Health Insurance with a Pre-existing Medical Condition

Obtaining health insurance with pre-existing conditions is not impossible!

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Obtaining a health insurance policy when you have an underlying medical condition is not impossible. It’s still easy to get private medical insurance for any future incidents, providing you with peace of mind and an assurance of care for potential future medical issues. There will, however, be some limitations to what is covered by your policy if you have a pre-existing condition.

Health insurance is intended to cover unexpected medical issues that arise after you start the policy. This means that most medical insurance policies do not cover pre-existing diseases or secondary conditions that are considered related because they predate the coverage of the policy.

There are, however, some instances where pre-existing conditions can be included in a health insurance policy, making medical professionals and treatment accessible even for those conditions. This usually happens when the insurer determines that the problem is unlikely to return. An insurer will assess the details of your medical history, going back anywhere between three and seven years, depending on their policy, to establish whether the specific details of your pre-existing or chronic condition make it something that should be covered or excluded within the policy.

What is a pre-existing medical condition?

Health insurance providers consider a pre-existing medical condition to be anything you’ve received treatment from a medical professional for in the past. 

Medical treatment is considered to be anything from consultations and medication to surgery, either by the NHS or in a private hospital.

Additionally, any serious condition that you’ve experienced symptoms of in the past five years can be considered pre-existing by most insurers, even if you received the diagnosis over five years ago.

It’s worth noting that each insurer is different. Some will base their parameters on different timeframes; generally, this could range anywhere from three to seven years.

The term “pre-existing condition” defines many types of illness, injury or disease. It can range from underlying, long-term conditions like asthma and diabetes to more sudden afflictions, like a stroke or pain from a back injury.

Pre-existing or chronic condition?

Chronic conditions are considered and treated a little differently to pre-existing conditions within a health insurance policy. Chronic conditions are generally persistent conditions with no known cure, long-lasting effects that require ongoing or long-term treatment to manage symptoms and have a likelihood of returning in the future.

As most chronic conditions require ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests, these are often synonymous with pre-existing conditions.

Examples of pre-existing conditions

  • Asthma
  • Back pain that required surgery
  • Cancer
  • Diabetes
  • Heart disease
  • High blood pressure
  • Osteoarthritis

Examples of chronic conditions

  • Asthma and hay fever
  • Diabetes
  • Glaucoma
  • High blood pressure (hypertension)
  • Skin conditions like eczema, acne and psoriasis

As you can see from these examples, there is potentially some crossover between pre-existing and chronic conditions. Different insurance providers may classify a condition differently depending on some of the more specific details for each individual case, such as longevity, severity and the likelihood of a recurrence.

Exceptions to insurance exclusions

While there is a considerable list of disease, illnesses and injuries that are considered pre-existing and would not qualify for cover under a new private medical insurance policy, there are also many pre-existing conditions that can be covered by health insurance.

Here is a list of some examples:

  • Acne
  • Arthritis
  • Asthma
  • Carpal Tunnel Syndrome
  • Eczema
  • Fibrocystic Breast Disease
  • Hypertension
  • Psoriasis
  • Varicose Veins

Please bear in mind that this is only a list of examples for guidance. Every healthcare insurer is different and will have their own specifications regarding what is or is not coverable under one of their private health insurance policy options.

Travel insurance with a pre-existing condition

Travel insurance is not the same as private health insurance. Unlike a dedicated medical health insurance policy, travel insurance is designed to protect you against unforeseen eventualities while travelling away from home, whether it’s domestic or abroad. The predominance of a travel insurance policy focuses on cover for your possessions and bookings, such as flights or hotels, but it does also incorporate medical care should anything untoward happen to you during your trip.

When it comes to pre-existing medical conditions, travel insurance will cover you for any incidents related to these conditions while you’re away. It is important to note that these must be declared at the time of taking out the policy, however. Any disease, illness or injury that you do not declare but which subsequently requires treatment during your trip may invalidate the policy if it wasn’t previously listed.

Making an insurer aware of pre-existing conditions is likely to affect the premium of your travel insurance policy, but it is imperative that you do so in order to be fully covered should anything happen that means you require treatment or the consultation of a medical professional.

Health insurance premiums when you have a pre-existing condition

Travel insurance is not the same as private health insurance. Unlike a dedicated medical health insurance policy, travel insurance is designed to protect you against unforeseen eventualities while travelling away from home, whether it’s domestic or abroad. The predominance of a travel insurance policy focuses on cover for your possessions and bookings, such as flights or hotels, but it does also incorporate medical care should anything untoward happen to you during your trip.

When it comes to pre-existing medical conditions, travel insurance will cover you for any incidents related to these conditions while you’re away. It is important to note that these must be declared at the time of taking out the policy, however. Any disease, illness or injury that you do not declare but which subsequently requires treatment during your trip may invalidate the policy if it wasn’t previously listed.

Making an insurer aware of pre-existing conditions is likely to affect the premium of your travel insurance policy, but it is imperative that you do so in order to be fully covered should anything happen that means you require treatment or the consultation of a medical professional.

An example

You have a pre-existing condition that you last received professional medical assistance for three years ago. If, after two years you’ve not required any further health care for that condition, an insurer may deem it no longer at risk of recurrence and therefore include it under your policy.

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As each insurer is different, timelines and the severity of a pre-existing condition are determined at the discretion of the provider. It is therefore important to check these details carefully and discuss them with your broker before deciding to agree to take out a policy. When discussing the details of your policy, be sure to establish if your pre-existing condition will be removed from exclusions if certain conditions are met.

At Clear Health, we know that private health insurance is unique and personal for every individual. We ensure that every policy is tailored to each client’s specific needs. We offer a full advisory service which will help you find the right policy to suit your needs.
To find out more about how Clear Health can help you find the right private medical insurance policy for you, get in touch to speak to one of our advisors and request a quote now.

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