Understanding pre-existing conditions on critical illness cover

Critical illness cover is a type of insurance that pays you a lump sum if you’re diagnosed with a serious health condition listed in your policy. This money can help cover treatment, support your family, or manage everyday costs, so you can focus on getting better without financial stress.

If you have a health condition before you apply, it’s called a pre-existing condition. This guide will help you understand what that means, how it can affect your policy and what to consider when applying for Critical Illness Cover with a pre-existing condition.

Pre-existing medical conditions

A pre-existing condition is any health issue you had before applying for insurance. Insurers assess your medical history to determine how past and present conditions may affect your likelihood of making a claim.

Examples of pre-existing conditions include:

• Asthma
• Cancer
• Obesity
• Depression
• Anxiety
• Diabetes
• Epilepsy
• High blood pressure
• High cholesterol
• Heart disease (including heart attacks or strokes)
• Kidney illnesses
• Neurological conditions such as cerebral palsy

Insurers identify pre-existing conditions through medical questionnaires, reports and past diagnoses, and these factors influence your policy terms.

How pre-existing conditions affect your policy

Having a pre-existing condition doesn’t automatically mean you can’t get critical illness cover, but it can affect how your policy is priced and what’s included. Insurers assess risk differently, and several factors will influence how they view your application, including:

• How long ago the condition occurred – the more time that’s passed since you last experienced symptoms or received treatment, the more likely it is that cover could be offered
• How well the condition is managed – some conditions, like high blood pressure or raised cholesterol, may still be covered if you can show they’ve been well-controlled over a specific period with no complications
• The severity and type of condition – certain conditions may lead to temporary or permanent exclusions, but this varies by insurer

To make an informed decision, insurers may ask you detailed questions about your medical history or request a report from your GP. Speaking with a protection adviser can also help, as they’ll know which insurers are more flexible and which policies are more suitable, based on your health background.

Key illnesses commonly covered by critical illness cover*:

• Cancer
• Heart attack
• Stroke
• Multiple sclerosis
• Organ failure
• Parkinson’s disease

*Coverage varies by insurer.

These are just a few examples of the pre-existing conditions commonly covered under a critical illness cover policy. Coverage can vary significantly between insurers - some may include less common conditions or offer protection for early diagnoses. That’s why it’s essential to carefully review the full list of covered conditions and their specific definitions before taking out a policy, to ensure it meets your individual needs and provides the protection you’re looking for.

What to prepare when discussing pre-existing medical conditions

When speaking to your insurer or adviser about pre-existing medical conditions, it’s important to come prepared with accurate and up-to-date information. This helps ensure you get the most suitable advice and increases the chances of securing the right level of cover. The more detail you can provide, the clearer the picture they’ll have of your health situation, which can positively influence the outcome of your application.

Be ready to share:

• Details of your diagnosis – what the condition is, when it was diagnosed and any related symptoms
• Treatment history – any medications, procedures or therapies you've received, and whether treatment is ongoing
• Current status – whether the condition is stable, in remission or still under active management
• Dates and timelines – when symptoms last occurred, when you last received treatment and any follow-up appointments or results.
• Medical reports or test results – if available, these can help speed up the underwriting process
• GP or specialist contact details – insurers may request a report or letter to support your application

Steps to take when applying for critical illness cover:

• Be honest about your medical history – insurers need accurate information to assess your risk fairly
• Compare providers – different insurers have different approaches to pre-existing conditions
• Seek expert advice – a protection specialist can help find the right cover for you

Understanding policy exclusions

If you have a pre-existing condition, eligibility for critical illness cover can vary. Some insurers may still offer cover, but it could come with higher premiums or exclusions on certain conditions. An exclusion means a specific illness or condition will not be covered by your policy. Common exclusions for pre-existing conditions include:

• Pre-existing conditions before the policy started
• Self-inflicted injuries
• Illnesses arising from drug or alcohol misuse
• Certain lifestyle-related conditions

If an illness is excluded, you won’t be able to make a claim for that condition, so it’s vital to check your policy details carefully.

That said, some exclusions aren't always permanent. In certain cases, insurers may review or even remove exclusions after a specified period (often 2 to 5 years) if you’ve been symptom-free or have successfully managed the condition. This varies by insurer, so it’s a good idea to ask about this when applying. Speaking to your insurer or a protection adviser can help you understand what may be possible over time and what steps you might need to take.

Alternative coverage options

If traditional critical illness cover isn’t the right fit, don’t worry - there are alternative insurance options that can still offer meaningful protection. These may be especially helpful for high-risk applicants, including those with pre-existing medical conditions.

Options to consider include:

• Specialist insurers – these providers tailor policies for individuals with specific health conditions or higher-risk profiles
• Income protection insurance – offers a monthly benefit if you’re unable to work due to illness or injury, helping to replace lost income
• Guaranteed acceptance policies – require no medical underwriting, making them more accessible, though they may come with limited benefits

To improve your chances of securing suitable cover, consider the following steps:

• Maintain a healthy lifestyle – staying active, eating well and managing health conditions effectively can improve eligibility
• Compare providers – some insurers are more flexible than others when it comes to health history, so it’s worth shopping around
• Seek expert guidance – working with a protection adviser can be invaluable in finding the right policy for your unique needs and circumstances

Get fee-free advice on critical illness cover

Understanding how pre-existing conditions impact critical illness cover can feel overwhelming. That’s where LifeSearch comes in. We can help you navigate your options and find the right protection for your health and financial security. Arrange a call with LifeSearch today for fee-free advice on securing critical illness cover.

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