Private Medical Insurance Existing Conditions Explained

Written by Pratik Aghera
Reviewed by Andrea Troy
7 min read
Updated: 2 Sep 2026
Health Insurance Guides
Private Medical Insurance Existing Conditions Explained

Private medical insurance existing conditions are usually excluded from cover, at least when a policy first starts. Most UK insurers will still accept you if you have a pre-existing condition, but the condition itself, plus anything related to it, is typically not covered from day one. New, unrelated illnesses or injuries that begin after your policy starts are covered as normal.

A pre-existing condition is any illness, injury or medical issue you have had symptoms, treatment, medication or medical advice for before your policy begins. The important word is “symptoms” – an undiagnosed but symptomatic problem can still count, even if you never saw a doctor about it. How an insurer handles it depends on the type of underwriting you choose.

Free Price Compare offers whole-of-market comparison of UK private medical insurance and health cash plans. This is insurance comparison, not medical advice: for any concern about your health or care, speak to your GP or call NHS 111.

Quick Answer: Private Medical Insurance Existing Conditions Explained

  • Two main underwriting types decide how conditions are treated: moratorium (usually a 5-year look-back, conditions excluded for the first 2 years) and full medical underwriting (assessed upfront, exclusions confirmed in writing).
  • Chronic conditions, such as diabetes or asthma needing ongoing management, generally stay excluded permanently – PMI is built for new, acute problems that can be cured or resolved.
  • Under moratorium, an excluded condition can become covered if you go 2 continuous years with no symptoms, treatment or advice for it.
  • When switching insurer, ask about Continued Personal Medical Exclusions (CPME) so you keep your built-up cover without new underwriting.
  • PMI never covers A&E, emergencies or NHS-only care – it sits alongside the NHS, and disputes over exclusions can go to the Financial Ombudsman Service.

Last updated: August 2026

Written by the Free Price Compare editorial team | Reviewed August 2026

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Will private health insurance cover pre existing conditions?

Private health insurance will generally not cover a pre-existing condition when your policy starts, though there are exceptions and time-based routes back into cover. Most UK insurers exclude anything you have had symptoms, tests, treatment or medication for in the recent past, commonly the last five years. What they do cover is new, unrelated conditions that arise after your cover begins.

The distinction that matters most is acute versus chronic. An acute condition is a short-term illness or injury that responds to treatment and can be cured, such as a hernia or a torn cartilage. A chronic condition is a long-term illness that needs ongoing management rather than a one-off cure, such as diabetes, asthma or arthritis. Private medical insurance is built to fund treatment for acute conditions – it is not designed to fund the day-to-day management of a chronic illness, which remains the role of the NHS.

Demand for private treatment has grown sharply alongside NHS pressures. According to gov.uk and NHS England referral-to-treatment figures for June 2026 (published 13 August 2026), around 7.27 million cases were on the waiting list, with roughly 2.48 million people waiting over 18 weeks and about 106,000 waiting over a year. That backlog is a large part of why people with existing conditions look at private cover for new, unrelated problems.

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Moratorium vs full medical underwriting

Moratorium underwriting and full medical underwriting are the two ways UK insurers assess your health when you apply, and they handle pre-existing conditions very differently. Choosing between them is the single most important decision for anyone applying with an existing condition, because it changes what you disclose, what is excluded, and whether that exclusion can ever be lifted.

How does moratorium underwriting work?

Moratorium underwriting excludes any condition you have had symptoms, treatment, medication or advice for in a set look-back period, usually the previous five years, without asking for a full medical history upfront. You answer a few basic health questions, or sometimes none at all. The excluded condition can become covered later if you complete a continuous period – commonly two years – with no symptoms, treatment or advice for it. This is the most common type for individual UK policies because the application is quicker.

The trade-off is uncertainty. Because nothing is assessed line-by-line at the start, you only find out whether a claim is covered when you make it, and the insurer will typically contact your GP for a report before approving it. A condition that flares up during the moratorium period resets the clock.

How does full medical underwriting work?

Full medical underwriting means the insurer assesses your medical history upfront and tells you in writing exactly what is excluded before you buy. This gives you certainty at the outset, which can work in your favour if a past condition is fully resolved and can be shown to be so. If you are still receiving treatment or monitoring for a condition such as diabetes, asthma or arthritis, an insurer will typically list it as a permanent exclusion.

Feature Moratorium Full medical underwriting
Medical history at application Few or no questions Full history assessed
When exclusions are known Only when you claim Confirmed in writing upfront
Look-back period Typically 5 years Whole history considered
Route to cover a past condition Usually 2 continuous symptom-free years Only if resolved and accepted at outset

Figures are indicative and may change. The right choice depends on your own medical history, so read each insurer’s definitions carefully before applying.

Moratorium vs full medical underwriting

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What conditions are usually excluded?

The conditions most commonly excluded from private medical insurance are long-term, chronic illnesses that need ongoing management, along with anything you have recently had symptoms or treatment for. Typical examples insurers exclude include diabetes, asthma, arthritis, epilepsy, high blood pressure, and conditions such as depression where you have had recent treatment. These do not mean cover is refused outright – you can usually still hold a policy, but the named condition and directly related problems sit outside it.

Beyond pre-existing conditions, private medical insurance as a product does not cover certain things regardless of your health history:

  • Accident and emergency care and 999 emergencies, which remain the role of the NHS.
  • Ongoing management of chronic conditions, once diagnosed, rather than acute flare-ups that can be treated.
  • Routine pregnancy and childbirth on most standard plans.
  • Cosmetic treatment and pre-existing conditions excluded at underwriting.

Some large employer schemes are written on a “medical history disregarded” basis, meaning pre-existing conditions are covered without individual underwriting. This is far more common in group business cover than on individual policies, and it is worth checking if you have access to a workplace scheme.

Can private health insurance deny pre existing conditions?

Private health insurance can decline a claim for a pre-existing condition where that condition falls within the policy’s exclusions or the underwriting terms you agreed to. Insurers rarely refuse to insure you altogether; instead they accept you and exclude the specific condition. A claim can also be declined for non-disclosure if you failed to give relevant information on a full medical underwriting application.

If you disagree with a decision, you can escalate it. The FCA regulates insurers, and unresolved complaints can go to the Financial Ombudsman Service. The Ombudsman looks at what the insurer asked about your health, whether it was fair to apply a pre-existing exclusion where there was no medical screening, and, where there was screening, whether any omission was a deliberate misrepresentation or an honest mistake. That framework is why keeping records of what you disclosed matters.

Claims volumes show how often people rely on this cover. The ABI reported that UK health insurers paid a record £4 billion in individual and workplace private medical insurance claims in 2024, up 13% on 2023, with 6.5 million people covered and 1.8 million people claiming.

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Switching insurers with an existing condition (CPME)

Continued Personal Medical Exclusions (CPME) are an arrangement that lets you move to a new insurer while keeping the cover you have built up, without a fresh moratorium or new full medical underwriting. Under CPME, the new insurer carries over the exclusions your previous policy applied – so conditions excluded before stay excluded, but anything you had earned cover for is preserved. Anyone already on a policy who wants to switch should ask about CPME first.

Without CPME, moving insurers can mean starting a new moratorium or new underwriting, which risks losing ground you have gained – for example, a condition that had become covered after two symptom-free years could be re-excluded. Because premiums for the same age, cover level and underwriting can vary noticeably between insurers, it is worth comparing on a like-for-like basis before you switch. Premiums for the same age, cover level and underwriting can vary noticeably between insurers, so comparing on a like-for-like basis before switching is sensible. If you are weighing up the wider costs of protecting your household, our overview of life insurance and how cover is priced is a useful companion read.

What does private medical insurance cost with a pre-existing condition?

Private medical insurance costs the same for the parts of your health that are covered whether or not you have a pre-existing condition, because the condition itself is usually excluded rather than loaded onto the price. Independent 2026 market research across seven leading UK insurers put the average basic policy at around £66.55 a month and comprehensive cover at around £98.53 a month, based on a single policy with a £250 excess on moratorium underwriting (Free Price Compare research, August 2026). Age is the biggest driver of price, not underwriting type alone.

Premiums for the same age and cover level can differ noticeably between insurers, so comparison matters. Renewal rises each year are common on pool-based pricing, and some insurers adjust renewals based on how you engage with their health and wellness programmes. If private cover for your condition is off the table because it is chronic and excluded, a health cash plan may help with everyday costs instead, and it is worth understanding how UK health insurance and cash plans compare.

Insurance prices move for reasons outside your control, much as with home and motor cover – our explainer on how insurance underwriting and pricing work shows the same principles apply across products. For travel, remember that travel insurance and pre-existing medical conditions are handled separately and must be declared on their own policy.

What does private medical insurance cost with a pre-existing condition

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FAQs about private medical insurance existing conditions

Which private health insurance covers pre existing conditions?

No standard UK individual policy fully covers an existing chronic condition from the outset. Some insurers can cover a past condition once you have gone two continuous years symptom-free and treatment-free under moratorium underwriting, or if full medical underwriting confirms it is resolved. Large employer schemes written on a medical history disregarded basis are the main route to covering pre-existing conditions without exclusions.

Does private medical insurance cover chronic conditions?

Private medical insurance is designed for acute conditions that can be treated and cured, not the ongoing management of chronic conditions. A chronic illness such as diabetes or arthritis will generally stay excluded, even under a moratorium. It may cover an acute flare-up in some cases, but not routine day-to-day management, which remains the role of the NHS.

What counts as a pre-existing condition?

A pre-existing condition is any illness, injury or medical issue you have had symptoms, treatment, medication or medical advice for before your policy starts. The word “symptoms” is key: an undiagnosed but symptomatic problem can still count even if you never saw a doctor. Most insurers look back over the previous five years under moratorium underwriting.

Can I get private health insurance if I have a pre-existing condition?

Yes, most UK insurers will accept you even with a pre-existing condition. The difference is that the condition itself, and anything directly related to it, is usually excluded from cover rather than the whole application being refused. New, unrelated conditions that begin after your policy starts are covered normally.

How long until a pre-existing condition is covered under a moratorium?

Under moratorium underwriting, a pre-existing condition can become covered once you have gone a continuous period, commonly two years, with no symptoms, treatment or medical advice for it. If the condition flares up or you need treatment during that window, the clock typically resets. This route only applies to acute conditions, not chronic ones, which usually stay excluded.

What is CPME when switching health insurers?

Continued Personal Medical Exclusions (CPME) let you move to a new insurer while keeping the cover you have already built up. The new insurer carries over your previous exclusions without a new moratorium or fresh underwriting. Always ask about CPME before switching, as it prevents you losing ground on conditions that had become covered.

Will my insurer check with my GP before paying a claim?

Insurers often ask for a report from your GP before approving a claim, particularly on moratorium policies where medical history was not assessed upfront. They use this to confirm whether the condition is pre-existing and whether it falls inside your cover. This is why accurate disclosure and keeping your own records matter.

What happens if my claim for a pre-existing condition is refused?

If your insurer declines a claim you believe should be covered, you can complain to the insurer first, then escalate to the Financial Ombudsman Service if it is not resolved. The Ombudsman assesses whether the exclusion was fairly applied and whether any non-disclosure was deliberate or an honest mistake. Keeping evidence of what you disclosed strengthens your case.

Does private medical insurance cover A&E or emergencies?

No. Private medical insurance does not cover accident and emergency care or 999 emergencies, which remain the responsibility of the NHS. It sits alongside the NHS to fund planned treatment for eligible acute conditions, not urgent or emergency care. For any medical emergency, always use NHS services or call 999.

Is moratorium or full medical underwriting better for existing conditions?

It depends on your history. Full medical underwriting gives certainty upfront and can favour you if a past condition is fully resolved and accepted at the start. Moratorium is quicker to apply for and can bring a condition back into cover after two symptom-free years. Compare each insurer’s definitions before deciding, as terms vary.

Do pre-existing conditions affect the price of the policy?

Usually the condition is excluded rather than priced in, so the premium reflects the cover you do have rather than being loaded for the excluded condition. Age, cover level and excess are the main price drivers. Premiums for the same profile can vary noticeably between insurers, so comparing quotes is worthwhile.

What is the difference between health insurance and a health cash plan for existing conditions?

A health cash plan pays fixed cash amounts towards everyday costs such as dental, optical and physiotherapy, and is far less concerned with pre-existing exclusions than full medical insurance. It does not fund private surgery or specialist treatment like PMI can. For people whose chronic condition rules out useful PMI cover, a cash plan can be a lower-cost alternative for routine expenses.

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Information correct as of 27 August 2026. Prices, tariffs, policy details and providers change frequently, so please check the latest details before making a decision. This article is for general information only and does not constitute financial advice. Free Price Compare is authorised and regulated by the Financial Conduct Authority (FCA).

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