Our exclusions

Equipsme are upfront about what is and isn’t covered for your employees, helping you to make the right decision about what's best for your business.

Our exclusion of three year pre‑existing conditions

At Equipsme, we don’t want your teams to have to fill out lengthy questionnaires about their detailed medical history.

Instead, we exclude from physio, diagnosis and treatment cover any pre‑existing conditions that a person has had in the three years before their cover starts.

There are benefits which you can use from day one which would cover existing health conditions. These are the GP services, nurse helplines and the health check, as well as stress support and dental and optical benefits (if chosen by the business for their employees).

But for conditions which require physio, diagnosis and treatment, there is an exclusion of three year pre‑existing conditions. Brand new medical conditions are covered as long as they continue to respond to treatment but the plan won’t cover the Physiotherapy, Diagnosis or Treatment cost of any health problem that anyone included under the plan already had symptoms of in the last three years – what we call “pre-existing conditions”.

A pre-existing condition is any disease, illness or injury that members:

have received medication, advice or treatment for in the three years before the start of cover, or
have experienced symptoms of in the three years before the start of cover; whether or not the condition was diagnosed.

Insurance is really about covering the unexpected. We think about it a bit like home insurance – you can’t insure your house while it’s actually on fire, so it seems reasonable you can’t take out health insurance against something that’s already happened or happening.

Other exclusions

Health insurance is there to help you get better from unexpected health issues, therefore there are some other exclusions that apply to our plans. These include:

Treatment of Cancer – the plan does not cover the treatment of cancer. However, members on cover Level 1, 2 or 3, have cover up to the point at which cancer has been diagnosed so we can help find out what’s wrong fast. For more information on our cancer cover please read more here.
Mental health conditions – if stress support is part of your plan we can help with telephone and face-to-face counselling, but we can’t provide other psychiatric treatment or support. However, you always have access to counsellors through the Health at Hand service, 24 hours a day, to help you when you need it most.
Pregnancy and childbirth – but the plan will pay to treat certain medical conditions that arise during pregnancy (if the plan includes Diagnosis and Treatment). We do not cover investigation or treatment of infertility and assisted reproduction or treatment designed to increase fertility. It can be a worrying time, so all members have access to Health at Hand, with dedicated midwives available to talk to, whatever the query.
The plan does not cover any treatment, investigations, assessment or grading to do with learning and development disorders or neurodivergent diagnosis.
Gender re-assignment or gender conformation or any connected treatments are not covered under this plan.
Ongoing, recurrent and long-term conditions – we call these “chronic conditions”.
Treatment received outside the UK.
Rest assured, pregnancy and childbirth, chronic conditions and overseas treatment are industry standard exclusions to health insurance.

And for information on our cancer cover please read more here.

Full details of our terms and conditions regarding what is and is not covered can be found in the Membership Handbook which is available via your portal/App login once a member of Equipsme, or on request.