With record numbers of the UK population covered by health insurance, it’s perhaps no surprise that payouts for health claims are also at record highs.

According to the latest full-year data from the Association of British Insurers (ABI), valid claims made by policyholders resulted in payouts totalling almost £3 billion.

For those insured, this financial support can provide a lifeline at a time that can be challenging for both the individual, their family and the people that care for their wellbeing, including colleagues.

Meanwhile, there are other people who might unnecessarily be missing out on the protections offered by private medical insurance or other types of health cover because they are under the illusion that a pre-existing medical condition makes them ineligible.

Accommodating additional complexity

In fact, this is one of the many myths that swirl around health and protection insurance. In reality, while pre-existing conditions might make it difficult to secure cover with some insurers, and could have implications for premiums (when compared with an individual that has no pre-existing conditions), there are likely to be brokers and providers that are capable of managing this additional level of complexity.

With access to the right expertise, it can be possible to seek out competitive premiums by, for example, exploring the specific details of your situation, understanding the level of cover you require from your insurance policy, and providing flexibility on excess payments.

Before considering how this process works, it is worth looking at what exactly constitutes a pre-existing medical condition. In simple terms, it refers to any health issues, including illnesses and injuries, that you already had before taking out or renewing your policy. It can encompass undiagnosed conditions as well as situations where you are receiving medication or have undergone tests.

A more detailed definition is provided by the ABI, which describes a pre-existing medical condition as: Any health condition you have now or had in the past; have been diagnosed with or are waiting for a diagnosis of; have been treated for or are having treatment for before the start date of any health insurance or income replacement insurance cover.

Types of cover

Where pre-existing conditions are involved, policies can be based on a process of full medical underwriting or moratorium underwriting.

Moratorium underwriting typically requires less involvement up front, with policyholders answering broad questions about their health rather than providing full details of their medical history. In many cases, any pre-existing conditions experienced within a period of five years are excluded from the policy until the individual is free from that condition for two continuous years.

However, at the point a claim is made, the insurer might require further medical information, which could necessitate the involvement of your GP.

An alternative approach is full medical underwriting, where insurers will require detailed information up front about your current health and medical history. This is used as the basis for underwriting the policy and determining the conditions that will be covered and those that will not.

Pre-existing conditions will usually be excluded on this basis, but it is sometimes possible to pay a premium to include them on the policy. In addition, some health insurance policies offered by companies will incorporate cover for pre-existing conditions as an employee benefit – but it is important to check the detail of a policy to see if this applies to you.

With full medical underwriting, at the point a claim is made, the process can be accelerated because the insurer is already clear on your medical situation and the precise nature of your cover.

The advantage of expert advice

A fundamental point here is that claims must be valid in the eyes of the insurer in order for approval to be given and the payout to be confirmed at the agreed benefit level.

Claims will only be valid if they are for a condition or treatment covered under the terms of the specific policy. When it comes to pre-existing conditions, claims can be rejected where relevant information is not provided to the insurer when taking out a policy (non-disclosure) or if the information supplied is deemed to be inaccurate.

The ABI highlights non-disclosure as the main reason for individual protection claims to be rejected, underlining the importance of being clear on the information you provide to the insurer, clear on the extent of your cover, and clear on what is not included.

In light of these risks, using a broker can be a highly effective strategy. If they are fully independent, the broker will have a view across all providers in the market and, ideally, will have the knowledge and experience to secure the best available option.

Even for individuals with more complex requirements or pre-existing medical conditions, they can play a valuable role in helping secure the health cover you want at a competitive price – sometimes even when you might not have thought it possible to get covered at all.


The information contained within this communication does not constitute financial advice and is provided for general information purposes only. No warranty, whether express or implied is given in relation to such information. Vintage Health or any of its associated representatives shall not be liable for any technical, editorial, typographical or other errors or omissions within the content of this communication.