Bupa and AXA Health both say they may want information from your doctor, and both say they need your consent first; the point their wording describes is when you claim, to check whether a condition began before your cover did. What happens if you left something out when you joined is set partly by those policies and partly by a 2012 Act of Parliament, and the answer turns on whether the omission was careless or deliberate. Unsure what an application is really asking you to declare? An FCA-authorised broker will ring to go over it, free, before you sign anything, once the form on this page is in.
Joining: you are asked, and what you say becomes the basis of cover
The Bupa By You policy guide (for policies starting after 1 May 2024, read 29 October 2026) describes two main ways an insurer can deal with your history at the start. Under full medical underwriting the insurer reviews your medical history at the application stage and then names the pre-existing conditions that will be left out, and the guide says it is "really important that you fill in your application form carefully". Under a moratorium it does not look at your history when you apply (page 12 for both).
What the guide does show is that, on full medical underwriting, your answers set the terms. The routes themselves, and which one a quote rests on, are set out on the page about underwriting routes and medical history disregarded; this page picks up from the point where the form is filled in.
Claiming: when an insurer asks to see your records
AXA Health's Personal Health membership handbook (October 2024, page 11 of the PDF; read 4 September 2026 in a copy hosted on more-health.co.uk, not AXA's own site) says that sometimes the insurer needs more detailed medical information, "including access to your medical records". That can mean your GP or specialist sending more detail, for which the GP may charge you and the plan does not cover the charge, and it can mean being asked to consent to the insurer accessing your records.
The same page says what follows if you refuse: "If you do not give us information we ask for, or do not consent to our accessing your medical records when we ask, we will not be able to assess your claim and so will not be able to pay it. We may also ask you to pay back any money that we have previously paid to do with this medical condition."
The reason for the request is on page 15 of the handbook: "Whenever you claim, we may ask your GP, specialist or practitioner for more information to confirm whether you had any symptoms before you joined." Bupa's guide (page 12) gives the same reason under both of its underwriting routes: when you claim, it may need to check that your symptoms or condition started after your cover did, and may ask your doctor for more information, which the doctor may charge for. So the records question usually comes up at the point where the insurer is deciding whether a condition began before cover started.
What you can do when the insurer asks your doctor for a report
Where an insurer wants a report written by your doctor, the Access to Medical Reports Act 1988 (section 3, on legislation.gov.uk, read 1 November 2026) says that nobody may apply to a medical practitioner for a medical report to be supplied "for employment or insurance purposes" unless the individual has been told of the application and has consented. The notification must tell you of your right to withhold consent and of your rights to see the report.
Bupa's guide (pages 10 and 11) turns this into steps. You can let your doctor send the report without seeing it, or ask to see it first, which must be done within 21 days of the insurer's request. You can ask your doctor to change a report you think is inaccurate or misleading, and if they refuse you can add your own comments before it is sent. You can also ask your doctor not to send it, but then the insurer will not be able to tell you whether the care is covered and may not be able to pay your claim. Your doctor may withhold some or all of a report where disclosure might cause harm or would reveal someone else's identity.
Those rights concern reports. AXA's handbook also asks for consent to access the records themselves, and on a free call-back a broker can talk through how a given insurer goes about it.
Leaving something out: what the law lets an insurer do
For a policy bought as a consumer, the Consumer Insurance (Disclosure and Representations) Act 2012 (section 2, read 26 October 2026) puts a duty on you: "to take reasonable care not to make a misrepresentation to the insurer". A misrepresentation only matters if it is a "qualifying" one. The FCA's rulebook (ICOBS 8.1.3) defines that as one made in breach of that duty where the insurer shows that without it, it would not have entered into the contract at all, or would have done so only on different terms. ICOBS 8.1.2A adds the FCA's view that rejecting a consumer's claim for a misrepresentation that is not qualifying would be unreasonable.
Section 5 splits qualifying misrepresentations in two, and Schedule 1 gives the insurer different remedies for each:
| Kind | What the Act says | What the insurer may do |
|---|---|---|
| Deliberate or reckless | The consumer knew it was untrue or misleading, or did not care, and knew or did not care that it was relevant (the insurer must show this) | May avoid the contract and refuse all claims, and need not return the premiums, except to the extent it would be unfair to keep them |
| Careless, insurer would not have offered cover at all | Anything not deliberate or reckless | May avoid the contract and refuse all claims, but must return the premiums |
| Careless, insurer would have offered cover on different terms | As above | The contract is treated as if on those different terms if the insurer so requires |
| Careless, insurer would have charged more | As above | May reduce a claim payment proportionately |
Which of the Act's outcomes would apply to a particular omission depends on the facts and the insurer's own underwriting. If you think something was missed on an existing application, a broker who rings back after the form can go through what to raise with your insurer.
Where AXA asked medical questions when you joined, its handbook (page 15) applies the same idea in its own terms: "If you did not answer fully or accurately, even if this was by accident, we may not cover treatment for the condition." It reaches any pre-existing condition, treated or not, and any condition you should reasonably have known about, diagnosed or not.
Smoking questions, and giving a false answer
If a health insurance application asks whether you smoke or use nicotine, the answer you give is treated like any other answer on the form. A false answer given knowing it was untrue and that it mattered to the insurer, or not caring either way, is what the 2012 Act calls deliberate or reckless; if the insurer shows it would not have offered the same terms, the table above shows it may avoid the policy, refuse all claims and keep the premiums unless keeping them would be unfair. A careless slip is treated more lightly, with the outcome set by what the insurer would have done had it known.
The duty to take reasonable care applies to a smoking question as to every other. For the specific policies you are looking at, whether smoking is asked, whether it moves the price and whether any test is used are shown by the application and the quote, and the broker's call-back can cover which questions each insurer puts about smoking.
Smaller questions about records and honesty
Can Bupa see my NHS records?
Bupa's guide describes asking your doctor for a medical report, and says it needs your permission to do so. Section 3 of the 1988 Act, which extends to England, Wales and Scotland, requires your consent before an insurer applies for a report from a doctor who has been responsible for your care; Bupa's guide points Northern Ireland readers to the Access to Personal Files and Medical Reports (NI) Order 1991.
Will I have to pay for my doctor's report?
Possibly. AXA says a GP may charge you and the plan does not cover that charge. Bupa says a doctor may charge a fee for a report and that it will let you know whether it will cover some of that cost.
What if I forgot a condition rather than hid it?
The Act treats a misrepresentation that is not deliberate or reckless as careless, and the insurer's remedies then depend on what it would have done had you answered fully. AXA's handbook still says it may not cover the condition even if the omission was accidental.
Can I read what my doctor sends the insurer?
Bupa's guide says you can ask to see the report before it is sent, within 21 days of the insurer's request, or to see a copy within six months of it being sent.
Does a condition I never had treated count?
For AXA, yes: its wording on incomplete answers reaches a condition whether or not you had treatment for it, and whether or not it was diagnosed. Before you apply, a call from the broker after you send the form is a chance to ask how each insurer words its symptom questions.