Health insurance for pre-existing conditions

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What are Pre-existing conditions?

When it comes to Health insurance, the term “pre-existing conditions” refers to a condition, illness or injury that existed prior to an individual taking a policy out. They are an incredibly important consideration in choosing private health insurance because almost all policies will exclude pre-existing conditions from cover, especially if they are long-term, chronic conditions.

For some people that are looking at taking out private medical insurance for the first time, this may be unwanted news. However, in a similar way to how you can not purchase car insurance to cover you for a road accident that you had the day before, you can’t purchase private health insurance to cover a pre-existing medical condition that has already been diagnosed and requires ongoing care.

However, whether a pre-existing condition is acute or chronic may make a difference to whether an insurer will look to cover the condition in future. Also, how a particular policy is underwritten should be considered.

Acute and chronic conditions

Acute pre-existing conditions refer to illnesses, injuries or medical conditions that are short-term and typically have a clear end date, such as a broken bone that will heal in a few weeks, a bad back or a migraine. Examples of acute pre-existing medical conditions include:

• Broken bone
• Pneumonia
• Appendicitis
• Gastroenteritis
• Concussion

Chronic pre-existing conditions are illnesses, injuries or medical conditions that are long-term and persistent, such as diabetes, asthma, heart disease, or arthritis. They are likely to require ongoing treatment and care, and may have a significant impact on an individual’s quality of life. Examples of chronic pre-existing medical conditions include:

• Diabetes
• Heart disease
• Arthritis
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Lupus
• Multiple Sclerosis
• Inflammatory Bowel Disease (IBD) such as Crohn’s Disease and Ulcerative colitis.

Underwriting

Underwriting plays a significant role in the coverage of pre-existing medical conditions.

What is full medical underwriting?

Full medical underwriting (FMU) is a process used by insurance companies to assess an individual’s health status and history. 

This normally will require that the individual joining a policy completes an application form detailing their medical history tougher with that of any dependents (if included on cover). Depending on the insurer, the questions are normally based on the last 5 years medical history and will ask for further information on medical conditions, treatment and any medication prescribed. This will then be assessed by an underwriter who may choose to exclude certain conditions giving the member a personalised certificate detailing this.

An insurer is more likely to exclude higher-risk conditions and also more recent medical history.

It’s important to keep in mind that full medical underwriting can be a rigorous process and an individual’s health status and history will be closely examined. It’s crucial to be completely accurate when providing information during the underwriting process to ensure that the policy provides the coverage you need.

An individual can also opt for full medical underwriting even if they have nothing to disclose, some members prefer having this in writing prior to taking a new policy out.

What is a Moratorium?

A moratorium is a period of time during which an individual’s pre-existing medical conditions are not covered under their insurance policy. It is a common feature of private health insurance policies in the UK.

The insurance company will not cover any medical expenses related to the individual’s pre-existing conditions. After the moratorium period has ended, coverage for the pre-existing conditions will typically be included in the policy, subject to the terms and conditions of the policy.

In easy to understand terms, insurance policies are designed to cover you for something that may happen in the future and not something that has already occurred. So how this works is that insurers do not cover any medical problems that are pre-existing to start. These are conditions you may have suffered from within the last 5 years, including treatment, advice, symptoms or taking any medication. The good news is that an insurer will look to cover any new eligible conditions after a policy is in place and an pre-existing conditions can be looked at after going 2 years treatment, symptom, advice and medication free

During the moratorium period individuals pay their premiums and any new conditions that are diagnosed and unrelated to any pre-existing conditions will be covered within the scope of the policy. Members should carefully read the policy to understand the specific terms and conditions of the moratorium.

What is Medical History Disregarded?

Medical history disregarded is a form of underwriting that does not take into account an individual’s medical history when providing coverage. This means that all pre-existing conditions will be covered from the start of the policy.

This form of underwriting is generally only used when insuring the workforce of a medium to large business and is not an underwriting option on individual policies. However some insurers will give individuals the option to add new born children on medical history disregarded underwriting.

Can I still get get private health insurance if I have pre-existing conditions?

Yes. Despite any exclusions that a policy may impose on coverage for pre-existing conditions, insurers in the UK are still required to provide private medical insurance to those with pre-existing conditions.

This means that individuals with acute or chronic pre-existing conditions should still firmly consider the benefits of taking out a private medical insurance policy, as it can provide additional coverage for unrelated conditions, illnesses or injuries.

How will my pre-existing conditions be treated?

Private medical insurance is intended to provide additional coverage and access to private healthcare, rather than to completely replace the care provided by the NHS. This means that where an individual may have pre-exciting conditions that are excluded from their policy, these can continue to be treated by the NHS as they were previously.

In the United Kingdom, pre-existing conditions are covered under the National Health Service (NHS). The NHS is a publicly funded healthcare system that provides coverage for UK residents, regardless of their medical history. It is important to note that the NHS is still responsible for the care and treatment of pre-existing conditions.

Conclusion

It’s important to consider all options when it comes to health insurance for pre-existing conditions and to thoroughly research and compare different policies. It’s also a good idea to consult with a healthcare professional to understand the specific needs of your pre-existing condition and how they may impact your insurance coverage.