Life insurance with liver disease

Liver disease covers a broad spectrum, and the cause matters enormously to insurers. Non-alcoholic fatty liver disease is one of the most common liver conditions in the UK and is usually insurable. Alcohol-related liver disease is among the hardest. Hepatitis, autoimmune conditions, and cirrhosis each have their own underwriting pathway. This guide covers all of them.

The short answer

The cause of your liver disease is the starting point for everything. Non-alcoholic fatty liver disease without cirrhosis is usually insurable with standard or lightly loaded terms. Hepatitis C that has been cured with direct-acting antivirals has good outcomes. Autoimmune hepatitis on stable treatment is moderately complex. Alcohol-related liver disease requires sustained abstinence and evidence of liver recovery. Cirrhosis of any cause significantly limits options, with Child-Pugh staging determining what is available.

What insurers ask about liver disease

Liver disease underwriting relies heavily on the cause, current liver function tests, and the degree of liver damage. The more detail you can provide, the better.

What is the cause of your liver disease?

This is the most important question. Alcohol-related, non-alcoholic fatty liver (NAFLD/NASH), hepatitis B, hepatitis C, autoimmune hepatitis, primary biliary cholangitis, haemochromatosis, and other causes are each assessed under entirely different frameworks. The cause determines the underwriting pathway from the outset.

What are your current liver function tests?

ALT, AST, GGT, bilirubin, and albumin levels are all important. Normal or near-normal liver function tests, even with a liver diagnosis, are viewed much more favourably than persistently elevated readings. Insurers will want your most recent blood results.

Have you had a FibroScan or liver biopsy?

A FibroScan (transient elastography) measures liver stiffness and indicates the degree of fibrosis. Results below 7.5 kPa generally indicate minimal fibrosis. Results above 12.5 kPa suggest cirrhosis. If you have had a FibroScan, the result is extremely useful for underwriting. Biopsy results (Metavir or Ishak scoring) serve a similar purpose.

Do you have cirrhosis?

Cirrhosis is the critical dividing line. Pre-cirrhotic liver disease (fibrosis stages F0-F3) has materially better insurance outcomes than established cirrhosis (F4). If you do have cirrhosis, the Child-Pugh classification (A, B, or C) determines the severity and directly impacts whether any standard cover is available.

What is your current alcohol consumption?

This is asked regardless of the cause of liver disease. For alcohol-related liver disease specifically, insurers want to know: how much you were drinking, when you stopped, and how long you have been abstinent. For other liver conditions, current alcohol intake is still noted as it affects prognosis.

What treatment or medication are you on?

Treatment details help paint the full picture. Antiviral treatment for hepatitis, immunosuppressive therapy for autoimmune conditions, or no treatment because the condition is being monitored - all carry different implications. Completed and successful treatment (e.g. sustained virological response for hepatitis C) is particularly positive.

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Recent liver function tests (ALT, AST, GGT) and any FibroScan results make a significant difference to the guidance our specialist brokers can give you.

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How specific liver conditions are viewed

The difference between liver conditions for insurance purposes is substantial. Here is how each of the major types is typically assessed.

Non-alcoholic fatty liver disease (NAFLD / NASH)

NAFLD is increasingly common and, in most cases, the most straightforward liver condition to insure. The key question is whether it has progressed to non-alcoholic steatohepatitis (NASH) and whether there is significant fibrosis.

Simple steatosis (fatty liver) with normal or mildly elevated liver function tests - usually standard rates or minimal loading. This is very common and not a major concern to underwriters
NASH without significant fibrosis (F0-F2) - typically insurable with minor to moderate loading. Liver function tests and FibroScan results determine the exact terms
NASH with advanced fibrosis (F3) - moderate to significant loading. Fewer insurer options. The FibroScan score and liver function tests are critical
NAFLD/NASH with cirrhosis (F4) - assessed as cirrhosis regardless of the NAFLD origin. See cirrhosis section below

Alcohol-related liver disease

Alcohol-related liver disease is among the most challenging liver conditions for insurance purposes. Insurers are assessing both the liver damage itself and the ongoing risk of alcohol use.

Current or recent heavy drinking - Most insurers will postpone until sustained abstinence is demonstrated. Typically a minimum of 2 years abstinence is required, and some insurers want 3-5 years
Abstinent for 2+ years, no cirrhosis, normalised liver function - Insurable with moderate to significant loading, typically +100% to +200%. The longer the abstinence and the more normal the liver function tests, the better the terms
Alcohol-related cirrhosis - Very difficult even with abstinence. Child-Pugh A with sustained abstinence may be considered by specialist insurers. Child-Pugh B or C is very unlikely on the standard market
GGT levels are particularly important as they are a marker for alcohol use. Normal or near-normal GGT after a period of abstinence is a positive sign

Hepatitis B

Hepatitis B underwriting depends on whether you are an active carrier, on antiviral treatment, or have cleared the virus.

Inactive carrier (normal liver function, low or undetectable viral load, no treatment needed) - typically insurable with minor to moderate loading
Chronic active hepatitis B on antiviral treatment with suppressed viral load - moderate loading. Stable liver function and no cirrhosis are important
Hepatitis B with cirrhosis - assessed based on cirrhosis severity. More difficult but not always impossible for Child-Pugh A

Hepatitis C

Hepatitis C insurance outcomes have improved dramatically since the introduction of direct-acting antiviral (DAA) treatments, which cure the virus in over 95% of cases.

Cured with DAAs (sustained virological response) - Good outcomes. Typically insurable with minor to moderate loading if there is no cirrhosis and liver function has normalised. This is a significant improvement over the pre-DAA era
Active hepatitis C, untreated - More difficult. Moderate to significant loading depending on liver function and fibrosis stage. Insurers may suggest postponing until treatment is completed
Hepatitis C with cirrhosis - Assessed as cirrhosis. Even if the virus is cleared, the cirrhosis itself drives the underwriting

Which liver condition do you have?

The cause makes all the difference. Get in touch with your diagnosis, latest blood results, and any FibroScan results for specific guidance from our specialist brokers.

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Autoimmune hepatitis

Autoimmune hepatitis is typically of moderate complexity for insurance purposes. Insurers want to understand how well the condition is controlled and whether there has been progression to fibrosis or cirrhosis.

Well-controlled on immunosuppressive therapy (azathioprine, prednisolone) with normal liver function - moderate loading, typically +50% to +100%
Poorly controlled or requiring high-dose steroids - significant loading or possible postponement
Autoimmune hepatitis with cirrhosis - assessed under cirrhosis criteria

Cirrhosis: the critical dividing line

Regardless of the underlying cause, cirrhosis fundamentally changes the insurance landscape. The Child-Pugh classification determines what options exist.

Child-Pugh A (compensated cirrhosis)

Limited options with significant loading

Compensated cirrhosis with preserved liver function may be considered by specialist insurers. Loadings are significant, typically +150% to +300% or more. The underlying cause matters here too - alcohol-related cirrhosis with ongoing abstinence is viewed differently from NAFLD-related cirrhosis. Not all insurers will engage, but options do exist.

Child-Pugh B or C (decompensated cirrhosis)

Standard market extremely unlikely

Decompensated cirrhosis - with symptoms such as ascites, variceal bleeding, or hepatic encephalopathy - is very unlikely to be insurable on the standard market. Guaranteed acceptance life insurance, which requires no medical questions, is the main option. Group life through an employer may also provide cover.

What liver disease does to premiums

Premium loadings for liver disease vary widely depending on the cause and severity. Here are indicative ranges:

NAFLD, simple steatosis - Standard to +25%. Very manageable
NASH, no cirrhosis - +25% to +75%. Still competitive
Hepatitis C, cured, no cirrhosis - +25% to +75%. Significantly improved from the pre-DAA era
Autoimmune hepatitis, controlled - +50% to +100%
Hepatitis B, inactive carrier - +25% to +75%
Alcohol-related, abstinent 2+ years, no cirrhosis - +100% to +200%
Cirrhosis (Child-Pugh A) - +150% to +300%+ if terms are offered at all

The honest answer

Liver disease insurance is driven by two things above all: the cause and whether cirrhosis is present. If you have NAFLD or cured hepatitis C without cirrhosis, you are in a much stronger position than many people expect. If you have alcohol-related liver disease, we will not pretend the process is straightforward - it requires evidence of sustained change and patience. If you have decompensated cirrhosis, we will be straight with you about the very limited standard market options and explain the alternatives that do exist. Whatever your situation, applying to the wrong insurer wastes time and risks declines on your record. Getting specialist guidance first is not optional - it is essential.

Critical illness cover with liver disease

Critical illness cover is harder to obtain with liver disease than life insurance. Most insurers will either decline or offer cover with a liver-related exclusion. This means the policy would not pay out for liver failure or liver transplant, but would still cover cancer (other than liver cancer in some cases), heart attack, stroke, and other specified conditions.

For simple NAFLD without fibrosis, critical illness may be available without exclusion from some insurers. For more advanced liver disease, a liver exclusion is the likely minimum if critical illness is offered at all.

Income protection with liver disease

Income protection availability depends heavily on the type and severity of liver disease. Mild NAFLD is unlikely to cause issues. More significant liver disease may result in a liver-related exclusion, and advanced liver disease or cirrhosis may make individual income protection unavailable. Group income protection through an employer is always worth checking as an alternative.

Put your policy in trust

If you have navigated the underwriting process to secure life insurance with liver disease, make sure the payout is protected too. Writing your policy in trust ensures the money reaches your beneficiaries directly, outside your estate, without probate delays or inheritance tax. Our partner brokers arrange this on every policy at no additional cost.

Read our full guide to trusts and estate planning

Frequently asked questions

I have been told I have a fatty liver. Will this affect my insurance?

Simple fatty liver (steatosis) without inflammation or fibrosis has minimal impact on life insurance. Many people with this finding on an ultrasound get standard or near-standard rates. If it has progressed to NASH (with inflammation) or fibrosis, the impact is greater but cover is still usually available.

I stopped drinking two years ago. Can I get life insurance now?

Two years of abstinence is typically the minimum most insurers want to see for alcohol-related liver disease. Your chances improve if your liver function tests have normalised, you have no cirrhosis, and you can demonstrate sustained abstinence (for example, through GP records). Some insurers want 3-5 years. A specialist broker can identify which insurers have the shortest abstinence requirements for your specific situation.

My hepatitis C was treated and cured. How does that affect insurance?

Cured hepatitis C (sustained virological response after DAA treatment) is viewed increasingly favourably. If your liver function has normalised and there is no cirrhosis, many insurers will offer terms with a minor to moderate loading. This is a dramatically better outcome than was available before DAA treatments became standard.

Does a raised GGT always indicate a problem?

Raised GGT can indicate several things including alcohol use, fatty liver, bile duct issues, or medication effects. Insurers will note a raised GGT and may request further information. If the cause is identified and benign (for example, medication-related), it may have minimal impact. Unexplained persistently raised GGT is more likely to result in further investigation or a loading.

I have cirrhosis but feel fine. Why is insurance so difficult?

Compensated cirrhosis (where you feel well and the liver is still functioning) is a better position than decompensated cirrhosis, but insurers are assessing the long-term risk. Cirrhosis is irreversible and carries ongoing risks of complications including liver failure and liver cancer, even when you feel well currently. This is reflected in the underwriting. Specialist insurers may still offer terms for compensated (Child-Pugh A) cirrhosis, but loadings will be significant.

Will my liver condition get worse over time, and should I get insurance now?

This depends entirely on the type of liver disease and how it is managed. Some conditions (like simple NAFLD) may not progress, while others may. From an insurance perspective, the general principle is that earlier is better. If your condition is stable now, securing cover at the current terms locks in those premiums regardless of future health changes. Waiting risks needing to accept higher loadings or having fewer options if the condition progresses.

Get honest advice about insurance with liver disease

Tell us the cause of your liver condition, your latest blood results, and any FibroScan findings. Our specialist brokers will tell you exactly which insurers to approach and what terms to expect.

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