Health insurance - Pre-existing conditions

What are pre-existing conditions?

A pre-existing condition in one you have been diagnosed with and/or received medication, advice, or treatment for in the last five years (occasionally three or seven, depending on the policy) before your policy begins. It’s also any condition for which you have experienced symptoms in the five years before your joining date, regardless of whether you’ve been diagnosed. An insurance policy can deny coverage for a condition you are diagnosed with during the policy term if they can demonstrate, typically via your medical records, that you were experiencing symptoms prior to the start date of the policy.

How does health insurance with pre-existing conditions work?

You can usually take out a health insurance policy if you have a pre-existing condition, but coverage of the condition will generally be excluded. For instance, if you have diabetes, your policy would pay for private medical treatment if you break a limb, but won’t pay for treatment of diabetes or conditions stemming from it, like nerve pain and vision problems. 

As another example, if you’ve had one heart attack or stroke, you won’t be covered for another for at least five years, or more if you’ve been receiving ongoing, even preventative, treatment for it.

If you have a chronic condition, one which requires ongoing and regular treatment to be managed, rather than one that can be cured with short-term treatment, you may find that ongoing costs, including for appointments and medication, are excluded. However, one-off costs, like hospitalisations, may be covered. Examples of chronic conditions include diabetes, glaucoma, asthma, hay fever, migraines, high blood pressure, and skin conditions like eczema, acne and psoriasis.

Some pre-existing conditions, including minor ones or ones which are unlikely to recur, will be covered by some policies.

Insurers will often start covering a condition again after you’ve been without symptom for five years. The terms of policies will vary, however, so you should always read the fine print. Moreover, there are two different types of underwriting that can impact the way pre-existing conditions are assessed and covered.

Different Types of Policies and Pre-Existing Conditions

There are two types of health insurance policies you can get with pre-existing conditions, hinging on the type of underwriting used by the insurer. Some insurers will allow you to choose what type of underwriting you want

• Full medical underwriting: With these policies, you have to supply the insurer with your full medical history, including answering questions about your health and giving them access to your medical records and permission to speak to your GP. They’ll use this information to calculate how risky and expensive you will be to insure and return to you with a quote, which will include your policy cost, which illnesses and treatments it will cover and which it will exclude, and if they will cover any of your pre-existing conditions. This underwriting process is good for letting you know if your pre-existing condition will be covered or not.
• Moratorium underwriting: You don’t have to supply detailed medical information. However, your insurer will look into your medical history when you make a claim and if they find a pre-existing condition, they will reject claims for it. They may, however, start coverage of pre-existing conditions after a set period or moratorium, usually two years. This means if you’re symptom-free for two years, you will then start being covered for that condition.

What medical conditions do you have to declare?

When you apply for your insurance, you’ll need to declare:

• Asthma and other respiratory problems
• Cancer
• Diabetes 
• Epilepsy 
• Heart disease
• Heart attacks
• Strokes
• High blood pressure
• Mental health conditions, including anxiety and depression
• Joint and bone inflammation
• Back pain you’ve had surgery for

Conditions which need to be disclosed but can be covered under some policies include:

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

If you have a pre-existing condition, it’s crucial that you both disclose it accurately and truthfully to your insurer as part of the underwriting process and read the terms and conditions of the policy to see which pre-existing conditions they may cover, and which they exclude.

What other health information do you need to provide?

When you apply for health insurance, you’ll also need to provide faithful information about your health and lifestyle. This may include if you smoke, how much alcohol you drink a week, and your body mass index (BMI).

Some health insurers will refuse coverage if you smoke, even just occasionally, and if your BMI is above a certain threshold.

What happens if you don’t declare pre-existing conditions?

Failing to disclose a pre-existing condition to your insurer can lead to them refusing to cover treatment of that condition and even to the policy being cancelled. It’s therefore crucial to protect your policy, coverage and investment by declaring all pre-existing conditions, including symptoms that may not have led to a formal diagnosis yet.