Getting cover with a pre-existing medical condition

Having a health condition does not close the door on life insurance. Most people with a pre-existing medical condition can still get cover, whether that is level term, decreasing term, increasing term or whole-of-life insurance¹. What usually changes is the price, the terms, or both: the insurer may charge a higher premium, exclude certain causes of claim, or cap the amount it will insure you for¹.

The process behind that is called underwriting. Every application goes through a risk assessment so the insurer can decide whether you are eligible for cover and how much your premium will cost². Many applications are accepted straight from the form, with no further information needed at all². Where more detail is required, the insurer may write to your GP or ask you to attend a medical screening, but only with your consent².

There are also options if standard cover is refused or priced out of reach. Over 50s guaranteed acceptance plans ask no medical questions, and there are specialist brokers who work specifically with people who have pre-existing conditions³. This page explains how all of this works, what insurers can and cannot legally do, and what happens if you leave something off your application.

Most people with a health condition can still get life insurance

The starting point is that a pre-existing condition does not necessarily mean you will be unable to secure life insurance². People with Type 1 diabetes can get cover, though the policy may come with extra restrictions³. People who have recovered from cancer may be asked for detailed medical information and to attend a medical examination, with higher premiums and restrictions on the maximum sum insured, but cover is often available³. The same principle runs through the wider protection market: having a pre-existing condition does not mean you will be unable to find critical illness cover either, though it is likely to cost more and carry more extensive exclusions⁷.

What tends to vary between people with the same condition is the acceptance terms rather than the yes or no. One applicant with well-controlled diabetes may be offered standard terms; another with complications may be offered a higher premium or a lower maximum payout⁴. Insurers assess the individual, not just the diagnosis, which is why two people with the same condition can receive quite different offers.

If standard cover is not available at all, there are fallbacks. Over 50s life insurance is not medically underwritten, so pre-existing health conditions do not affect eligibility or the cost, though these plans are restricted to lower sums insured and are more expensive for the amount of cover⁵. Specialist intermediaries also exist: firms such as The Insurance Surgery help people with pre-existing medical conditions find life insurance and travel insurance⁸. The trade-off with any non-medically underwritten cover is that you pay more for less cover, because the insurer is taking on applicants whose health it knows nothing about⁵.

What counts as a pre-existing medical condition

The Financial Ombudsman Service, which settles disputes between consumers and insurers, defines it plainly: a pre-existing medical condition is an illness or injury you had before your policy began or was renewed⁹. Guidance on mental health and insurance uses a similar definition: a condition, whether psychological or physical, that you already have at the time you apply for insurance¹⁰.

In practice, insurers ask about more than conditions you have right now. Applications normally cover your current health, previous health problems, and any major health problems in the family¹¹. For life insurance specifically, the health questions typically ask whether other illnesses have been diagnosed within the past five years, and whether you have received any medical treatment in the past 12 months¹². So a condition you had years ago, or one you think of as resolved, can still count as something you must declare.

Disability charity Scope puts the duty simply: you must tell an insurance company of any conditions you have before buying a policy¹³. Macmillan's guidance for people affected by cancer says the same: you usually have to tell insurance companies about pre-existing conditions such as cancer¹⁴. The definition is deliberately broad, and it is better to declare something the insurer did not strictly need than to leave off something it did.

How underwriting works: the insurer's risk assessment

Underwriting is the process every application goes through so the insurer can determine whether you are eligible for cover and how much your premium will cost². Its purpose, in the words of one consumer guide, is to ensure "the cost of the insurance is proportional to the risk involved"¹⁰. Life insurance in particular is most often underwritten based on your personal circumstances: your age, your health and your lifestyle¹⁵.

The ombudsman's approach to individually underwritten policies is that whether a condition is covered, and whether it costs more, depends on the insurer's underwriting criteria for the specific policy⁹. That is why the same condition can be treated differently by two insurers: each sets its own criteria, based on the data it holds and the claims it expects. Insurers are not free to decide on a whim, though. To make these decisions they must have acted reasonably with information that is relevant and reliable: they ask about your medical history and current situation, and look at relevant, reliable data¹⁷.

Underwriting also behaves differently across insurance types, which matters if you are weighing up more than one kind of protection:

The contrast with private medical insurance is worth noting. The Association of British Insurers states that treatment for some illnesses, including pre-existing conditions, will likely not be covered by an individual private medical insurance policy²¹. BIBA's guidance summarises the split: for private medical insurance you will not normally be covered for these conditions, whereas for some other insurance types the insurer may offer cover, sometimes for a higher premium²². Even payment protection insurance, an older product, followed this pattern: most PPI policies excluded pre-existing medical conditions entirely, though some covered them later if the consumer stayed symptom-free for a defined period²³.

Many applications are decided straight from the form

A common fear is that applying with a health condition means weeks of forms and examinations. In fact, many applications are accepted straight from the application, without the need for any further information in order to underwrite the policy². The health questions on the form do much of the work: insurers ask about conditions diagnosed within the past five years and any medical treatment in the past 12 months, alongside questions about your current health and family history¹².

For someone with diabetes, for example, the application will ask for full details of when you were first diagnosed, your medical history, and the specifics of your treatment and medication⁴. That level of detail is often enough for the insurer to make a decision on the spot. The more complete and accurate your answers, the more likely the decision can be made without delay, because the underwriter is not left waiting to fill gaps.

The questions are not only about diagnosed illness. Applications also cover lifestyle: smoking, high alcohol consumption, and even dangerous sports or motorcycling can push up premiums²⁴. So the "straight from the form" decision weighs your health disclosures together with your age, the size of the cover you want, and how you live.

When the insurer asks for a GP report or medical screening

Where the form alone is not enough, the insurer has two main routes. Sometimes the insurer will write out to your GP for additional information, or it may require you to attend a medical screening, before it can make a decision on your application². Insurance companies may request medical information from your GP or hospital doctor to better understand the condition and accurately price the additional risk²⁵.

Your rights in this process are set out clearly. If a GP or hospital doctor report is requested, you will be asked for your fully informed consent, and there may be a question about whether you want to see a copy of the report before it is sent²⁵. You are entitled to talk with your GP or hospital doctor before medical reports are sent to the insurance company²⁵. The insurer needs your consent to arrange any of this². For mortgage life insurance, the same pattern applies: you make an honest declaration and your GP will be asked to confirm your medical conditions, and in unusual circumstances you may require further medical examinations before a premium can be quoted²⁴.

Two things are worth knowing about what triggers these requests. First, insurers ask for more information if you have certain medical or lifestyle disclosures, if your age and cover amount meet a certain threshold, or if you are applying for a very high level of cover². Second, the questions reach back further than many people expect. The ombudsman's guidance on travel insurance complaints notes that insurers need to be told about past or current health issues even if you have recovered²⁶. The same logic applies to life applications: a condition from years ago can still be relevant to the insurer's assessment.

Acceptance terms: higher premiums and exclusions

Once the insurer has decided, it writes to you with the acceptance terms. It will let you know if your premium has been increased, or if there are any exclusions to be placed on your policy². Those are the two levers insurers use, and they can appear separately or together.

Higher premiums are the most common outcome. Insurers may consider you high risk, which could mean your premium is more expensive, and they may require a medical exam before covering you⁴. For cancer survivors, the terms can include higher premiums and restrictions on the maximum sum insured³. For critical illness cover, the cover you find is likely to be more expensive and may carry more extensive exclusions than for someone with no history of medical issues⁷.

Exclusions work differently: the insurer offers cover but rules out claims connected to the condition. Income protection insurance shows both patterns: pre-existing medical conditions may be excluded or come with special terms, especially if you had symptoms, treatment or advice before applying²⁷. And it is not true that income protection never covers pre-existing conditions: sometimes it does, but usually with conditions and higher premiums involved²⁸.

If the terms you are offered are poor, you are not obliged to accept them. You can approach a different insurer, since each sets its own underwriting criteria⁹, or use a specialist broker who knows which insurers take a more favourable view of particular conditions⁸. Guaranteed acceptance life insurance exists for those who cannot get standard cover, though it is more expensive and restricted to lower sums insured⁵.

Why a pre-existing condition can make cover cost more

The reason sits at the heart of how insurance works. Any significant pre-existing medical or other health conditions that increase the risk of you dying early will also increase premiums²⁴. The insurer is not penalising you; it is pricing the risk it is taking on, so that the cost of the insurance is proportional to the risk involved¹⁰.

There is an important limit on that pricing power. Insurers may ask you to pay a higher premium, but only if they have the evidence to show you are more likely to claim because of your pre-existing condition¹⁴. Macmillan's guidance is explicit on this point: a loading must be evidence-based, not assumed. So a mild or well-managed condition that does not affect life expectancy may make no difference to the price at all, while a condition with a documented effect on mortality will.

The effect also depends on the type of insurance. For life insurance with a mental health condition, you may have to pay more than people who do not have any health conditions¹⁰. For private medical insurance, the approach is different: you will usually not be charged extra to add pre-existing conditions, because the insurer will simply exclude the ones it cannot cover²⁰. Most health insurance policies do not cover pre-existing conditions at all, and a policy that does cover one carries a higher premium¹⁰. The same condition can therefore be priced, excluded or ignored depending on what you are buying.

Premiums are also built from more than health. They are based on your age, the medical information you and your doctor provide, plus your lifestyle²⁹. Smoking, high alcohol consumption and dangerous sports all push the price up alongside any medical disclosures²⁴, which is why two applicants with the same condition can still be quoted different amounts.

A diagnosis after the policy starts does not change your premium

One of the most reassuring rules in this market is that underwriting happens once, at application. If you already have life insurance and are subsequently diagnosed with diabetes, you do not have to tell your insurer or pay higher premiums³. The same applies after a cancer diagnosis: once a policy is in place, the premiums cannot be increased³.

The protection runs further than price. As long as you make full and honest disclosures on your application and continue paying the premiums, the policy cannot be cancelled if you later develop cancer¹. This is why buying cover while you are healthy, or before a condition worsens, matters so much: the terms you are accepted on are locked in.

This also explains why some people hold more than one policy. You can have a joint life insurance policy and a single life insurance policy at the same time²⁹, and you must tell each insurer that you have existing life insurance in place¹². Someone who took out cover before a diagnosis can keep that policy on its original terms and, if more cover is needed, apply for a second policy under the new circumstances. Renewable term insurance takes a different route: medical underwriting is bypassed at renewal, but the renewed premium is based on the customer's increased age at that point³⁰.

Tell the insurer everything: what non-disclosure can do to a claim

The duty of disclosure is the sharpest edge of this whole subject. You must tell an insurance company of any conditions you have before buying a policy¹³. If you do not let them know and then need to make a claim, your policy may be invalid and the company may not pay¹³.

The consequences are spelled out across the market. For critical illness applications: you must tell the truth about any pre-existing conditions, and if the insurer finds out later that you were not entirely honest, it could void your entire policy⁷. For life insurance, if your family later needs to claim, your policy may be declared void and any payout refused¹. Underwriters themselves make the same warning: if you do not disclose something on your application, it could have an impact on your or your loved one's ability to make a claim on the policy².

There is some protection if the omission was genuine rather than deliberate. The Financial Ombudsman Service's approach, in cases where a customer did not tell their insurer about a significant change in health, is that if the insurer would have covered the condition for an additional premium, it is generally fair for the insurer to pay the claim minus that additional premium³³. So an honest mistake may reduce a payout rather than destroy it, though a deliberate lie is treated far more harshly.

The scale of the problem is real. In travel insurance, a third of travellers with pre-existing medical conditions admitted they would not declare all of them when buying a policy³², and in most policies pre-existing conditions are not covered unless they have been declared¹⁶. Travel bodies make the same point: failure to declare pre-existing medical conditions can void your policy, or result in your claim not being settled, or not settled in full³⁰. The lesson from those markets carries straight across to life insurance: declare everything, including conditions you consider minor, historic or embarrassing, and answer every supplementary request for information completely².

Where to get help

Several free, independent sources of help exist for people navigating insurance with a health condition. Macmillan publishes detailed guidance on insurance and cancer, including how insurers must justify any higher premium with evidence¹⁴ and a breakdown of the types of insurance available to people affected by cancer³⁴. Mental Health and Money Advice explains your rights when applying for insurance with a mental health condition, including the requirement that insurers act reasonably with relevant and reliable information¹⁷. Scope offers advice on insurance for disabled people¹³, and its guidance covers the duty to disclose and what happens if you do not.

For specialist products, Mental Health and Money Advice lists specialist insurance providers for pre-existing mental health conditions, including brokers who work with this market⁸. If an application is refused or a claim is rejected, the Financial Ombudsman Service can look at whether the insurer acted fairly, and its published approach to pre-existing medical conditions sets out what it expects from individually underwritten policies⁹. Before applying at all, the guide to buying protection insurance explains the difference between going direct and using an adviser or broker, and applying for cover walks through the medical questions in detail.