I decided to write a post about my recent journey buying private medical insurance because I wanted to share that it is still possible, although arguably less straightforward, to get health insurance in the UK with a pre-existing condition.
It’s worth disclaiming upfront that the information in this post is based on my own personal experience and from the research I did in early 2018 prior to making the decision to buy health insurance for the first time.
Although much of the information given in this post is based on the UK medical insurance market as I live in the UK, if you feel able to share, I’d love to hear some of your stories about taking out private health insurance with a pre-existing condition or what happens in other countries across the world. Please leave comments in the box below.
Why take out Private Medical Insurance when we have the NHS?
It seems to me that private medical insurance is seen as more of a luxury than a necessity in the UK, because we already have a National Health Service (NHS) that delivers comprehensive healthcare that is free at the point of use.
My family has never had private medical insurance. Indeed my parents, immigrants that arrived in the UK in the 1960s, have always felt privileged to be able to access our NHS and never considered the need to take out health insurance as I was growing up.
I only started to question this as an adult after getting sick at university, but I still never really investigated the possibility fully until now because I assumed that having a pre-existing condition meant I was ‘un-insurable’. In the end, there were a few key reasons why I decided health insurance was worth investigating seriously:
- Waiting times
Currently, NHS waiting times are the longest they have been. There is waiting involved to see a hospital team for the first time. The government currently has a target of 18 weeks to measure the time it takes for you to be seen by a hospital team after your GP makes a referral. Although this target is largely met the majority of the time, it’s not so straightforward and usually waiting for treatment is actually far longer. For example, this target only measures the amount of time it takes for you to have an initial appointment with a specialist doctor in a hospital setting. It does not measure the time taken for you to receive a diagnosis and treatment. If at the initial appointment your doctor decides that you need some tests done to determine what is wrong for instance, then you often need to wait again for those tests to be done and then for those results to be reviewed in another appointment before you can move on to treatment. So in my experience the waiting time to get from assessment to diagnosis and then to treatment is actually significantly longer than 18 weeks.
- Continuity of care (seeing the same doctor).
While your care in the NHS may be under one individual consultant, I have found that it is less likely, particularly in larger hospital trusts, that you will actually see your consultant. Instead it is more likely that you will see one of the junior doctors (specialist registrars) working under him. This might work fine for some, but I have found that because junior doctors go on rotation, it is less likely that you will see the same person more than once or twice. I have found that this made my care very disjointed and has made my own diagnosis and assessment process more complicated and timely. However, I believe that when you have medical insurance, you actually get to see the consultant in person and are able to have a lengthier discussion with him making sure that you, the patient, have more time to ask questions and make the right decisions about your care.
- Self- Empowerment
A deeper reason why I opted to buy health insurance was because I wanted to be more proactive about my health and feel like I had more autonomy over my healthcare decisions. Autonomy is so important for someone with illness because depending on the nature of your condition it is likely that to a lesser or greater extent has already taken away some of your independence. I also value being able to have choice over appointment times (it can be quite important when you’re trying to balance healthcare needs with full time employment) and when I want/ need the time with an experienced consultant. Taking out insurance made me feel like I was giving myself the right to choose how, when and where I get treated and made me feel like I was taking back some control over my life.
The things you need to know when you have a pre-existing condition
One of the biggest factors to consider if you want to buy private health insurance is the policy’s underwriting. There are two main ways (and then a third option) in which insurance policies work:
- Full underwriting. This is when you provide full details of your medical history. With this method you disclose any past medical conditions on the application and the insurer would then decide if they are able to offer cover for those conditions or not. Different insurers may come back with different results. With full underwriting any potentially serious medical conditions that you have experienced in the past (even if it was over five years ago) may be excluded. If an exclusion is placed on the plan, it is usually possible to have that exclusion reviewed at each policy renewal date (likely to be once a year) but you would probably need to have medical evidence provided by your doctor to support your argument that the past condition is no longer a problem.
- Moratorium underwriting. This method of underwriting excludes pre-existing medical conditions that you have suffered from over a set period determined by the insurer (usually the past five years). The main difference compared to full underwriting is that you do not need to provide any medical information immediately. Then, when you make a claim in the first two year period, it is up to your doctor to say whether this has been a pre-existing condition or not. But be aware that an insurer always has the right to check your medical records to ensure that you’ve not suffered from the condition you’re claiming for within that five year window.
Please note that a pre-existing condition, as far as insurance companies are concerned, means any condition where you have shown symptoms of as well as anything you have received advice and treatment for. For example, you went to your GP complaining of knee pain and you were sent away at the time with a simple prescription for some anti-inflammatory pain killers for a few weeks. You then happen to take out medical insurance within the following five years. But then in the first two years of your policy start date, your knee pain returns and it turns out you need an operation, the insurer may be in a position to argue that they will not cover you for this. This is because you displayed symptoms of the condition (knee) in the five year period prior to your policy start date.
I think it is true to say that this method of underwriting creates a level of uncertainty for you and the insurer. Because you have not negotiated these things upfront, you do leave yourself vulnerable to interpretation at the time you need to make a claim. I’ve been told by the brokers that I spoke with that there is heavy emphasis on what your doctor (most likely your GP but possibly your consultant) says was pre-existing or not.
- There is, however, a third option. You can also get underwriting on a fixed moratorium Fixed moratorium underwriting is a more lenient type of underwriting than rolling moratorium underwriting. It still excludes any medical conditions you’ve suffered from in the five years leading up to the policy start date. However, once you’ve served two years on the policy, the insurer will then consider covering you for that condition – regardless of whether you’ve been receiving treatment for that condition or not.
Sounds great, right? Firstly, there is only one health insurer in the UK at the moment that offers a fixed moratorium policy and the monthly premium is significantly higher (approximately by £30-50 a month for a comparable level of cover with a standard moratorium underwriting). Secondly, it’s important to be aware that often conditions like heart disease, stroke, cancer and diabetes may never be covered by an insurer, even those offering a fixed moratorium. You always need to check!
So what policy underwriting do you pick?
It’s certainly not a straightforward decision when taking out insurance with a pre-existing condition, but the main message I want to send is that it is possible to get yourself insured.
Ultimately you need to weigh up the best option for you based on your medical history and your pre-existing condition. You need to consider how far away you are from when you last had a flare up of your condition, and also the potential of an insurer being able to argue that a pre-existing condition is connected to something new that arises after your policy cover begins. For example, I had spine surgery at the L4/L5 section of my lumbar spine just under five years ago, but no broker was clear as to whether an insurer would agree that a need for another surgery on another part of my spine (let’s say the cervical spine which is neck and shoulders) would count as a new condition or part of the same condition. It would only be decided at the time of a claim and depend on how my doctor presented the case and what the insurers’ chief medical officer would say in return.
I will leave you with some other pointers I picked up during my investigation:
- Make sure you speak to a few different brokers and get advice on your condition, rather than rely on the online questionnaire and quote systems if you have a pre-existing condition. If you can I’d also speak with your GP as they will be key in future negotiations – remember many insurers require GP referral prior to agreeing to pay for any new claim
- Insurance only tends to cover acute flare-ups rather than ongoing management of conditions so if I had a bad back, for instance, it won’t pay for ongoing physiotherapy that I need but it would pay out if I had a more acute flare up of pain.
- Even if you can’t get your pre-existing condition covered (this may be the case if you have a condition like diabetes or heart disease) insurance can still cover you for a new, unrelated condition. Just because you have one condition doesn’t mean you won’t get another.
- Some insurers do give a discount for non-smokers and for keeping your weight within a healthy BMI. This has given me an extra incentive to drop a few kilos of weight to get me within a healthy BMI range!