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Health insurance for pre-existing medical conditions

Our quick and simple guide to how health insurance works for people with medical conditions and how you can save money on your cover

A photo of Daniel Sharpe-Szunko, the author

By Daniel Sharpe-Szunko

Published on: 20 April 2023

7 min read

Health insurance for pre-existing medical conditions

More and more people in the UK are turning to private health insurance to try and avoid being stuck on long NHS waiting lists. While the NHS does a great job, issues with waiting times and access to treatment has led to an increased demand for health insurance policies.

It’s very easy to assume that health insurance will be too expensive for people with pre-existing conditions. This generally isn’t the case and there are some quick and simple ways that you can save money on health insurance if you have medical conditions.

Pre-existing conditions health insurance need-to-knows

These are some of the key points you will need to know if you’re looking for health insurance and you have medical conditions.

1. Health insurance doesn’t replace the NHS

Health insurance is intended to help supplement NHS care – not replace it completely.

Usually, you will need to get a referral from your GP before you can claim for treatment on your health insurance. This is because with most providers your policy won’t cover ‘primary care’.

The NHS classifies primary care as your first point of contact in the healthcare system e.g. a GP, dentist or opticians appointment. Health insurance will require you to have this initial appointment before claiming for follow up consultations or treatment.

Note: Sometimes your insurance provider will include virtual GP services as a benefit of your cover. You can use this GP service rather than your own as your first point of primary care.

2. You won’t pay more because of your medical history

Other insurance policies such as life insurance or income protection might charge slightly more based on your medical history or medical conditions. Health insurance doesn’t work like this and your price won’t increase based on your health.

Health insurance providers will instead base your price on your age, where you live and other factors like policy excess.

3. Your medical conditions won’t usually be covered

You can get health insurance when you have a medical condition, but most of the time your policy won’t cover any treatment you need for this condition.

You may be covered for conditions that you had over 5 years ago. You also may be able to be covered for conditions you had before buying your policy after a set amount of time. Some providers will agree to cover conditions after 2 years if you don’t experience symptoms or have treatment within those first 2 years.

4. Full medical underwriting can help you to save money

This can take a little longer when you apply as the insurer will want some medical information and can even request a report from your GP. Though this may seem like extra hassle now, it does mean the insurer could agree to cover your condition now or in the future. It is likely though that they will choose to exclude (not allow claims for) your condition.

What is a pre-existing condition for health insurance?

Insurers will class any medical conditions you have as ‘pre-existing’ or ‘chronic’.

A ‘chronic’ medical condition is a condition that is considered life long as there is no known cure. Most of these can be treated with medication or other treatments e.g. physiotherapy. This would include conditions such as diabetes or epilepsy.

You may also hear the term ‘acute’ condition mentioned relating to insurance policies. An acute condition is a one-off event or medical issue you are expected to recover from that isn’t life long e.g. a heart attack. Basically, it is a condition that is considered ‘cureable’.

A pre-existing condition is any condition where you have had treatment or experienced symptoms within the last 5 years. This can include chronic conditions and acute conditions.

Health insurance policies will not normally offer cover for pre-existing medical conditions. They will help cover the cost of treatment for any new symptoms you develop after your policy is in place.

Can you get health insurance for pre-existing conditions?

No, you should still be able to buy health insurance if you have one (or multiple) medical conditions. There will normally be exclusions applied to your policy though. An exclusion simply refers to anything you can’t claim for – in this case that would be your medical condition.

What is the best private health insurance for pre-existing conditions UK?

There are a lot of different insurers available in the UK for health insurance, which is good as this means you have options. Certain providers will work better for some people compared to others.

Some of the UK’s main health insurance providers include:

The Exeter often comes out ahead of the rest in terms of health insurance for people with pre-existing conditions. This is because of their innovative and flexible approach to underwriting and can even offer options for people who have chronic medical conditions like diabetes.

Often, other insurance providers won’t allow claims for pre-existing conditions, or anything related. The Exeter Health+ will allow customers to claim for complications of medical conditions, even if they won’t cover the condition itself.

How to save money on health insurance for pre-existing medical conditions

Everyone wants to get the best value for money when they’re looking for a new insurance policy. There are some really simple ways to save money on health insurance and still receive the cover and benefits you need.

  1. Remove benefits you don’t need – as health insurance is a flexible policy, you can remove benefits you don’t need to make your policy more affordable
  2. Pay more excess – health insurance works in a similar way to policies like car insurance. If you need to claim you will pay a small amount towards this (excess). The more excess you agree to pay, the cheaper your policy can be.
  3. Do some research – We’d always suggest this with any form of insurance policy. You should shop around and compare quotes to make sure you don’t end up paying more than you need to.
  4. Pick a guided hospital list – You can let the insurer give suggestions on which specialist to use rather than choosing yourself from a long list. Guided policy options are usually priced lower as your treatment options are more limited.
  5. Choose full medical underwriting – if the provider assesses your medical history and excludes certain things from your policy, this can equal lower prices
  6. Speak to a health insurance expert – a specialist health insurance broker will be able to explain all your options and help you find the right policy for the level of cover you need.

Here is where we answer the questions that tend to come up most when talking about health insurance for people who have medical conditions.

Are pre-existing conditions covered by health insurance?

You won’t normally be covered for pre-existing medical conditions when you apply for a new health insurance policy.

Do any insurers cover pre-existing conditions?

No, there aren’t any UK providers that will automatically cover pre-existing conditions. It is possible that you may be covered for certain conditions, if you remain symptom and treatment free for an amount of time set by the insurer.

This will depend on the provider and policy you choose and not all providers will offer cover after a set time.

What is a waiting period for a pre-existing condition?

A ‘waiting period’ will be a period of time after which your medical conditions might be covered by your health insurance provider. Most of the time this will be if you have been free of symptoms or treatment for 2 years after you initially took out a policy.

Not all insurers will have this rule and even those who do may still decline to provide cover for your specific condition after this point. You should speak to a health insurance expert to work out your best options, if you are keen to choose a provider who could eventually cover your condition.

What happens if I don’t declare pre-existing medical conditions?

Your policy won’t be valid if you haven’t declared an ongoing or pre-existing medical condition. If the insurer finds out you are trying to claim to treat a condition you already had, they won’t approve your claim.

They may even cancel your policy with no refund if they feel you misled them when you applied.

How do insurers assess applications from people with medical conditions?

This depends on the type of underwriting you choose. You have two main choices:

  1. Moratorium underwriting – this is what most people choose as this tends to be the faster and easier option. You’re asked for very minimal medical information (and may not be asked for any) when you apply.
  2. Full medical underwriting – this is a longer process but can be worth it. This would require more medical information and sometimes a report from your GP. If you have medical conditions, this option can lead to lower premiums as insurers will exclude certain factors from your policy.

Do I need health insurance if I have medical conditions?

This will come down to personal opinion and your medical history won’t affect if you need health insurance or not. Health insurance is meant to work alongside NHS care as an added boost to the treatments you can receive and how fast you will be seen.

What is the best way to compare health insurance for pre-existing conditions?

It can be hard to know what the best options are for health insurance even if you don’t have medical conditions. This is because there are such a wide range of policy options, and every insurer will offer something slightly different.

To compare what policies are available you can:

Useful health insurance guides

Below are more of our recent MPO news articles and guides about health insurance, the NHS and health related topics.

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