Guide to health insurance and pre-existing conditions
If you have had health problems in the past, you may worry that private health insurance is not available to you. In most cases, that is not true. However, your medical history can affect what you can claim.
23.06.26
By
Alex Mhandu
Individual private medical insurance (PMI) is designed to cover new, eligible medical problems – not conditions you already had before the policy started.
This matters if you have decided to consider private medical insurance because you are waiting for treatment through the NHS. A new policy is unlikely to pay for treatment for existing conditions. You may still choose to pay privately for treatment, but that is likely to be self-funded.
This guide explains how UK health insurance treats pre-existing conditions, what insurers may check when you apply or claim, and why it is worth getting advice when you compare private medical insurance quotes.
What is a pre-existing medical condition?
A pre-existing medical condition is any illness, injury, symptom, or medical problem that existed before your policy started.
It does not have to be formally diagnosed. For example, it may include symptoms you had already noticed, medication you were taking, a problem you had discussed with a GP, a referral to a specialist, or an issue where you were waiting for tests or results.
This means that ongoing stomach pain may be considered pre-existing, even if you have not yet been diagnosed with a digestive condition. The same may apply to back pain, chest symptoms, headaches, a lump, breathing problems, or any other issue where you had symptoms or had already sought advice.
Insurers may also look at related symptoms, not just named conditions. So, if you are not sure whether something is relevant, it is safer to mention it when you apply (depending on the type of medical underwriting your policy has).
Can you get private health insurance with a pre-existing condition?
Yes, you can usually still get private health insurance with a pre-existing condition. The key point is that the past condition – and related problems – may be excluded from your cover.
For individual cover, assume that pre-existing conditions will be excluded, but it will cover new, eligible illnesses or injuries that start after your policy begins.
Health insurance cannot usually be bought after a problem appears and then used to pay for that same problem. If you are already waiting for treatment, self-pay private healthcare may be an option if you do not want to wait for NHS treatment. Insurance may still help with future, unrelated conditions if they are covered by the policy.
What about company health insurance?
Some larger employer schemes may offer medical history disregarded (MHD) cover. It means the insurer does not assess employees' past medical history in the usual way when evaluating eligible claims. These types of policies are normally available to businesses that will be enrolling more than 15 employees on the scheme and will cost more than policies that don’t cover pre-existing conditions.
If you own a business or arrange staff benefits, you may want to read our guide to how company health insurance works in the UK.
Chronic vs acute conditions: what is not covered?
Private medical insurance is mainly designed for acute conditions that start after your policy begins. Insurers will typically not cover chronic conditions.
An acute condition is usually a short-term illness, injury, or disease that is likely to respond to treatment. The aim is to help you recover or return you to the state of health you were in before the condition began.
A chronic condition is different. It can be long-term, ongoing, likely to come back, or needs monitoring, medication, or control, rather than a one-off course of treatment. Examples may include asthma, diabetes, high blood pressure and irritable bowel syndrome.
Private medical insurance does not normally cover the long-term management of chronic conditions. It may still cover new and unrelated acute problems if your policy terms allow it.
The dividing line is not always obvious. This is one reason it helps to speak to an insurance broker before you buy cover or make a claim.
How insurers assess your medical history
Underwriting is the process an insurer uses to decide what it can cover, what it will exclude, and what the policy will cost. For individual private health insurance, there are two common routes.
|
Type of assessment |
How it works |
Main benefit |
Main drawback |
|---|---|---|---|
Full Medical Underwriting (FMU) |
You answer detailed questions about your medical history before the policy starts. The insurer may ask for more information from your GP. |
You should know from day one what is and is not covered. |
It takes more effort at the start, and you must answer the questions carefully. |
Moratorium underwriting |
You do not usually give your full medical history upfront. Instead, conditions you had in the five years before the policy starts are automatically excluded at first. When you make a claim, your insurer will request your medical records from your GP to check if it is pre-existing and determine whether to provide cover. |
It can be quicker and simpler to set up. |
You may not know whether a claim is covered until the insurer checks your medical records. |
As mentioned above, for some Group policies (i.e. through an employer), medical history may be disregarded altogether. This is known as medical history disregarded (MHD).
Full Medical Underwriting (FMU)
With full medical underwriting, you declare your medical history before the insurer agrees your final terms. You may need to complete a health questionnaire, and the insurer may also seek more details from you, your GP, or a specialist.
The main advantage of FMU is clarity. Once the insurer has assessed your application, you should know which conditions are covered and which are excluded.
The main disadvantage is that the process can take longer. It also relies on accurate answers. If you forget something important, you may find the process is delayed when you come to make a claim, or that you aren’t covered for your claim type.
Moratorium underwriting
With moratorium underwriting, you do not usually give your full medical history at the start. Instead, any condition you had during a set period before the policy starts is automatically excluded. This period is often the previous five years.
Many moratorium policies then use a two-year clear rule. This means a condition may become eligible again if two consecutive years elapse without symptoms, treatment, medication, tests, or medical advice for that condition.
However, note that if symptoms return or you seek medical advice within the two years, the clock will restart. Exact rules vary by insurer and policy, so always check the wording before you rely on this.
How do insurance companies know about pre-existing conditions?
Insurers usually check your medical history when you make a claim. This is especially common with moratorium underwriting, because your full history was not assessed when you bought the policy.
When you make a claim, the insurer may ask for:
Details of your symptoms and when they began
A GP referral letter or consultant report
Access to your GP or hospital records
Information about previous tests, treatment, or medication
Confirmation that the problem is not linked to an excluded condition
If your records show that you had symptoms, advice, tests, or treatment before the policy started, the insurer may treat the claim as pre-existing and decline it.
It’s important to make sure you disclose all relevant information to the insurer. If an insurer discovers that an undeclared pre-existing condition, or related symptoms, is relevant to your claim, it will reject the claim. It may also cancel the policy entirely.
This does not mean you need to remember every minor cough or cold. However, you should answer the questions honestly and ask for help if you are unsure what to include.
Common questions about health insurance and pre-existing conditions
Does private health insurance cover cancer treatment?
Yes, private health insurance can cover cancer treatment. Some policies offer cancer cover as standard, while others offer it as an optional extra. If you have had cancer in the previous five years, it’s unlikely you will be able to get cover. However, even if there’s a history of cancer in your family, this shouldn’t prevent you from getting a policy. Insurers can’t ask you about any genetic testing you’ve had in relation to cancer in your family, but if you get negative results, you may wish to tell your insurer.
If you choose a policy with cancer cover, check carefully what it includes. Some will pay out for radiotherapy and chemotherapy, while others can give you access to pioneering treatments. If you decide to have cancer treatment with the NHS as an inpatient, some of these policies will pay out a daily rate in place of private treatment.
Are kidney stones a pre-existing condition?
Kidney stones may be treated as pre-existing if you had stones, symptoms, tests, advice, or treatment before your policy started. If you have been completely clear for the period required by your policy, cover may be possible in future. Check the wording before you claim.
Is a hernia a pre-existing condition?
A hernia can be an acute condition. However, if you noticed swelling, pain, or other symptoms before the policy started, it is likely to be considered pre-existing. A new hernia that appears after the policy starts may be covered, depending on your terms.
Is asthma or IBS covered?
Asthma and irritable bowel syndrome are usually treated as chronic conditions because they are ongoing and need long-term management. Private medical insurance does not normally cover routine monitoring, repeat medication, or long-term control of chronic conditions.
Are migraines considered pre-existing?
Recurring migraines, or headaches you had before the policy started, are likely to be treated as pre-existing. Ongoing migraine management may not be covered. If you develop new headaches after the policy starts, the insurer will look at your history and the policy terms before deciding whether to accept a claim.
How an insurance broker can help you find the right cover
Choosing between full medical underwriting and moratorium underwriting can be difficult. The right route depends on your medical history, your budget, and what you expect to use the policy for.
A policy that looks simple online may not be the best fit. It may have exclusions you have not noticed and may leave you unsure about whether a future claim would be accepted.
Alan Boswell Group can help you:
Compare policies from different insurers
Understand what conditions are likely to be covered
Check how exclusions may affect you
Choose between full medical underwriting and moratorium underwriting
Need help with your health insurance?
If you have a medical history, speak to our advisers before you choose cover. We can help you compare private medical insurance quotes and explain the likely effect of any exclusions. Get in touch with our expert health insurance team.