Sourcing the best and most comprehensive critical illness cover can feel even more important if you have a pre-existing medical condition but it can be difficult. In this article, we'll explain how you can apply for critical illness insurance if you have a pre-existing medical condition, how your medical condition is assessed as well as what you do and don't need to declare.
We explain the simplest and most effective way to find the best critical illness cover if you have a pre-existing medical condition at the end of this article and we also explain how to get up to £100 cashback when you buy your insurance.
If you'd like to skip ahead you can, "How to get the best critical illness cover at the best price with a pre-existing medical condition"
What is a pre-existing medical condition?
As you might suspect, this is any medical condition that you currently have or have been diagnosed with in the past. Records of your medical history will show details of diagnosis, as well as the symptoms and both of these are relevant when it comes to applying for personal insurance such as critical illness cover and life cover.
Minor illnesses or injuries are unlikely to affect your application but you should mention anything that is relevant to the medical questions asked. Your medical records are likely to be checked in the event of a claim and any non-disclosure (this means anything you missed out or misrepresented when you completed your application) could result in your claim being declined.
Examples of pre-existing medical conditions
Common conditions that you may need to disclose during your application for critical illness cover are:
- high or raised blood pressure
- high or raised cholesterol
- history of cancer
- high BMI or obesity
- heart attack/heart disease
- family history of serious health conditions
- depression, anxiety, stress or other mental health condition
The questions are designed to reveal most medical conditions that will be of concern to the insurer (the list above covers some of these). Critical illness insurance applications will also ask whether you plan to see a doctor for anything or are awaiting further medical investigations having seen a doctor. Usually, any offer of insurance is postponed until medical checks are concluded.
What is critical illness cover and how does it work?
Critical illness insurance covers the insured person in case they are diagnosed with a serious illness such as cancer, heart attack or stroke. On average, a critical illness insurance policy will cover you for around 50 different illnesses; some policies cover more illnesses and some, significantly less.
If you are diagnosed with an illness or condition that is covered by your critical illness insurance policy, it pays the amount of money that was chosen as a tax-free lump sum or an income. Serious illnesses that are deemed less severe such as early-stage cancer are usually covered for a partial payment which means the policy will pay a percentage of the full payout (20-30%) without affecting the full payout cover. However, most types of cancer that are above stage 1 will result in a full payout if you are covered by critical illness insurance.
Most critical illness insurance policies include children's critical illness cover too and will pay out a percentage of the sum insured if the policyholder's child is diagnosed with a listed illness without affecting the adult's cover. Children's critical illness cover usually doesn't cover any pre-existing medical conditions.
The illnesses covered by critical illness insurance vary from one insurance company to the next and some insurers offer more than one critical illness policy to choose from. Each policy will carry its own terms and conditions alongside a list of the illnesses including a specific description of the severity that must be met to make a valid claim.
You'll find more information in our article, "Critical illness insurance - what is it and is it worth having?"
Critical illness insurance is sometimes confused with terminal illness cover but these are two significantly different types of cover. Where critical illness insurance pays out if you are diagnosed with specific serious illnesses, terminal illness benefit pays out if your illness is likely to cause death within 12 months. Terminal illness benefit is an early death payout from life insurance cover and is almost always included at no extra cost. Be careful to check that your life insurance quote states critical illness benefit as well as terminal illness benefit.
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Does critical illness insurance cover pre-existing medical conditions?
Yes, a critical illness insurance policy can cover existing medical conditions depending on the specific details of the condition. Understandably, insurance companies are a little wearier when it comes to health issues that are directly linked to an increased chance of suffering a critical illness due to the increased risk that there will be a claim. However, it is still worth exploring the insurance to see if you can be covered.
For example, if you have been diagnosed with raised blood pressure or cholesterol, you may be at a greater risk of heart disease. The underwriters at the insurance company would want to check how your condition has progressed over a period of time - someone whose blood pressure spikes on a regular basis may be more difficult or expensive to insure than someone whose blood pressure has been stable for some time, even if this is with medication.
Underwriters at insurance companies use guidelines to assess a critical illness insurance application and these vary depending on which insurance company you apply to.
A specialist critical illness adviser* can help you to anticipate the outcome of your application helping you select the insurance company that is most likely to accept your application and avoid excessive price increases.
How will a pre-existing medical condition affect a critical illness cover application?
There are a few different ways in which your existing medical health could affect the outcome of an application for critical illness insurance.
Your critical illness insurance application may prompt the insurance company to write to your GP for a full report of your medical history and they may also ask you to attend a medical examination. The insurance company pays for the report and any medical exam which will be arranged around your convenience. These requirements vary depending on the insurer and form part of their underwriting guidelines.
Once the underwriters have all of the information that they need to assess your application, you will receive a decision with one of the following outcomes:
|Underwriting Decision||Underwriting Decision Explained|
|Standard rates||Your application is accepted at the price you were quoted without any amendment to the policy conditions.|
|Rated premium||Your application is accepted at an increased price but without any amendment to the policy conditions.|
|Policy Exclusion||Your application is accepted at the price you were quoted but one or more conditions have been excluded from the policy meaning that it won't pay out if you are diagnosed with these.|
|Postponement||Your application is put on hold, usually because you are undergoing investigations or because the insurance company believe that they may be able to offer you better terms after your medical condition improves.|
|Decline||Your application is declined and the critical illness cover is not offered.|
If you're unsure about why a particular decision has been made, most good insurance companies will supply you with a letter explaining the reasons why but you have to request this from them.
In fact, the best course of action is to engage with a specialist adviser who will not only investigate the decision that you have received but will also check this against what you can expect from other insurers in the market.
Specialist advisers usually have access to the underwriters who make the decisions about your application and can often get to the root of why a decision has been made and may even challenge this if it isn't correct. Their expert knowledge of critical illness insurance and how underwriting works puts them in a better position to get you the best outcome and it won't cost you anything to take this route.
Can I get critical illness insurance cover if I have a pre-existing medical condition?
Yes, it is usually possible to get critical illness cover if you have a pre-existing medical condition.
If you have applied for critical illness insurance and received one of the non-standard decisions we describe in the above table, you may wish to double-check that you're getting the fairest deal available in the market. Just because one insurance company decides to charge you more, apply exclusions or decline your application, it doesn't mean that all other insurers will do the same.
Whether you've already applied for critical illness insurance or you're thinking of applying, speaking to a specialist critical illness adviser can help you source the insurer with the fairest outcome. It is well worth your time speaking to one before you apply as you'll save time completing applications and potentially going for a medical exam with an insurance company that won't offer you the best decision. You'll find information about how to do this towards the end of this article.
Do I need to declare pre-existing medical conditions for critical illness insurance?
Not always but you have to answer all the questions that you are asked truthfully and to the best of your knowledge. A critical illness insurance application is similar to a life insurance application but tends to ask questions in more depth. Some of these questions are likely to be time-limited so you may be asked if you have suffered a particular health condition within the last 5 years. If you suffered the illness 8 years ago and were fully recovered more than 5 years ago then you can truthfully answer 'no' to such a question. You shouldn't feel compelled to provide more information about your health than what is asked of you - the onus is on the insurance company to ask about anything they feel is relevant to making an offer of insurance.
A family history of health problems is a good example of something that you will be asked about when you apply for life insurance or critical illness insurance. You can only answer what you know and not all people are aware of the health history of their immediate biological family and where it is reasonable, you can't be expected to disclose what you don't know.
What information do I need to provide about my pre-existing medical condition?
If you disclose a medical condition that you currently have or were diagnosed with in the past, you'll usually be asked some specific details about it. Here is a list of the information that you will usually need to provide when you apply for critical illness cover:
- The specific name of your diagnosis
- Details of treatment including medication
- The date that you were diagnosed
- The results of tests and investigations
Providing detailed information about your health when you apply can sometimes avoid the need for doctor's reports and medical examinations but in some cases these will still be required. If you are unsure of the details asked, it is always better to say that you don't know to avoid any misrepresentation that could lead to a claim being declined in the future.
How will the diagnosis of a new medical condition affect my existing critical illness cover?
A medical condition that is diagnosed after you start your critical illness insurance policy will not affect its validity as long as you answered all questions truthfully when you applied.
Unlike most general insurance policies, critical illness insurance is a contract that continues to cover you for the term that you chose. The term is the number of years that you took the insurance policy over. This means that the cover continues to protect you even if you become ill. There is no need to tell your insurance company about any changes to your health unless you wish to make a claim.
Some critical illness insurance policies include waiver of premium as standard or you may have selected this as an additional benefit at the outset. The benefit covers a situation where, if you are off work and unable to work for a period of time, your insurance company could waive the monthly premiums due for up to a year. This option can prevent the insurance from lapsing if you stop working and become unable to keep up with payments.
Does critical illness cover exclude pre-existing medical conditions?
Not usually but it really depends on the nature of your medical condition and whether it is likely to significantly increase the risk that you will suffer one of the listed illnesses in the future.
One of the most common exclusions is for total and permanent disability cover. If you were to become completely and permanently unable to do your own occupation the critical illness insurance would usually pay out under this listed illness. It is usually affected if either your occupation increases your risk for injury or if you have had a substantial amount of time off work due to illness or injury in the past. I say affected because the cover could be completely excluded but it could also be restricted to pay out if you're unable to care for yourself without assistance, which is a reduced standard of cover to the one where you would receive a payout as soon as you were unable to carry on working.
If you have a pre-existing medical condition that is listed on your insurance then you will not be covered for that condition. A good example here would be cancer, due to the risk of recurrence. If you wish to put in place critical illness insurance that will cover you for all illnesses except those linked to your diagnosis, this usually requires expert guidance and advice. A specialist critical illness insurance adviser* can provide appropriate solutions with the insurance companies that are able to tailor your critical illness cover according to your medical history.
How to get the best critical illness cover at the best price when you have a pre-existing medical condition
Insurance companies provide you with a quotation in the first instance. The quotation is an indication of how much it will cost for you to be covered for critical illness based on:
- Your age
- Whether you smoke this includes any nicotine or tobacco products you've used in the last 12 months
- The amount that your wish to be covered for, usually referred to as the sum assured
- The number of years you wish to be covered for usually referred to as the term
- The type of critical illness insurance you choose - you can choose a decreasing, level or increasing amount of cover or one that pays out a regular income
Simply selecting the cheapest critical illness insurance quote if you have a health condition to disclose is unlikely to help you find the best cover or price. The cheapest insurer may also have the harshest underwriting guidelines for your particular health concern, resulting in a poor outcome after you have completed the application process.
This is why comparison sites and online quoting platforms comparing life insurance and critical illness policies are unhelpful when it comes to buying critical illness insurance with a pre-existing medical condition. They don't have the complexity to fully understand your current health and select an appropriate insurer on this basis.
Applications can be time-consuming and if you end up with an unsatisfactory outcome, you may have to reapply with a different insurer only to go through the whole process again.
You can avoid wasting time and effort applying to an insurer that will increase the price or postpone or decline your application. It is best to speak to a specialist adviser so that you can explain your health history to them enabling them to source the policy and insurance provider with the best critical illness cover and price before you apply.
Best critical illness insurance providers for pre-existing medical conditions
Insurance providers can vary drastically in how they assess your critical illness cover application and most people would prefer to know which insurers are best for them before they apply.
It is also wise to compare the different policies on offer as some insurance providers will cover a wider range of illnesses and offer better definitions for a claim. Whilst you may be concerned about your existing health, most people still want to find the best policy and price.
At Money to the Masses we have tried and tested a specialist company where the advisers are experts when it comes to critical illness insurance available across the market. They are experienced with many pre-existing health conditions and have built a deep knowledge of the guidelines at each insurance company too. They will search the market for the best cost of life insurance and critical illness insurance and where appropriate may offer different types of illness policies that suit your needs and circumstances.
If you complete a short callback form*, an adviser will speak to you about your health condition and what you need before doing some research on your behalf. You don't have to proceed with the solutions that they offer you but you will gain a much better understanding of which cover is available to you and how much it is likely to cost so that you can make an informed decision. As a Money to the Masses reader you'll also receive up to £100 cashback if you buy your critical illness insurance this way.
If a link has an * beside it this means that it is an affiliated link. If you go via the link, Money to the Masses may receive a small fee which helps keep Money to the Masses free to use. This link can be used if you do not wish to help Money to the Masses and do not wish to qualify for the cashback referred to in the article