What are pre-existing conditions in health insurance?

27/02/2023

The importance of pre-existing conditions in health insurance

Obtaining private health insurance is a great way to avoid surgery waiting times, obtain personalised care, and gain access to new life-saving treatments and medications. As the old adage goes: health is wealth - and having health insurance can help you get better and faster treatment for any unexpected illnesses or onset conditions in the future, such as cancer.

If you’re thinking about getting private health insurance, you might be worried about the impact any of your pre-existing conditions may have on the cost of your premium - or worried that you might not be able to obtain health insurance at all.

In this article, we’re going to discuss what challenges those with pre-existing conditions may face when obtaining health insurance, and discuss which conditions won’t be covered under most plans. But first of all - what is a pre-existing condition in health insurance?

Understanding health insurance

In order to understand the concept of pre-existing conditions, it’s helpful first to understand the health insurance model in the UK. Like any other type of insurance, health insurance operates via a premium system. This means you’ll be quoted a yearly cost for your health insurance cover, and you’ll typically pay for your premium via monthly payments.

The cost of your premium will usually be determined by factors such as your age and postcode, as well as the type of cover you plan on getting. For example, 70 plus insurance tends to be more expensive than insurance for someone in their 30s.

Your premium will usually cover all forms of short-term, non-emergency curable illnesses. Depending on your level of cover, your premium goes toward paying the cost of appointments, specialist consultations, X-rays, surgery, and various other treatments and medications.

However, when it comes to long-term chronic illnesses or pre-existing conditions, most health insurance companies won’t include care or treatment for these in your cover. This is because health insurance is there to safeguard you from future illnesses, not treat current or ongoing health problems.

However, some pre-existing treatments can be treated under certain circumstances - it all depends on the type of cover you go for, your specific condition, as well as the policies of your chosen health insurance company. For example, if you opt for a moratorium underwriting, you may be eligible for cover if you don’t have any symptoms, treatment, medication, or medical advice regarding your condition for two full years from the beginning of your insurance policy.

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So, what is a pre-existing condition?

While the term ‘pre-existing condition’ is somewhat of an umbrella term, it generally refers to any form of medical condition or injury that you had prior to obtaining (or applying for) private health insurance. These can include chronic conditions such as asthma, arthritis, and diabetes, as well as long-term conditions such cancer, HIV and AIDS.

In general, health insurance companies consider the following illnesses and conditions to be pre existing conditions:

  • Asthma and other chronic respiratory conditions
  • Diabetes
  • Arthritis
  • Heart disease
  • Cancer
  • Crohn's Disease
  • Cystic fibrosis
  • Back pain
  • Chronic joint problems
  • Allergies
  • High blood pressure
  • Psychological and psychiatric conditions (depression, anxiety, etc)
  • Any injury that occurred prior to obtaining health insurance
  • All other forms of chronic or incurable illness

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Why don’t health insurance policies cover these conditions?

Health insurance companies only cover conditions that develop once you’ve already obtained cover. When you buy health insurance, you’re paying for security and peace of mind in the event of future illnesses, not paying for current medical treatment.

You can still obtain private medical care for an ongoing illness in a private practice, but this would be paid out-of-pocket, rather than claimed on your insurance. This is why obtaining health insurance is so valuable - you’re able to access fast treatment without having to pay extortionate rates upfront. With NHS cancer treatment waiting times at record highs, having health insurance is a great way to protect yourself in the event of an unwanted diagnosis in the future.

Can I still get health insurance with pre existing conditions?

Despite chronic and long-term conditions not being covered by most health insurance companies, you can still obtain insurance cover if you have pre-existing conditions. In most cases, your condition simply won’t be included in your cover, so you’ll need to obtain treatment from either the NHS or a private specialist.

Some health insurance policies will also allow you to pay for optional “extras” when you apply for a premium: these can be useful if you’re looking for extra care such as dental cover, but do note that pre-existing chronic conditions won’t be covered under any insurance policy.

Do also note that emergency care is typically not covered by any health insurance policy: if you have an urgent medical emergency, head to your nearest A&E for an appropriate diagnosis and treatment.

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What is the time frame for pre-existing conditions?

Generally, health insurance companies will count any pre-existing condition that you’ve been diagnosed with - or had symptoms of - in the last five years. Health insurance companies don’t need a formal diagnosis when it comes to pre-existing conditions: if you’ve experienced symptoms, you shouldn’t expect them to be covered in your care.

How can I know if my pre existing condition is covered?

So, how can you know whether or not your pre-existing condition is covered by your insurance provider? It’s simple: when you apply for health insurance, you’ll either undergo a full medical underwriting, or a moratorium underwriting. An underwriting is a way for the insurance company to calculate any financial risk associated with your medical profile, and it also serves as an easy way for you to be informed of what you’re covered for, and what type of care isn’t included.

Full medical underwriting

A full medical underwriting means that you’ll be required to fill out an application form and provide answers to specific medical questions. The insurer will then let you know your exclusions - if any - prior to the start of your policy. Do note that this information is not used to determine the cost of your premium.

When you undergo a full medical underwriting, you’ll know right away whether or not your pre-existing condition is covered. If your condition isn’t covered, it’s up to the specific healthcare insurer to decide whether they’ll take on the risk.

Moratorium underwriting

A moratorium underwriting allows those with pre-existing conditions to obtain an insurance policy, and even end up receiving care for certain pre-existing conditions under certain conditions. Your provider has the right to inspect your medical records before approving your claim, and if they find that your claim is related to any condition (chronic or otherwise) that you’ve experienced in the last five years, they’re likely to reject it.

However, if you go two years without symptoms, treatment, medication or advice on the condition since the beginning of your policy, it may be able to be covered by your insurer. Don’t forget that all insurers will have their own moratorium policies, so it’s important to check with each individual provider.

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Final Thoughts

Even if you suffer from a pre-existing condition, you can still obtain health insurance (and the peace of mind that comes along with it!) Most health insurance companies won’t be able to offer cover for chronic or long-term conditions, but this doesn’t mean you won’t be able to obtain health insurance to protect you against future illness. As always, make sure to check with each provider individually, as not all insurance companies will offer the same policies.

 

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