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.
Getting international health insurance with a pre-existing condition is harder than standard coverage—but it's not impossible. Understanding how insurers handle existing conditions helps you find coverage that actually works for your situation.
What Counts as Pre-existing
Insurers define pre-existing conditions as any health issue you had before your coverage started. This typically includes:
- Diagnosed conditions: Diabetes, heart disease, cancer, autoimmune disorders
- Chronic conditions: Asthma, high blood pressure, arthritis, depression
- Previous treatments: Past surgeries, hospitalizations, ongoing therapies
- Current medications: Prescription drugs you take regularly
- Symptoms under investigation: Even undiagnosed issues you've seen a doctor about
The Look-back Period
Most insurers have a "look-back period"—typically 2-5 years. Conditions you had within this period are considered pre-existing. A condition from 10 years ago that's fully resolved may not count, but recent or ongoing issues will.
How Insurers Handle Pre-existing Conditions
International insurers use three main approaches:
1. Full Medical Underwriting
The insurer reviews your complete medical history before deciding on coverage.
- Pros: If accepted, your condition may be covered from day one
- Cons: May be declined, face exclusions, or pay higher premiums
- Best for: Those with well-controlled conditions who want clarity upfront
2. Moratorium Underwriting
No medical questions asked, but pre-existing conditions are excluded for a set period (usually 2 years).
- Pros: Guaranteed acceptance, no medical forms
- Cons: Existing conditions not covered initially
- Best for: Those who want coverage now and can manage conditions out-of-pocket short-term
3. Exclusion
Specific conditions are permanently or temporarily excluded from coverage.
- Pros: Can still get coverage for everything else
- Cons: Your main concern may not be covered
- Best for: Those with minor conditions who primarily need general coverage
Find Coverage That Works
Compare providers who accommodate pre-existing conditions.
See Options →We may earn a commission when you apply through our links. This does not affect our recommendations.
Your Coverage Options
Option 1: International Health Insurance with Underwriting
Apply for standard international health insurance and go through medical underwriting. Outcomes vary:
- Full acceptance: Condition covered, possibly with higher premium
- Acceptance with exclusion: Covered for everything except that condition
- Acceptance with waiting period: Condition covered after 12-24 months
- Decline: Not offered coverage (can try other insurers)
Option 2: Moratorium-based Plans
Choose a plan with moratorium underwriting. You get coverage immediately for new conditions, and pre-existing conditions become covered after the moratorium period (typically 2 years) if you haven't needed treatment.
Option 3: Local Insurance
Some countries have guaranteed-issue health insurance:
- Germany: Statutory insurance (GKV) accepts all, no pre-existing exclusions
- Netherlands: Basic insurance is guaranteed issue
- France: After 3 months residency, access to public system
- UK: NHS access for residents regardless of conditions
Option 4: Combination Approach
Use local/public healthcare for your pre-existing condition while maintaining international insurance for everything else and evacuation coverage.
Recommended Providers
These providers have established processes for applicants with pre-existing conditions:
| Provider | Pre-existing Approach | Typical Waiting Period | Notes |
|---|---|---|---|
| Cigna Global | Full underwriting | None if accepted | Case-by-case review |
| Allianz Care | Moratorium or underwriting | 2 years (moratorium) | Choice of approach |
| BUPA Global | Full underwriting | None if accepted | Thorough medical review |
| IMG Global | Exclusion | 12 months | Standard exclusion period |
| AXA Global | Moratorium or underwriting | 2 years (moratorium) | Flexible options |
Cigna Global
Uses full underwriting with case-by-case evaluation. Known for considering complex cases and sometimes covering conditions others won't—though premiums may be higher.
Allianz Care
Offers choice between moratorium and full underwriting. The flexibility lets you choose the approach that fits your situation.
BUPA Global
Thorough underwriting process but known for working with applicants to find solutions. May offer coverage with condition-specific deductibles or waiting periods.
Application Strategies
Be Completely Honest
Never hide or minimize conditions. Insurers can void your policy retroactively if they discover undisclosed conditions—leaving you uninsured when you need it most.
Gather Documentation
Before applying, collect:
- Recent medical records
- List of current medications with dosages
- Letters from doctors confirming condition stability
- Test results showing condition is controlled
Apply to Multiple Insurers
Different insurers assess risk differently. A decline from one doesn't mean others will decline you. Apply to 2-3 insurers simultaneously (this is normal and expected).
Consider a Broker
International insurance brokers know which insurers are more accommodating for specific conditions. They can guide your applications and negotiate on your behalf—typically at no cost to you (they're paid by insurers).
Timing Matters
Apply when your condition is stable and well-controlled. Recent hospitalizations, medication changes, or flare-ups make underwriting harder.
Get Expert Help
Compare plans from providers who work with pre-existing conditions.
Compare Plans →We may earn a commission when you apply through our links. This does not affect our recommendations.
Medications Abroad
Managing ongoing medications is a key concern:
Prescription Coverage
- Most comprehensive plans cover prescriptions, but verify your specific medications
- Some plans have formularies—lists of covered drugs
- Specialty medications may have limits or require prior authorization
Availability
- Not all medications are available in all countries
- Brand names differ internationally
- Some countries have stricter regulations on certain drugs
Practical Tips
- Bring a supply (typically 90 days) when relocating
- Carry a letter from your doctor explaining your medications
- Research availability in your destination country before moving
- Identify local doctors who can prescribe your medications
Country Considerations
Where you're moving affects your options:
Countries with Guaranteed Healthcare Access
Consider destinations where public healthcare covers pre-existing conditions:
- Spain: Residents can access public healthcare
- Portugal: SNS available to residents
- France: Comprehensive coverage after residency
- UK: NHS access for residents
- Germany: Mandatory insurance covers all conditions
Countries with Affordable Cash-pay Care
If insurance won't cover your condition, these destinations have affordable out-of-pocket care:
- Mexico: Quality private care at fraction of US costs
- Thailand: Excellent hospitals, very affordable
- Colombia: Modern healthcare at low prices
- Ecuador: Affordable care plus IESS social security option
Common Questions
Will my condition ever be covered?
Often yes. With moratorium plans, conditions typically become covered after 2 years symptom-free. With underwriting, well-controlled conditions may be covered from the start, possibly with a higher premium.
What if I'm declined by all insurers?
Consider: moratorium-based plans (guaranteed acceptance), local insurance in countries with guaranteed issue, or relocating to a country with universal healthcare access.
Should I choose moratorium or full underwriting?
Choose moratorium if: You want guaranteed acceptance, can manage your condition out-of-pocket for 2 years, or have been declined elsewhere.
Choose full underwriting if: Your condition is well-controlled, you want potential immediate coverage, or you prefer clarity over uncertainty.
What about mental health conditions?
Mental health is treated similarly to physical conditions. Depression, anxiety, and other mental health diagnoses are pre-existing if you've been treated. Some insurers are more accommodating than others—Cigna and Allianz generally have better mental health coverage.
Can I switch insurers later?
Yes, but the new insurer will treat any conditions as pre-existing again. If you find good coverage, consider staying long-term. Some insurers offer "continuous coverage" credits if switching from another international plan.
What if my condition develops after I get insurance?
Conditions that develop after your policy starts are covered under your policy—they're not pre-existing. This is why getting insurance before health issues arise is valuable.
Find Coverage for Your Situation
Compare providers who work with pre-existing conditions.
Get Started →We may earn a commission when you apply through our links. This does not affect our recommendations.
Disclaimer: This guide is for informational purposes only. Coverage for pre-existing conditions varies significantly by insurer, condition, and individual circumstances. Always verify coverage details directly with insurers and consider consulting an insurance broker for complex situations.
