Should I consider a Medical Exclusion?

If you are looking to switch health insurers to change benefit levels or achieve a better price, then you may be offered medical exclusions if you have answered unfavourably to the insurers switch criteria. There are times when considering a medical exclusion can be a sensible choice.

Within this guide we hope to point out the things you should consider before accepting an exclusion on your policy and also to point out when it may be in your interest to accept an exclusion. As with all things, this will come down to personal preference, budget and also your own personal view on risk.

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What is a Medical Exclusion?

A medical exclusion is usually shown on your medical insurance certificate and will outline the condition/s you are not covered for as a result of accepting the policy.  The insurer will make it quite clear which condition/s they are not covering for each individual before the policy starts.

Medical exclusions are quite common when people are underwritten on FMU (full medical underwrite) terms, they are also used when you switch medical insurance as a way of removing bad risk.

If you are concerned about whether a condition will be covered or not, speak to one of our specialists for advice.

Private Health Insurance FAQ's

There are certain circumstances when a medical exclusion may be the right thing for you.


For example, your premium has significantly increased due to a claim for a hip replacement.

After the initial 6 months the replacement should be settled, and any signs of problems would have likely surfaced. At this point you could consider excluding that hip from your policy, as the replacement should last 10 – 15 years. At this point the saving you could make with the exclusion could fund any treatment in the future.

With some providers you would then get the option to bring this condition back under cover at a review stage, or if you have been re-underwritten on moratorium terms (selected providers only) this condition would become eligible for benefit again, once you have completed a 2 year trouble free period with your new plan in place.

By choosing to exclude the condition you should find in many cases you are able to reduce your premium as you are no longer paying an increased price as a result of the claim for the hip replacement. It should not affect cover for any other condition you may need to claim for*.

*this can depend on the new insurers terms and how they word the exclusion. To be safe always seek advice before making a decision and ask for the exclusion wording in writing before proceeding.