Chronic Conditions and Health Insurance

Health Insurance is designed to cover the cost of treatment for acute medical conditions which start after your policy begins. Your policy is not designed to cover the routine medication and monitoring of chronic conditions.  An acute condition is a disease, illness or injury that is likely to respond quickly to treatment. That treatment aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

Private Medical Insurance will typically not cover chronic conditions. There are options from two providers in the UK market where there is an element of chronic condition cover available. Only one of these relates to individual health insurance cover. They will both offer this additional benefit for SME, small business schemes. If you are looking for cover of this type it really is worth considering paying the small additional premium.

What do Health Insurance providers term as Chronic Conditions?

The definition is any disease, illness or injury which have one or more of the following characteristics:

– Needs long-term monitoring

– Control or relief of symptoms

– Requires rehabilitation

Continues indefinitely; &

Has no known cure or is likely to come back.

What happens if a Chronic Condition gets worse?

There are some insurance policies which will cover the treatment of flare-ups of a chronic condition. Flare-ups are normally defined as unexpected complications or sudden worsening of the illness. Your insurer will aim to get you back to the same level of health you were in prior to the flare up.

Which medical conditions could be deemed as chronic?

There are many examples of chronic medical conditions and below you will find just a few examples:

– Diabetes


– Arthritis

– High Blood Pressure

– Psoriasis

– Heart Failure

What happens if an Acute Condition turns into a Chronic Condition?

Even if you have no exclusions on your health insurance, once a condition has been diagnosed as chronic you will be advised by your provider that they will no longer offer cover for the routine monitoring and medication for it. At this point, you will need to revert back to the NHS for your treatment. This rule will apply whether you have full medical, moratorium or MHD underwriting. Cover for flare-ups may still be available but this will be subject to your insurer’s terms and conditions.

If you have a Health Insurance policy and would like further information about medical conditions that are covered we will be happy to assist you. Please contact us on 01245 929 129 or email