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Private health insurance exclusions

Find out what’s not covered by health insurance

Before you take out health insurance, it’s important that you have a thorough understanding of what is and isn’t covered. This will usually depend on the type of cover you take out, but there are some things that are generally not covered on most policies, whatever provider you choose.

Take a look over our guide to things you can expect not to be covered with health insurance.

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  • Pre-existing conditions

  • Chronic conditions

  • Cosmetic surgery

  • Additional exclusions

It’s a common misconception for people to think that once they’ve taken out health insurance, they’ll be able to receive treatment for any symptoms, conditions, illness or injuries they’re already suffering from. This is usually referred to as a pre-existing condition. Pre-existing conditions, and ailments related to it, are often excluded from your policy because health insurance is designed to treat new conditions that occur after your cover has started.

When you take out health insurance cover with us, we’ll normally ask you to fill out a medical history form to help us confirm what your policy will and won’t cover for you.

There are two different underwriting options: full medical underwriting (available online and over the phone) and Moratorium (available only over the phone).

If you select full medical underwriting, this means that your medical history is taken into account when deciding on what conditions we may or may not be able to cover. We usually don’t cover you (or any family members on your policy) for conditions that existed before you take out insurance with us.

With Moratorium you will not be covered for any pre-existing medical conditions until two years have passed without any incident for each condition.

You will also be unable to receive treatment for a condition considered to be ‘chronic’. This is defined by having characteristics such as:

  • Needing ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests
  • Needing ongoing or long-term control or relief of symptoms
  • it requires your rehabilitation or for you to be specially trained to cope with it
  • it continues indefinitely
  • it has no known cure
  • it comes back or is likely to come back

These conditions aren’t covered because health insurance is used to treat acute conditions where you can receive treatment in a private healthcare facility to restore your health back to how it previously was. You can however, sometimes claim for flare ups of chronic conditions.

Procedures to change your appearance are generally not covered by health insurance. This is because most policies are made to cover and treat medical conditions whereas cosmetic surgery is considered a lifestyle choice.

Most insurers will however, pay for reconstructive surgery for medical reasons. We will pay for eligible treatment to restore your appearance as a direct result of an accident or cancer surgery, for example. However this applies if the accident or surgery was during continuous period of cover under this agreement or under any other Bupa medical insurance provided without a break in your cover.

There are certain conditions that most insurers won’t cover treatment costs for, as well as pre-existing and chronic conditions, and cosmetic surgery. Some of which include:

  • AIDS/HIV
  • Allergies or allergic disorders
  • Birth control, conception, sexual problems and gender re-assignment
  • Deafness
  • Dental/oral treatment
  • Dialysis
  • Treatment to correct eyesight (eg long or short)
  • Intensive care (other than in some specific circumstances)
  • Learning difficulties, behavioural and developmental problems
  • Overseas treatment and repatriation
  • Pregnancy and childbirth
  • Puberty, menopause and ageing
  • Sleep problems and disorders
  • Speech disorders

Learn more about private health insurance

Our useful guides are here to help you understand the fundamentals of health insurance. We also cover a number of key health topics – such as looking after yourself as a parent and taking care of your children’s health.

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Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No. 3956433. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Arranged and administered by Bupa Insurance Services Limited, which is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales No. 3829851. Registered office: 1 Angel Court, London, EC2R 7HJ.

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