Chronic Conditions Explained
Health insurance covers many illnesses, they are summarised as curable, acute conditions. The most common conditions covered include cancer, heart problems, musculoskeletal issues, such as joint replacements and injury, and mental health issues.
Private health insurance is not designed to cover chronic conditions, whether your symptoms started before or after taking out a policy. However, there are some elements of chronic conditions you will be covered for such as initial diagnosis or an acute flare up. Due to the ongoing nature of most chronic conditions, insurers do not cover the routine monitoring and maintenance required to control them. If insurers were to cover all aspects of a chronic condition the premium you would pay would be far higher.
What are chronic conditions?
A chronic condition is a disease, illness or injury that has one or more of the following characteristics: it needs long-term monitoring, ongoing or long-term control or relief of symptoms, it requires rehabilitation, and it has no known cure or is likely to come back.
When there is no cure, chronic conditions can only be managed with drugs or other treatments to prevent a flare up or exacerbation of symptoms.
Treatment of chronic conditions is focussed on helping the patient learn how to live with the illness as opposed to curing it. This type of treatment is usually in the form of a long-term rehabilitation programme with no specified end date. As chronic conditions are incurable they need to be monitored through regular check-ups and diagnostic tests to ensure the condition remains stable.
It is the regular check-ups and diagnostics and any required medication that is not covered by a health insurance policy.
Although cancer can in many ways fall into the category of a chronic condition, most insurers now cover every stage of a cancer journey, and it is not classed under the general exclusion of chronic conditions on the policy.
The most common chronic conditions include diabetes, hypertension, chronic pulmonary obstructive disease (COPD), arthritis, asthma, and atrial fibrillation.
What aspects of chronic conditions are covered?
Even though they are not covered in full by most health insurance companies, there are still elements of chronic conditions that can be covered.
The initial diagnosis of a chronic condition will always be covered by a policy subject to the underwriting and provided it is not an excluded condition already.
Once a chronic condition has been diagnosed the insurer will cover the cost of treatment that attempts to cure the condition. Once these treatments have been exhausted the treatment would then be classed as ‘maintenance’ and therefore not covered by a health insurance policy.
Another situation where an insurer will pay for the treatment of a chronic condition is if a new treatment becomes available. If the new treatment is aimed at curing the condition, then most insurers will pay for it, however once it is clear a cure is unlikely the cover will be removed.
Acute flare-ups of a chronic condition are covered. If a long-term condition gets worse, it may be considered as an acute fare-up. This is when there is a sudden and unexpected deterioration of the condition or its symptoms which can be modified by a short course of treatment. Most insurers cover the treatment of an acute fare-up when the condition is likely to respond quickly. The aim is to restore you to the state of health immediately before suffering the acute fare-up.
If urgent medical attention is needed to help stabilise or treat a fare-up, access should be by the NHS emergency services in the normal way, as your health insurance, in most cases, does not cover emergency treatment. However, when the condition has been stabilised and the consultant has agreed that you are well enough, you may be able to transfer to private care if you need planned treatment.
Once an acute flare up has been controlled the insurer will not cover the ongoing treatment and management of the condition.
Switching your policy with a chronic condition
All insurers have different criteria when it comes to switching your policy and some insurers have a list of chronic conditions that do not need to be disclosed. This does not mean that they will cover the ongoing monitoring and maintenance, but acute phases would be covered without an exclusion being applied when you transfer your policy.
Examples of chronic conditions that do not need to be disclosed to some insurers are, hypertension, hyperlipidaemia, an underactive thyroid, stable type 2 diabetes, stable benign prostate disease, carpal tunnel syndrome and acid reflux. Some of these conditions would need to meet further criteria in terms of how they are managed and how long they have been stable.
As there are many options and different criteria when it comes to chronic conditions, using Morehealth to manage the switch process for you is invaluable, it saves you time and hassle. We understand the complexities of underwriting and will guide you through the process, whilst making you fully aware of what will and will not be covered before you switch insurers.