Written by
John Spencer
John Spencer is the founder of Compare Expat Plans, where he focuses on helping people compare health plans for life abroad. He emphasizes clear information, neutral analysis, and practical decision support.
Quick Verdict
Cigna Global
Best for those who want clear upfront decisions on coverage. Full medical underwriting means you know exactly what's covered from day one.
Full underwriting approach
Bupa Global
Best for flexibility with the moratorium option—skip detailed medical questions and get coverage for pre-existing conditions after 2 years claim-free.
Moratorium option available
Aetna International
Best for corporate coverage where group underwriting may be more favorable. Individual policies require full medical disclosure.
Group plans advantageous
Side-by-Side Comparison
Cigna Global
Cigna Global uses full medical underwriting, meaning you disclose your complete medical history and receive a decision on each condition. This approach provides clarity but requires detailed disclosure.
PEC Approach Strengths
- Clear upfront decision—know exactly what's covered
- Some conditions may be covered with loading (higher premium)
- Well-controlled conditions often accepted with terms
- Guaranteed renewal protects you once enrolled
- Experienced medical underwriters review individual cases
Limitations
- Requires detailed medical history disclosure
- Some conditions may be permanently excluded
- Loading can make premiums significantly higher
- No moratorium option for simpler application
Bupa Global
Bupa Global offers both full medical underwriting and moratorium underwriting. The moratorium option lets you skip detailed medical questions—pre-existing conditions are excluded initially but become covered after 2 years without claims for those conditions.
PEC Approach Strengths
- Moratorium option provides simpler application process
- Pre-existing conditions covered after 2-year claim-free period
- Choice between moratorium and full underwriting
- Good for those who prefer not to detail medical history
- Conditions become fully covered, not just with loading
Limitations
- 2-year wait for pre-existing condition coverage under moratorium
- Must be treatment-free for conditions to become covered
- Moratorium can be risky if you need care during waiting period
- Full underwriting option may have higher loadings than competitors
Aetna International
Aetna International uses full medical underwriting for individual policies. Their corporate focus means group plans may offer more favorable terms for those with pre-existing conditions.
PEC Approach Strengths
- Group plans often have more lenient underwriting
- Clear documentation of what's covered and excluded
- Corporate accounts may negotiate better terms
- Guaranteed renewal protects ongoing coverage
- Strong for US citizens with existing conditions
Limitations
- No moratorium option available
- Individual policies require full medical disclosure
- Less flexible than Bupa for application approaches
- Serious conditions may result in exclusions
Have Pre-existing Conditions?
Get quotes from multiple providers to compare how your specific conditions will be handled and what coverage options are available.
Compare Coverage OptionsWe may earn a commission when you apply through our links. This does not affect our recommendations.
Premium Impact by Condition
How common pre-existing conditions typically affect premiums. Actual impact depends on severity, control, and individual health history.
Loading = percentage increase to base premium. "Moratorium" means condition excluded initially but covered after claim-free period. "Case-by-case" means individual review required.
Understanding Pre-existing Condition Coverage
Full Medical Underwriting Explained
With full medical underwriting, you complete a detailed health questionnaire disclosing all conditions, treatments, and medications. The insurer reviews this and decides to: accept at standard rates, accept with loading (higher premium), accept with exclusions, or decline coverage. This approach gives clarity upfront but requires complete honesty—non-disclosure can void your policy.
Moratorium Underwriting Explained
Moratorium underwriting (offered by Bupa) means you don't disclose detailed medical history upfront. Instead, any condition you've had symptoms, treatment, or advice for in the past 5 years is automatically excluded. After 2 continuous years without symptoms or treatment for a condition, it becomes covered. This is simpler to apply for but riskier if you need care during the waiting period.
What Counts as Pre-existing?
Generally, any condition you've had symptoms of, received treatment for, or consulted a doctor about—typically within 5 years before application. This includes conditions you may not have been formally diagnosed with. Conditions under investigation also count. The definition varies slightly by insurer, so check specific terms.
Loading vs Exclusions
Loading increases your premium (e.g., 30% loading means $1,000 base becomes $1,300) but the condition is covered. Exclusions mean the condition is never covered. Loading is generally preferable—you pay more but have coverage. Some insurers offer to remove loadings after claim-free periods. Exclusions are typically permanent unless you switch insurers.
Guaranteed Renewal Protection
All three providers offer guaranteed renewal, meaning once you're enrolled, new conditions that develop can't cause your policy to be cancelled or your premium to be individually increased (beyond general rate changes). This protection is valuable—once covered, you're protected long-term even if your health declines.
Best For
Choose Cigna If:
- You want clear upfront decisions
- Your conditions are well-controlled
- You prefer knowing exactly what's covered
- You're comfortable with detailed disclosure
- Loading is acceptable if needed
Choose Bupa If:
- You prefer simpler application (moratorium)
- You can wait 2 years for PEC coverage
- Your conditions don't need immediate care
- You don't want to disclose full history
- You want conditions fully covered eventually
Choose Aetna If:
- You have employer-provided coverage
- Group underwriting benefits you
- You're a US citizen needing US care
- Your employer can negotiate terms
- Individual coverage isn't your only option
Frequently Asked Questions
Can I get coverage with diabetes or heart disease?
Usually yes, but with conditions. Well-controlled Type 2 diabetes often receives coverage with 25-50% loading. Heart conditions are more challenging—expect exclusions or significant loading. Bupa's moratorium may cover these after 2 claim-free years. Get quotes from multiple providers to compare terms.
What happens if I don't disclose a condition?
Non-disclosure can void your entire policy, not just claims related to that condition. Insurers investigate claims and can access medical records. Be completely honest—it's better to have a loading or exclusion than to have claims denied for misrepresentation.
Is the moratorium option a good choice?
It depends. Moratorium works well if your conditions are stable and you're unlikely to need care in the next 2 years. It's risky if you have active conditions requiring ongoing treatment. The benefit is simpler application and eventual full coverage—the risk is 2 years without coverage for those conditions.
Can loadings be removed over time?
Some insurers will review loadings after a claim-free period and may reduce or remove them. This varies by provider and condition. Bupa's moratorium approach achieves this automatically—after 2 years, the condition is covered at standard rates.
Does mental health history affect coverage?
Yes, significantly. Mental health conditions are often excluded initially by all providers. History of depression, anxiety, or other mental health treatment typically results in exclusions. This is one reason mental health coverage is challenging in international health insurance.
What if I develop a new condition after enrolling?
New conditions that develop after enrollment are covered normally—that's the benefit of guaranteed renewal. Your premium may increase at renewal based on claims, but you can't be singled out for rate increases or denied renewal based on new conditions.
Disclaimer: Pre-existing condition coverage varies significantly based on individual health history. This comparison provides general guidance only. Specific terms, loadings, and exclusions will be determined during the underwriting process. Always disclose complete medical history and verify coverage terms in writing before purchasing.
