Are pre-existing conditions covered by health insurance? (2024)

Insurance companies use something called underwriting to help work out the risk of insuring you. With health insurance, there are two types of underwriting. Both cover you for new, eligible conditions that crop up after your policy starts, but they deal with pre-existing conditions in different ways.

Full medical underwriting

With full medical underwriting, it’s crystal-clear right from the start if any pre-existing medical conditions are covered or not.

When you apply for cover, you’ll need to fill in a questionnaire about your medical history. Your insurer might also need to speak to your doctor. Once they’ve gathered all the information, they’ll decide what symptoms and conditions they can or can’t cover and let you know.

Choosing full medical underwriting can help speed up the claims process, because your insurer already knows about your medical history.

Moratorium underwriting

With moratorium underwriting, you don’t need to tell your insurer about any pre-existing medical conditions when you apply for cover. Instead, each time you claim they'll look at your medical history to see if it’s a new or pre-existing condition or symptom and if you’re covered for it or not. They may also speak to your doctor.

We don’t normally cover pre-existing conditions, which is any disease, illness, or injury you’ve had symptoms, medication, tests, treatment or advice for in the five years before you take out cover.

However, if you pick moratorium underwriting, we may be able to cover an eligible pre-existing condition after a certain amount of time.From your cover start date, you’ll need to go two continuous years without advice, tests, treatment or medication for your pre-existing condition for us to consider covering it.

So, what does that mean? Let’s say you had treatment for a bad back two years ago. If you take out health insurance with us, this wouldn’t initially be covered, because we’d class it as a pre-existing condition. However, if you go two continuous years from your policy start date with no treatment, diagnostic tests, medication or advice for your back pain, we might then cover it.

Are pre-existing conditions covered by health insurance? (2024)
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