were treated for or even something you went to your GP and asked for advice about.
You don't need to have had a diagnosis for your symptoms to be considered pre-existing by your insurer. You may have gone for tests, scans or other investigations before you had health insurance and only received a diagnosis later. It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance.
For example, you might take out a policy and then go and see your GP about some back pain you've been experiencing. They recommend that you go for a course of physiotherapy sessions, so you call your insurance company to see if you can access it privately. They'll check to see whether treatment for back pain is included and find that you went to see your doctor or had physiotherapy for back pain three years ago. That means they won't pay for your treatment as it was there before you had insurance and is classed as pre-existing conditions.
By contrast, if you had an injury such as a broken leg before you had health insurance, you'll still be able to claim if you break the other leg in the future. (Although most insurance companies will look closely at your premiums if you're taking part in activities that lead to frequent injuries).
A pre-existing condition can mean more than one thing. Some conditions can also be excluded from cover if they're related to symptoms you had before or a chronic condition. Health insurance doesn't cover treatment for long term chronic illnesses like asthma, diabetes or high blood pressure. You'll only be covered for acute conditions that can be cured rather than managed.
If you had heart disease and needed surgery to relieve your symptoms, your insurance could cover the cost of surgery if it started after you took out the policy. However, if you'd been to see your GP with chest pain or breathlessness before the start date of your insurance, then it wouldn't.
A chronic condition like diabetes can have a range of possible side effects, and your insurance company will exclude all of them if your condition was diagnosed before you took out your health plan. This could be anything from eye issues caused by diabetic retinopathy to foot problems and even heart disease. Generally speaking, if your insurer can relate any issues to a pre-existing medical condition, they will.
You can still get health insurance with a pre-existing medical condition; you just won't be able to get coverage for that particular health problem. Health insurance is designed to help you with acute illness or injury that arises unexpectedly. Hence, it's still worth having insurance as you'll be able to access private healthcare for other health issues. If you've suffered from high blood pressure, that may not be covered, but you could still access private cancer care if you need it in the future. It's also worth remembering that your pre-existing condition may not be excluded permanently. It all depends on whether you remain symptom-free and the type of underwriting you have on your policy.
Private health insurance offers individuals two types of underwriting: moratorium underwriting and full medical underwriting.
As the name suggests, moratorium underwriting applies a moratorium period to your policy. That means that any illness you had in the five years before you took out the policy will be excluded from cover but could be added if you stay symptom-free for the first two years of the policy. If you'd had physiotherapy for a musculoskeletal issue, such as hip pain, any hip problems would be excluded for the first two years of the policy. If you didn't have any recurrent during that time, your insurance providers could add it on. That could be useful if you experience problems as you get older, as your insurance would potentially pay for a hip replacement if you needed it in the future.
Moratorium underwriting is often the cheapest type of underwriting because health insurance companies don't take details of your medical history when you take out the policy. Instead, they'll look at your medical records and then decide whether to cover treatment after you've made a claim. This means that you'll only find out whether they'll cover your treatment when you make a claim, and it can take longer for you to get a decision.
When you take out a policy with full medical underwriting, you'll be asked to provide medical information at the start. Your insurer can then carry out a full assessment of your overall risk level before giving you a quote. This means that you'll have confirmation of what is and isn't covered from the outset, and you can generally get a quick decision when you make a claim.
This type of underwriting tends to come with a higher monthly premium but is worth considering if you've received treatment in the past and want some certainty around the types of medical treatment and expenses that you'll be able to claim for in the future. It also helps you to avoid making claims and having them turned down. While some insurance companies don't look at individual claims when setting your premium, others do, and rejected claims could increase the amount you pay in the future.
Most health insurance companies will exclude all pre-existing conditions for the first two years of your policy. This is because they offer cover based on the chance you'll need medical treatment for something similar in the long term. If you've been treated for cancer or heart problems in the past five years, there's a risk of reoccurrence, so it'll be excluded from your health insurance. Alternatively, if you've experienced any health condition that could lead to a flare-up in the future, that'll be excluded too.
However, we have come across one insurance provider who offers coverage for pre-existing conditions. General and Medical offer cover for up to two pre-existing conditions from a defined list. These include conditions that could resolve and reoccur in the future and long-term chronic conditions. The language they use on their website suggests that they will only cover treatment needed for an acute phase of a pre-existing illness rather than providing management of an ongoing condition. However, you'll still be able to get coverage for the following:
It won't come as a surprise to learn that you'll need to pay additional premiums to add this to your health insurance policy. Coverage is limited to an annual limit of £1,000, but this increases by £1,000 every year you have the policy and remain symptom-free, up to a maximum limit of £10,000. It gives you some reassurance that if you experience a flare-up, you'll be able to get quick treatment. We think it could be beneficial if you have diabetes, as several conditions could potentially be excluded from coverage due to a diagnosis.
Different insurers offer different levels of information about how they define pre-existing conditions and the approach they take to them. In some cases, it's worth looking at the information they provide about individual needs, especially if there's a particular illness that you're concerned about. We've gathered some information on the best health insurance companies' websites related to pre-existing conditions. This selection should give you an idea of the type of information that you'll be able to access when you're doing your research; we hope you find it helpful.
AXA has created a series of videos explaining medical insurance terms, including one about pre-existing conditions, which you can watch here.
You can find out about Aviva's approach to pre-existing medical conditions here.
Bupa's website explains how they approach pre-existing conditions here. They also explain different types of underwriting and other exclusions.
Freedom Health Insurance talks about chronic and pre-existing conditions here and explains how it affects the insurance coverage you can get.
Vitality's website gives you a health insurance summary which confirms that pre-existing conditions are excluded. However, they don't go into greater detail.
WPA talk about their underwriting options and their approach to pre-existing conditions here. You can also click through to find out more about related conditions if that's relevant to you.
Health insurance brokers are regulated by the Financial Conduct Authority in the UK and can offer you independent advice about the right health insurance to suit you, based on your circumstances. They have excellent knowledge of all the providers and products available. They can take your existing medical condition into account and help you find the policy that will suit your needs and budget.
At myTribe, we start by providing you with impartial guides and information to help you consider factors that will affect your health insurance. We'll give you a comparison quote before putting you in touch with a highly rated broker for specialist advice.
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
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