FAQs

This is an injury or illness which exists prior to taking out your policy – under the rules of the scheme, a pre-existing condition would be ‘excluded’ from your plan.

In the period before taking out the plan, usually five years, if you have already received treatment or medical advice for a condition, this would be considered a ‘pre-existing condition’ on your new PMI plan and excluded from cover. It may automatically be covered after a further period of time, typically 2 years, provided there has been no further treatment sought. Our advisers would be happy to discuss this with you and offer advice.

Generally, the term ‘chronic’ is applied when an illness becomes long term and may be controlled, but not cured. In some cases, the condition could be life threatening, but it does not have to be. A chronic illness or condition is a disorder/disease that progresses slowly and over a long duration. This might cause incapacity for episodic or continuous periods, e.g. asthma, chronic bronchitis, arthritis, diabetes, chronic heart disease and HIV.

If a disease or condition is a one-off (has a rapid onset) and/or is experienced over a short duration, then it is known as an ‘acute condition’. Usually, insurers will cover acute conditions in a PMI plan because such conditions may be considered as curable; unlike a chronic condition, where treatment may only relieve the symptoms instead of curing the underlying condition. Acute may be used to highlight the sudden onset of a disease, such as acute myocardial infarction (heart attack). Plus, the term ‘acute’ can be used to make a distinction between different forms of diseases, e.g. acute leukaemia and chronic leukaemia. However, it does not always have to relate to a severe condition, e.g. you could have an ‘acute’ (minor) injury.

A ‘moratorium’ imposes a blanket exclusion on a pre-existing condition that goes back over a set period of time (typically, 5 years). The terms ‘fully underwritten’ and ‘moratorium’ are the two main types of underwriting used when dealing with private medical insurance. As a comparison, to check what you would and would not be covered for, you would need to disclose your full medical history for a ‘fully underwritten’ policy.

A fixed moratorium would not cover any medical conditions for the first 2 years that have happened in the previous 5 years before joining the scheme. After the 2-year period, you would be covered automatically, even if the condition were to reoccur within that 2 year period. There are some insurers who offer these types of policies.

Before the start date of your policy, if you had a pre-existing medical condition in the 5-year period that has been excluded for the first 2 years of cover, you will be automatically covered if you have not had a re-occurrence of the same condition during that 2 year period. If you had suffered a re-occurrence, a further 2-year period would be needed following the completion of treatment without you receiving any advice, treatment or medication for this condition before the condition would automatically be covered.

A qualifying period (typically, 2 years) would be applied under a rolling moratorium – during which the policyholder could not need seek medical advice or receive treatment for a pre-existing condition. However, if treatment or medical advice is sought received during the qualifying period (i.e. regular medical check-ups) then the qualifying period would then start afresh from the date the treatment/advice is completed. Due to this form of underwriting, some conditions would never be covered, since advice, treatment and/or medication may always be needed.