What is a pre-existing condition? Medical Insurance (UK)

What is a pre-existing condition?

All UK health insurance providers describe pre-existing conditions differently and provide different levels of information on their websites.

Generally speaking, a pre-existing condition is defined as a medical condition you had before you purchased health insurance. It could be a medical condition you’ve been treated for or even something you’ve gone to your GP for advice about.

You don’t have to have a diagnosis for your insurance company to consider you already having symptoms. You may have had tests, scans, or other tests before you had health insurance and only received a diagnosis later. It refers to any medical condition that you have seen your doctor approximately five years prior to the start date of your health insurance.

For example, you may take out a policy and then go to your GP for back pain you are having. They recommend you go on a physiotherapy course, so call your insurance company to see if you can access it privately. They will check if back pain treatment is included and establish that you have seen your doctor or had physiotherapy for back pain in the past three years. This means they won’t pay for your treatment because it existed before you had insurance and is classified as a pre-existing condition.

In contrast, if you had an injury such as a broken leg before you had health insurance, you will still be able to make a claim if you break your other leg in the future. (Although most insurance companies will keep a close eye on your premiums if you participate in activities that lead to frequent injuries).

What about related conditions?

A pre-existing condition can mean more than one thing. Some conditions may also be excluded from coverage if they are related to symptoms you previously had or a chronic condition. Health insurance does not cover the treatment of long-term chronic diseases such as asthma, diabetes or high blood pressure. You will only be covered for acute conditions that can be cured and not controlled.

If you’ve had heart disease and need surgery to relieve symptoms, your insurance may cover the cost of the surgery if it started after you took out the policy. However, if you had seen your GP with chest pains or shortness of breath before the start date of your cover, then it would not.

A chronic condition like diabetes can have a number of possible side effects, all of which your insurance company will exclude if your condition is diagnosed ago you took your health plan. It can be anything from eye problems caused by diabetic retinopathy to foot problems and even heart disease. Generally speaking, if your insurer can link any issues to a pre-existing medical condition, they will.

Can I get health insurance with a pre-existing medical condition?

You can still get health insurance with a pre-existing medical condition; you simply won’t be able to get insurance for that particular health problem. Health insurance is designed to help you in the event of an acute illness or injury that occurs unexpectedly. Therefore, it still pays to have insurance as you will be able to access private healthcare for other health issues. If you have suffered from high blood pressure, this may not be covered, but you can still access private cancer care if you need it in the future. It’s also worth remembering that your pre-existing condition cannot be turned off permanently. It all depends on whether you will remain symptom-free and on the type of insurance you have on your policy.

Private health insurance offers individuals two types of coverage: moratorium insurance and full medical insurance.

What is a download moratorium?

As the name suggests, an underwriting moratorium applies a moratorium period to your policy. This 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 remain symptom-free for the first two years of the policy. If you were having physiotherapy for a musculoskeletal problem, such as hip pain, any hip problems would be excluded for the first two years of the policy. If you haven’t had a recurrence during that time, your insurance providers can add it. This could be useful if you have problems as you get older, as your insurance would potentially pay for a hip replacement if you need it in the future.

Moratorium insurance is often the cheapest type of insurance because health insurance companies do not take information about your health history when you take out a policy. Instead, they’ll look at your medical records and decide if they’ll cover your treatment after you’ve submitted a claim. This means that you will only find out if they will cover your treatment when you apply, and it may take longer to get a decision.

What is a full medical guarantee?

When you take out a comprehensive health insurance policy, you will be asked to provide medical information at the outset. Your insurer can then carry out a full assessment of your overall risk level before giving you a quote. This means you’ll have confirmation from the start of what’s covered and what’s not, and you can generally get a quick decision when you make a claim.

This type of insurance usually comes with a higher monthly premium, but it’s worth considering if you’ve had treatment in the past and want some certainty about the types of treatment and costs you’ll be able to claim in the future. It also helps you avoid making claims and getting them rejected. While some insurance companies don’t look at individual claims when setting premiums, others do, and denied claims can increase the amount you pay in the future.

Do any insurers cover pre-existing medical conditions?

Most health insurance companies will exclude all preexisting conditions for the first two years of your policy. This is because they offer cover based on the chance that you will need treatment for something similar in the long term. If you have been treated for cancer or heart problems in the last five years, there is a risk of it happening again, so this will be excluded from your health insurance. Alternatively, if you have experienced any medical condition that could lead to deterioration in the future, this will also be excluded.

However, we have come across one insurance provider that offers coverage for pre-existing conditions. The general and medical offer covers up to two pre-existing conditions from a defined list. These include conditions that may resolve and recur in the future and long-term chronic conditions. The language they use on their website suggests they will only cover treatment needed for the acute phase of a pre-existing condition, not providing treatment for an ongoing condition. However, you will still be able to get cover for the following:

• Acne
• Arthritis
• Asthma
• Carpal tunnel syndrome
• Crohn’s disease
• Diabetes
• Eczema
• Fibrocystic breast disease
• Gastroesophageal reflux disease
• Glaucoma
• Hypertension
• Psoriasis
• Ulcerative colitis
• Varicose veins

It will come as no surprise to learn that you will have to pay additional premiums to add this to your health insurance policy. Cover is limited to an annual limit of £1,000, but this increases by £1,000 each year you have the policy and remain symptom-free, up to a maximum limit of £10,000. This gives you some reassurance that if you do experience a worsening, you will be able to receive prompt treatment. We think this could be useful if you have diabetes, as several conditions could potentially be excluded from coverage due to the diagnosis.

Where can I read more about how health insurance treats pre-existing medical conditions?

Different insurers offer different levels of information about how they define pre-existing conditions and their approach to them. In some cases it is worth looking at the information they provide about individual needs, especially if there is a particular disease you are concerned about. We’ve gathered some information about the best health insurance company websites for pre-existing conditions. This selection should give you an idea of ​​the type of information you will be able to access as you research; we hope you find it helpful.

AXA PPP healthcare

AXA has produced a series of videos explaining health insurance terms, including one on pre-existing conditions, which you can watch here.

Aviva

You can learn more about Aviva’s approach to pre-existing health conditions here.

Bupa

Bupa’s website explains how they approach pre-existing conditions here. They also explain different types of risk taking and other exclusions.

Exeter

Exeter provide details of how they treat pre-existing conditions in their policy document, which you can download from their website – you’ll find the links at the bottom of the page.

Free health insurance

Freedom Health Insurance talks about chronic and pre-existing conditions here and explains how this affects the insurance you can get.

Vitality

Vitality’s website provides you with a health insurance summary that confirms pre-existing conditions are excluded. However, they do not go into great detail.

WPA

WPA discusses its download options and access to existing terms here. You can also click to learn more about the associated terms if relevant to you.