Pre-existing conditions and underwriting: how 8 international insurers compare

International health insurers assess a pre-existing condition on one of four bases: full medical underwriting, moratorium, continued personal medical exclusions (CPME) or switch terms, and medical history disregarded for groups. IPMIcompare read the policy documents of 8 insurers on 18 October 2026: four publish a moratorium for individuals in their current documents (Allianz Care, IMG Global Prima, William Russell and APRIL MyHEALTH Singapore), AXA lists one only in a 2022 handbook, and Cigna Global, Bupa Global and Blue Cross Blue Shield Global Solutions publish none for individuals.

This guide compares the terms side by side: look-back and clear periods, entry ages, price, switch terms, and what each insurer publishes about chronic conditions and high blood pressure. Every fact links to the insurer's own document. Terms can differ by country and plan, so the policy documents you receive at quote take precedence.

The four underwriting bases

Full medical underwriting (FMU). You answer a medical questionnaire when you apply. The insurer decides on each condition before cover starts: covered, covered with a premium loading, excluded, or, at some insurers, declined. You know your terms from day one.

Moratorium. You answer no medical questions. Conditions you had symptoms of, treatment, medication or advice for in a look-back period before your start date are excluded.^A3 Each can become eligible after a continuous clear period with no symptoms, treatment, medication, special diet or advice.^A2 At Allianz Care the wait restarts for a condition if any of these happen during it.^A4 You find out what is covered when you claim.

Continued personal medical exclusions (CPME), also called switch or continued terms. When you move from another insurer, the new insurer keeps the terms you already had, including exclusions, and does not underwrite you again.^A5 It depends on moving straight from one policy to the next.^W3

Medical history disregarded (MHD). The insurer ignores members' history. It is a basis for company groups: IMG offers it to groups of 10 or more.^I1 Cigna's Inspire page for small groups says 5 or more, while the FAQ data on the same page says 10.^C7 An individual cannot buy it.

Which insurer offers which basis

One row per product. "Not published by the insurer" means we looked in the documents listed under Sources and did not find it. Terms with an old source are dated in the cell and confirmed at quote.

Aetna International no longer sells new individual cover in Europe, the Middle East, Africa or Asia-Pacific (see Aetna below).^E1

For the other terms that decide a claim (limits, waiting periods, deductibles), see the international health insurance feature matrix.

Moratorium compared

This is the comparison the "moratorium underwriting" explainers leave out: the actual terms, from each insurer's wording.

Not in the table: Cigna Global (moratorium only for Cigna Inspire groups^C7), Bupa Global (none published for individuals), APRIL MyHEALTH Thailand and MyHealth International (not offered^{P4, P6}), IMG Global Medical Insurance (not published), and Blue Cross Blue Shield Global Solutions (a 6-month waiting period instead^G1).

Three things the table shows.

1. A 5-year look-back is not the rule. UK explainers, and Google's AI Overview for "moratorium underwriting", describe an automatic 5-year look-back. Allianz Care, William Russell and APRIL MyHEALTH Singapore look back 24 months or 2 years.^{A3, W3, P1}
2. The clear period must be continuous. At Allianz Care, one prescription or one consultation for the condition during the 24 months starts the wait again.^{A2, A4} A condition you treat every day may never come clear.
3. A moratorium can cost more. William Russell says about 4% more,^W1 APRIL Singapore adds 5%,^P2 and in our broker experience IMG Global Prima charges about 5% more while Allianz Care and AXA charge the same.^BX

CPME and switch terms compared

CPME and switch terms matter when you already have cover with exclusions and want to move. The common condition is continuity: move from one policy straight to the next.

Leaving a company plan? Group cover ends with your membership, and a group's medical history disregarded basis does not travel with you. Our guide to leaving your employer's health plan covers the group-leaver routes, deadlines and the order to do things in.

Full medical underwriting: what an insurer can decide

Full medical underwriting gives the insurer the widest choice. The published outcomes:

• Cover the condition as normal. Bupa Global's medical team may cover a condition, possibly for an extra premium.^{B2, B3} IMG Global Medical Insurance Platinum covers disclosed conditions not excluded by rider.^I3
• Cover it for a higher premium (a loading). Allianz Care,^A1 William Russell,^W1 APRIL MyHEALTH Singapore^P1 and Blue Cross Blue Shield Global Solutions ("accepted at a higher rate")^G1 all publish this.
• Exclude it. Cigna, Allianz Care, Bupa, IMG, William Russell and APRIL publish exclusions as an outcome.^{C1, A1, B3, I3, W1, P1} Cigna's starting point is that a pre-existing condition is excluded unless Cigna agrees to cover it.^C1
• Restrict it. Bupa Global.^B3
• Decline the application. Bupa Global,^B3 William Russell,^W1 APRIL^{P1, P6} and Blue Cross Blue Shield Global Solutions.^G1

Can an exclusion be removed later? Cigna lets you remove a medical exclusion for an extra premium,^C2 and does not guarantee to remove exclusions at renewal.^C1 Bupa Global may remove an exclusion or a higher premium on review.^B3 William Russell says an exclusion cannot be "bought out".^W2

At renewal. Cigna Global does not re-underwrite without material changes,^C11 and does not refuse to renew because of claims or any condition.^C1 Bupa Global adds no new personal restrictions or exclusions at renewal.^B3

Declare everything. Every insurer read says an undisclosed condition is not covered. Cigna,^{C1, C9} Allianz Care,^A10 Bupa,^B3 William Russell^W8 and Blue Cross Blue Shield Global Solutions^G2 also say they can cancel the policy or treat it as void. Cigna separates careless misrepresentation (exclusions, rejected claims, cancellation) from deliberate misrepresentation (cancellation, premiums kept, paid claims recovered).^C9

Age limits by basis

Age often decides the basis before your history does. "-" means no separate age for that basis in the documents listed under Sources.

Insurer notes: high blood pressure, chronic conditions and renewal

Cigna Global

Cigna publishes the most specific high blood pressure terms we found.^C8

• Pre-Existing Condition Care. From age 60 (or turning 60 during the year), if you declared hypertension on the medical questionnaire and it is a special exclusion on your certificate, Cigna pays medically necessary outpatient costs to maintain it: Silver US$500, Gold US$1,500, Platinum US$3,000 a year. From 40 to 59 it is Platinum only, up to US$2,000. Complications are not included, and it does not apply if you bought the condition back for extra premium. The same benefit covers type 2 diabetes, glaucoma, high cholesterol, asthma and other listed conditions. A waiting period applies; Cigna does not publish its length.
• A nurse-led Chronic Condition Management programme names high blood pressure.^C8
• The application form asks about high blood pressure (question 2).^C9 A broker factsheet dated 2015 lists high blood pressure among conditions that may be covered with a premium loading, "not a guarantee": confirmed at quote.^C10

Allianz Care

The full underwriting form asks about "abnormal blood pressure or high cholesterol".^A9 Allianz publishes no rule specific to hypertension. It defines a chronic condition,^A7 and says pre-existing chronic conditions follow your underwriting terms.^A8 Its moratorium (24 months, rolling) is in the tables above.^{A2, A3, A4}

Bupa Global

Chronic conditions diagnosed after you join are covered on all 5 Bupa Global Health Plans.^B5 The membership guide adds "depending on underwriting".^B4 At renewal Bupa adds no new personal restrictions or exclusions, and may remove an exclusion or higher premium on review.^B3 Bupa publishes nothing specific about high blood pressure in the documents we read.

AXA Global Healthcare

New chronic conditions are covered on Comprehensive, Prestige and Prestige Plus. On Foundation and Standard, AXA pays only inpatient treatment for an acute flare-up.^{X4, X5} AXA's chronic page uses hypertension as its example of an ongoing condition.^X4 Its moratorium terms for raised blood pressure (moratorium table above) come from the April 2022 handbook. AXA does not link that handbook from its current pages, so they are confirmed at quote.^X3

IMG

IMG sells two different international lines. Global Prima (IMG Europe) offers FMU, moratorium and CPME, with "no age limits and lifetime renewal", and some plan options cover chronic conditions.^{I1, I2} Global Medical Insurance (the US line) is fully underwritten, with a Pre-Existing Condition Waiver for people with prior cover.^I3 IMG publishes nothing specific about high blood pressure in the documents we read.

William Russell

Monitoring and maintenance of chronic conditions: none on Bronze, limited on SilverLite, full on Silver and Gold. Acute flare-ups are covered on every plan.^W6 Under moratorium, high blood pressure that shows itself in the first 6 months counts as pre-existing.^W3 The FMU form asks about high blood pressure.^W7 From age 55, FMU is the only option.^W1

APRIL International

• MyHEALTH Singapore: under moratorium, chronic hypertension may never be covered.^{P1, P2} The FMU form asks about raised blood pressure.^P7
• MyHEALTH Thailand: FMU and CPME only. Under a Thai rule (clause 26.1.2), two years after your first start date APRIL cannot refuse a claim for a pre-existing condition from the 5 years before that has not shown itself. A declared condition accepted without an exclusion endorsement is covered (clause 26.1.1). The English terms are a translation; the Thai version is legally binding. Underwriter: Sompo Insurance (Thailand).^P5
• MyHealth International: health questionnaire only; no moratorium or CPME.^P6
• APRIL's general guide says hypertension may still be excluded under a moratorium.^P8

Blue Cross Blue Shield Global Solutions

Living Abroad (formerly GeoBlue Xplorer) is for US citizens and US permanent residents abroad, and some foreign nationals tied to a US entity. It is medically underwritten, with a 6-month pre-existing waiting period that prior cover can reduce.^{G1, G2} Nothing specific about high blood pressure was found in the documents we read.

Aetna International

Aetna stopped individual business in Europe, the Middle East, Africa and Asia-Pacific from 1 November 2022. Its individual IPMI customers had left Aetna cover by 31 October 2023 at the latest.^E1

Which basis suits which history

This follows from the published terms above. It is a guide to the questions to ask; the insurer's terms decide.

• No conditions, or minor ones that settled long ago. A moratorium can be quicker to buy, and with no recent history there is little for it to exclude. Check the price: it can be the same or up to about 5% more.^{W1, P2, BX}
• An ongoing condition you treat every day, such as high blood pressure. The clear period needs no treatment or medication,^A2 and APRIL MyHEALTH Singapore says chronic hypertension may never qualify.^P1 Full medical underwriting is where an insurer decides on the condition up front, and can accept it.
• You already have cover with exclusions. CPME or switch terms keep what you have, as long as there is no break.^{A5, W3}
• Your age. Moratorium is open only under 40 at William Russell, to 45 at APRIL MyHEALTH Singapore and under 65 at Allianz Care.^{W3, P1, A6} Cigna Global and IMG Global Prima publish no upper age to join.^{C3, I2}
• You are leaving a company plan. Read leaving your employer's health plan.

Asking whether you personally can get covered with a condition? HealthiNomad has a plain guide: health insurance abroad with a pre-existing condition. Travelling for months with high blood pressure? See its guide to travel insurance with high blood pressure for long trips.

Getting an indication before you apply

Our process: we get an indication from the insurer first, where the insurer offers one. With your consent, we send the insurer's underwriters a summary of your situation and medical history. We ask how they would treat it on each basis they offer: covered, excluded, or loaded. You then choose the insurer and the basis knowing the likely outcome.

An indication is not an offer. The insurer's final terms come with the full application, and you must answer its questions fully and honestly.

Two client outcomes

Frequently asked questions

Sources

Every insurer fact above comes from the insurer's own document, read on 18 October 2026, listed below. "In our broker experience" marks the only figures that do not come from an insurer document. Terms can change; the policy documents you receive take precedence. This guide is general information. It is not personal or medical advice.

1. BX IPMIcompare broker experience (Mo Buglow, 18 Oct 2026). Not from an insurer document; shown on the page as "in our broker experience".
2. C1 Cigna Global, Policy Rules, CGHO Policy Rules CGIC EN 02/2026: general exclusion 2 (p.19), cl. 1.3 (p.4), cl. 3.1.1 (p.6), cl. 13.2 and 13.6 (p.15), definitions (p.25). https://www.cignaglobal.com/dvc-pdfs/CGIC-EP38/en/CGHP%20Policy%20Rules%20CGIC%20EN%2002_2026.pdf (linked from https://www.cignaglobal.com/brokers/global-individual-health/plans-useful-documents). Read 18 Oct 2026.
3. C2 Cigna Global, Policy Rules (as C1), cl. 1.3: removing a medical exclusion for an additional premium. Read 18 Oct 2026.
4. C3 Cigna Global, international health plans: https://www.cignaglobal.com/international-health-plans ("no upper age limit"). Read 18 Oct 2026.
5. C4 Cigna Global, https://www.cignaglobal.com/seniors-health-insurance, and Senior Plan Sales Brochure 591560 DTC EN 11/2024, p.3. Read 18 Oct 2026.
6. C5 Cigna Global, Underwriting factsheet (© 2015): https://www.cignaglobal.com/pdf/Underwriting.pdf. Read 18 Oct 2026. Dated 2015: terms confirmed at quote.
7. C6 Cigna Global, Group Leavers factsheet (© 2015): https://www.cignaglobal.com/pdf/Group%20Leavers.pdf. Read 18 Oct 2026. Dated 2015: terms confirmed at quote.
8. C7 Cigna Global, Cigna Inspire: https://www.cignaglobal.com/employers/small-to-medium-enterprises/international-health-plans/cigna-inspire. Read 18 Oct 2026.
9. C8 Cigna Global, Customer Guide 591048 CGHO EN 02/2026, pp.6 and 35: https://www.cignaglobal.com/dvc-pdfs/UKCEIC-UKCEICP11/en/591048%20CGHO%20Customer%20Guide%20EN_02_2026.pdf. Read 18 Oct 2026.
10. C9 Cigna Global, Application Form 200043 CGHO Broker EN 02/2026, question 2 and p.5: https://www.cignaglobal.com/dvc-pdfs/GENERIC-229/en/200043%20CGHO%20Application%20Form%20Broker%20EN_02_2026.pdf. Read 18 Oct 2026.
11. C10 Cigna Global, Premium loading factsheet (© 2015): https://www.cignaglobal.com/pdf/premium-loading.pdf. Read 18 Oct 2026. Dated 2015: confirmed at quote.
12. C11 Cigna Global, Customer Guide (as C8), p.52. Read 18 Oct 2026.
13. A1 Allianz Care, Individual Benefit Guide, Care, valid from 1 Nov 2025, pp.11 and 57: https://www.allianzcare.com/content/dam/onemarketing/azcare/allianzcare/en/docs/DOC-IBG-CARE-EN-1125.pdf. Read 18 Oct 2026.
14. A2 Allianz Care, Individual Benefit Guide (as A1), moratorium definition, p.54. Read 18 Oct 2026.
15. A3 Allianz Care, Individual Benefit Guide (as A1), p.58. Read 18 Oct 2026.
16. A4 Allianz Care, Individual Benefit Guide (as A1), rolling moratorium, p.59. Read 18 Oct 2026.
17. A5 Allianz Care, Individual Benefit Guide (as A1), CPME/CTT, pp.44-45. Read 18 Oct 2026.
18. A6 Allianz Care, Individual Benefit Guide (as A1), "Insured person", p.51; also application forms FRM-APP-CARE-FMU-EN-0126 (https://www.allianzcare.com/content/dam/onemarketing/azcare/allianzcare/en/docs/FRM-APP-FMU-EN-2025.pdf, p.2) and FRM-APP-CARE-MORI-EN-0126 (https://www.allianzcare.com/content/dam/onemarketing/azcare/allianzcare/en/docs/FRM-APP-MORI-EN-2025.pdf, pp.2 and 5). Read 18 Oct 2026.
19. A7 Allianz Care, Individual Benefit Guide (as A1), chronic condition definition, p.43. Read 18 Oct 2026.
20. A8 Allianz Care, Individual Benefit Guide (as A1), p.11. Read 18 Oct 2026.
21. A9 Allianz Care, FMU application form FRM-APP-CARE-FMU-EN-0126, p.7 (URL as A6). Read 18 Oct 2026.
22. A10 Allianz Care, Individual Benefit Guide (as A1), pp.35-36. Read 18 Oct 2026.
23. B1 Bupa Global, expat FAQ: https://www.bupaglobal.com/en/for-you/expat. Read 18 Oct 2026.
24. B2 Bupa Global Health Plans brochure, April 2026, Bupa Insurance Limited, BIN-BGHP-SALE-EN-XXXX-2606-0065255, pp.13 and 17: https://www.bupaglobal.com/-/media/BupaGlobal/PDFs/2026/Products/BGHP/BINS/BINS-Bupa-Global-Health-Plans-Sales-Brochure-EN-APR26-0065255.pdf. Read 18 Oct 2026.
25. B3 Bupa Global, Major Medical membership guide, 1 Dec 2024, Bupa Global DAC, DAC-MMHP-MEMB-EN-XXXX-2411-0055057, pp.2, 8, 15, 20, 22, 24, cl. 6.3-6.4: https://www.bupaglobal.com/-/media/BupaGlobal/PDFs/2024/Products/BGHP/DAC/BGHP2/DAC-Major-Medical-Global-Health-Plan-Membership-Guide-EN-DEC24-0055057.pdf. Read 18 Oct 2026.
26. B4 Bupa Global, Major Medical membership guide (as B3), glossary. Read 18 Oct 2026.
27. B5 Bupa Global Health Plans brochure (as B2), p.13. Read 18 Oct 2026.
28. X1 AXA Global Healthcare, international health insurance: https://www.axaglobalhealthcare.com/en/international-health-insurance/. Read 18 Oct 2026.
29. X2 AXA Global Healthcare, Comprehensive IPID PB127112a/10.26, p.1: https://www.axaglobalhealthcare.com/globalassets/intermediary/resources/individual/comprehensive-ipid-bxi.pdf. Read 18 Oct 2026.
30. X3 AXA Global Healthcare, "Your handbook - Comprehensive April 2022", pp.24-26: https://www.axaglobalhealthcare.com/globalassets/intermediary/sales-tool-kit/individualfamily/uk/handbook/apr-22/comprehensive-handbook-bxi-april-2022.pdf. Read 18 Oct 2026. Not linked from AXA's current pages and may be superseded: confirmed at quote.
31. X4 AXA Global Healthcare, chronic conditions: https://www.axaglobalhealthcare.com/en/international-health-insurance/health-cover/chronic/. Read 18 Oct 2026.
32. X5 AXA Global Healthcare, combined summary of benefits PB166479/10.26, p.11: https://www.axaglobalhealthcare.com/globalassets/intermediary/sales-tool-kit/global-health-plan-individual-combined-summary-of-benefits.pdf. Read 18 Oct 2026.
33. E1 Aetna International, news, 19 Jun 2024: https://www.aetnainternational.com/en/about-us/news-insights/aetna-deal-allianz-partners.html. Read 18 Oct 2026.
34. I1 IMG (international), underwriting: https://www.imglobal.com/intl/underwriting (no date printed). Read 18 Oct 2026.
35. I2 IMG, Global Prima brochure CM0050A2292240228 / 0426, pp.2 and 14: https://www.imglobal.com/docs/library/intl-forms-library/gpmi-brochure.pdf. Read 18 Oct 2026.
36. I3 IMG, Global Medical Insurance brochure CM0050A2223231120 / 0126, pp.2 and 4: https://www.imglobal.com/docs/library/forms-library/gmi-brochure.pdf. Read 18 Oct 2026.
37. I4 IMG, Global Medical Insurance Bronze certificate (sample), p.25: https://www.imglobal.com/docs/library/policy-summaries/global-medical-insurance-bronze.pdf. Read 18 Oct 2026.
38. I5 IMG, Global Medical Insurance Silver certificate (sample), p.17: https://www.imglobal.com/docs/library/policy-summaries/global-medical-insurance-silver.pdf. Read 18 Oct 2026.
39. W1 William Russell, underwriting ("Updated: 04 March 2025", for policies starting in 2026): https://www.william-russell.com/international-health-insurance/how-it-works/underwriting/. Read 18 Oct 2026.
40. W2 William Russell, pre-existing medical conditions (updated 20 Dec 2024): https://www.william-russell.com/international-health-insurance/how-it-works/pre-existing-medical-conditions/. Read 18 Oct 2026.
41. W3 William Russell, Individuals & families plan agreement 2026, p.7: https://www.william-russell.com/wp-content/uploads/WRE-26-Personal-Health-PA.pdf; and moratorium application form v9, p.1: https://www.william-russell.com/wp-content/uploads/WRE-Personal-Health-App-MORI.pdf. Read 18 Oct 2026. (The underwriting web page says "39 or under" for moratorium; the plan agreement's "under 40" applies.)
42. W5 William Russell, who we cover: https://www.william-russell.com/international-health-insurance/who-we-cover/. Read 18 Oct 2026.
43. W6 William Russell, plan agreement (as W3), pp.18 and 41. Read 18 Oct 2026.
44. W7 William Russell, FMU application form v10, question 1c: https://www.william-russell.com/wp-content/uploads/WRE-Personal-Health-App-FMU.pdf. Read 18 Oct 2026.
45. W8 William Russell, plan agreement (as W3), p.8. Read 18 Oct 2026.
46. P1 APRIL International, MyHEALTH Singapore terms and conditions, MH SG 07/2026, pp.7 and 10-12: https://assets.april.fr/april-international/Products/pdf-product-myhealth-singapore-terms-and-conditions-en.pdf?vh=d2d30e&func=proxy. Read 18 Oct 2026.
47. P2 APRIL International, MyHEALTH Singapore moratorium application form, MH SG 07/2026, p.3: https://assets.april.fr/april-international/Products/pdf-product-myhealth-singapore-application-form-mori-en.pdf?vh=041337&func=proxy. Read 18 Oct 2026.
48. P3 APRIL International, MyHEALTH Singapore: https://www.april-international.com/en/long-term-international-health-insurance/myhealth-singapore. Read 18 Oct 2026.
49. P4 APRIL International, MyHEALTH Thailand: https://www.april-international.com/en/long-term-international-health-insurance/myhealth-thailand. Read 18 Oct 2026.
50. P5 APRIL International, MyHEALTH Thailand terms and conditions, MH TH 2026/05 (English translation), pp.5, 9, 14, cl. 26.1.1-26.1.2: https://assets.april.fr/april-international/Products/pdf-product-myhealth-thailand-terms-conditions-en.pdf?vh=0820d5&func=proxy. Read 18 Oct 2026.
51. P6 APRIL International, MyHealth International terms and conditions 2026-2027, NMHI26, pp.5, 20, 24: https://assets.april.fr/april-international/Products/pdf-product-myhealth-international-2.0-general-conditions-en-2025.pdf?vh=8a9ff9&func=proxy. Read 18 Oct 2026.
52. P7 APRIL International, MyHEALTH Singapore FMU application form, question 3, p.6: https://assets.april.fr/april-international/Products/pdf-product-myhealth-singapore-application-form-fmu-en.pdf?vh=5301b4&func=proxy. Read 18 Oct 2026.
53. P8 APRIL International, guide: what is a pre-existing condition (updated 19 May 2026): https://www.april-international.com/en/long-term-international-health-insurance/guide/what-pre-existing-condition. A general guide; the plan terms are in P1. Read 18 Oct 2026.
54. G1 Blue Cross Blue Shield Global Solutions, Living Abroad: https://bcbsglobalsolutions.com/individuals-and-families/international-medical-insurance/living-abroad/worldwide-and-outside-us/. Read 18 Oct 2026.
55. G2 Blue Cross Blue Shield Global Solutions, Worldwide Premier certificate, 4 Ever Life International, effective 1 Jul 2026, form 130.201 03/26, pp.10, 11, 23, 42: https://30n0q935.media.zestyio.com/4ELI_Worldwide_Premier_Cert-2026-07.pdf. Read 18 Oct 2026.