A lot of insurers won’t cover treatment for anything you had before your policy started, which can make it feel like your options are limited. But the good news? Having a pre-existing condition doesn’t mean you can’t get private health insurance — or that it’s not worth having.
In this article, we’ll break down what counts as a pre-existing condition, how insurers usually handle them, and what to keep in mind when picking a policy.
What is a Pre-Existing Condition?
In private health insurance, a pre-existing condition is essentially any illness, injury, or health condition that you had before your new policy begins. This includes conditions you’ve been diagnosed or treated for in the past, as well as any clear symptoms you experienced before your start date – even if you didn’t have an official diagnosis at the time.
Put simply, if you had any health issues or symptoms before starting your policy, insurers will usually class it as a “pre-existing condition.” That could be anything from past chest pain to something diagnosed like arthritis — basically, anything that showed up before your cover kicked in.
How far back do insurers look? Typically, insurers review your recent medical history to decide what counts as pre-existing. Any condition you’ve had within those 5 years before the policy will be flagged and excluded (more on exclusions below). If you had a condition a long time ago (say 6–10 years ago) and it hasn’t caused any trouble since, it might not be treated as a pre-existing issue in your new policy.
Which Pre-Existing Conditions Are Typically Not Covered?
Private health insurance is only really meant to cover new health issues that pop up after your policy begins. Every insurer has their own set of exclusions, but most won’t cover pre-existing conditions — especially if it’s something long-term or that tends to come back. Some common examples of conditions that are usually excluded include::
- Diabetes (type 1 or type 2)– a long-term metabolic condition.
- Heart disease or heart conditions – e.g. a history of angina or heart attack.
- Asthma and other chronic lung conditions– any ongoing respiratory condition you already have.
- Arthritis or joint– e.g. osteoarthritis diagnosed before the policy.
- Cancer (any form) – cancers diagnosed/treated before your cover starts.
- Serious past injuries or surgeries – for example, chronic back pain or a spinal surgery you needed before (future related back issues would be excluded).
- Mental health conditions like depression or anxiety disorders (if you’ve had them before)
In short, basically any illness or health condition you had prior to taking out the new policy is considered a pre-existing condition and not covered. Each insurer might phrase it slightly differently, but they all follow that general rule.
Pre-Existing vs Chronic Conditions
It’s also important to distinguish pre-existing conditions from chronic conditions. A chronic condition is an ongoing or incurable illness that requires long-term management (for example, diabetes, asthma, arthritis, hypertension). Most UK health insurance policies exclude chronic conditions outright, meaning they won’t pay for routine treatment or check-ups for those illnesses. This is partly because private insurance is intended for acute, treatable issues rather than long-term management.
So, if you have a chronic condition before joining, it’s doubly excluded – both because it’s chronic and because it’s pre-existing. Even if a chronic condition is well controlled, ongoing needs like regular medication, monitoring, or therapy for it will fall to the NHS or yourself, not the private insurer. Some policies might cover unexpected acute flare-ups of a chronic illness but they won’t cover the day-to-day maintenance care.
Can You Get Health Insurance If You Have a Pre-Existing Condition?
Yes! Having a pre-existing condition doesn’t mean you can’t buy private health insurance. You absolutely can still get a policy even if you’ve had health issues before. The catch is that the insurer will exclude your condition (and anything related to it) from coverage, at least initially.
In practice, this means if you try to claim for treatment related to that pre-existing condition, the insurance won’t pay out. You’d need to rely on the NHS or pay privately for that specific issue. However, the policy will cover you for new and unrelated conditions that arise after your cover begins.
How Coverage for Pre-Existing Conditions Works (Underwriting Methods)
When you apply for private health insurance, the provider will decide what to do about any existing conditions through a process called medical underwriting.
In the UK, major insurers like AXA, Bupa, Aviva, Vitality, WPA and others generally offer two main underwriting options for individual policies: Full Medical Underwriting and Moratorium Underwriting. Both methods provide the same cover for any new conditions that arise after you join. The key difference is how they deal with your pre-existing conditions (and how you disclose your medical history). Below we explain each method:
Full Medical Underwriting (FMU)
With full medical underwriting, you tell the insurer your entire relevant medical history upfront when applying. You’ll fill out a detailed health questionnaire, listing any past illnesses, surgeries, ongoing medications, doctor visits, etc. – essentially disclosing all pre-existing conditions and even minor ailments you’ve had.
The insurer’s medical team then reviews this information (and sometimes may ask your GP for additional records. Based on that, they’ll decide exactly what will be covered and what will be excluded on your policy before it starts.
- Any serious pre-existing conditions you disclose will be listed as exclusions in your policy documents. For example, if you have a previously diagnosed knee problem, your policy might state an exclusion like “no coverage for any claims relating to the left knee.” These exclusions are often permanent for full underwriting – the insurer typically won’t cover that specific condition throughout the life of the policy (though you’ll still be covered for everything else).
- Sometimes, for more minor or well-controlled conditions, an insurer might not impose a strict exclusion or might set a temporary exclusion (or even offer cover). But as a rule, insurers “don’t usually cover” pre-existing conditions under full underwriting – they identify them and carve them out of the coverage from day one.
- The advantage of full underwriting is certainty. Right from the start, you know which conditions are excluded and which are covered. There’s no ambiguity at claim time because everything was declared upfront. This can make the claims process smoother.
(Tip: It’s crucial to answer all health questions truthfully and accurately in full underwriting. If you fail to disclose something important, it could lead to a claim being rejected later for non-disclosure. It’s better to over-share your medical history than leave something out!)
Moratorium Underwriting
With moratorium underwriting, the application process is quicker and simpler because you do not have to provide your full medical history upfront. There might just be a short form or a few yes/no health questions, but you won’t list every doctor visit. Instead, the insurer automatically applies a blanket exclusion: any condition you’ve had in the recent past is excluded from cover at the start. You don’t need to declare those conditions one by one – the insurer assumes anything you’ve suffered in that timeframe is pre-existing and not covered initially.
Here’s how it works in a typical “2-year moratorium” plan (used by many UK insurers):
- Initial Exclusion: Any condition (illness or injury) that you had in the 5 years before your policy starts is considered pre-existing and will not be covered when your policy begins. This includes related conditions or complications stemming from that pre-existing issue. Essentially, the insurer draws a line – everything recent is excluded at first.
- Waiting Period: After you start the policy, you’ll need to go a continuous period of 2 years without any symptoms, treatment, medication, or advice for each pre-existing condition for that condition to become eligible for coverage. In other words, if you can stay symptom-free and treatment-free for a condition for two consecutive years while insured, the insurer will then consider that condition “inactive” and will cover it going forward. Think of it as a probation period for your old ailments – get through 2 years with no flare-ups, and the condition can be included in your cover again
- Reset if Recurrence: If you do have any recurrence or treatment for the condition during those first two years, then the 2-year clock resets. You would need to wait another full two-year period from the last date you had symptoms, saw a doctor, or received treatment for that condition. Only after a full 2-year clear spell (no issues related to that condition) will it be covered. Essentially, the moratorium is “rolling” – any time the condition crops up, the waiting period starts over.
It’s important to realise that moratorium underwriting does not guarantee your pre-existing condition will ever be covered – it only gives the possibility. Some conditions might never meet the criteria.
Moratorium works best for conditions that are resolved or mild. If your condition is in the past and unlikely to recur, you have a good chance of getting it covered after the waiting period. If it’s something that might flare up periodically, the moratorium may just keep resetting, and the condition will effectively never be covered.
Always check the policy wording: some insurers also have certain severe conditions that they flat-out won’t ever cover even after the moratorium period (this can apply to things like very serious cancers or etc., depending on the provider’s rules). But generally, the 2-year moratorium rule is the standard for most ailments.
Note for switchers: If you already have a health insurance policy and are looking to switch providers, be mindful of how pre-existing conditions carry over. Normally, if you start a brand new policy, that insurer’s underwriting rules apply from scratch – meaning a condition you developed under your old policy could be treated as pre-existing by the new insurer (since it existed before your new start date).
Final Thoughts
Dealing with pre-existing conditions in health insurance can seem complicated, but the core idea is simple: insurance is meant for the unknown and the new, not the issues you already have. All major insurers therefore exclude known pre-existing conditions to keep things fair (and premiums affordable).
The good news is you can still get private health insurance even with a medical history – you’ll just have some exclusions to be aware of. And beyond those exclusions, you’ll enjoy all the benefits of private healthcare for any new condition or emergency that crops up in the future. Many people with pre-existing conditions find value in having insurance for everything except their known issue, especially given the peace of mind and faster treatment options it provides for new problems
To recap, always check how an insurer underwrites your policy. If you want certainty about what’s covered from the start, consider full medical underwriting (but expect your pre-existing conditions to be listed as exclusions). If you prefer a quick setup and hope a past condition might be covered after a couple of good years, a moratorium underwriting could be suitable. And if you’re switching insurers, make sure to carry over your underwriting so you don’t lose any cover you’ve earned.
Finally, don’t be discouraged by the term “not covered for pre-existing conditions.” It doesn’t mean you shouldn’t bother getting insured – in fact, that’s more reason to have insurance for everything else that life might throw at you next. Private health insurance is there to get you prompt, quality care if something new goes wrong with your health, helping you avoid long NHS waits and giving you more choice in treatment. Your past or current condition will still be taken care of (by the NHS or other means), while your insurance stands ready to protect you against future health issues.
With the right policy and understanding of the terms, you can confidently navigate private health insurance – pre-existing conditions and all – and secure the coverage that’s right for you. Stay informed, ask questions, and here’s to your health!
Sources:
https://www.bupa.co.uk/health/health-insurance/understanding-health-insurance/preexisting-conditions
