What is a pre-existing condition?


When you start looking at private medical insurance, please remember that a new policy may exclude pre-existing medical conditions.

Medical conditions that were diagnosed prior to your policy start date, that are deemed to be a risk by the underwriter could be excluded.

The exclusion applied would normally show as the condition itself and anything “related to or arising from” it. As some medical conditions are linked quite closely together, it is a good idea to think about what would or could be excluded in the future.

There are two main types of underwriting which are full medical underwriting and moratorium underwriting.

Although you do not have to disclose your medical history for moratorium underwriting prior to taking the policy, if the condition happened in the 5 years prior to your policy start date then you would have no cover until you are symptom, treatment, advise and medication free – usually for a period of two years.

With full medical underwriting you provide a full disclosure of your medical history and this form is sent to the insurers underwriting department for assessment. They will then show any exclusions for pre-existing conditions on your insurance certificate.

Can you find out what exclusions you would have before you agree to buy a policy?

Yes, you really can. Speak to your broker and give them the details of the medical conditions in question, they can then speak to the underwriters and obtain clarification of exclusions prior to you accepting the quotation.

This is reliant on you providing full details of your medical history to your broker. The more information you provide, the more specific the underwriters can be.

Are pre-existing conditions excluded on company policies?

If you are a larger business with 15 or more main members to be covered on your policy then you would be in a position to request medical history disregarded underwriting which means that your employees would have cover for pre-existing conditions.

What about chronic conditions?

Please remember that all UK private medical insurance is designed for the treatment of acute medical conditions and does not cover the routine monitoring or medication for chronic conditions. This applies even if the diagnosis comes after the start date of your policy.

Even if you have medical history disregarded underwriting on a company scheme,  the insurer will only cover you up to the point of diagnosis and for any “flare ups” of a chronic condition. Routine treatment of a chronic condition would be dealt with via the NHS.

What about switching to a different provider?

If you have health insurance as an individual or company and your renewal is due, your broker can obtain quotations for you from different insurers. If there is a competitive option available and you are able to satisfy the switch declaration (answer the questions that they ask) from that insurer,  you could transfer your policy across and the original exclusions for pre-existing conditions (if applicable) and underwriting would be carried across to the new insurer.

We want to make sure that our clients know what cover they have before they need to make a claim. Sorting out any issues relating to pre-existing conditions at the very beginning gives our client’s clear and transparent information about their cover before they agree to buy a policy.

If you would like the team at SMP Healthcare Ltd to help you find a policy and liaise with the insurance underwriters on your behalf, please get in touch.

Telephone 01245 929129 or 0800 0470127

Email: enquiries@smphealthcare.com