Can You Get Private Health Insurance With Pre-Existing Conditions?

The difference between being able to buy a policy and having a particular condition covered is the key to understanding how health insurance works when you already have a medical history — and most of us have one. This guide explains what insurers look at, the main ways they assess your history, and what to consider if you already have cover.

What insurers mean by a pre-existing condition

A pre-existing condition is generally any illness, injury or symptom you have had before your cover starts. Insurers usually look beyond formal diagnoses: if you have had symptoms of something, taken medication for it, received treatment, or asked a doctor or other medical professional for advice about it, it is likely to count, even if you were never told exactly what was wrong.

Everyday examples might include a recurring back problem, a knee injury you have seen a physiotherapist about, raised blood pressure, or anxiety you have discussed with your GP. How far back an insurer looks, and exactly how it defines a pre-existing condition, depends on the insurer and the policy, so the policy wording is always what counts.

Getting a policy is different from having a condition covered

These are two separate questions, and it helps to keep them apart.

• Can you take out a policy? Usually, yes. A past or current health condition does not normally prevent you from buying private health insurance.
• Will that condition be covered? Often not, at least at first. On a new policy, an existing condition is commonly excluded, either for a period or permanently, depending on how the policy is underwritten.

An exclusion applies to that specific condition, and usually anything related to it, rather than to the whole policy. If a knee problem is excluded and you later develop an unrelated condition, such as a hernia, the new condition can be covered in the usual way, subject to the policy’s terms, limits and any excess. If you are looking at cover just for yourself, our page on individual health insurance explains how a policy is put together.

Why cover can still be worthwhile with an exclusion

It is natural to feel that a policy is worth less if the condition you already know about is not included. But private health insurance is mainly designed for the unexpected: new conditions that may develop in future, which none of us can predict. An exclusion for an old back problem does not stop a policy helping with the private diagnosis and treatment of eligible new conditions later on, depending on the cover you choose.

How insurers assess your medical history

The way an insurer takes your medical history into account is called underwriting. For individual and family policies in the UK, the two most common approaches are full medical underwriting and moratorium underwriting. Underwriting rules vary by insurer and policy, so what follows describes how these approaches generally work rather than any one insurer’s terms.

Full medical underwriting

With full medical underwriting, you complete a health questionnaire when you apply and declare your medical history. The insurer may also ask your GP for more information. Before your cover starts, it tells you which conditions are excluded or restricted. These are usually listed in your policy documents as personal exclusions.

The main advantage is clarity: you know from the outset what is and is not covered, and claims can be more straightforward because your history has already been assessed. The trade-off is that applying can take a little longer, and exclusions are often permanent, although some insurers may be willing to review an exclusion later.

Moratorium underwriting

With moratorium underwriting, you usually do not need to complete a detailed medical questionnaire. Instead, the policy automatically excludes conditions you have had symptoms, medication, treatment or advice for during a set period before your cover starts. Many insurers look back over the previous five years, but this is not universal, so it is worth checking the policy you are considering.

Moratorium cover tends to be quicker to set up, but there is less certainty. Because your history is not assessed up front, the insurer will usually check whether a condition is pre-existing when you make a claim, which can involve asking your GP or specialist for information at that point.

Can an excluded condition become eligible later?

Under some moratorium arrangements, yes. If you go a specified, continuous period after your cover starts without symptoms, treatment, medication or advice for that condition, it may become eligible for cover, subject to the insurer’s rules. Two years is a common example, but insurers set their own periods and conditions. If you need treatment, medication or advice during that time, the period usually starts again.

This is never guaranteed, and some conditions may remain excluded under an insurer’s rules. Long-term conditions that need ongoing management are a common example, as explained below.

Which approach suits you depends on your medical history and how much certainty you want before you buy. It is worth talking it through before you decide, because changing underwriting later is not always straightforward.

Should you wait until an old condition has cleared up?

Not necessarily. Some people put off applying in the hope that an old problem will eventually stop counting, but waiting does not always help:

• Any new condition that develops while you are uninsured would itself be pre-existing when you eventually apply.
• Premiums generally rise with age, so delaying may mean paying more when you do take out cover.
• Under a moratorium, the symptom-free period that can make an old condition eligible usually runs from the date your cover starts, so starting later can simply mean that period starts later too.

Accepting an exclusion for something you already know about can be a reasonable trade for cover against conditions you cannot foresee. It is usually worth finding out what your options look like now, rather than assuming you need to wait.

If you already have health insurance

Moving an existing policy can work differently from starting afresh. Some insurers offer switch underwriting, sometimes called continued personal medical exclusions (CPME), which aims to carry your existing underwriting terms over to the new policy. In the right circumstances, conditions that started while you were insured could continue to be covered, rather than being treated as new pre-existing conditions.

Whether this is available, and on what terms, depends on the insurer, your current policy, how long you have been covered and your claims history. Moving onto new moratorium or full medical underwriting terms instead could mean losing cover for conditions your current policy includes. For that reason, it is sensible not to cancel an existing policy until new cover has been confirmed and you have compared the terms carefully.

A note on long-term conditions

Private health insurance is designed mainly for acute conditions: those likely to respond quickly to treatment. The ongoing management of chronic conditions, such as diabetes or asthma, is not normally covered, whichever type of underwriting you choose, although some policies may help with an initial diagnosis or a short-term flare-up. PHIN’s guide to private medical insurance explains more about what policies typically do and do not cover.

Answer medical questions carefully

If you are asked about your health when you apply, take care to answer fully and accurately. If something is missed or answered incorrectly, an insurer may be able to change the policy terms, pay only part of a claim or, in some cases, cancel the policy. If you are unsure whether something is relevant, check before you answer. The Financial Ombudsman Service explains how it looks at complaints about misrepresentation and non-disclosure and about claims involving pre-existing medical conditions.

Covering your family

On a family policy, each person’s medical history is usually considered separately, so an exclusion for one person does not normally affect cover for everyone else on the policy. Find out more about family health insurance.

Have another question? Our FAQs cover common questions about health insurance, life insurance and protection.

This guide is general information to help you understand how health insurance can work. It is not personal advice. Underwriting rules, exclusions and cover vary between insurers and policies, and no particular condition can be assumed to be covered.