Pre-existing conditions and health insurance

What is a pre-existing medical condition?

‘Pre-existing condition’ is a term that crops up a lot when it comes to health insurance, so it’s worth spending a few moments understanding what it means if you’re considering taking out a policy or making a claim.

A pre-existing condition is any disease, illness or injury that you’ve had symptoms of or you’ve sought advice or treatment for in the past.

Health insurance is designed for the diagnosis and treatment of conditions that arise after your policy has begun, not to provide medical care for problems you’ve had previously. That’s why pre-existing conditions and in some cases associated specified conditions from the five years before taking out a health insurance policy are usually excluded from cover.

If, within the first two years of your policy starting, a pre-existing condition doesn’t give you any further trouble, your insurer may then be able to offer you cover for it.

So, does insurance cover pre-existing diseases? Not usually when you first buy a policy. But there are exceptions, which you can read about further down.

The difference between acute and chronic conditions

An important distinction when it comes to health insurance is that it only covers ‘acute’ conditions. Cover for ‘chronic’ health issues is rarely offered by health insurance providers.

Acute conditions are the sorts of illnesses and injuries that can be resolved quickly, usually with the help of medical or surgical intervention.

Hip replacement or cataract removal are examples of operations people regularly claim for through their private medical insurance. Treatment is aimed at getting you back to your normal as soon as possible without you needing any further input in the future.

Does health insurance cover cancer?

A new diagnosis of cancer can normally be treated through private medical schemes and longer periods of treatment are possible.

Can I get cover for pre-existing conditions?

Health insurance is designed to cover problems that arise after you’ve taken out a policy, much like your car insurance. You can’t claim for treatment for a knee injury you sustained in the past, in the same way you wouldn’t be able to claim for a car accident that happened before your policy started.

Michelle Cooper, Director of Health Insurance adds: "Most health insurance policies don’t cover pre-existing conditions – these are illnesses or injuries you had before taking out the policy. However, some insurers may offer cover if you’ve been symptom-free for a certain period. It’s always worth checking with your provider to understand what is and isn’t included."

Do any health insurers cover pre-existing conditions?

Some providers offer health insurance for pre-existing conditions at an extra cost.