Does my private medical insurance cover an illness I already had?

It depends on what was declared when the policy was taken out and on what the policy says. If the insurer asked you about that illness and you declared it, what was signed applies, whether that is accepting it, expressly excluding it or raising the premium. If it did not ask you about it, or you did not know about it, it cannot be held against you later. If your concealment involved wilful misconduct or gross negligence, the insurer may refuse to pay. General exclusions of pre-existing illnesses, if they restrict your rights, must be clear, highlighted and signed separately.

Alburquerque Abogados

José Manuel Alburquerque
Insurance law

If you declared it

  • The insurer can simply accept it, expressly exclude it in the specific terms or charge more.
  • If it was accepted without being excluded, it is covered. Ask for written confirmation of what is left out.
  • It cannot turn you down or impose worse terms on you just because you have an illness or a disability, except for reasons that are justified, proportionate and documented in advance.

If you did not declare it

  • If you were not asked about it, you were under no obligation to declare it.
  • If you were asked and your failure to declare it involved neither wilful misconduct nor gross negligence, the insurer cannot refuse to pay altogether, although it can reduce what it pays. It can also cancel the policy within one month of finding out.
  • If you concealed it knowingly or with gross negligence, the insurer may refuse to pay.
  • If you finished cancer treatment more than five years ago and have had no relapse, it cannot be used to turn you down or to worsen your terms.

Illnesses that arise later

Once the insurance is in place, new illnesses are covered under the terms of the policy, you do not have to report them and the insurer cannot exclude them later. What it can do is decline to renew the policy on expiry, giving two months' notice in writing. If you change insurer, the new one can exclude what you already have. Ask before cancelling the old one.

This answer is provided for educational purposes and offers initial guidance on the question raised. Every matter has its own circumstances and nuances that require individual assessment. For that reason, before taking decisions with significant consequences, it is advisable to consult a professional and not to rely solely on this information. Personalised advice makes it possible to apply these explanations to the specific case and to assess the options available with greater certainty.