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Private health insurance and pre-existing conditions explained

In this guide we explain what a pre-existing condition is and how it can affect your health insurance. We also look at the importance of declaring all your pre-existing conditions.

Health insurance provides access to private healthcare and helps cover the cost. It covers things like:

  • Seeing a private GP, physiotherapist or mental health professional.
  • Treatment in private hospital.
  • Specialist drugs and treatments.

When you apply for private health insurance, the insurer will ask about your health and lifestyle. At this point, you need to tell the insurance company if you have a pre-existing condition. Your medical history is one of the factors that affects the cost of your health insurance.

What is a pre-existing medical condition?

It's any medical problem you’ve had before applying for private health cover. These can be: 

  • physical health conditions
  • mental health issues
  • long-term conditions
  • one-off medical events.

For example, it includes conditions like high blood pressure, asthma, diabetes and arthritis. Also, depression and anxiety, as well as broken bones, migraine, back ache, hip and knee pain.

Tell your insurance company if you’ve had any symptoms, tests or treatment for any illness or injury in the past. They’ll also need to know if you're currently going through diagnosis tests for a condition.


Private health insurance and mental health

You can often get cover for mental health conditions as long as your health insurance offers it.

A mental health condition is any disorder that has a negative effect on your mood, the way you think or how you behave. Insurance companies can provide cover for conditions that come on suddenly. But they're less likely to offer cover for long-term or ongoing conditions.

Find out more: Mental health and private insurance explained


How do insurance companies approach pre-existing medical conditions?

Underwriting is an insurance company’s way of deciding whether they can insure you. When you apply for private health insurance, you can choose the type of underwriting.

If you never had private health insurance before, there are usually two choices - Moratorium and Full Medical Underwriting. Both provide cover for any new medical conditions. But they have different approaches to pre-existing medical conditions.

Moratorium underwriting

With this type of underwriting, you don’t need to tell the insurance company about your full medical history when you take out the cover.

The insurer will only tell you if you’re covered at the time you make a claim. They won't cover you for any conditions you've had in the five years before you took out the insurance. But if you've not had treatment, medication or advice for those conditions for two years, they may cover you for them in the future.

Full Medical Underwriting

With this type of underwriting, you'll need to complete a questionnaire about your medical history. In some cases, you'll also need to give the insurer access to your medical records. The insurer can then decide if they want to insure you or not for a pre-existing condition.

So, you may be able to get insurance for a pre-existing medical condition that is excluded with Moratorium underwriting. 

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

If you make a claim for a pre-existing condition that you haven't declared, you won't be able to get treatment. And you may even have your policy cancelled.

It’s very important to give the insurer the full picture about your health. That way they can make an informed decision about the type of cover you can have. And you’ll know exactly which conditions are insured and which aren’t.

How do insurers know about pre-existing medical conditions?

You'll need to tell the insurer about your health and lifestyle when you apply or make a claim.

With Full Medical Underwriting, you’ll complete a medical questionnaire. And you may have to let the insurer have access to your medical records. At this stage the insurer will be able to see exactly which conditions you’ve had in the past.

With Moratorium underwriting, your insurer will review your medical details when you make a claim. They can ask to see your medical records to check whether you’ve already had the condition you’re claiming for.

How can I get treatment for the condition if it is not covered on my health insurance?

Having private medical insurance does not prevent you from using any NHS service. You can make an appointment with your GP as usual, and they can refer you to a specialist if needed.

Physiotherapy and mental health support are available at private facilities. You’ll need to cover the cost yourself.  You can also choose to pay for private surgery if it’s not covered by your plan.

There are also charities who can support your needs. And social care services can help with conditions such as dementia and diabetes. 


Will my private health insurance cost more if I have a pre-existing medical condition?

Having a pre-existing condition means you’re more likely to make a claim. So, if your insurer covers your pre-existing condition, they may charge you higher premiums. This compensates for the increased risk to the insurer of you making a claim.

With Moratorium underwriting, the cost of your health insurance isn’t affected. This is because your pre-existing conditions are excluded for at least two years.

There are ways to control the cost of your insurance. You can increase your excess or opt for a basic level of cover. It’s a good idea to shop around when you get quotes to see how prices vary between providers. Be sure to check what is and isn’t covered by each insurance company so you can compare like for like.

Find out more: The cost of private health insurance explained

Vitality health insurance

Want to know more about health insurance or thinking about taking out a policy? Here are some of the benefits of taking out health insurance with Vitality:  

  • See a private GP within 48 hours  
  • Avoid lengthy hospital waiting lists  
  • Get specialist drugs and treatments  
  • See a consultant fast  
  • Refer yourself for physiotherapy  
  • Get mental support fast - and without a GP referral 
  • Discounts from top brands. And rewards for getting healthy. 
Get health insurance quote in minutes.
Published: 25 June 2024

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