Pre-existing conditions and international health insurance

A pre-existing condition does not stop you getting international health insurance, but it changes what is covered. IPMIEMEA explains the four underwriting routes, FMU, moratorium, CPME and switch terms, and what they mean for expats in the Gulf and Europe.

What counts as a pre-existing condition

A pre-existing condition is any illness, injury or symptom that you had, or had advice or treatment for, before your policy started. The exact definition is in each insurer's wording, and it is wider than most people expect. It usually includes conditions that were diagnosed, conditions that were investigated but not diagnosed, symptoms you saw a doctor about even if nothing was found, and conditions that are related to something you have had before.

The insurer cares about this because international private medical insurance (IPMI) is priced on the assumption that it is covering future, unknown risk. A condition that already exists is a known cost. Insurers handle that in one of four ways, and the route you are offered shapes the whole policy. Understanding the routes is the single most useful thing you can do before you apply.

Full medical underwriting (FMU)

Under full medical underwriting you complete a medical questionnaire when you apply. The insurer reviews it, may ask for more information or a report from your doctor, and then tells you in writing how it will treat each condition. There are three possible outcomes for any condition:

• Accepted. The condition is covered on standard terms.
• Excluded. The condition, and anything the insurer considers related to it, is not covered. Some exclusions are permanent; some can be reviewed after a period.
• Loaded. The condition is covered, but the premium is increased to reflect the expected cost.

The advantage of FMU is certainty. You know from day one exactly what is and is not covered, and the insurer cannot later argue about a condition it has already reviewed and accepted. The disadvantage is the effort of completing the questionnaire accurately, and the fact that a condition may be excluded outright. For anyone with a significant medical history, or anyone who wants to know where they stand before they claim, FMU is usually the better route.

Moratorium underwriting

Under a moratorium there is no medical questionnaire. Instead, the policy automatically excludes any condition you had symptoms of, or advice or treatment for, during a set period before the start date. That exclusion is then lifted for a condition if you go a further set period after the start date without symptoms, treatment, medication or advice for it. If you do have treatment during that period, the clock resets.

The appeal is speed and simplicity: you can be covered quickly without disclosing your history. The drawback is uncertainty. You do not find out whether a condition is covered until you claim, at which point the insurer reviews your medical records and applies the test. Two things catch people out:

• Regular medication keeps the clock running. A condition controlled by a daily tablet is being treated, so it does not become covered, however well it is managed.
• Related conditions count. A claim for something the insurer considers linked to a pre-existing condition can be caught by the exclusion even if the new problem has a different name.

A moratorium suits people with a clean or very minor history who want cover in place quickly. It suits people with ongoing conditions less well, because those conditions will simply never be covered.

Continued personal medical exclusions (CPME)

CPME is a route for people who already hold a private medical insurance policy and are moving to a new insurer. Instead of underwriting you afresh, the new insurer agrees to carry over the terms of your existing policy. The exclusions you have now continue; nothing new is added, and nothing is removed.

This is valuable if your health has changed since you first took out cover. Under FMU, a new insurer would review your full history and might exclude a condition that your current insurer covers because it developed after your current policy began. Under CPME, that condition stays covered because it was not excluded on the old policy.

CPME is not automatic. The new insurer will ask for your existing policy documents, including the schedule of exclusions, and may decline to offer it if the old policy is too different from the new one, if there has been a gap in cover, or if the old insurer is not one it recognises. Ask early, provide the documents, and do not cancel the old policy until the new one is confirmed in writing on CPME terms.

Switch terms

"Switch terms" is a broader label for what happens when you move between insurers. CPME is one form of it. Other insurers offer a "moratorium switch", which is a moratorium on the new policy that counts the time you spent on the old one, so that a condition which had already passed the symptom-free period under the old moratorium is covered from day one under the new.

What all switch terms have in common is that they depend on continuous cover. A gap of even a short period between policies can mean the new insurer treats you as a new applicant and underwrites you from scratch. If you are changing insurer, line up the start date of the new policy with the end date of the old one, and keep every document from the old policy, including the original acceptance letter and the latest schedule.

In the Gulf, switch terms rarely apply to a move from an employer group policy to an individual international plan, because group policies are usually not underwritten individually. Some insurers will nevertheless consider a group-to-individual transfer on favourable terms. Ask.

Chronic conditions that start after the policy begins

A pre-existing condition is one you had before the policy started. A chronic condition that is diagnosed after the start date is a different thing, and it is where international plans differ most from domestic ones. Many domestic policies, including common UK ones, exclude chronic conditions altogether. Many international plans cover them, subject to the plan's limits, including the ongoing medication and monitoring they need.

Read the wording on chronic conditions before you buy. Look for whether they are covered at all, whether there is a separate limit, whether medication is included under outpatient cover, and what happens at renewal. For an expat who develops a long-term condition abroad, this is the clause that matters most, and it is one reason people prefer a lifetime-renewable international plan to a series of local ones.

What this means in the Gulf and Europe

The region adds two practical wrinkles.

In the Gulf, most expats hold an employer group policy that covers existing conditions because the workforce is insured as a whole. When they add an individual international plan, those conditions are underwritten for the first time. The result is that the top-up plan may exclude exactly the condition the employer plan covers. That is not a reason to skip the top-up; it is a reason to keep the employer plan for that condition and to be clear about which policy you will claim on for what. Our guide to Gulf mandatory insurance and top-up cover covers the mechanics.

In Europe, a residence visa may depend on the policy. An exclusion for a serious condition is a matter for you, but it may also be a matter for the consulate if the visa rule expects comprehensive cover. Ask the insurer how it will treat the condition before you apply, and ask the consulate or your visa agent whether an exclusion affects the application. The Spain and Portugal pages explain the visa context.

How to declare, and what to ask

1. Declare everything. Diagnoses, investigations, symptoms you saw a doctor about, medication, and anything you have been advised to monitor. If in doubt, include it. An undeclared condition is the most common reason a claim is refused.
2. Ask for the decision in writing. Under FMU, you should receive a schedule of any exclusions or loadings. Keep it.
3. Ask whether an exclusion can be reviewed. Some insurers will reconsider after a period without symptoms or treatment.
4. Ask about CPME or switch terms if you already hold a policy, and do not cancel it until the new one is confirmed.
5. Ask about chronic conditions that may arise after the start date.
6. Keep copies of everything you submit and everything you receive.

Pre-existing condition

A condition, symptom or injury you had, or had advice or treatment for, before the policy started. The exact definition is in the policy wording.

Full medical underwriting (FMU)

You complete a questionnaire and the insurer tells you in writing how it will treat each condition: accepted, excluded or loaded.

Moratorium

No questionnaire. Conditions from a set period before the start date are excluded, and may be covered later after a set symptom-free and treatment-free period.

CPME

Continued personal medical exclusions. A new insurer carries over the exclusions of your existing policy instead of underwriting you again.

Switch terms

Any arrangement under which a new insurer takes account of your existing cover, including CPME and a moratorium switch. Depends on continuous cover.

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An increase in premium applied to cover a declared condition rather than exclude it.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to a regulated broker.