Critical illness insurance is designed to pay out a cash lump sum if you suffer a serious illness, for example – 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.
