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
Most Flexible
Allianz Care
Most likely to cover chronic conditions. Moratorium option available. Best for diabetes, heart history.
Get Allianz QuoteMiddle Ground
Bupa Global
Case-by-case underwriting. May cover with loading or waiting period. Good continuation options.
Get Bupa QuoteStrictest
Cigna Global
Best service but strictest underwriting. Good for minor conditions only. Best coverage once accepted.
Get Cigna QuoteIf you have chronic conditions, your insurer choice matters more than anything else. Allianz is most likely to cover existing conditions. Bupa takes a case-by-case approach. Cigna provides the best service but is strictest on pre-existing conditions.
Side-by-Side Comparison
| Feature | Cigna Global | Bupa Global | Allianz Care |
|---|---|---|---|
| Chronic Condition Approach | Strict exclusions | Case-by-case | Most flexible |
| Diabetes (controlled) | Often excluded | May cover | Often covered |
| Hypertension | Usually covered | Usually covered | Usually covered |
| Asthma | Usually covered | Usually covered | Usually covered |
| Thyroid Conditions | Usually covered | Usually covered | Usually covered |
| Heart Disease History | Often excluded | Case-by-case | May cover |
| Medication Coverage | Excellent | Excellent | Good |
| Best For | Minor conditions | Moderate conditions | Complex conditions |
Cigna Global
Cigna Global provides the best service and medication coverage once you're accepted—but they're strictest on chronic conditions at underwriting. Minor, well-controlled conditions may be fine; complex conditions are often permanently excluded.
Chronic condition handling:
- Full medical underwriting required
- Minor conditions (hypertension, mild asthma) often covered
- Complex conditions (diabetes, heart history) often excluded
- Clear yes/no decisions (less negotiation than Bupa)
- Excellent medication coverage once accepted
- Best network for specialist access
Best for: Those with minor, well-controlled conditions. People who prioritize service quality over underwriting flexibility. Anyone with conditions likely to be covered.
Bupa Global
Bupa Global takes a case-by-case approach. Instead of automatic exclusions, they review your specific situation. They may cover conditions with premium loading (higher cost) or waiting periods rather than excluding outright. Lifetime renewal protects you once accepted.
Chronic condition handling:
- Individual case-by-case review
- May cover with premium loading (10-50% extra)
- May cover with waiting period (12-24 months)
- More negotiation possible than Cigna
- Lifetime renewal once accepted
- No-claims discount helps offset loading
Best for: Those with moderate chronic conditions. People willing to pay more for coverage. Anyone who values lifetime renewal protection.
Allianz Care
Allianz Care is the most accommodating for chronic conditions. Their moratorium underwriting option lets you skip medical questions—conditions excluded for 24 months, then covered if stable. They're also most likely to cover conditions that Cigna excludes.
Chronic condition handling:
- Most flexible underwriting of the three
- Moratorium option: no medical questions, 24-month wait
- Full underwriting: more lenient than competitors
- Diabetes often covered (unlike Cigna)
- Mental health history treated more favorably
- Heart disease may be covered with waiting period
Best for: Those with complex chronic conditions. Anyone declined by Cigna or Bupa. People who prefer the moratorium option.
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How Common Conditions Are Handled
| Condition | Cigna | Bupa | Allianz |
|---|---|---|---|
| Type 2 Diabetes (controlled) | Often excluded | May cover with loading | Often covered |
| Hypertension (stable) | Usually covered | Usually covered | Usually covered |
| Asthma (mild/moderate) | Usually covered | Usually covered | Usually covered |
| Hypothyroidism | Usually covered | Usually covered | Usually covered |
| High Cholesterol | Usually covered | Usually covered | Usually covered |
| Depression/Anxiety history | Usually excluded | Often excluded | May cover |
| Heart Disease history | Often excluded | Case-by-case | May cover with wait |
| Cancer (in remission) | Usually excluded | Waiting period | Waiting period |
*These are general patterns. Individual decisions depend on severity, control, and complete medical history.
What "Controlled" Means
For a condition to be considered "controlled" or "stable," insurers typically look for:
- Regular monitoring (doctor visits, tests)
- Consistent medication compliance
- Numbers in acceptable range (A1c, blood pressure, etc.)
- No hospitalizations related to the condition
- No recent changes in treatment
Documentation Matters
When applying with chronic conditions, provide:
- Recent lab results (within 6 months)
- List of current medications and doses
- Letter from your doctor about condition status
- Treatment history and any complications
Medication Coverage for Chronic Conditions
Once your condition is covered, medication coverage varies:
- Cigna: Best medication coverage—most drugs covered, easy refills, good network
- Bupa: Excellent coverage—similar to Cigna, good for specialty drugs
- Allianz: Good coverage—may have more limits on specialty medications
Getting Medications Abroad
- Brand names may differ by country
- Some medications may not be available everywhere
- Bring documentation of your prescriptions
- Consider 90-day supplies when available
- International pharmacies can often source medications
Which Is Best For You?
Choose Allianz Care if you...
- Have diabetes or heart disease history
- Have mental health history
- Have been declined elsewhere
- Prefer moratorium underwriting
- Have multiple chronic conditions
- Want the most flexible approach
Choose Bupa Global if you...
- Have moderate, well-controlled conditions
- Are willing to pay premium loading for coverage
- Want lifetime renewal protection
- Value case-by-case consideration
- Have conditions that need negotiation
- Want no-claims discounts to offset loading
Choose Cigna Global if you...
- Have minor, well-controlled conditions
- Are likely to pass underwriting
- Want the best service once accepted
- Prioritize medication coverage
- Need the largest specialist network
- Have conditions Cigna typically covers
Frequently Asked Questions
Should I disclose all my conditions?
Yes, absolutely. Non-disclosure can void your policy when you need it most. Insurers can access medical records. It's always better to know upfront what's covered than to face a denied claim later.
What if I'm declined by all three?
Work with a specialist international insurance broker who can access niche markets. Consider local insurance in your destination country—some have guaranteed-issue options. Some conditions may require you to self-insure for that specific issue.
Can conditions become covered over time?
With Allianz's moratorium: yes, after 24 months symptom-free. With full underwriting: some insurers review exclusions after 2-5 years. Ask your insurer about their review policy—but don't count on it.
What about conditions that develop while I'm insured?
Conditions that develop after your policy starts are fully covered—they're not pre-existing. This is why getting insured while healthy is so valuable. Once you have a policy, new diagnoses are covered.
Is "well-controlled" good enough?
Depends on the condition and insurer. Well-controlled hypertension on medication is usually fine. Well-controlled diabetes on insulin still often gets excluded by Cigna. Allianz is most lenient about what "controlled" means.
Do chronic conditions affect premium?
Cigna: usually exclusion (not loading). Bupa: often loading (10-50% extra). Allianz: sometimes loading or waiting period. Loading means you pay more but the condition is covered—often worth it.
Disclaimer: This comparison provides general patterns. Every application is evaluated individually based on specific medical history. Get actual underwriting decisions before choosing your insurer.
