What is a chronic condition?

What is a chronic condition?

A chronic condition is a disease, illness or injury that needs ongoing attention.

Most health insurance companies don’t cover chronic conditions, so it’s really important to know what counts as chronic, what doesn’t, and when and where your cover begins and ends.

What are the features of a chronic condition?

In insurance terms, a chronic condition refers to any ailment which:

  • needs ongoing or long-term monitoring through consultations, examinations, check-ups or tests
  • needs ongoing or long-term control or relief of symptoms
  • requires rehabilitation, or for you to be specially trained to cope with it
  • continues indefinitely
  • has no known cure
  • reoccurs or is likely to come back in the future.

What sort of conditions are we talking about?

Chronic conditions can include things like Crohn’s Disease, which is an inflammatory bowel condition that flares up from time to time; diabetes or asthma, which require close management and ongoing monitoring; degenerative diseases like multiple sclerosis, muscular dystrophy or Parkinson’s; conditions like hyperthyroidism and other immune deficiency disorders; PCOS or endometriosis in women - associated with various health issues; plus numerous other long-term conditions.

Why don’t health insurance companies cover chronic conditions?

The trouble with chronic health conditions is that there’s no end point, so there’s no end point to how much they’re going to cost in terms of monitoring and treatment. Which means that they can become really, really expensive. And as with any kind of insurance, a few people claiming very large amounts means that in order to cover their losses, insurance companies are forced to put prices up for everyone. That can make insurance more difficult for anyone else to afford.

By excluding chronic conditions, insurance firms can control costs more closely, and keep prices down for everyone.

What happens if I’ve already got a chronic condition?

If you already have a chronic condition, you can still have private health insurance. All it means is that you won’t be able to claim for any treatment or consultations directly related to that condition. You will be able to get private health support for other health conditions, depending on the terms of your plan.

What happens if I get diagnosed with a chronic condition under my insurance?

If in the course of medical investigations that your health insurance is paying for you get diagnosed with a chronic condition, eligible treatment will usually be covered up to the point of that chronic condition diagnosis by your insurance company (if diagnosis and treatment are part of your plan).

However, they will NOT pay for follow-up consultations and ongoing support. Instead, you’ll be referred back to the NHS to manage your chronic condition for the longer term.

For many people, however, early diagnosis is the bit that they need private health insurance to help with. Often the most important step is being able to get quick access to a consultant to  get that crucial diagnosis – especially if symptoms are confusing or debilitating,

What happens if I’m not sure if I’ve got a chronic condition, or if my private health insurance will cover me?

If you’re not sure, ASK.

It’s absolutely crucial to stay in touch with your insurer throughout the claims process. Call them up, talk them through what your GP or consultant has said, and ask for confirmation whether they’ll cover you for next steps - BEFORE you head onto further treatment.

Are there any exceptions to the chronic conditions rules?

Some insurers will take things on a case by case basis, and may be able to cover SOME aspects of your care, so it’s always worth reading the small print of your plan, and getting in touch to ask specific questions about your specific case.

Other common exceptions include heart care. For instance at Equipsme, if someone has Level 2 or Level 1 and has certain types of heart surgery, we will carry on paying for the long term check-ups related to that surgery.

How do I find out more about Equipsme and chronic conditions?

You can check out our handbook, which you’ll find on your Equipsme members portal, or read our exclusions page online. Because we’re backed by AXA Health, you can also read more about their chronic condition policies, including real life examples.