What does private medical insurance not cover?

When taking out private medical insurance you will often have different options like therapies cover for example, which you can choose to add or exclude from your policy. 

Are there things private medical insurance doesn't cover?

Knowing what you are and aren’t covered for by your health insurance is very important. If you are taking out private medical insurance for the first time it is unlikely you will be covered for any pre-existing conditions.

Cover is designed to provide benefit for acute conditions but not the long term monitoring of chronic conditions. However, many policies should cover for flare ups of a chronic condition provided the condition is not excluded due to the underwriting on you policy. 

Acute conditions are categorised as having a rapid onset but can typically be resolved within six months. Examples of acute conditions are a broken bone, heart attack or a stroke.

What are Chronic Conditions?

Chronic conditions are a disease, illness or injury that has one or more of the following:

The Condition requires ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests

It needs ongoing or long-term control or relief of symptoms

The condition requires you to need rehabilitation or for you to be specially trained to maintain the condition yourself, for example regular stretching or pain management.

Continues indefinitely with no known cure

Is expected to "flare up" or is likely to come back

Examples of Chronic Conditions

  • Asthma
  • Arthritis
  • Diabetes
  • High blood pressure

What else is commonly excluded from health insurance cover?

Emergency treatment

Treatment required due to an act of war or terrorism


Fertility Treatment

Cosmetic surgery

Pregnancy and childbirth costs

Organ transplants

Treatment for alcoholism or substance abuse

For more information about what is not covered, or if you have any specific questions about a condition and how it would be viewed by insurers, why not speak to one of our specialists. Healthcare Clarity advisers can speak to the underwriters at each insurer, to gain you the most favourable terms with regards to your pre-existing conditions.

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