Pre-existing conditions and how underwriting works

For anyone with an existing health issue, this is the only question that really matters.

Everything else in the policy is secondary to how it treats what you already have.

What usually counts

• Conditions diagnosed before cover started.
• Symptoms you experienced even without a diagnosis.
• Conditions you sought advice about.
• Conditions under investigation.
• Conditions being treated or monitored.
• The definition is usually broader than people expect.

Full medical underwriting

• You complete a detailed medical questionnaire.
• The insurer decides terms based on your answers.
• Specific exclusions are written into the policy.
• You know exactly where you stand from the start.
• Premiums may be loaded for certain conditions.
• Clarity is the main advantage.

Moratorium underwriting

• No questionnaire at the outset.
• Pre-existing conditions excluded for a defined period.
• They may become covered after a symptom-free interval.
• The assessment happens when you claim, not when you buy.
• Convenient at purchase, uncertain at claim time.
• Understand the exact conditions for the exclusion to lift.

Continuous personal medical exclusions

• Used when switching from a previous policy.
• The new insurer carries over existing exclusions.
• Nothing new is excluded beyond those.
• Requires evidence of continuous prior cover.
• Ask both insurers to confirm in writing.

Medical history disregarded

• Usually only available on large group schemes.
• Existing conditions are covered without exclusion.
• Often the most valuable feature of employer cover.
• Ask what happens if you leave the employer.
• Ask whether conversion to an individual policy is possible.

Why insurers ask so much

• Pricing depends on the risk they are accepting.
• Incomplete information makes the contract unstable.
• They verify at claim stage, not at purchase.
• Full disclosure protects you as much as them.

Disclosure

• Answer every question fully.
• Include things you consider trivial.
• Include symptoms without a diagnosis.
• Include medicines and supplements.
• Ask if a question is unclear rather than guessing.
• Insurers can review your medical records at claim stage.
• Non-disclosure can void the whole policy, not just one claim.

Keep evidence of what you disclosed

• Save a copy of the completed application.
• Save any email clarifications.
• Save the acceptance terms.
• Check the policy schedule for exclusions actually applied.
• Query anything you did not expect immediately.

The lookback period

• Policies define how far back they examine your history.
• Some look back a few years, some indefinitely.
• Symptoms count even without a diagnosis.
• Consultations count even if nothing was found.
• Check the exact wording rather than assuming.

Family medical history

• Some applications ask about relatives' conditions.
• This can affect terms for certain hereditary risks.
• Answer accurately but only what is asked.
• Ask what the information will be used for.

Genetic testing and cover

• Rules differ widely between countries.
• Ask whether test results must be disclosed.
• Ask whether they can affect future terms.
• Discuss this with a clinician before testing.

Chronic conditions

• Often defined and limited separately from acute illness.
• Some policies exclude ongoing management entirely.
• Some cover flare-ups but not routine monitoring.
• Read this section very closely if it applies to you.
• Ask for a written example of what would be paid.

Conditions that develop during cover

• Normally covered, subject to the usual limits.
• May become a pre-existing condition if you switch insurer.
• This is why continuous cover matters.
• Think carefully before letting a policy lapse.
• Even a short gap can change your position permanently.

Switching insurer

• Never cancel the old policy first.
• Get the new terms in writing before doing anything.
• Ask specifically how existing conditions will be treated.
• Ask whether waiting periods restart.
• Compare total exposure, not just premium.
• A cheaper premium with new exclusions is not cheaper.

Conditions that are stable for years

• A condition treated long ago may still count.
• Some insurers exclude it, some accept it with conditions.
• Terms vary considerably between insurers here.
• It is worth obtaining more than one quotation.
• Provide the same information to each for a fair comparison.

If cover is declined

• Ask for the reason in writing.
• Ask whether cover with exclusions is possible.
• Ask whether a higher premium would change the decision.
• Try specialist insurers for your condition.
• Check what the local public system provides.

Getting a written summary of your terms

• Ask for a plain statement of what is excluded for you personally.
• Ask when each exclusion could lift, if ever.
• Keep it with the policy schedule.
• Review it at every renewal.

If a claim is refused on these grounds

• Ask which clause is being relied on.
• Ask what evidence was used.
• Compare it against what you disclosed.
• Ask your doctor to clarify the timeline if relevant.
• Use the formal appeal process.
• Escalate to the relevant ombudsman if needed.

Employer schemes and existing conditions

• Group cover often accepts conditions individual cover would exclude.
• This makes leaving the scheme costly in health terms.
• Ask about conversion rights before resigning.
• Factor this into any job decision.

Planning ahead

• Arrange cover before conditions develop where possible.
• Avoid gaps between policies.
• Keep your own medical records organised.
• Review cover before any planned move abroad.
• Underwriting terms are hardest to improve once you need them.

The point to remember

Three things:

1. Disclose everything, including symptoms without a diagnosis.
2. Never cancel an old policy before new terms are confirmed in writing.
3. A gap in cover can turn a covered condition into an excluded one.

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