Pre-existing Medical Conditions & Duty of Disclosure

This page is designed to give an oversight of two key areas involved in the process of obtaining Private Medical Insurance coverage for UK Residents - the effect of pre-existing medical conditions on an application for health insurance cover, and the possible results of not disclosing important medical information to a health insurance provider or insurer.

Pre-existing Medical Conditions

As to whether pre-existing medical conditions would be covered under a new medical insurance cover, this will very much depend on the nature of the condition, how long you have had it, what treatment you have had or are still having and other factors which may need to be taken into account by the health insurance company.

With regards to how an insurer providing health insurance cover will treat cover for any pre-existing condition, this will be directly influenced by the type of underwriting employed by an insurer or plan provider. This is either on a "Full Medical Underwriting " or a "Moratorium" basis.

Full Medical Underwriting

Where an insurance plan is "Fully Medically Underwritten", medical history is disclosed on the application form. This is then assessed upon submission to the insurer, by that health insurance provider's underwriters on a case by case basis.

Once assessed, one of a number of outcomes may result:

The application is accepted without exclusions
The application is accepted, but with exclusions on pre-existing conditions
The application is declined

Under this system of underwriting it is impossible to give a 100% accurate assessment of the effect a pre-existing condition may have on an application for cover without actually submitting an application - as everyone's individual circumstances are different, a case by case approach is necessary. It is an unfortunate fact, however, that the more serious and/or long term a condition is, the less chance there is of having it covered by a new medical insurance plan.

Moratorium Underwriting

A Moratorium is a waiting period that must elapse before claims for pre-existing conditions may become eligible under a new Private Medical Insurance plan.

Whilst an application form for this type of underwriting may not ask for any medical information to be disclosed, there are specific rules and conditions that must be met before pre-existing conditions would be considered by a health insurance provider for cover. Below you will find some examples of these wordings which demonstrate exactly how Moratorium Underwriting in health insurance cover operates:

Standard Life

Moratorium or No Medical Assessment

As with any type of insurance, you can only take out cover against unforeseen events, which is why private medical insurance cannot cover you for pre-existing conditions. Our moratorium clause enables you to join Standard Life Healthcare without having to complete a health questionnaire. Instead, we apply a blanket exclusion for any pre-existing conditions you have, or have had, in the five years before you join us. The 'moratorium' refers to the fact that this exclusion is not necessarily permanent. If, after taking out health care insurance with us, there is a period of two consecutive years during which you do not need any further treatment, medication or consultations for a pre-existing condition (or any related conditions), then should subsequent treatment for that condition become necessary, it will be covered (subject to normal terms and conditions).

Secure Health

2. Moratorium

With this option, you do not need to fill in a health questionnaire when applying for health care insurance. Instead, in the first two years of your health insurance cover, we will not provide benefit for treating any medical condition or directly related condition for which you had symptoms (whether or not a diagnosis had been made), consultation, medication, monitoring, advice or treatment or were aware of in the five years immediately before you joined the plan. (These are known as 'pre-existing conditions').

After two years of continuous membership, we will pay benefit for any pre-existing medical conditions you had before the start of your plan, if you have not had any symptoms (whether or not a diagnosis had been made), consultation, medication, monitoring, advice or treatment for these pre-existing conditions in the first two years of your membership.

If you have received treatment or advice or had symptoms in the first two years of membership, we will not pay benefit for these pre-existing or related conditions until two years have passed since you last had symptoms (whether or not a diagnosis had been made) or needed any consultation, medication, monitoring, advice or treatment.

Please understand that your policy will probably never cover long-term medical conditions which are likely to continue to need regular or periodic treatment, medication or medical advice. This is because each time you need any such treatment, the moratorium starts again, so it is unlikely that there would ever be two clear years during which you remain free of all symptoms (whether or not a diagnosis had been made) consultation, medication, monitoring, advice or treatment.

Of course, any unexpected medical conditions arising after the start of your health insurance cover will be covered immediately, subject to the policy terms and conditions.

Note: We strongly advise you against delay in seeking medical advice and treatment during the moratorium for a pre-existing condition simply to obtain cover under your policy.

Under the "Moratorium" system of underwriting, it may well be that pre-existing medical conditions may never be covered but health insurance cover could still be given for new and unrelated illnesses and diseases.

Duty of Disclosure

You must disclose to your health insurance company/plan provider, before an insurance contract is concluded, any fact or circumstance which is known to you (or which ought to be known to you) which may affect the terms of your policy.

It is especially important to disclose any Pre-existing Medical Conditions, where required, on an application form. Non-disclosure of required information to your health insurance company may lead to a future claim being denied or the cancellation or invalidation of your Private Medical Insurance policy.

Important Note

This document is intended as a "quick reference" guide to Pre-existing Medical Conditions and Duty of Disclosure, and is not a full and comprehensive guide to policy benefits and limits. Full details of coverage provided by each Insurer / Plan Provider under their health care insurance cover are contained within their plan rules and/or policy wordings, which are available upon request.

Andrew Wilson
Business Development and Sales Manager

Medibroker Limited
8th June 2006