Chronic and pre-existing conditions.
Understand what they are, how they affect your health insurance and what we cover.
Questions about your cover?
Call us on 01202 756 350 or contact us online.
Understanding the difference
Chronic and pre-existing conditions
When you apply for private health insurance, medical conditions and health issues you have had in the past could affect your cover. Some could become temporary or general exclusions on your new policy.
In general, most private medical insurance excludes both pre-existing and chronic conditions. This helps to keep health insurance affordable. If these conditions were not excluded, there would be more claims, and health insurance would be much more expensive.
Understanding these two types of medical condition will help you make better choices when you apply for a private medical insurance policy.
Good to know
What is a chronic condition?
Long-lasting, and managed rather than cured
A chronic condition is a disease, illness or injury that has one or more of the following characteristics:
- It is persistent and long-lasting in its effects.
- It needs ongoing or long-term treatment to control or relieve the symptoms.
- It needs 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.
- It needs ongoing or long-term monitoring through consultations, examinations, check-ups or tests.
Chronic conditions are often life-long and can limit quality of life. They can usually only be kept under control, for example with medication, diet or a change of lifestyle. Common examples include asthma, diabetes, arthritis, chronic obstructive pulmonary disease, heart disease and epilepsy.
Acute
An acute condition
Comes on suddenly and unexpectedly, and tends to respond quickly to a short period of treatment, leading to a full recovery. Private medical insurance is designed to meet the cost of treating unexpected acute conditions.
Chronic
A chronic condition
Persistent and long-lasting. In most cases it cannot be cured, only kept under control, and needs ongoing treatment or monitoring.
Are chronic conditions covered?
What we cover, and where cover stops
Freedom Elite and Freedom Essentials do not cover the ongoing management of chronic conditions. They are designed to cover short-term, planned treatment for unexpected acute conditions. In practice, this means:
What we cover
- Finding the cause of new symptomsA consultation with a specialist and the diagnostic tests needed to find the cause of your symptoms.
- Treatment to stabilise your symptomsIf your condition can be treated but not cured, we pay for treatment that stabilises and relieves the initial symptoms.
- Acute flare-upsIf a well-controlled chronic condition suddenly and unexpectedly flares up, we pay for the short-term treatment needed to re-stabilise it.
What we do not cover
- Ongoing monitoring and controlOnce your condition is stable, routine check-ups are not covered. We would expect them to be carried out through your GP on the NHS.
- Medication to control a chronic conditionThe cost of medication to keep a chronic condition under control is not covered.
- Emergency admissionsPrivate medical insurance covers planned treatment in a private hospital. In an emergency, go to the accident and emergency department of your local NHS hospital.
Before we withdraw cover
We may, with your permission, ask your doctor or specialist for medical information, and we take your individual circumstances into account. If we decide your condition is now chronic, we will write to explain why, and give you as much notice as we can so you can make other arrangements, such as moving to NHS care.
The full detail
Our Chronic Conditions Explained leaflet includes worked examples, such as asthma, diabetes and hip pain.
Read the Chronic Conditions Explained leaflet (PDF)What is a pre-existing condition?
Conditions from before your cover started
A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment, or had any symptoms (whether or not it was diagnosed), in the five years before your joining date.
Health insurance does not usually cover pre-existing conditions. It covers unexpected new conditions that first arise after your cover starts, rather than events that have already happened or can be predicted.
This means any medical condition you had in the five years before your cover with us started, including symptoms, undiagnosed conditions and related conditions, will not be covered unless we have agreed to cover it.
Getting cover with a pre-existing condition
Your underwriting makes the difference
You can still get health insurance if you have a pre-existing condition, but it is unlikely your policy will cover it. The type of underwriting on your policy decides whether a pre-existing condition could be covered in future. The two most common types are:
Moratorium underwriting
Any condition you had in the five years before your policy started is excluded for the first two years. Cover may be reinstated later if the condition has not come back for a continuous period of two years since you were last treated for it.
Full medical underwriting
You answer questions about your medical history, including pre-existing conditions. Any conditions we will not cover are shown on your certificate of insurance as a written endorsement.
Switching insurer or setting up a company scheme?
If you are moving from another insurer, continued personal medical exclusions or switch moratorium underwriting may be available. Company schemes are arranged through an intermediary, who can explain the underwriting options for your scheme, including medical history disregarded where specific criteria apply.
Explore group health insuranceChronic and pre-existing conditions FAQs
Questions, answered
Private medical insurance is designed for new, unexpected acute conditions. We cover a consultation with a specialist and the diagnostic tests needed to find the cause of new symptoms, and treatment that stabilises and relieves the initial symptoms. We do not cover the ongoing monitoring and control of a chronic condition. All cover is subject to your policy terms and conditions.
It is a sudden and unexpected worsening of a chronic condition that was in remission or well controlled. Examples include an unexpected heart attack resulting from coronary heart disease, or a sudden asthma attack. We pay for the short-term treatment needed to re-stabilise your condition. Once it is stable again, cover for that condition stops.
If your condition worsens and your specialist recommends an operation that will stabilise it or permanently resolve the problem, such as a hip replacement, this may be covered, subject to your policy terms. Each claim is assessed individually.
Yes. Before withdrawing cover, we may, with your permission, ask your doctor or specialist for medical information, and we take your individual circumstances into account. If we decide your condition is now chronic, we will write to you to explain why, and give you as much notice as we can so you can make other arrangements, such as moving to NHS care.
It depends on your underwriting. With moratorium underwriting, a condition may be covered again once you have gone two continuous years without symptoms, treatment, medication or advice for it after your policy starts. With full medical underwriting, any conditions we will not cover are listed on your certificate of insurance.
Exclusions that normally apply to chronic conditions may not apply to cancer. Our cancer promise explains the cancer cover included with Freedom Elite.
If you are already a member, contact our claims team on 01202 283 580 before arranging any treatment. If you are thinking about cover, call us on 01202 756 350, contact us online, or speak to your intermediary.
Still have questions?
Talk to us about your cover
Our team can talk you through how chronic and pre-existing conditions are treated on your policy.
This page is general guidance only. Any decision about cover is based on the level of cover, benefits, terms and conditions of your policy, and each claim is assessed individually. The chronic conditions guidance applies to Freedom Elite and Freedom Essentials, not Freedom Worldwide.