How does health insurance work?

Health insurance gives you access to private medical care to quickly get you back on your feet. You may have taken out an individual policy or have coverage provided by your employer as an employee benefit. You can contact your insurer to make a claim and discuss your options when you need care.

A health insurance policy can offer different levels of coverage and will also have some policy exclusions. These can vary between insurers, and some will also depend on your medical history, so it's essential you understand what's included when you take out a policy.

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What's the difference between acute and chronic illnesses?

The main difference between acute and chronic diseases is in the type of care they need and whether they're curable. However, the line between the two can occasionally blur. For example, you may be diagnosed with cancer and need treatment that will manage your condition but can't cure it long-term. Even so, it is still defined as an acute illness.

A chronic illness is a condition that may stay with you throughout your life but can be managed and controlled. So even though it can't be cured, you can still have a good quality of life.

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Why you need to know the difference between chronic and acute conditions

Put simply, health insurance only covers acute illnesses and excludes chronic conditions. Chronic diseases are automatically excluded from every health insurance policy. A private healthcare provider only offers care for short-term conditions that doctors can treat with a single course of treatment. This could include surgery and some follow-up rehabilitation, for example, physiotherapy. However, they aren't set up to provide longer-term care.

If you have a chronic illness that needs long-term monitoring, you'll need to rely on the NHS.

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What's an acute illness?

As we've already mentioned, if you have an acute illness, you'll typically recover with a single course of treatment. For example, you might sustain a fracture in an accident. Whilst you'll initially receive NHS treatment at A&E, you can use your health insurance for any further surgery or follow-up treatment.

If you need a hip or knee replacement, this is also treated as an acute condition, as it can be resolved with one course of treatment.

Every health insurer also provides coverage for cancer treatment. Cancer is defined as an acute illness, even though you may need a longer course of treatment.

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What's a chronic condition?

Chronic conditions are illnesses that will stay with you throughout your life and need management as they can't be resolved completely. Chronic diseases can include:

  • Diabetes
  • Chronic kidney disease
  • High blood pressure
  • Angina and heart disease

Whilst the symptoms of these conditions can be controlled or reversed, you'll likely need long-term monitoring by your GP or an NHS consultant. Medication can play a part in your care. However, your doctor may recommend other techniques, including lifestyle changes, increased physical activity or relaxation techniques that can help you to manage your condition.

Broker explaining policies
A broker can help you understand which medical conditions are covered.

Why are chronic and acute illnesses treated differently?

Chronic and acute illnesses are typically treated differently because they require a different approach.

A long-term, multi-disciplinary approach can work best with chronic illnesses. For example, some conditions can be worsened by poor nutrition or inadequate physical activity. An NHS GP or consultant can refer you to various services to help you make lifestyle changes. Chronic illnesses may respond to medication; however, creating an effective regimen can take time and will likely need regular checks to monitor the effect on symptoms and any side effects.

By contrast, acute illnesses can typically be resolved quickly with the proper care. For example, you may need surgery or a course of physiotherapy, which a private healthcare provider can offer. Your care plan may include some follow-up checks, but you won't need long-term monitoring as you would with a chronic condition.

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Is there any overlap between acute conditions and chronic illness?

There can be some overlap between acute conditions and chronic illnesses. Chronic disease can have different phases. A chronic phase can bring ongoing, low-level symptoms where you can go about your usual daily activities with appropriate medication and support. However, an acute phase will bring increased symptoms that impact your health and may require surgery or other medical interventions.

For example, angina is a warning sign for an increased heart attack or stroke risk. Acute symptoms could require surgery to help prevent a heart attack.

Are acute symptoms of a chronic illness covered by health insurance?

Your medical insurance coverage will depend on any medical conditions you had when you took out the policy. Pre-existing conditions that needed advice or care in the five years before you had the policy are excluded for the first two years. That means that if you already have angina or diabetes, your insurance won't cover any related medical conditions.

However, if you took out the policy and were diagnosed with a chronic disease later, the acute phases can be covered, although your chronic illness still won't be.

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Get in touch

We provide a personal service to help you find the best health insurance for your needs and budget. We'll ensure that you understand your options and make an informed choice. Get in touch for a comparison quote.

Sam Zainal
Senior Broker

Sam Zainal

Sam has been in the industry for over 11 years and has extensive experience in customer service and protection insurance.

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