6 min read
Having a condition such as asthma, high blood pressure or depression doesn’t automatically mean you can’t get cover, but it may influence the cost of your policy or the terms offered.
How well your condition is managed – and whether you’ve had recent symptoms or treatment – can play a significant role in how providers respond to your application.
Why do pre-existing conditions matter to health insurers?
Health insurance is designed to cover the cost of future, unforeseen medical treatment. If you’ve already been diagnosed or treated for a condition before applying, insurers may see this as a higher risk of future claims.
Common examples of pre-existing conditions include:
High blood pressure or high cholesterol
Asthma
Diabetes
Depression or anxiety
Back pain or musculoskeletal issues
Heart conditions
Cancer
Previous surgeries or hospital admissions
These conditions don’t necessarily prevent you from taking out a policy, but they may be excluded from cover – at least initially. Exclusion means that the insurer won’t cover any costs arising from the medical condition.
Ultimately, exclusions vary by insurer and underwriting method, but they typically apply to conditions that:
Required treatment, medication or advice in the recent past
Involve regular symptoms or flare-ups
Have a high risk of recurrence
Could lead to complications needing future treatment
For example, if you’ve had treatment for a slipped disc or recurring migraines, any future claims related to those may be excluded.
Always check your policy documents carefully to understand what is and isn’t covered.
How do insurers assess pre-existing conditions?
When you apply for health insurance, the insurer will need to decide how to handle any pre-existing conditions you might have. This is usually done through one of two approaches: full medical underwriting or moratorium underwriting. Each one works a little differently, so it’s worth understanding what to expect.
Full medical underwriting
With full medical underwriting, you’ll be asked about your medical history and lifestyle before your cover starts. This gives the insurer a good idea of your overall health and helps them decide what will – and won’t – be covered.
If you’ve had any health conditions in the past, they’ll typically be excluded from the policy. So, for example, if you injured your knee before taking out the insurance, any future treatment linked to that injury probably wouldn’t be covered.
This form of underwriting might take a little longer than the moratorium alternative, but the big plus is that you’ll know exactly where you stand from day one. And if you ever need to make a claim, things may be more straightforward because the insurer already has all the details they need.
Moratorium underwriting
Moratorium underwriting is quicker to set up, because you don’t need to give any medical history when you apply. Instead, if you make a claim later on, the insurer will check your records at that point to see whether your condition started before you applied for the policy (pre-existing).
Generally, anything you’ve had symptoms, treatment, advice or medication for in the five years before your policy starts won’t be covered – at least not right away. But if you go two full years without any further issues after the policy begins, that condition might be covered in the future. That’s a fairly big win to weigh up.
For instance, if you had a back problem five years ago but then don’t need any treatment or advice for it in the two years after taking out your policy, you may be able to claim for it.
While this option is easier at the start, making a claim can take longer while the insurer gathers your medical history. You might also need your GP to fill in a form before you can get treatment – and there could be a cost and delay involved with that.
How do insurers respond to pre-existing conditions?
What happens to your cover if you’ve had a health issue in the past? It really depends on the condition itself, how recently you had symptoms or treatment, and which underwriting option you go for. Here are some of the most common outcomes:
Temporary exclusion: Some conditions might be left out of your cover for a limited time – often around two years. If you don’t have any symptoms or treatment during that period, the insurer might reconsider and include it in the future.
Permanent exclusion: If the condition is ongoing, long-term or considered high-risk, it’s more likely to be excluded from your cover for good.
Covered as normal: If the issue was minor and happened years ago – and hasn’t caused any trouble since – there’s a good chance it won’t be excluded at all.
Although most insurers won’t cover pre-existing conditions, your policy should still give you peace of mind by covering new and unrelated health issues that crop up after your cover starts.
How business insurance could help you get cover for pre-existing conditions
This is where business health insurance can be a real game-changer. While most individual health insurance policies exclude pre-existing conditions, some business health insurers will cover them – often for an additional premium.
This means that if you have access to a company scheme through your employer – or arrange a policy for yourself if you are self-employed – you could get cover for conditions like Crohn’s disease, asthma, diabetes, high blood pressure and more, depending on the provider.
Some insurers also offer cover once you’ve been symptom-free and haven’t needed treatment or medical advice for a set period (often around two years). The exact approach will depend on the type of underwriting chosen, so make sure you check the terms before you go ahead.
The importance of full disclosure
Even if your condition feels minor or well under control, it’s really important to answer all the application questions honestly and in full. It might be tempting to skip over something or downplay your medical history, but if your insurer later finds out something was left out, it could lead to your claim being refused.
By being upfront from the start, your insurer can give you a fair decision – and you’ll know exactly what’s covered if you ever need to use your policy. It’s all about making sure there are no surprises further down the line.