Health Insurance Question RE: pre-existing conditions

Read BUPA's FAQs on moratoriums and pre existing conditions (link below and extract in italics, my emphasis in bold) - they are very clear that your varicose veins would be a pre existing condition.

The moratorium is much longer than you think - 2 years, and it's not just a wait period - there needs to be nothing at all wrong in that time - no symptoms. Frankly it seems impossible for you to claim for them as if they are giving you trouble now they aren't going to magically be fine for 2 years and then get bad enough to be treated.

https://www.bupa.co.uk/health/health-insurance/health-insurance-faqs

A moratorium condition is any disease, illness or injury or related condition, whether diagnosed or not, which you or your dependant:

received medication for
asked for or received, medical advice or treatment for
experienced symptoms of, or
were to the best of your knowledge aware existed
in the five years before your start date stated in your membership certificate.

By a ‘related condition’ we mean any symptom, disease, illness or injury which reasonable medical opinion considers to be associated with another symptom, disease, illness or injury.

We’ll pay for treatment of a moratorium condition if after the relevant start date you or your dependant do not:

receive any medication for
ask for or receive any medical advice or treatment for, or
experience symptoms of,
the condition for a continuous period of two years while you are covered under this policy.

You can call us to check that any proposed treatment is covered before you arrange it.


Note you would need to find out what kind of underwriting they do on your husband's policy. Cover under my work insurance policy (which is BUPA) is fully medically underwritten rather than on a moratorium, and they just permanently exclude anything of note you've already had an issue with, so that's even more restrictive than a moratorium. Although I think in practical terms they will probably amount to the same for you.

SueMaggie wrote: »

Definitely agree that you need to find out the kind of underwriting you would be subject to if you were to be added to the policy.

Your husband's underwriting status should be on his Membership Certificate under the heading "Details of individuals covered under this membership" where it says "Underwriting method applied". If it says non-underwritten this means pre-existing conditions aren't excluded (so are covered if all other requirements are met re who, when, where etc the treatment is done).

However, even if your husband is non-underwritten you wouldn't necessarily be the same if you were to be added to the policy as some businesses want their employees to be non-underwritten, but any dependants to be underwritten (as it's cheaper for the employer that way). So you'll need to find out what underwriting would be applied if you were to be added to the policy.

If you'd be underwritten then your varicose veins would be excluded as they're a pre-existing condition.

This point in bold is very important. Some large company policies will be on a medical history disregarded basis, meaning all pre existing conditions are covered. However, this is usually only the case where all employees are enrolled (or all over a certain grade perhaps) and there is no option about whether you are covered or not. In this case, the underwriter accepts that there might be some people within the staff who they wouldn't have wanted to cover, but the majority will be healthy and so it offsets.

So a friend of mine works for a company where all staff get single life private medical insurance and her cover is on a medical history disregarded basis. Mine on the other hand is an optional benefit we can choose to take or not to take and hence everyone who takes it out goes through full medical underwriting as the insurer assumes that the really healthy won't bother to take out the cover and they need to protect themselves against anti-selection from the less healthy.

I would be relatively surprised even if your husband's policy is on a medical history disregarded basis if he would be allowed to add family without underwriting as you mention salary sacrifice - meaning adding you is optional rather than family cover being given to all staff.

teddysmum wrote: »

If pre-existing conditions were covered by insurance, insurers could go out of business, as people would only take out a policy when they had need.

Exactly, that's what they call anti-selection. I remember an ex's mate being really surprised to discover he couldn't just take out a policy, pay £100 for the first month's cover and then get the insurer to pay for £5k of knee surgery he needed... I didn't know what to say... wasn't it obvious they wouldn't allow that?

Re: conditions on both sides of the body at different times, I am sure that would depend on the actual condition.

If you have typical varicose veins in one leg you are very likely to get the in the other, as the root cause is the same. I think it would count as a pre-existing condition, even if the site were different. Same with standard osteoarthritis in a knee, for example.

On the other hand, if you broke your left arm 10 years ago (and assuming it was by something discrete and you don't have brittle bones or frequent falls) you are not at any increased risk of breaking your right arm now, so if you did that would not be a pre-existing condition.

(this is a medical not actuarial opinion)

MonkeyDr wrote: »

Re: conditions on both sides of the body at different times, I am sure that would depend on the actual condition.

If you have typical varicose veins in one leg you are very likely to get the in the other, as the root cause is the same. I think it would count as a pre-existing condition, even if the site were different. Same with standard osteoarthritis in a knee, for example.

On the other hand, if you broke your left arm 10 years ago (and assuming it was by something discrete and you don't have brittle bones or frequent falls) you are not at any increased risk of breaking your right arm now, so if you did that pre-existing condition.

(this is a medical not actuarial opinion)

Speaking as an actuary, the underwriting decisions on private medical insurance are made by underwriters and if they take anyone's view into account, it would usually be that of a doctor rather than an actuary.

I would generally agree with the view that they should consider each case on it's merits, so your broken arm caused by an accident wouldn't lead to an exclusion for the other arm.

However, it really does depend on the individual underwriter's desk the case lands on - my experience is life policies and such policies as income protection and critical illness insurance have quite sophisticated underwriting manuals, usually provided by the reinsurer (the company that insures the insurer) with a lot of medical and claims analysis behind them. They have a number of options from declining to quote, to exclusion, to adding a loading to the premium but then providing full cover for that higher premium.

Private Medical Insurance however is not typically reinsured and there is a bit of a tendency if doing full medical underwriting at point of sale to exclude all pre existing conditions even if statistically the fact you had a certain condition in the past makes you no more likely to suffer it in the future than someone who has never suffered from it.

Underwriting at claims stage, which is effectively what a moratorium does, is a bit more sophisticated and they will look into your medical history if they have any reason to suspect the issue might be pre-existing - in particular claims made shortly after a policy has been taken out will attract a fair degree of scrutiny.