As an FCA-authorised broker that has helped arrange over 750,000 policies, WeCovr is a leading expert in the UK private medical insurance market. In this guide, we tackle one of the most common questions we hear: are pre-existing conditions covered? We’ll explain the rules, your options, and how to find the right cover for you and your family in 2025.
Navigating the world of private medical insurance (PMI) can feel complex, especially when it comes to understanding what is and isn't covered. The single biggest point of confusion for many is how insurers treat medical conditions you've had in the past.
The short answer is that standard UK private health insurance is designed to cover new, unforeseen medical issues that arise after your policy begins. It does not typically cover pre-existing or long-term (chronic) conditions.
But don't let that put you off. Understanding the landscape is the first step to making an informed decision. PMI can still offer immense value as a complement to the NHS, providing fast access to specialists and treatments for future health concerns. In this comprehensive guide, we'll break down everything you need to know.
Before we go any further, let's define our terms in plain English. For a health insurer, a pre-existing condition is any disease, illness, or injury for which you have experienced symptoms, received medication, or sought advice or treatment from a medical professional.
Most UK insurers look back at your medical history over the past five years before the start date of your policy.
Here are some real-life examples of what would be considered a pre-existing condition:
The key takeaway is that a condition doesn't need a formal diagnosis to be considered pre-existing. If you've had symptoms or sought advice for it, an insurer will count it.
It's also vital to understand the difference between acute and chronic conditions, as this is fundamental to how PMI works.
Feature | Acute Condition | Chronic Condition |
---|---|---|
Duration | Short-term | Long-term, often lifelong |
Outlook | Curable, full recovery expected | Incurable, requires ongoing management |
Treatment | A single course of treatment (e.g., surgery) | Continuous monitoring and treatment (e.g., medication) |
PMI Coverage | YES - This is the primary purpose of PMI. | NO - Routine management is excluded. |
Let's be direct: No, standard private medical insurance in the UK does not cover pre-existing conditions. It also doesn't cover the ongoing management of chronic conditions.
This isn't a loophole or a hidden clause; it's the foundational principle of how health insurance works in the UK. Insurers calculate premiums based on the statistical risk of a person needing future, unknown treatment. Covering conditions that already exist would be like insuring a car after it has already crashed – the costs would be astronomical, and premiums would become unaffordable for everyone.
PMI is designed to be a safety net for the unexpected, complementing the excellent care the NHS provides for emergencies, chronic conditions, and pre-existing issues. With NHS waiting lists for elective treatment in England involving around 7.5 million treatment pathways (according to early 2024 NHS data), having PMI provides peace of mind that you can bypass these queues for new eligible conditions.
When you apply for health insurance, the provider needs to understand your health status to determine your premium and what they can cover. This assessment process is called underwriting. There are two main types in the UK.
With FMU, you complete a detailed questionnaire about your medical history and that of your family. You must disclose any conditions, consultations, and treatments you've had. The insurer may also ask for permission to contact your GP for more information.
This is the most common type of underwriting for individual policies because it's simpler and faster. You don't need to fill out a health questionnaire. Instead, the insurer applies a blanket exclusion for any pre-existing conditions you've had in the five years prior to your policy start date.
This exclusion can, however, be lifted. This is often called a "rolling moratorium."
How it works: If you go for a continuous two-year period after your policy starts without having any symptoms, needing any treatment, or seeking any medical advice for that specific pre-existing condition, it may become eligible for cover.
Pros: Quick and easy application process with no upfront medical forms.
Cons: There's a degree of uncertainty. You won't know for sure if a condition is covered until you make a claim and the insurer investigates your medical history at that point.
Feature | Moratorium (MORI) | Full Medical Underwriting (FMU) |
---|---|---|
Application Process | Fast & simple. No health questionnaire. | Slower. Requires a detailed health questionnaire. |
Upfront Certainty | Low. Cover is determined at the point of claim. | High. Exclusions are clearly stated from the start. |
Cover for Pre-Existing | Excluded for at least the first 2 years. | Permanently excluded, unless specified otherwise. |
Best For | People who want a quick start and have few or no recent health issues. | People who want absolute clarity on their cover from day one. |
An expert PMI broker like WeCovr can talk you through which underwriting option is best for your personal circumstances, ensuring you get the right policy for your needs.
While the general rule is no, there is one key scenario where a pre-existing condition could eventually be covered: the rolling moratorium.
Let's use an example to see how this works in practice.
Example: Sarah's Knee Pain
- The Condition: In 2024, Sarah visited her GP for persistent knee pain. She was advised to rest and take painkillers.
- The Policy: In January 2025, Sarah takes out a new private health insurance policy with moratorium underwriting. Her knee pain is automatically excluded as a pre-existing condition.
- The Moratorium Period: For the next two years, Sarah's knee is fine. She has no symptoms, doesn't see a doctor about it, and takes no medication for it.
- Potential Cover: In February 2027, over two years after her policy started, the knee pain returns. Because she has completed the two-year clear period, she can now make a claim. Her insurer will investigate and, provided the two-year rule has been met, they will likely cover her specialist consultations and treatment.
Important Note for Switchers: If you already have private health cover and are looking to switch providers, you may be offered "Continued Personal Medical Exclusions" (CPME) underwriting. This allows you to carry over the terms of your existing policy, meaning you can keep cover for conditions that would be excluded if you were a brand-new customer. This is a complex area where advice from a broker is invaluable.
Beyond pre-existing and chronic conditions, there are other standard exclusions you'll find in most UK PMI policies. It's important to know these so you have a realistic expectation of what your cover is for.
So, if PMI doesn't cover your existing conditions, what are your options? The good news is you have several, and a combination is often the best approach.
The NHS is world-class at managing long-term conditions and providing emergency care. It should remain your first port of call for any pre-existing issues. Don't think of PMI as a replacement for the NHS, but as a partner to it.
This is the smartest way to view private health cover. By taking out a policy, you are protecting yourself against future health problems. Should you be diagnosed with a new, acute condition, you'll have the power to:
A health cash plan is not insurance, but a different type of plan that can work alongside PMI or NHS care. You pay a monthly premium and can then claim cash back on routine healthcare expenses, up to an annual limit.
Crucially, cash plans often cover pre-existing conditions. They are great for budgeting for predictable costs.
Service | NHS | Private Medical Insurance (PMI) | Health Cash Plan |
---|---|---|---|
Pre-Existing Conditions | YES | NO | YES (usually) |
Chronic Conditions | YES | NO (for routine management) | NO (for management) |
New Acute Conditions | YES (with waiting lists) | YES (fast access) | NO (doesn't cover surgery) |
Dental & Optical | Limited cover (charges apply) | Usually an optional add-on | YES (core benefit) |
Physiotherapy | YES (with waiting lists) | YES (often included) | YES (up to annual limits) |
The best way to manage your health is to be proactive. Many of the best PMI providers now include a wealth of wellness benefits to help you stay healthy. These can include:
At WeCovr, we support this proactive approach. When you take out a policy with us, we provide complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help you achieve your health goals.
Trying to compare policies, underwriting types, and exclusion lists from different insurers can be overwhelming. That's where we come in.
WeCovr is an independent, FCA-authorised PMI broker. Our job is to do the hard work for you.
Understanding the rules around pre-existing conditions is the key to unlocking the true value of private medical insurance. It's not about replacing the NHS; it's about adding a powerful layer of choice, speed, and comfort for your future healthcare needs.
Let WeCovr guide you through your options. Our friendly, expert advisors are ready to help you compare quotes and build a plan that gives you peace of mind for 2025 and beyond.
Click here to get your free, no-obligation PMI quote from WeCovr today!