Critical illness insurance is designed to pay out a cash lump sum if you suffer a serious illness, for example – a heart attack, stroke, loss of limb, etc.
This money could be used to help cover any expenses you may otherwise struggle to pay due to extended time off work for recovery.
The question is, can you still get cover if you have a pre-existing medical condition?
What illnesses are considered pre-existing conditions?
A pre-existing condition is usually defined as any medical condition, illness, or injury you’ve experienced before applying for insurance. This can include previous serious illnesses, ongoing medical issues you’re receiving treatment for or even symptoms that are currently being investigated.
Some of the most frequently disclosed conditions include:
Diabetes (Type 1 or Type 2)
Asthma
High blood pressure
High cholesterol
Anxiety or depression
Back problems
Arthritis
Heart conditions (such as heart attack)
Even if the condition is mild or well-managed, it usually still needs to be mentioned.
For a detailed list, see our guide on what illnesses critical illness insurance covers.
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How does critical illness cover work for pre-existing conditions?
You may assume that having a pre-existing condition automatically means you won’t qualify for cover. However, it may be possible, though the outcome will depend on your circumstances and the insurer’s underwriting criteria.
When you apply, one of the following outcomes is likely:
1. You’re accepted on standard terms
If your condition is minor, well-controlled, or was a long time ago with no ongoing issues, you may still qualify for cover at standard rates. This means your price won’t change due to the medical condition.
2. You’re accepted with a higher premium
If the insurer considers you a higher risk, they may increase your monthly premium.
3. The condition is excluded
In some cases, the insurer may offer you cover but exclude claims related to your pre-existing condition (and sometimes related conditions).
For example, if you’ve previously had heart disease, the policy may exclude heart-related claims.
4. Your application is postponed
If your condition is recent or still under investigation, the insurer may ask you to reapply in 6–12 months once things are more stable.
5. Your application is declined
In higher-risk cases, particularly recent or severe illnesses, you may be declined.
It’s worth noting that different insurers assess risk differently, so speaking to an adviser can make a significant difference. There may also be options available that do not require a medical questionnaire.
Will critical illness cover pre-existing conditions?
Policies usually won’t pay out for a condition you already had before the policy started. If your condition is excluded during underwriting, any claims relating to it won’t be paid.
However, your policy may still cover you for conditions that develop after your policy starts, such as new, unrelated illnesses or illnesses not linked to your disclosed condition.
If, for example, you had asthma and that was excluded, you could still potentially claim for cancer, stroke, or other unrelated conditions, provided they meet the policy definitions.
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How will a pre-existing condition affect your policy?
Your medical history may influence several aspects of your cover:
Premium costs
If your risk profile is higher, your premium may increase. If you disclose a health condition when you apply, insurers will likely ask you about:
When you were diagnosed
Whether you’re still receiving treatment
How stable the condition is
Any complications
Your overall health
In general, your age and health can impact the cost of cover, though it can be increased depending on how insurers assess your overall risk.
Exclusions
Even if you have a medical condition, you may still receive cover, but with exclusions applied.
These exclusions are normally permanent and clearly listed in your policy schedule. For example, there may be a limit on the amount of cover you can take out, or certain conditions that won't apply to the policy
Medical evidence requirements
Insurers usually like to have a thorough understanding of your health as it helps them to determine your risk. If they are unsure about any details of your medical history, they may request further information.
Some applications may require:
A GP report
Medical records
Further medical questions
This can make the process slightly longer. The main point is to ensure that they have all necessary information to make an accurate evaluation of your eligibility for cover and premium costs.
What happens if I don't declare a medical condition?
It can be tempting to leave something out, especially if you think it’s minor or won’t matter. However, failing to declare a pre-existing medical condition on your application can cause serious problems later.
You have a duty to answer all questions honestly and accurately. Insurers base their decision on the information you provide. So, if key information is missed or deliberately withheld, it can affect whether a claim is paid.
If you fail to declare a condition, the insurer may:
Reduce the payout amount
Add exclusions after the policy has started
Cancel your policy altogether
Even if the claim isn’t directly related to the undeclared condition, the insurer could still review your original application and reassess whether they would have offered you cover in the first place.
Insurers can request medical records when you claim. Therefore, if they find something that wasn’t disclosed, it may delay or invalidate the claim.
What happens if I'm diagnosed with a medical condition after taking out cover?
If you’re diagnosed with a new medical condition after your policy has started, it won’t affect your existing cover.
Once your policy is active, the insurer can’t change the terms, increase your premium, or add exclusions based on new diagnoses. As long as the condition is one of the illnesses listed in your policy and meets the insurer’s definition, you may be able to make a claim.
Just remember that:
Conditions you had before applying may be excluded or affect your terms
Conditions diagnosed after your policy starts are typically covered, provided they meet the policy criteria
Once it’s in place, your protection is fixed based on your health at the time of application. This can often encourage people to take out cover sooner rather than later.
How to Buy Critical Illness Cover Through Cavendish Online
You can arrange Critical Illness cover either online or over the phone, depending on your needs.
Buy Online
You can apply online if:
You have no medical disclosures
You don’t have hazardous hobbies or a high-risk occupation
You want the same amount of critical illness cover as life cover
Simply select Critical Illness as a ‘policy extra’ once you receive your Life Assurance quotes.
Please note: only a limited number of providers are available online, and cover amounts must match your Life policy.
Buy over the phone
For more flexibility and access to a wider range of insurers, speaking to our team may be the better option.
Guidance Team
If you know what you’re looking for but want help with quotes and the application process: 01392 241 850 (Mon-Fri, 10am-6.30pm)
Advice team (whole of market)
If you have medical disclosures, a higher-risk job, hazardous hobbies, or would like a personalised recommendation: 01392 436 193 (Mon-Fri, 9am-5.30pm)
Speaking to an adviser can be particularly helpful if your circumstances are more complex, as critical Illness cover often requires more careful consideration than standard Life insurance.
