"I have a condition, they won't accept me" is the belief that stops many people ever applying. In truth, having an existing condition does not always mean refusal. Here is how the assessment works and what options you have.
An existing condition is not the final answer
Insurance companies assess risk individually, not by the name of the condition alone. The factors considered together include the type and severity of the condition, how long you have had it, how well it is controlled, the medication used, any complications, and your overall health behaviour. Two people with the same condition can therefore receive very different decisions — well-controlled blood pressure on medication and blood pressure with complications are entirely different cases.
There are several possible outcomes, not just accept or refuse
- Accepted at standard rates — where the condition does not significantly affect the risk.
- Accepted with a loaded premium — according to the assessed level of risk.
- Accepted with an exclusion — everything covered except the specified condition and related conditions.
- Deferred — awaiting treatment results or further tests.
- Declined — only where the risk exceeds that plan's criteria.
Importantly, each company's and each plan's criteria differ. Being declined in one place does not mean everywhere will decline you.
The iron rule: always declare truthfully
More dangerous than a loaded premium is concealing a condition to get through, because if the company discovers it later it may exercise its right to avoid the contract and refuse the claim under the law — meaning you paid premiums for nothing with no real cover. A full declaration with terms that may not be ideal is still far better than a contract broken at its foundation.
How to prepare for the best possible outcome
Gather your treatment history: the latest test results, the list of medication, and your treating doctor's opinion. Clear information helps the company assess accurately and usually works in your favour. If the condition has been well controlled for a sustained period, good test results are excellent evidence. And in some cases, conditions imposed earlier can be asked to be reviewed once your health improves, under the company's criteria.
If the main plan doesn't go through, are there alternatives?
The market has plans with more lenient health conditions for some groups — plans focused on accident cover, or plans with few health questions in exchange for more limited cover and conditions. Read the limitations and understand them properly before choosing, and don't forget that your basic state healthcare entitlement is always there behind you.
In short
You can start even with an existing condition. The essentials are declaring truthfully, preparing complete information, and letting the system actually assess you rather than deciding against yourself in advance. If you would like help thinking through the approach before submitting an application, get in touch and tell us your situation.