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Guide to Health Insurance Exclusions

Guide to Health Insurance Exclusions
  · 6 minutes read

Health insurance in the UK is not essential, as everyone is eligible for free-at-the-point-of-care healthcare through the National Health Service (NHS). However, there are a number of reasons why people might choose to purchase private insurance, including:

Faster access to treatment, choice of hospital and consultant, cover for treatments not available on the NHS, or peace of mind.


For an individual with complicated health needs, it is of paramount importance to understand health insurance exclusions. It is important to know about health insurance exclusions in the UK because they can have a significant impact on your coverage.

What are exclusions?

In the context of health cover, refer to specific medical treatments, services, or conditions that are not covered by your insurance policy.

Exclusions VS Limitations Vs Waiting/Moratorium Periods


It refers to specific medical services, treatments, or conditions that are NOT covered by the insurance policy. These are explicitly listed in the policy documents and are permanent throughout the health insurance term.

When a service or condition is excluded, the insurance company will not provide any financial assistance or coverage for expenses related to that service or condition.


Limitations are restrictions on the extent or duration of coverage for certain services or conditions. They define the maximum amount or number of services that the insurance policy will cover.

For example, a policy might have a limitation on the number of physical therapy sessions covered in a year, or it might limit the coverage for specific types of surgery or treatment.

Waiting Periods

Waiting periods or Moratorium Periods are periods of time during which the policyholder must wait before specific benefits become available. These are often applied to certain pre existing conditions or specific services.

For example, a policy might have a waiting period for coverage of maternity benefits, meaning that the policyholder needs to wait a specified period after buying the policy before they can use the maternity benefits.

Common Exclusions in UK Health Insurance

Health insurance policies often come with exclusions, which are specific medical conditions or treatments not covered by your plan. Let’s explore these exclusions concisely:

Pre-existing Conditions

These are health issues you had before getting your policy. Most UK health insurance policies exclude pre-existing conditions, while some may offer coverage after a waiting period.

Cosmetic and Elective Procedures

Treatments not deemed medically necessary, like plastic surgery or teeth whitening, are usually not covered.

Experimental or Unproven Treatments

Procedures not widely accepted or proven in the medical community are often excluded to control costs and ensure safety.

Chronic Conditions

These long-term health issues, like diabetes or heart disease, are usually covered but may have limitations or waiting periods.

Maternity Care

Some policies do not include maternity care, so you’ll need to plan and budget for these costs yourself or consider supplementary maternity insurance or NHS services.

Impact on Policyholders

How Exclusions Can Affect Your Healthcare Coverage

Exclusions in health insurance can significantly impact your healthcare coverage, leaving you responsible for the costs of certain treatments or services. To avoid unpleasant surprises, always review your policy’s terms and conditions.

The Potential Financial Implications for Policyholders

When excluded treatments or conditions arise, policyholders may face substantial financial burdens. This could lead to unexpected expenses, especially for pre-existing conditions or elective procedures.

Strategies to Mitigate the Impact of Exclusions

To mitigate the impact of exclusions, consider the following strategies:

1. Review Your Policy

Regularly review your policy to understand what is and isn’t covered. If needed, consider updating or switching to a more comprehensive plan.

2. Supplementary Coverage

Consider supplementary insurance policies for areas not covered by your primary insurance, such as maternity care or elective procedures.

3. Plan Ahead

If you’re aware of potential healthcare needs in the future, plan and budget for them in advance.

Frequently Asked Questions

Navigating the intricacies of health insurance exclusions can be tough. To provide clarity on some of the most common concerns, we’ve compiled a list of frequently asked questions related to health insurance exclusions in the UK.

1. Can I get coverage for pre-existing conditions?

Coverage for pre-existing conditions in UK health insurance policies varies. While many policies exclude coverage for pre-existing conditions, some may offer coverage after a specific waiting period or under certain conditions. It’s crucial to carefully review your policy to understand the terms and conditions regarding pre-existing conditions. If you have a pre-existing condition, consider discussing your options with your insurer or broker to find the best policy to meet your needs.

2. Are there policies that cover cosmetic procedures?

Most standard UK health insurance policies do not cover cosmetic procedures. Cosmetic surgeries are typically considered non-essential and are excluded from coverage. If you require coverage for cosmetic procedures, you might need to explore supplementary insurance policies that specifically cater to these treatments. Ensure you understand the terms and limitations of any supplementary policies before proceeding.

3. What options do I have for maternity coverage?

Maternity coverage can be a crucial concern for those planning to start a family. Some health insurance policies exclude maternity care, which means you’ll need to explore alternative options. Here are a few ways to secure maternity coverage:

Supplementary Maternity Insurance: You can purchase separate maternity insurance to cover pregnancy and childbirth expenses.

National Health Service (NHS): In the UK, NHS offers free maternity services to residents. While it may not cover all costs, it can provide essential care during pregnancy and childbirth.

Employer-Provided Coverage: Some employers offer maternity coverage as part of their employee benefits package. Be sure to check with your employer about the options available to you.

4. How can I challenge an exclusion in my policy?

Challenging an exclusion in your insurance policy can be a complex process. Here are the steps to consider if you believe an exclusion is unjust:

1. Review Your Policy: Thoroughly review your policy documents to ensure that the treatment or condition is indeed excluded.

2. Contact Your Insurer: Reach out to your insurance company to discuss the exclusion and your concerns.

3. Seek Professional Advice: If you believe the exclusion is unfair or unjust, consult with an insurance advisor or broker who can offer expert guidance and help you navigate the situation.

4. File a Complaint: If you are unable to resolve the issue directly with your insurer, you can file a complaint with the Financial Ombudsman Service, an independent body that deals with insurance disputes.

5. Consider Policy Amendment: In some cases, your insurer might be willing to amend your policy to provide coverage for a specific treatment or condition, although this may result in higher premiums.

Remember that challenging an exclusion can be a time-consuming process, and success is not guaranteed. It’s crucial to be well-informed about your policy’s terms and seek professional guidance when needed.

Rachel Trippier picture

Rachel Trippier

Rachel is the Founder's Associate at

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