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Pre-Existing Conditions, Exclusions and Private Medical Insurance (PMI)

What is a pre-existing condition?


A pre-existing condition (in a medical insurance context) is a medical condition that a potential policy holder has or has had in the last 5 years before taking out the policy. If you have had symptoms, treatment, medication or advice on a medical condition in the 5-year window prior to the policy set-up, you will not be covered for this condition by the PMI policy.


Does that mean I would never be covered for a pre-existing condition?


There is a circumstance where a pre-existing condition would be covered. An example - say you sign up for a PMI policy and have a pre-existing condition. There has been a remission of the condition since it was present. If you remain symptom, treatment, medication and advice free (on that condition) for two years after the policy set-up, you should be covered after that two-year date going forward (Note - this is at the discretion of the insurer).


What about chronic conditions? Am I covered?


A chronic condition is defined as a medical condition such as diabetes or asthma, that continues indefinitely, and has no known cure. If you develop any of these conditions whilst being on the policy, you will be covered for the diagnosis. You will not be covered for the subsequent day-to-day maintenance of those conditions; however, you will be covered for any unexpected acute flare-ups. Pre-existing chronic conditions will not be covered


Does a pre-existing condition make your policy much more expensive?


Generally, no - your premium will not go up if you have a pre-existing condition, it will just be excluded from the policy. However, there are some exceptions - please speak to one of our expert advisers who will be happy to fill in the gaps.


What are some of the other exclusions (beside pre-existing conditions) that apply on a typical PMI policy?


Generally, private medical insurance will not cover you for:

  • War, riots and terrorism
  • HIV and AIDS
  • Cosmetic treatment
  • Fertility treatment or normal pregnancy
  • Injuries that are self/inflicted
  • Injuries that result from dangerous sports or pastimes
  • Addictions and substance abuse
  • Weight loss treatment


This list may look reasonably long, but remember that there are many, many conditions that are covered by PMI. Thousands have their lives changed by the rapid access to higher-grade treatment that health insurance offers.


Get a free no-obligation quote from one of our trained advisers today, and see how surprisingly secure health insurance can make you feel.