Health Insurance and Pre-Existing Conditions

You can usually still get private health insurance with a pre-existing condition, but that condition and anything related to it will normally be excluded, at least at first. With moratorium underwriting, anything from the past 5 years is excluded to begin with, but can become eligible after 2 continuous years on the policy without symptoms, treatment or advice for it. Chronic conditions are not covered for ongoing management.

So a medical history does not shut you out. It changes what the policy will pay for, and that is worth understanding properly before you buy. This guide explains what counts as pre-existing, how each type of underwriting treats it, and how to get the clearest terms for your situation.

Can you get private health insurance with a pre-existing condition?

Yes. Most people with a medical history can still buy a policy. What changes is what it covers. Your existing condition, and related problems, will usually be excluded, while new, unrelated conditions that start after your cover begins are covered in the normal way. How long the exclusion lasts depends on the underwriting method you choose.

That distinction matters more than people expect. Say you have had trouble with your lower back but nothing else. A policy would still pay for a new hernia, a cataract or suspected cancer investigations. It just would not pay for the back.

Where people come unstuck is assuming a policy will help with a problem they already have. If you are buying cover specifically because of a current health issue, a new policy is unlikely to pay for that issue. You may be better off looking at paying for that treatment yourself and insuring for the future.

What counts as a pre-existing condition?

A pre-existing condition is any illness, injury or symptom you had before your policy started. It does not need a formal diagnosis. If you saw a GP, had tests, took medication, received advice or simply had symptoms, insurers will usually treat it as pre-existing. Most look back over roughly the last 5 years, although the exact rules vary.

The undiagnosed part catches people out. Suppose you mentioned occasional chest pain to your GP 2 years ago, they ran a test and found nothing, and you moved on. To an insurer, that can still count as a symptom you had before cover started.

Common examples include:

• Back, Neck And Joint Problems
• Sports Injuries
• High Blood Pressure
• Asthma And Diabetes
• Anxiety Or Depression
• Previous Cancer
• Heart Problems

Related conditions matter too. An exclusion usually covers the original problem and anything linked to it. If you have a history of knee trouble, for example, a later knee operation may be treated as related even if the cause seems different to you.

For some conditions the detail gets complicated quickly. Endometriosis is a good example, and our guide to private health insurance for endometriosis looks at how insurers approach it.

How underwriting decides what is covered

Underwriting is how an insurer turns your medical history into a list of what it will and will not pay for. For a new individual policy, there are 2 main routes: moratorium and full medical underwriting. If you are switching from another insurer or joining a company scheme, there may be other options. The method you choose has a bigger effect on pre-existing conditions than the insurer you choose.

Moratorium underwriting

This is the most common route for new policies. You do not complete a detailed health questionnaire. Instead, anything you have had symptoms, treatment or advice for in the 5 years before your policy starts is automatically excluded at first.

The exclusion is not necessarily permanent. If you then go 2 continuous years on the policy without symptoms, treatment or advice for that condition, it can become eligible for cover. Medication counts as treatment, so a condition you take regular tablets for will usually stay excluded.

Here is how that plays out. Say you had physio for a shoulder injury 3 years ago and it has been fine since. On a moratorium policy, the shoulder is excluded when you join. If you go 2 years without any symptoms, treatment or advice for it, a later shoulder problem could be covered. If it flares up and you see your GP in month 14, the 2 year period usually starts again.

The trade off is uncertainty. You will not know for sure whether something is covered until you claim, and the insurer may need to check your GP records first, which can slow the first claim down.

Full medical underwriting

With full medical underwriting, you complete a health questionnaire when you apply, and the insurer may contact your GP. It then tells you up front which conditions are excluded. Some exclusions are permanent, while others may be reviewed later depending on the insurer.

It takes a little longer to set up, but you know where you stand from day one, and claims are usually quicker because the history has already been assessed. If you have a fairly clear medical history, or 1 or 2 issues from a long time ago, it can work out better than a moratorium. Our article on full medical underwriting or moratorium goes into the choice in more depth.

Continued personal medical exclusions

If you already have private medical insurance, you may be able to switch on continued terms, often called CPME or switch underwriting. The new insurer carries over your existing exclusions and moratorium dates rather than starting again. That matters if you have been on a moratorium for a while, because a fresh moratorium would reset the clock.

Medical history disregarded

Some company schemes offer medical history disregarded underwriting. As the name suggests, pre-existing conditions can be covered, subject to the scheme rules. It is generally only available on group policies, and availability depends on the insurer and the size of the group.

Underwriting options compared

For a fuller explanation of each method, see our guide to health insurance underwriting.

Pre-existing and chronic conditions are not the same thing

A pre-existing condition is about timing: you had it before the policy started. A chronic condition is about the nature of the illness: it is long term, needs ongoing management and has no known cure. Diabetes, asthma, arthritis and high blood pressure are common examples. A condition can be both, and chronic conditions are not covered for ongoing management whenever they start.

That last point surprises people. Even if a chronic condition first appears after you take out cover, the policy will not pay for its long-term management. What it may pay for is the initial diagnosis and treatment of an acute flare up, where the aim is to get you back to how you were before. The routine check ups, monitoring and medication that follow stay with the NHS.

So if you develop new joint pain on a policy, the investigations to find out what is wrong may well be covered. If those tests lead to a diagnosis of rheumatoid arthritis, the ongoing care usually is not. Our guide to chronic conditions explained covers this in more detail, including how some insurers treat certain stable chronic conditions when you switch.

If you have had cancer before

A previous cancer is normally treated as a pre-existing condition, and insurers often apply stricter rules to it than to other conditions. On full medical underwriting it may be excluded permanently. On a moratorium, check the policy wording carefully, because the definition of being trouble free can include routine follow up appointments and monitoring.

That does not stop you being covered for new, unrelated conditions. And because cancer cover varies so much between policies, it is worth looking at our cancer cover comparison to see how insurers differ on treatment limits and drug cover.

Mental health history

Past anxiety, depression or counselling counts as a pre-existing condition in the same way a physical problem does. Under a moratorium, recent treatment or advice would be excluded at first. If mental health support matters to you, look closely at what each policy offers, because mental health cover is often an optional extra with its own limits.

Be accurate about your medical history

If you choose full medical underwriting, answer the questions carefully and honestly. Under the Consumer Insurance (Disclosure and Representations) Act 2012, you have a duty to take reasonable care not to misrepresent anything to the insurer. Leaving something out, even by accident, can lead to a claim being reduced or refused, and a deliberate misrepresentation can lead to the policy being cancelled.

In practice, reasonable care means checking dates rather than guessing, and mentioning things you are unsure about rather than leaving them out. If you cannot remember when you had a particular treatment, your GP surgery can help you check your records. On a moratorium, you do not fill in a questionnaire, but the insurer will check your history when you claim.

If a claim is turned down because of a pre-existing condition and you think that is unfair, you can complain to the insurer first and then, if you are still unhappy, to the Financial Ombudsman Service, which is free to use.

Switching insurer when you have a medical history

Switching is where pre-existing conditions cause the most trouble, because a careless move can cost you cover you have already earned. Imagine you have been on a moratorium policy for 3 years and a knee problem from before you joined has now become eligible. Move to a new insurer on a fresh moratorium and that knee would likely be excluded again for at least 2 years.

Switching on continued terms avoids that, and some insurers do not ask you to disclose certain stable conditions when you transfer to them. Rules vary, so it pays to check before you cancel anything. Our guide to switching health insurance companies walks through the steps.

This is where we spend a lot of our time. The same medical history can be treated quite differently by different insurers, so when we compare cover for someone with a history, we look at how each one would handle their specific conditions, not just the price.

Business cover and pre-existing conditions

If you run a business, a group scheme can change the picture. Depending on the insurer and the size of the group, you may be able to choose medical history disregarded underwriting, which can cover employees' pre-existing conditions within the scheme rules. That can make a real difference for staff who would struggle to get cover on their own. Our page on business health insurance explains how company schemes work.

How to get the clearest terms

A few practical steps make a noticeable difference:

• List Your Conditions And Dates
• Check Your GP Records
• Choose Underwriting With Care
• Never Cancel Before Your New Cover Starts
• Compare How Insurers Treat Your History

That last step is easy to skip. Insurers do not all treat the same condition the same way, so it is worth taking time to compare health insurance providers on their terms for your situation. If the cover is just for you, our page on individual health insurance sets out the options.

Frequently asked questions

Does private health insurance cover pre-existing conditions?

Not usually, at least not straight away. On a moratorium policy, a condition from the past 5 years is excluded at first but can become eligible after 2 continuous years on the policy without symptoms, treatment or advice for it. On full medical underwriting, the insurer lists exclusions up front, and some may be permanent.

Is there any private insurance that covers pre-existing conditions?

The main route is a company scheme with medical history disregarded underwriting, which can cover pre-existing conditions within the scheme rules. If you are switching from another insurer, continued terms can also protect cover you have already built up. For a brand new individual policy, cover for an existing condition is unlikely from day one.

Can I join Bupa with a pre-existing condition?

Yes, the same applies to Bupa as to the other main UK insurers. Having a medical history does not stop you joining, but the condition will normally be excluded under the underwriting method you choose. How a particular condition is treated can differ between insurers, which is why comparing their terms is worthwhile.

Which health insurance is best for pre-existing conditions?

There is no single best insurer. The right choice depends on the condition, how long ago you had it, whether you are switching and which underwriting method suits you. For some people a moratorium is better, for others full medical underwriting gives clearer terms. Comparing how several insurers would treat your history is the most reliable way to find out.

Will a pre-existing condition make my premium more expensive?

Usually not directly. UK insurers tend to exclude a pre-existing condition rather than charge more to cover it. Your age, location and level of cover have a bigger effect on the price. Claims you make once you are insured can push your premium up at renewal, though.

Get help with cover for your medical history

Pre-existing conditions are one of the areas where independent advice makes the most difference. Morehealth is an FCA regulated, whole of market broker with more than 15 years of experience. We will look at how different insurers would treat your history, explain the exclusions in plain English and help you switch without losing cover you have already earned. There is no fee for our advice.

Contact our team, call 0800 028 5540 or message us on WhatsApp to talk through your options.