A Complete Guide to UK Private Health Insurance for Pre-Existing Conditions

When you have pre-existing conditions, getting PMI or health insurance for existing conditions can be tough. It’s not just about finding a provider who’ll cover you; you also need to figure out how your conditions affect the insurance terms and costs.

Now, let’s take a closer look at how pre-existing conditions impact PMI and examine the choices for individuals looking for coverage.

What is a Pre-existing condition and How Does it Affect You?

A pre-existing medical condition refers to any illness or health problem that you’ve been diagnosed with, treated for, or shown symptoms of before starting a new health insurance policy. This definition covers a broad spectrum of conditions, including chronic illnesses like diabetes, heart disease, and respiratory conditions, as well as shorter-term issues that have been treated in the past.

In the UK, typical pre-existing conditions affecting PMI eligibility and terms include cardiovascular diseases, back and joint issues, as well as cancer. These conditions are widespread among the population and pose significant considerations for both insurance providers and policyholders.

What chronic condition?

Chronic conditions are long-term health issues that persist over an extended period, typically lasting for three months or more. These conditions often require ongoing management, treatment, or monitoring to control symptoms and maintain overall health. Examples of chronic conditions include:

• Diabetes
• Hypertension (High Blood Pressure)
• Asthma
• Arthritis
• Allergy
• Chronic Obstructive Pulmonary Disease (COPD)
• Heart Disease
• Chronic Kidney Disease
• Depression
• Chronic Migraine
• Crohn’s Disease

These are just a few examples and there are many other chronic conditions that you may experience.

The Impact of Pre-Existing Conditions on PMI

Pre-existing conditions significantly influence your eligibility for PMI and the coverage you can receive. Private medical insurance providers in the UK assess the risk associated with insuring individuals with pre-existing conditions differently, which can lead to variations in policy terms, including exclusions, higher premiums, or extended waiting periods for coverage of specific conditions.

Pre-Existing Conditions Example

For example, if you have a history of cancer, you might discover that PMI providers offer you cover with certain conditions, like a higher premium or an initial waiting period before accepting claims related to cancer. This strategy enables insurers to mitigate the risk associated with covering a condition that typically requires ongoing management and treatment.

Chronic conditions example

If you’re diagnosed with diabetes, your health insurance policy might exclude coverage for any flare-ups since chronic conditions are typically automatically excluded. However, certain insurers, like General and Medical, might provide cash benefits to assist with your treatments.

What is underwriting in health insurance?

In health insurance, underwriting involves assessing your risk factors like medical history, age, lifestyle, pre-existing conditions and job. Insurers use this to decide if they’ll cover you, and if so, the terms like premiums and coverage limits. This process helps them manage risks and set fair premiums based on your risk level.

In the UK, health insurance underwriting options typically include:

Full Medical Underwriting

Under full medical underwriting, the insurer requires detailed medical information from the applicant, including past medical history, treatments received and any ongoing health issues. This thorough review process allows the insurer to assess the risk accurately and decide on the coverage terms. 

While this method can be time-consuming, it provides clarity on what is covered and what is excluded right from the start, reducing the likelihood of disputes over coverage at the time of a claim. 

Let’s say you’ve previously been treated for a heart condition under full medical underwriting; you would disclose this information during the application process. The insurer would then evaluate this data to determine whether to cover this condition or exclude it from your policy, ensuring clear terms are established upfront.

Moratorium Underwriting

Moratorium underwriting offers an alternative approach, where the insurer does not initially require a detailed medical history. Instead, coverage for pre-existing conditions is excluded for a set period, typically around two years. 

If the policyholder does not require treatment for the excluded condition during this period, the condition may then be covered in the future. This approach simplifies the application process but can lead to uncertainties about what is covered and when.

General exclusions in health insurance

Health insurance general exclusions encompass conditions or circumstances not covered by the policy. These commonly include:

• Pre-existing conditions
• Cosmetic procedures
• Experimental treatments
• Self-inflicted injuries
• Illegal activities
• War or civil unrest
• Birth and fertility
• Alcohol and drug abuse

Understanding these exclusions is crucial to ensure you have the appropriate coverage for your healthcare needs.

Continued Personal Medical Exclusions (CPME) Underwriting

Continued Personal Medical Exclusions underwriting refers to an insurance practice where an insurer excludes coverage for specific pre-existing medical conditions even after the policyholder switches to a new insurance plan or provider. This means that certain health issues diagnosed before obtaining the new policy will remain uncovered. 

For instance, if someone has a history of diabetes and switches insurance plans, the new insurer might continue excluding coverage for diabetes-related expenses. Similarly, conditions like hypertension, asthma, or mental health disorders could be subject to continued exclusion, depending on the insurer’s underwriting policies.

The challenge is significant, but with careful consideration and possibly the assistance of an experienced broker, it is possible to secure health insurance for existing conditions that provide valuable support and peace of mind.

Choosing the Right PMI Provider

Choosing the right private medical insurance provider in the UK is crucial, especially for individuals with pre-existing conditions. It requires careful consideration of several factors. 

Start by assessing your healthcare needs, including coverage for pre-existing conditions, prescription medications and preferred healthcare providers. 

Research different insurers to compare their coverage options, network of doctors and hospitals, premiums and excess.

Look for insurers with a strong reputation for customer service and prompt claims processing. 

Consider any additional benefits or perks offered by the insurer, such as wellness programs or telemedicine services. 

Finally, get recommendations from friends, family or healthcare professionals to make your decision.

The Benefits of Using a Broker

Navigating the world of PMI can feel overwhelming due to its complexity and the many choices available. That’s where a broker can be incredibly helpful for you. A broker simplifies the process, offering personalised guidance and advice to meet your specific needs. With their deep understanding of the market, they can compare different policies and providers, ensuring you get the best policy possible.

Also, brokers can speak up for you, negotiating terms and handling the paperwork to secure PMI. This support is especially valuable if you have pre-existing conditions, as it can be tough to find favourable terms on your own.

Coverage Options for Pre-Existing Conditions

When it comes to PMI for individuals with pre-existing conditions, the options for coverage can vary a lot among providers. Typically, insurers might offer policies that don’t cover conditions diagnosed or treated before the policy starts. However, some private medical insurance providers may have more flexible terms. For instance, they might have a moratorium period where pre-existing conditions could be covered if you haven’t sought treatment for them during that time.

Limitations and Exclusions

Understanding the limitations and exclusions that apply to your coverage is crucial, especially for pre-existing conditions. These can vary a lot between policies and can affect how useful your insurance is. Before signing up, make sure to read the fine print and ask the right questions.

Reducing your premiums

Premiums for PMI can be higher if you have pre-existing conditions because insurers see you as a higher risk. But there are ways to lower these costs. You might choose a higher excess, downgrade your hospital list or choose lower-level outpatient cover if available, to reduce your monthly premiums. Also, insurers like Vitality Health and Aviva give discounts to policyholders who lead healthy lifestyles, like not smoking or maintaining a healthy lifestyle. Paying an annual sum can reduce your premium by 5% with AXA Health and 6% with Freedom Health.

Navigating PMI with Pre-Existing Conditions

Finding the best policy requires a proactive approach. You should start by assessing your needs and understanding the specifics of your pre-existing conditions. This information is crucial when comparing policies and providers.

Tips for Finding the Best Health Insurance for Existing Conditions:

• Be Transparent

Always be upfront about your medical history when applying for PMI. Concealing information can lead to issues with claims later on.

• Compare Options

Look beyond the premiums and compare what each policy covers, especially regarding treatment for pre-existing conditions.

• Consider Specialist Providers

Insurers like General and Medical specialise in covering individuals with specific conditions or offer policies designed for those with pre-existing conditions.

The Role of Experienced Brokers

Experienced health insurance brokers, like us at Premier PMI, play a crucial role in securing the right policy for you. We’re experts who not only find the best coverage but also guide you through every step, including the claiming process. With our knowledge and support, you can navigate the complex world of health insurance confidently, ensuring you get the protection and care you deserve.

Why Choose Premier PMI for Your Health Insurance Needs?

• Tailored Advice 

We stand out for our personalised approach to health insurance for pre-existing conditions. Understanding that each individual’s health needs are unique, especially when pre-existing conditions are involved, we offer tailored advice to ensure our clients find the best possible coverage.

• Comparison Services

With access to a wide range of private medical insurance providers in the UK, we can compare different policies on your behalf, saving you time and money. This comparison service ensures that you’re aware of all your options and can make an informed decision. 

• Industry Experience 

Our extensive experience in the health insurance industry means we are well-equipped to navigate its complexities. Our knowledge of the market and relationships with insurers allow us to negotiate favourable terms for our clients.

• Commitment to Clients

We are committed to finding the best possible coverage for individuals with pre-existing conditions. We understand the challenges these individuals face and work diligently to provide solutions that offer peace of mind and comprehensive coverage.

• Save up to 38% by switching with us

For four decades, our health insurance specialists have consistently delivered substantial savings to our clients, slashing renewal premiums by an impressive 38%.

Choosing us means partnering with a broker that prioritises your health and financial well-being, ensuring you receive the support and coverage you need.

Get Tailored Health Insurance Advice from Premier PMI

At Premier PMI, we understand the unique challenges faced by individuals in finding comprehensive and affordable health insurance for existing conditions. Our team of dedicated brokers is here to guide you through the process, offering unbiased advice and comparisons from leading private medical insurance providers in the UK.

Whether you’re looking for coverage for yourself or your family, we’re committed to finding a plan that meets your needs and budget. Contact us today to start your journey towards peace of mind with the right health insurance coverage.

Get in touch with us at contact@premierpmi.co.uk or call us at 01280360122 for a personalised health insurance quote that considers your pre-existing conditions. Let us help you secure the coverage you deserve.

Stuart Hendy, Senior PMI Advisor &Editor

Stuart Hendy is a highly experienced health insurance broker with extensive knowledge of private medical insurance and private treatment. His expertise is frequently sought by industry professionals and his insights have been featured in leading financial publications. Stuart is committed to providing his clients with the best possible healthcare solutions and empowering them to make informed decisions.

• LinkedIn

FAQ