How to get health insurance with pre-existing medical conditions

September 29, 2015

Ill health or repetitive conditions affect many thousands of people here in the UK and could strike any one of us, anytime, without prior warning.

However this doesn’t mean we should put our lives on hold and go into hiding, scared stiff that our existence will change the minute we succumb to such indefatigable forces of nature. Instead we want to go on living in pretty much the way we have been up to now; give or take a few tweaks depending on the extent of the medical prognosis.

And this means being treated the same as we were previously too, and being in a position to continue our lives as we were before ill-health struck.

Just because you’ve been unfortunate enough to suffer either a long term illness or recurrent medical condition, it doesn’t mean you shouldn’t be approved for health insurance policies.

Yet the very next question on everyone’s lips is: just how do we go about challenging the disadvantageous situations which tend to crop up in the health insurance industry at the merest mention of a pre-existing illness or condition?

If you do suffer from an ongoing medical condition, you will have probably said words to this effect when applying for any financial product: “Well yes, I do suffer from epilepsy, yet it’s fully under control and doesn’t hamper any part of my life”.

Not too long ago you probably wouldn’t have got past the word ‘epilepsy’ before being pulled up short and refused cover. Mercifully times (and attitudes) have changed, and today more insurers will underwrite a bespoke health policy which takes into account your acknowledged medical situation from the outset. Yet that’s not to say you being accepted and approved for a health policy is a given. Sadly for the most part private medical insurance products tend to exclude both pre-existing and chronic conditions.

The underlying reason for this is that health insurers see some conditions as high risk, and if they weren’t excluded then it would lead to a far greater percentage of claims being made.

This ultimately ensures that health insurance plans would cost policyholders significantly more in terms of increased premiums.

bobGet a FREE health insurance quote

Get a quote 


So the chances are that should you have been diagnosed with diabetes or alternatively had a hip replacement within  5 years of taking out such a dedicated cover you’ll find yourself uninsured with direct regards to those particular conditions.

Conversely the policy will cover you for anything new from that point onwards, so it’s often a case of swings and roundabouts. It’s more likely that an insurance provider will suggest that you run the rule over moratorium underwriting as opposed to the full underwriting, essentially affording you a health plan which is tailored to the individual and their requirements; more on this later.

But if we rewind a little, what exactly qualifies as a pre-existing and/or chronic condition in this instance? The former routinely encapsulates any disease, illness or injury which comprises of any of the following characteristics;

A) You have received medication, advice or treatment in the 5 years leading up to the date your health insurance policy started

B) You have experienced symptoms whether the condition has been diagnosed or not in the five years before your joining date

These are generally conditions and health implications such as respiratory, circulatory, heart or back problems along with any malignant disease, psychiatric disorder or mental illness (including depression).

Chronic conditions on the other hand are defined (in health insurance jargon) as a disease, illness or injury which displays one of the following traits;

A) Requiring long term treatment and management so as to control the symptoms

B) Requiring rehabilitation periods

C) It continues indefinitely

D) It has no known cure

E) It has a propensity to return at any given time, or is understood to

F) It needs ongoing/long-term monitoring via consultations, examinations, check-ups, and/or tests

Again, chronic conditions can manifest from any area covered above, including respiratory, circulatory and heart in particular, along with cancer and HIV for example.

This helps explain why health insurance plans underwritten and agreed to on a moratorium basis prove so popular, and represent a means to an end for those looking to secure some additional and longer-reaching peace of mind should they experience major health issues at any juncture in life.

Effectively this means that for those of you who’ve suffered from a medical condition during the 5 years directly before the inception of a health insurance policy, said condition will be overlooked (or rather the condition will be intentionally excluded) for the initial 2 years of any future plan drawn up with the provider.

Cover can then be reinstated thereafter so long as the medical condition has not returned during the intervening 2 years grace, and perhaps more pertinently for a continuous passage of time equivalent to 2 years since the date it was last treated.

To put it another way (or indeed, clarify the accepted scenario), health insurers offering a moratorium-derived plan will agree to exclude any condition which has been diagnosed/subsequently treated within 5 years of a new policy with them commencing. And providing that the new policyholder doesn’t require any additional treatment or consultation regarding said condition in the 2 year meantime, then the exclusion will henceforth cease to exist and you’ll start from that juncture with a clean slate as such.

In practice this would work in the following way…

Say you’d had a hip replacement a few years previous yet were now completely free of pain and enjoyed good mobility, resulting in no further medical checks for at least 2 years. In this situation you would then be covered for any further hip-related issues 2 years down the line onwards. Diabetes would be another matter, unfortunately, as this would remain excluded on the acceptance that as a chronic condition the policyholder would need follow-up monitoring and regular treatments.