Life Assurance for Non-Standard Medical Risks: Diabetes, Heart Conditions, and Other Chronic Conditions Abroad

Having a pre-existing medical condition does not automatically disqualify you from obtaining life assurance. The protection insurance market includes specialist underwriters and carriers experienced in assessing non-standard medical risks — and the terms offered have improved significantly in recent years as medical understanding of chronic conditions has advanced.

However, applicants with diabetes, cardiovascular disease, cancer histories, or other significant medical conditions should expect the underwriting process to be more detailed, potentially take longer, and may result in premium loadings or specific exclusions. For internationally mobile individuals — who may have incomplete UK medical records or be under the care of overseas physicians — there are additional complexities.

This guide explains how non-standard medical risk underwriting works, what to expect for the most common chronic conditions, and how internationally mobile applicants can navigate the process effectively.

As of 2026, underwriting guidelines vary between insurers and are updated as medical evidence evolves. Conditions once routinely declined may now attract modest loadings; conditions that attracted modest loadings previously may now qualify for standard terms in some carriers. This guide is illustrative of general market practice and should not be taken as a definitive statement of any specific insurer's current approach.

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What Is Non-Standard Medical Risk Underwriting?

When an applicant's health history falls outside the parameters of standard terms — because of a specific diagnosis, ongoing treatment, abnormal test results, or lifestyle factors — the insurer's underwriting team (or a reinsurer's medical underwriting specialists) conducts a more detailed assessment.

The assessment aims to quantify the increase in risk above the standard mortality or morbidity table, and to determine the appropriate response:

• Standard terms: The condition is assessed as not materially increasing risk, or is sufficiently well-controlled that standard rates apply
• Premium loading (rating): The premium is increased above standard rates to reflect the elevated risk. Often expressed as a percentage ("+50%", "+100%") or as an additional premium per thousand pounds of sum assured ("£3.50 per £1,000 sum assured per annum")
• Exclusion: A specific condition or cause of death is excluded from the policy
• Postponement: The insurer defers a decision, pending stabilisation of a condition, completion of treatment, or a specified monitoring period
• Decline: The insurer is unwilling to provide cover

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Diabetes

Diabetes is one of the most commonly encountered conditions in life assurance underwriting. The underwriting approach depends on the type of diabetes and its control:

Type 1 Diabetes

Type 1 diabetes (insulin-dependent, typically onset in childhood or early adulthood) carries a higher insurance risk than Type 2, because it is associated with more complex long-term complications (cardiovascular disease, renal impairment, neuropathy, retinopathy) and typically requires more intensive management.

What underwriters assess:

• Current HbA1c level (a measure of average blood glucose control over approximately 3 months). Well-controlled Type 1 (HbA1c below approximately 58 mmol/mol, or 7.5%) is underwritten more favourably than poorly controlled diabetes
• Complications present: Are there signs of nephropathy (microalbuminuria, reduced eGFR), retinopathy, or cardiovascular complications?
• Duration of diabetes
• BMI and blood pressure
• Smoking status

Typical outcomes: For a well-controlled, complication-free Type 1 diabetic aged under 45, life assurance is generally available with a rating of approximately +50% to +100% above standard terms. Poorly controlled or complicated Type 1 diabetes may attract higher loadings or declines, particularly at older ages or higher sum assured levels.

Type 2 Diabetes

Type 2 diabetes (typically onset in middle age, managed with diet, oral medication, or insulin) is increasingly common and is underwritten individually based on the same factors: control (HbA1c), complications, duration, and co-morbidities.

Typical outcomes: Diet-controlled or orally managed Type 2 diabetes that is well-controlled and of relatively recent onset may attract standard terms or a modest loading (around +25% to +50%) in many insurers. Insulin-dependent Type 2 with long duration or complications will attract higher loadings.

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Cardiovascular Conditions

Hypertension (High Blood Pressure)

Well-controlled hypertension (blood pressure maintained within normal range on medication) is often acceptable at standard terms, or with a modest loading, particularly in younger applicants. Poorly controlled hypertension, or hypertension combined with other risk factors (diabetes, obesity, smoking), attracts more significant loadings or declines.

History of Heart Attack (Myocardial Infarction)

A history of myocardial infarction requires careful underwriting. Key factors:

• Time elapsed since the event (more favourable after two to five years, assuming recovery and stable management)
• Degree of cardiac damage (left ventricular ejection fraction — LVEF)
• Current cardiac medication and control
• Whether revascularisation was performed (stenting or CABG)
• Presence of ongoing symptoms or complications

A single uncomplicated MI in a younger individual, well treated and with a full recovery demonstrated over a number of years, may attract a loading of +100% to +200% above standard terms. Complex or recent cardiac events are typically declined, pending stabilisation and medical review.

Atrial Fibrillation (AF)

AF is among the more commonly encountered cardiac conditions in protection underwriting. Paroxysmal (intermittent) AF in a younger patient with good rate control and no thromboembolic events may attract standard or near-standard terms. Persistent or permanent AF, or AF with associated stroke history, attracts higher ratings or declines.

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Cancer History

Cancer underwriting is highly condition-specific and depends on the cancer type, stage, treatment, and time elapsed since treatment:

• Low-risk, fully treated cancers (e.g., stage I melanoma, non-melanoma skin cancer, early-stage thyroid cancer, cervical cancer in situ): May be offered at standard terms, particularly after a defined period of remission (often two to five years)
• Higher-risk cancers (e.g., breast cancer, bowel cancer, lymphoma) in full remission: Often available with ratings after five years of remission, depending on staging and treatment
• High-risk or metastatic cancers, or recent diagnoses under active treatment: Typically declined for new life assurance applications until treatment is complete and a remission period has elapsed

For internationally mobile applicants: Cancer treatment received overseas may be less familiar to UK-based underwriters. Providing translated records, oncology reports, and a summary from the treating oncologist in English improves the quality of the underwriting assessment and reduces processing delays.

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Mental Health Conditions

Mental health is an increasingly important area of life assurance underwriting. Historically, mental health conditions were frequently declined or heavily loaded. The market has improved significantly:

• Mild to moderate depression or anxiety, well-controlled: Increasingly offered at standard or near-standard terms, particularly if the condition has been stable and unmedicated for two or more years
• Severe depression, bipolar disorder, schizophrenia: More significant loadings; some carriers decline, while specialist carriers may offer rated terms
• History of suicide attempt: Typically results in a deferral of 3 to 5 years from the most recent attempt, and a suicide exclusion clause is often applied

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Navigating Non-Standard Underwriting as an Internationally Mobile Applicant

Medical Records in Overseas Languages

Underwriting decisions are based on complete medical information. For applicants who have received medical care overseas — in Arabic, French, German, Thai, or any other language — it is worth obtaining translations of key records before submitting the application. The insurer's medical officer cannot properly assess records they cannot read.

No Established Primary Care Physician

Some internationally mobile individuals — particularly younger executives who have been healthy and rarely need a doctor — have no regular GP. This complicates the Attending Physician Statement process (the insurer cannot obtain a GP report if there is no GP).

Solution: Many carriers will accept a comprehensive medical examination in lieu of a GP report, performed by a physician they appoint. For applicants who have not seen a doctor in several years, this may also reveal existing conditions that should be disclosed — and being assessed through a comprehensive examination is a more transparent and defensible disclosure method than relying on memory.

Time Zones and Communication

Processing a non-standard underwriting application requires multiple exchanges between the applicant, their adviser, the insurer's underwriting team, and potentially overseas physicians or reinsurers. For internationally mobile applicants who are frequently travelling or operating across multiple time zones, appointing an adviser who can manage the process on their behalf and respond promptly to information requests is important.

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Strategies for Non-Standard Risk Applicants

1. Approach multiple insurers: Different insurers apply different underwriting guidelines. An application that results in a decline with one carrier may be accepted at standard terms or with a modest loading by another.

2. Use a specialist non-standard underwriter: Some specialist brokers and advisers work exclusively with impaired risk clients, and have relationships with carriers who specialise in non-standard risk underwriting.

3. Apply while in remission or with stable control: Life assurance is hardest to obtain during active treatment or unstable disease. Applying after a defined period of stability — and assembling comprehensive medical evidence of control — materially improves outcomes.

4. Consider smaller sum assured: If the desired sum assured attracts a decline, a smaller sum may be acceptable. Some cover is better than none.

5. Explore relevant life plans and excepted policies: For business protection purposes, some non-standard risk underwriting outcomes that lead to declines on individual life policies may be more achievable under group or excepted scheme underwriting, which applies group mortality tables rather than strict individual underwriting.

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How Global Investments Can Help

Global Investments works with HNW individuals and internationally mobile clients who have non-standard medical profiles to identify the most suitable carriers and structure the best possible underwriting presentation.

We understand which carriers are most receptive to specific conditions, have experience managing applications for clients with incomplete or overseas medical records, and can co-ordinate with specialist reinsurers when standard market capacity is insufficient.

We do not advise applicants to conceal or minimise medical information — non-disclosure is the most significant risk a policyholder faces, as it can void the policy entirely at the time of a claim. Our aim is to present each client's medical position accurately and completely to the market that is most likely to respond constructively.

Contact Global Investments to discuss your protection requirements.

Underwriting outcomes depend on individual medical circumstances and insurer guidelines, which change. This guide reflects general market practice as of 2026 and is informational only. Past underwriting decisions with any particular insurer are not indicative of future outcomes.