Long-term illnesses affect around 15 million people in the UK. When it comes to private medical insurance (PMI), many of these will also be considered a pre-existing medical condition, which could impact the cover you get; here’s how it could affect your policy and your options.
- What is a pre-existing medical condition?
- Can I get medical insurance with a pre-existing condition?
- What does private medical insurance cover?
- How does insurance work with pre-existing medical conditions?
A pre-existing medical condition is any illness or condition that you’ve had before the policy is taken out. This includes anything you’ve been tested, treated for, or diagnosed with.
When it comes to private medical insurance (PMI), some policies are even more specific, and a pre-existing condition will also include those you’ve had symptoms for but not been diagnosed with. Examples of pre-existing medical conditions include heart problems, respiratory illnesses, and diabetes.
Yes, you can still get private medical insurance with a pre-existing condition. That said, you may find your choice of provider limited; you might have to meet certain criteria.
It’s also worth noting that the cost of private medical insurance is likely to be higher compared to people with no existing medical conditions.
Does private health insurance exclude pre-existing medical conditions?
Generally, pre-existing medical conditions are excluded from private health insurance, but you should still be able to find suitable cover.
PMI is designed to treat acute conditions, which are classified as unexpected illnesses or conditions that get better with treatment, such as joint pain, broken bones, hernias, or cataracts.
Depending on your policy, you can be covered for diagnosis, treatment, hospital stays, and after-care. PMI also helps you bypass long NHS waiting lists, and you’ll often have a choice of where you’re treated.
As a rule, PMI does not cover chronic illnesses, which many pre-existing medical conditions are classed as.
What is a chronic condition?
Chronic conditions are long-term illnesses and conditions currently without a cure. Instead, they’re usually managed with medication or therapy.
Examples of chronic conditions include:
- Irritable bowel syndrome
- Long Covid
- Neurological conditions such as Multiple Sclerosis
- Respiratory conditions such as asthma
If you have a pre-existing medical condition, insurers use one of two ways to assess the risk of a claim being made (known as ‘underwriting’).
Full medical underwriting
This means your PMI provider will gather as much information as possible about your health. You’ll usually need to fill out a medical questionnaire, and the provider may contact your GP to better understand your health and how your pre-existing conditions are managed.
After your medical history has been assessed, the PMI provider will make it clear what they can and can’t cover in your policy.
While all this can take longer to arrange at the outset, it should help speed up any future claims because your provider is fully aware of your circumstances.
Policies based on moratorium underwriting can be easier to take out. This is because providers won’t usually ask you too much about your medical history.
However, if you have pre-existing conditions (within the last five years), these will be excluded from your policy. If you don’t suffer from that same condition for another two years after taking out your policy, your provider will start covering you.
Making a claim on these policies can take a little longer, as your provider will need to assess your medical history before accepting a claim.
Does a pre-existing condition have to be diagnosed?
This will depend on the terms set by the insurer. With some policies, a condition does not need a formal diagnosis to be considered a pre-existing medical condition – just that you’ve had symptoms and sought advice.
Are kidney stones a pre-existing condition?
If you know you have kidney stones, have symptoms that suggest kidney stones, or have sought advice from your GP about them, it can be considered a pre-existing condition.
Many insurers will consider kidney stones a pre-existing condition if you’ve suffered from them in the last five years. However, if you take out PMI and have no symptoms or flare-ups for two years (from your policy’s start date), your provider may offer you cover for this condition at renewal.
Are migraines considered pre-existing conditions?
Migraines are considered an acute but pre-existing condition in that a migraine will end, but it’s something you’re likely to experience on an ongoing basis if you’re prone to them (migraines affect around six million people in the UK).
In most cases, migraines shouldn’t affect your ability to find or buy PMI, but if in doubt, speak with the insurer to discuss any concerns.
Can PMI cover cancer treatment?
If it is pre-existing then it would not be covered as standard under most policies. However, some policies can cover cancer treatment – if this is something you want cover for, then be sure to check with your broker or insurer before taking out the policy.
Understanding your PMI options
PMI can give you extra peace of mind. But, with the number of options available, choosing the right policy for you and your family can be time-consuming.
To help you work through the choices available, you can speak to a member of our medical insurance team on 01603 967955.