As mentioned above, Private Medical Insurance policies do not cover members for “chronic” conditions. A chronic condition is defined by the Association of British Insurer’s as;
A disease, illness or injury that has one or more of the following characteristics:
- It requires ongoing or long-term monitoring through consultations, examinations, check-ups or tests.
- It requires ongoing or long-term control or relief of symptoms.
- It requires your rehabilitation, or for you to be specially trained to cope with it.
- It continues indefinitely.
- It has no known cure.
- It comes back or is likely to come back.
The method of underwriting is essential to determining what is covered under your Private Medical Insurance policy.
On a fully underwritten policy, pre-existing conditions are not covered. These are disclosed to the Insurer at the beginning of the policy when submitting an application. A pre-existing condition is a medical condition, illness or injury that was sustained prior to obtaining medical insurance. The Insurance provider would normally place “exclusions” on the policy that would relate to that condition and these are clearly defined in the policy documentation.
On a ‘Moratorium’ policy, all pre-existing conditions from the last 5 years are excluded from cover, but providing that you have been symptom, check and test free for the pre-defined period (usually two years), the policy will then cover those conditions thereafter. The benefit of a ‘Moratorium’ policy is that you can obtain cover for pre-existing conditions; however at point of claim, the Insurer will need to check medical records to ensure that the claim is not in relation to a pre-existing condition.
The only policy where all pre-existing conditions are covered from outset is on a Medical History Disregarded underwriting basis. The Insurer will cover the members for all conditions (albeit not chronic conditions) and this is usually only available to larger size company schemes as the Insurer is accepting all potential medical risks from all members, hence they need a larger group of people in order to significantly diversify their risk.