Pre-Existing Conditions and Health Insurance - The Facts

When buying a private medical insurance policy, customers often ask about pre-existing conditions and whether health insurance will cover them. Whilst health insurance is not designed to cover pre-existing conditions, your choice of underwriting will determine whether your pre-existing conditions will be covered in the future.

Here is a short guide to pre-existing conditions and how your choice of underwriting will affect your cover.

What is a pre-existing condition?

A pre-existing condition is any medical condition you have received medication, advice or treatment for, or experienced symptoms of, before the start of your health insurance policy.

How will underwriting affect my cover?

When you take out a medical insurance policy, you will be offered a choice of underwriting. There are two common types of underwriting- moratorium and full medical underwriting.

If you choose full medical underwriting, you will need to complete a medical history declaration before your policy begins. This will mean answering questions about your health. Your doctor may be contacted for more information about particular conditions. Your insurer will then decide what conditions are to be excluded from the policy, and inform you of the exclusions before the policy starts.

If you choose a moratorium policy, you will not need to complete a medical history declaration. However, the insurer will automatically exclude any medical condition that you have asked advice on, received treatment for, or suffered symptoms of, during the five years before your policy starts.

Will they cover my pre-existing condition in the future?

If you choose full medical underwriting, you will have to ask your insurer in the future if you want any exclusion to be covered.

With a rolling moratorium policy, if you go treatment, symptom and advice free for two continuous years after the start of your policy, your insurer will reinstate cover for that condition. However, if medical advice is sought or treatment received during the qualifying period, then the qualifying period will start afresh from the date the advice or treatment is received.

Some health insurers also offer fixed moratorium policies. With a fixed moratorium policy, pre-existing conditions will be covered after two years of the health insurance policy, even if you seek treatment, advice or medication during that time period.

What about chronic conditions?

A chronic condition is any condition that needs ongoing or long-term monitoring, continues indefinitely, has no known cure, and is likely to come back. Common examples are asthma and diabetes.

If your chronic condition is pre-existing, it is unlikely that you will be covered for it on your health insurance for these reasons:

• Full medical underwriting will probably apply exclusions for that condition
• A rolling moratorium policy will only cover conditions if you do not suffer from them for two years from the policy start date- this is unlikely with a chronic condition
• A fixed moratorium carries considerably more risk for the insurer, and applicants with ongoing chronic conditions may be refused cover.

How do I decide what type of underwriting is best for me?

Each type of underwriting has its own advantages and disadvantages. If you have suffered no medical conditions in the last five years, or if your conditions have been mild, moratorium underwriting may be the best option for you- whether rolling or fixed.

If you have suffered pre-existing conditions in the past 5 years, particularly if they have been serious, then full medical underwriting may be the wiser choice.

Rather than trying to work out the best type of underwriting for you, it can be best to speak to an FSA authorised health insurance broker who will be able to help you choose your underwriting. A broker will be able to advise you on specific pre-existing conditions as well as finding an insurer that is likely to cover them.