27/02/2023
Obtaining private health insurance is a great way to avoid long waiting times, prioritise your health and well-being and gain access to breakthrough treatments and medicine.
When it comes to getting health insurance, there are many things to take into consideration, including pre-existing medical conditions.
A pre-existing condition is anything you’ve had symptoms, advice, treatment or medication for, before taking out the policy.
Some of the most common pre-existing conditions include: asthma, diabetes, heart disease, cancer, back pain and high blood pressure among others.
The purpose of health insurance is to get you back to the same level of health you were in when you took out the policy.
If you have a pre-existing condition, the likelihood is, it won't be covered in your policy. However, this doesn't mean that health insurance isn't available to you. You can still get cover for future, unrelated illnesses or injuries that could occur.
Whether you're looking to get started with your first health insurance policy, or you're already covered and want to see if you can switch and save on your policy or find better suited cover. We're exploring pre-existing medical conditions and health insurance options.
How does health insurance work?
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 involves paying a monthly or yearly premium to cover your private healthcare bills.
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 need. For example, 70 plus insurance tends to be more expensive than insurance for someone in their 30s. This is because as we get older, we're more likely to require healthcare.
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 medical 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.
There may be a possibility that your policy can eventually cover something that's classed as a pre-existing condition. 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.
What counts as a pre-existing medical 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.
Some common examples of pre-existing conditions include:
- 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
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 for the bills upfront. With only 71.4% of people in England receiving their diagnosis and starting their first treatment within 2 months (the NHS standard waiting time), 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 medical insurance with 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.
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 policy.
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? When you apply for health insurance, you’ll either choose full medical underwriting, or 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.
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 medical 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 five years leading up to your policy start date
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. Using a free, expert intermediary service like Usay Compare, can help to guide you through the process of finding the right policy with the most suitable underwriting option for you. They'll be able to discuss full details of exclusions so you are confident in your policy.
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.
If you're ready to see what health insurance options are available to you, get in touch with one of our expert advisers for a free, no obligation consultation. They'll guide you through the process and help you to make informed decisions for your future health.
Fill out the form below or give us a call on: 01285 864670
