What are Pre-existing Conditions in Private Health Insurance?

If you currently have, or are looking to take out private health insurance, you'll likely have come across the term 'pre-existing conditions' or 'pre-existing medical conditions'.

So, what are they? How do insurers view them? And what does it mean for you if you have one (or more) and wish to take out private health insurance?

In this article we'll cover all you need to know about pre-existing conditions — what they are, examples, and when they might or might not be covered by your provider.

What is a pre-existing medical condition?

The Association of British Insurers defines a pre-existing condition as:

Private health insurance isn't ordinarily designed to cover pre-existing conditions. Rather, it is designed to offer you protection against unexpected conditions that arise after your policy start date.

So, if you have experienced any health conditions in the past or at the time of taking out a policy, and in which you have or are waiting for a diagnosis or treatment, it's unlikely these will be covered.

There are some instances where your insurer may agree to cover a pre-existing condition, and this depends on how your policy is underwritten. We'll look at this in more detail later on.

What are some examples of pre-existing conditions?

Here are some examples of conditions that private health insurers typically recognize as a 'pre-existing condition'. Note this list is not exhaustive and will differ from insurer to insurer and some providers may cover one or more of these as standard. All the details will be listed in your policy documents so be sure to familiarize yourself with these.

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

The short answer is yes, absolutely. Having one or more pre-existing conditions does not affect your ability to take out a private health insurance plan, however, in most cases any policy you opt for won't cover these conditions unless your provider has agreed to this (more on this later). This means you won't be able to make a claim for treatment or costs related to this specific illness or injury.

So why do most insurers shy away from covering pre-existing conditions? Well, it all comes down to risk. Insurers see pre-existing conditions as risky from a financial point of view simply because you are more likely to seek treatment and therefore make a claim. Pre-existing conditions are more predictable and in some cases chronic (i.e. long-term) so insurers prefer to not take these odds. Instead, private health insurance is more tailored to protect you from unexpected illness or injury.

Can I get private health insurance cover for pre-existing conditions?

There are some insurers who will offer specialist cover for pre-existing conditions (though be sure to read the terms, conditions and limitations carefully). Private health insurance provider General and Medical, for example, offer pre-existing conditions cover that can be added to your policy for an additional premium. You can choose up to two of the pre-defined conditions approved by them with an annual limit of £1,000 (this limit is increased yearly to a maximum of £10,000 providing no claims related to the condition(s) have been made).

Another option available to you is choosing the right type of underwriting. In a nutshell, underwriting is where insurers use the medical information you provide to assess whether you have any pre-existing medical conditions and use this to evaluate your application for health cover. Choosing the right underwriting method for your circumstances can help determine whether your pre-existing conditions might be covered later on by your health insurance.

Type of medical underwriting

You can choose the method through which insurers evaluate any pre-existing medical conditions you have. There are two main methods of medical underwriting that insurers will use to assess your application for private health insurance:

Moratorium underwriting

With this type of medical underwriting you won't need to disclose information about your medical history to your insurer when you apply for private health insurance. However, you will need to provide this should you wish to make a claim, and your insurer may also need information from your GP, too.

However, with moratorium underwriting you'll typically find all pre-existing conditions you have experienced within a defined, set period of time prior to taking out cover (usually five years) will be excluded from your cover.

The upside if that many insurers will eventually cover you provided you have not received any treatment, diagnosis, medication or advice for your pre-existing condition(s) for a set period of time after you have taken out your policy, in most cases this is two continuous years. This means that you will then be be covered for this condition after this period has ended.

Full medical underwriting

Unlike moratorium underwriting, if you choose full medical underwriting you will need to complete a full health questionnaire and let your insurer know of any pre-existing medical conditions you have. Your insurer may also request information from your GP, too. If you choose to add a partner or family to your health insurance policy you'll also need to disclose their medical history.

It is crucial that the answers you give are accurate and truthful—if you don't, issues may arise further down the road if you need to make a claim. Your insurer will then review this information and detail what pre-existing conditions they will and will not cover.

The benefits of opting for full medical underwriting is that there is greater understanding and clarity from the get-go about what is and isn't covered in your policy. Also, as your insurer already has a record of your medical history so the claims process can be a lot smoother.

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