Pre-Existing Conditions and Expat Health Insurance: What Is Covered
A pre-existing condition is a health problem you had, or had symptoms of, before your policy began. Most expat health insurers exclude, limit or price these conditions. How you apply decides which one happens. This guide explains the two main methods, the risks and how to choose.
This guide is general information, not personal advice. Insurers define terms differently, so read your policy.
The short answer
Expat health plans normally do not pay for conditions you had before you joined, unless the insurer agrees to cover them. You choose between two ways of applying: moratorium underwriting, which is quick but leaves you uncertain, and full medical underwriting, which takes longer but tells you up front what is covered.
What counts as pre-existing
Definitions vary, but insurers usually mean a condition you have had symptoms of, received advice or treatment for, or taken medication for, often within a set number of years before the policy starts. It can include a long-term condition such as diabetes or asthma, an old injury, or something that is under investigation. Related conditions can be caught too. Read the policy definition, not a summary.
Moratorium underwriting
With a moratorium, you do not give your full medical history at the start. Instead, the insurer excludes conditions you have had in a set period before joining.
- The exclusion usually lasts for a fixed period, commonly two years.
- The clock is often rolling: if you have symptoms, advice, tests or treatment for the condition during that period, the clock restarts.
- If you go the full period with no symptoms or treatment, the condition may then become eligible for cover.
Advantages: quick to set up, no long medical form, and often cheaper.
Risks: you do not know what is covered until you claim. You may pay for a condition the insurer later says is excluded. The insurer can investigate your history at claim stage.
Full medical underwriting
With full medical underwriting, you disclose your history up front. The insurer then accepts the condition, adds an exclusion, raises the premium or declines it.
- Any special terms are written on your certificate, so you see them before you rely on the plan.
- You may gain cover for conditions that a moratorium would have excluded.
Disadvantages: a longer application, often a higher premium, and more detail to gather, especially for a family.
Side by side
- Speed. Moratorium is fast. Full medical underwriting takes longer.
- Certainty. Full medical underwriting gives written terms. A moratorium leaves questions until a claim.
- Cost. A moratorium is often cheaper at the start. Full medical underwriting can cost more but avoids surprises.
- Best for. A moratorium suits healthy people with no recent history. Full medical underwriting suits anyone with a condition they want covered or a history they want to be certain about.
Disclosure risk
Whatever the method, answer every question fully and honestly. If you leave something out and the insurer later finds it, a claim can be refused and the policy cancelled. If you are unsure whether a symptom counts, include it. Keep copies of your answers and your doctor’s records.
Switching insurers
Moving to a new insurer can restart the clock. A moratorium on a new policy usually starts again from the join date, so conditions you had waited out may become excluded again. Before switching, ask whether the new insurer will carry over your terms and compare what you would lose. If your health has changed, you may find a new insurer offers worse terms than the one you have. Do not cancel until the new policy is confirmed in writing.
Chronic and long-term conditions
A condition that needs regular care, such as diabetes, asthma or high blood pressure, is the hardest to insure. Many plans exclude it, or cover only emergencies related to it. Some insurers will cover a stable condition for an extra premium once you have gone through full medical underwriting. A moratorium rarely helps with a condition that needs treatment every year, because the clock keeps restarting. If you have one, compare plans that cover chronic care and check any annual limit.
Pregnancy and maternity
Maternity cover usually has its own waiting period, often ten months or more, and it must be bought before you are pregnant. Treating pregnancy as a pre-existing condition is common, so a plan taken out after conception normally will not cover it. If you plan a family, ask about maternity cover when you apply.
Mental health and past treatment
Mental health treatment can be pre-existing too. Insurers may ask about therapy, medication and past diagnoses. Answer honestly. Past treatment does not always rule out cover, but terms vary, so ask each insurer how it treats it. Take an independent broker’s advice if you are unsure.
Group and employer plans
If you are covered through an employer, the rules can be different. Some group plans accept existing conditions without questions, which makes them valuable. Check what happens to your cover if you leave the job, because you may then face underwriting again. Ask whether you can convert to an individual plan without new medical checks.
What about the NHS?
If you plan to return to the UK, the NHS may cover conditions that private insurance excludes once you are ordinarily resident. Our guide to expat health insurance vs NHS rights explains the residence rule.
A worked example
This example is illustrative.
A 45-year-old has had treatment for a heart condition in the past three years. She joins an international plan on a moratorium to avoid the paperwork. A year later she needs a procedure related to the condition. The insurer reviews her records and declines the claim as pre-existing, because the clock restarted when she had a check-up during the exclusion period.
Had she chosen full medical underwriting, the insurer might have excluded the condition, loaded the premium or covered it, but she would have known which before she paid for anything. She could then have chosen a different plan or set aside savings.
How to choose
- List every condition, symptom, test and medication in the last five years.
- If the list is empty, a moratorium may be fine.
- If it is not empty, compare full medical underwriting quotes.
- Ask each insurer in writing how it treats related conditions.
- Take advice from an independent broker if you have seen a doctor recently, because many insurers sell without advice.
Pairing health cover with other protection
Health cover does not replace income or pay a lump sum. Read about critical illness cover abroad and income protection for expat contractors, both of which also ask about your health history.
Cover for existing conditions often goes hand in hand with critical illness cover for expats, and our international health insurance page explains how plans are underwritten. Our insurance for UK expats overview shows the full set of options. For the full range, see our expat insurance hub and our page on expat health insurance. Our guide to how much life insurance expats need covers the life cover side.
Frequently asked questions
Are pre-existing conditions covered by expat health insurance?
Usually not unless the insurer agrees. They may be excluded, limited or priced into the premium.
What is a moratorium?
It is an underwriting method where conditions you had before joining are excluded for a set period, often two years, with the clock restarting if you have symptoms or treatment.
What is full medical underwriting?
You give your full medical history up front and the insurer tells you what it will cover, exclude or charge extra for.
Which is better, moratorium or full medical underwriting?
A moratorium is quicker and often cheaper. Full medical underwriting gives certainty. Choose by your health history.
What happens if I do not disclose a condition?
The insurer can refuse a claim or cancel the policy. Always answer fully.
This article is for information only and is not financial or medical advice. Insurer terms differ and can change. Take advice from an independent broker if you have a recent medical history.
