Individual health insurance benefits

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What´s not covered

As with all health insurance policies, there are certain things that are not covered. Flexible Health essentials, premier and elite specifically excludes the following list which is a summary only. For a full list please see ´What is not covered´ in ´A Guide to Your Policy´. A copy is also available on request.


  • If you have chosen Moratorium Underwriting: Benefit will not be provided for at least 2 years for any pre-existing condition(s) which you or any family member(s) applying for cover have had during the 5 years before your policy starts, or any new symptoms/conditions that start in the first 14 days of your policy (90 days for cancer conditions, whether diagnosed or not).

    Pre-existing conditions are medical condition(s) and other directly related conditions, for which treatment was received and/or medication was prescribed or professional advice was sought or where symptoms existed (whether the underlying condition has been diagnosed or not).

    If you or any family member(s) applying for cover do not have symptoms, treatment, medication or advice for pre-existing conditions for 2 continuous years after your policy starts, then benefit may be provided within the terms of your policy.

    Your policy will not provide benefit for pre-existing long-term medical conditions (and related conditions) which are likely to require regular or periodic treatment, medication or advice. This is because the Moratorium symptom-free period starts each time you receive such treatment, so it’s unlikely you’ll ever have two consecutive years free of treatment.

    Examples include:

    • Diabetes
    • Crohn’s disease
    • Ankylosing Spondylitis
    • Uncontrolled hypertension
    • Rheumatoid Arthritis
    • Fibromyalgia
    • Multiple Sclerosis (MS)
    • Ulcerative Colitis
    • Polymyalgia Rheumatica
    • Chronic Fatigue Syndrome/ME
    • Lupus (SLE)

    It is important that you or any family member(s) applying for cover do not delay seeking medical advice or treatment for any condition during the moratorium period.

  • If you have chosen Full Medical Underwriting: Benefit will not be provided for pre-existing conditions that you had when you took out the Policy unless declared to and accepted in writing by WPA. Benefit is also not available for any medical conditions/symptoms, whether diagnosed or not, if these arise in the first 14 days of the start of the Policy.
  • If you have chosen Switch with Continued Personal Medical Exclusions: You and your family member(s) applying for cover will have any existing personal exclusions from your current insurance policy carried over, if you/they have previously been subject to full medical underwriting and if there has been no break in insurance cover since underwriting.
  • You are not required to have been fully medically underwritten with your last insurer, as long as there has been no break in cover from the time you initially underwent full medical underwriting.

    You and your family member(s) applying for cover will need to answer a few questions about your medical history. On occasions, it may be necessary to apply additional personal exclusions to your new WPA policy. You will not be covered for medical conditions that started before you took out your previous insurance (the point that you underwent full medical underwriting).

  • If you have chosen Switch with Continued Moratorium: Benefit will be provided in line with the Moratorium Underwriting term of your current insurer.

    The benefits and terms and conditions of your new WPA policy will apply; it is only the dates of underwriting with your current insurer that will be matched. There must be no break in insurance cover since underwriting.

  • Your WPA policy will not provide benefit for pre-existing long-term medical conditions (and related conditions) which are likely to require regular or periodic treatment, medication or advice. This is because the Moratorium symptom-free period starts each time you receive such treatment, so it’s unlikely you’ll ever have two consecutive years free of treatment.

    Examples include:

    • Diabetes
    • Crohn’s disease
    • Ankylosing Spondylitis
    • Uncontrolled hypertension
    • Rheumatoid Arthritis
    • Fibromyalgia
    • Multiple Sclerosis (MS)
    • Ulcerative Colitis
    • Polymyalgia Rheumatica
    • Chronic Fatigue Syndrome/ME
    • Lupus (SLE)

    It is important that you or any family member(s) applying for cover do not delay seeking medical advice or treatment for any condition during the moratorium period.

  • Cancer surgery and non-surgical or diagnostic treatment (essentials only).
  • Cancers diagnosed or for which symptoms or signs develop within the first 90 days of the policy commencing or the first 90 days of upgrading your cancer benefit (by adding the Advanced Cancer Drugs or Cancer Cover Benefits), unless we agree in writing. This is also referred to as a ´90 day deferment period´. You will be required to complete a medical declaration to upgrade your cancer benefit.
  • For optional extras, benefit will not be provided for any medical conditions you had when you took out the policy (pre-existing conditions) and any medical conditions/symptoms, whether diagnosed or not, which arise in the first 14 days of your policy, unless declared to and accepted in writing by WPA.
  • Any long-term illness that lead to long-term monitoring or management (chronic conditions).
  • Dental problems (unless dental benefit is included in your policy or added as an Extra). Where this is included/added to your policy, benefit will not be provided for wisdom teeth unless the treatment is performed in general dental surgery (not hospital).
  • Fertility problems, pregnancy & childbirth.
  • Neonatal treatment.
  • Psychiatric conditions.
  • HIV/AIDS.
  • Cosmetic surgery.
  • Care and/or treatment arising from or related to taking part in winter sports (e.g. skiing, snowboarding), scuba diving and motor sports or engaging in professional sport or any accident or injury that occurs whilst on a winter sports holiday and whilst staying in a winter sports resort.
  • Any claim that has not been pre-authorised.
  • Treatment outside the UK except where Emergency Abroad cover applies.
  • If you have added the emergency abroad extra to Premier cover or if you have selected Elite, the emergency abroad benefit excludes:
    • Travel to the USA and its dependency Puerto Rico.
    • Conditions (and any related conditions) that require current treatment in the UK or for which you have undergone treatment for in the 6 months prior to travel.
  • Please note: if you transfer from Essentials to Premier or Elite a medical declaration must be completed. Personal medical exclusions may then apply. This is not required for transfers from Premier to Elite unless enhancing your cancer benefit.

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