With Health Insurance, you pay regular premiums and in exchange the insurer covers the cost of private medical care for eligible conditions in some of the UK’s top private hospitals should you need it.
But what is an eligible condition and what happens if you’re already suffering from existing health problems at the time you take out the policy? Can you even get Health Insurance with a pre-existing condition on your medical records?
The answer is yes, in most circumstances you can get Health Insurance if you suffer from a pre-existing condition. However, whether or not this condition will be covered on the policy depends on your circumstances, the condition in question and your insurer.
A pre-existing condition is any medical condition you’ve suffered from in the past. Insurers aren’t typically concerned with minor conditions such as coughs and colds but are more concerned with major conditions such as cancer, heart / circulatory complaints and mental health problems.
Many people think you can’t get Health Insurance without a pristine medical history, but this isn’t actually true. There are few medical conditions that will entirely rule you out of getting Private Medical Insurance, so if you do have a health condition all hope is by no means lost.
It’s best to speak with an expert, such as one of the team here at Drewberry to ensure you’re getting the best policy for your circumstances.
How far back into your medical history the insurer will look for any medical conditions when deciding on your policy terms will depend on the type of underwriting you choose.
As an individual taking out a new UK Private Health Insurance policy, you have two options to choose from with your medical underwriting:
Which one you opt for could have a big bearing on whether your pre-existing medical condition is covered by your Health Insurance policy, so it’s important to understand the difference between the two.
Moratorium underwriting excludes most pre-existing medical conditions you’ve suffered from over a set period, usually the past 5 years. After serving a period on the policy without having any symptoms or receiving advice, medication or treatment for a particular pre-existing condition, the insurer may look to cover it at their discretion.
Moratorium underwriting is the most common type of medical underwriting for Health Insurance. It is divided into plans underwritten on a rolling moratorium or a fixed moratorium basis.
Here the insurer will consider any claims for medical conditions that you’ve suffered from in the 5 years before taking out the policy, providing you’ve served 2 years on the policy without any symptoms or advice, medication or treatment for that condition.
This includes both self-funded private treatment or NHS treatment.
Providing you can give the necessary medical evidence to show you’ve received no care for that problem, the insurer may remove the exclusion for that condition going forward.
Fixed moratorium underwriting represents a more lenient type of underwriting than rolling moratorium underwriting.
While it still excludes any medical conditions you’ve suffered from in the 5 years leading up to the policy start date, once you’ve served 2 years on the policy the insurer will then consider covering you for that condition. This is regardless of whether you’ve received treatment for that condition or not over those 2 years.
It’s important to realise that often the most serious conditions — e.g. cardiac and cancer cases — are unlikely to be eligible for fixed moratorium underwriting.
While this is a more favourable type of underwriting for clients, there’s only one insurer on the market that still uses fixed moratorium underwriting for its Private Medical Insurance.
Opting for full medical underwriting means you disclose your full medical history upfront to the insurer in a health questionnaire.
It usually leads to a total exclusion of any medical condition you’ve suffered from in the past, regardless of how long ago you suffered from that condition.
This exclusion will usually be permanent, although it may be possible to get it lifted at a later date with supporting medical evidence.
For more minor conditions, however, you may be able to negotiate coverage with your insurer, particularly if that condition occurred a number of years ago.
This depends entirely on your circumstances and is best discussed with your adviser. However, broadly speaking, you should consider the below guidelines for your medical history.
For serious medical conditions — e.g. cancer or cardiac / cerebrovascular conditions — it may be better to opt for moratorium underwriting.
That’s because after 2 years on the policy, the insurer will reassess your health and, providing you haven’t sought any advice, medication or treatment for that condition in those 2 years, potentially look in to covering you.
A fully medically underwritten policy, on the other hand, would likely place a permanent exclusion on such a serious medical condition, one which can be very tricky to get an exclusion removed at a later date.
If you’ve suffered from a minor condition in the past 5 years, then full medical underwriting may be better than moratorium underwriting.
This is because moratorium underwriting will put an exclusion on most medical conditions you’ve suffered in the past 5 years regardless of severity.
However, when an insurer examines your medical history during the full medical underwriting process they may deem the condition to be minor enough for them to offer you cover for it regardless.
Health Insurance can be complicated enough without having to worry about pre-existing conditions and whether or not they’ll be covered. For that reason, we recommend speaking to an adviser before you delve into taking out cover if you have any health problems.
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I’ve held a policy with Drewberry for several years now. They are always friendly, insightful and offer great service.