Are pre-existing conditions covered by health insurance?

If you’ve had a health problem in the past, it might not be covered by your health insurance, because this is normally meant for new or unexpected medical issues.

A pre-existing condition is a medical issue you’ve experienced in the past. This includes chronic conditions like diabetes or asthma, and one-off symptoms like knee pain.

With us, a pre-existing condition is when you’ve had symptoms, medication, advice, treatment, or tests for something before taking out health cover. This could be for any disease, illness, or injury. And if you’ve had symptoms or tests for something but haven’t been diagnosed yet, we’ll still count it as a pre-existing condition.

Having an existing condition isn’t a red light to taking out health insurance. But you may find your condition isn’t covered by the policy or there are certain requirements to tick off.

You should always check any health insurance policy carefully to make sure you pin down what is and isn’t covered and any other restrictions it might have.

Some insurers might give a thumbs up to covering certain conditions. Or you may be able to get cover for a condition if you’ve been symptom free for a certain number of years. You’ll need to check with individual insurers to see what the terms and conditions of their health insurance is.

Insurance companies use something called underwriting to help work out the risk of insuring you. With health insurance, there are two types of underwriting. Both cover you for new, eligible conditions that crop up after your policy starts, but they deal with pre-existing conditions in different ways.

Full medical underwriting

With full medical underwriting, it’s crystal-clear right from the start if any pre-existing medical conditions are covered or not.

When you apply for cover, you’ll need to fill in a questionnaire about your medical history. Your insurer might also need to speak to your doctor. Once they’ve gathered all the information, they’ll decide what symptoms and conditions they can or can’t cover and let you know.

Choosing full medical underwriting can help speed up the claims process, because your insurer already knows about your medical history.

Moratorium underwriting

With moratorium underwriting, you don’t need to tell your insurer about any pre-existing medical conditions when you apply for cover. Instead, each time you claim they'll look at your medical history to see if it’s a new or pre-existing condition or symptom and if you’re covered for it or not. They may also speak to your doctor.

We don’t normally cover pre-existing conditions, which is any disease, illness, or injury you’ve had symptoms, medication, tests, treatment or advice for in the five years before you take out cover.

However, if you pick moratorium underwriting, we may be able to cover an eligible pre-existing condition after a certain amount of time. From your cover start date, you’ll need to go two continuous years without advice, tests, treatment or medication for your pre-existing condition for us to consider covering it.

So, what does that mean? Let’s say you had treatment for a bad back two years ago. If you take out health insurance with us, this wouldn’t initially be covered, because we’d class it as a pre-existing condition. However, if you go two continuous years from your policy start date with no treatment, diagnostic tests, medication or advice for your back pain, we might then cover it.