Key takeaways: What is and isn't covered on business health insurance when you have a chronic condition?

Like most health insurance, our business health insurance plans are designed to cover acute conditions. An acute condition is a disease, illness or injury that is likely to respond quickly to treatment that aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or that leads to your full recovery.

Chronic conditions are generally not covered with business health insurance. However, there are some situations where we can help. We'll cover the initial investigations needed to diagnose a condition. And if a chronic condition flares up unexpectedly, we may be able to cover short-term treatment. 

What's in this article

Jump to sections:

What is a chronic condition?

A chronic condition is a disease, illness or injury with one or more of the following characteristics:

  • It needs ongoing or long-term monitoring through consultations, examinations, check-ups or tests
  • It needs ongoing or long-term control or relief of symptoms
  • It requires rehabilitation or special training to cope with it
  • It continues indefinitely
  • It has no known cure
  • It comes back or is likely to come back.

This is the definition used by the Association of British Insurers (ABI), and it's used by most health insurers, including AXA Health.

What's the difference between an acute and a chronic condition?

An acute condition is a disease, illness or injury that's likely to respond quickly to treatment, aiming to return you to the same state of health you were in before, or leading to your full recovery. Most business health insurance is designed to cover acute conditions. The distinction matters because it determines what your plan does and doesn't cover.

What are some examples of chronic conditions?

Chronic conditions are wide-ranging. Some common examples include1:

  • asthma
  • diabetes
  • epilepsy
  • angina
  • osteoarthritis
  • long-term depression.

Some of these conditions, including Crohn's disease and long-term depression, are likely to always need ongoing treatment or to come back over time. If an employee is diagnosed with one of these conditions, we'll get in touch to explain when we'll stop covering their treatment and what their options are from that point.

1National Library of Medicine

A note on cancer

Cancer is treated differently to other chronic conditions. Please contact us for more information on how your plan would cover cancer.

What is covered on business health insurance when you have a chronic condition?

There are some situations where we can provide cover, even when a condition is chronic:

  • Initial diagnosis

We'll cover the initial investigations needed to diagnose a condition, including consultations with a specialist and diagnostic tests.

  • Short-term treatment for unexpected flare-ups

If a chronic condition gets significantly worse or flares up unexpectedly, we may be able to cover short-term treatment. Always get in touch with us before arranging any treatment so we can check what your plan covers.

  • Extended Cover option

If you include the Extended Cover option in your plan, your employees can get cover for outpatient routine follow-up consultations and associated diagnostic tests with a specialist for the purpose of monitoring specified chronic conditions. Including angina, asthma, diabetes, epilepsy, heart valve problems, high blood pressure, glaucoma, osteoarthritis, rheumatoid arthritis, thyroid problems and ulcerative colitis. Please note this doesn't include outpatient drugs and dressings.

Our 24/7 health support line — included as standard

Whatever your plan covers, your employees always have access to our 24/7 health support line, included as standard with every AXA Health business health insurance plan. They can speak to a nurse or counsellor at any time, day or night, about any health concern, including questions about living with or managing a chronic condition. Midwives and pharmacists are also available 8am–8pm Monday to Friday, 8am–4pm Saturday and 8am–12pm Sunday.

The health support line is not a diagnostic or advice service and cannot respond to emergencies. In an emergency, please call 999 or 111, or attend A&E.

What isn't covered on business health insurance when you have a chronic condition?

Most ongoing treatment for chronic conditions falls outside the scope of business health insurance. We won't usually cover:

  • Routine follow-up consultations for a chronic condition (unless you have the Extended Cover option)
  • Monitoring of a medical condition (unless you have the Extended Cover option)
  • Treatments that only offer temporary relief of symptoms, without dealing with the underlying condition
  • Ongoing, long-term treatment for conditions that are recurring or have no known cure.

If we're not able to continue covering treatment for a chronic condition, we'll always let the member know in advance. That gives them time to talk to their GP or specialist about their options — whether that's continuing treatment privately at their own cost, or transferring their care to the NHS.

When does an acute condition become a chronic condition?

Not every condition starts out as chronic. Sometimes what begins as an acute condition turns out to be longer-lasting, recurring or harder to resolve. When that happens, it may need to be reclassified as chronic.

A condition is likely to be considered chronic if it:

  • hasn't responded to treatment in the way that was expected
  • keeps coming back after treatment
  • requires ongoing monitoring, medication or management with no clear end point.

If we think a condition may be chronic, we'll tell you. We may ask your employee's permission to contact their GP or specialist to confirm the diagnosis, the treatment plan and how the condition is likely to progress.

If you're ever unsure whether a condition is covered, get in touch with us before arranging any treatment. We'll help you understand what your plan covers – and make sure your employees know where they stand.

Build a plan that's right for you

Find out more about our business health insurance, including what is and isn't covered, and get a quote

Get a quote