What is Medical Underwriting
in Health Insurance?
Learn exactly what medical underwriting means and how it impacts your private health insurance policy.
What does medical underwriting mean?
Medical underwriting refers to the use of medical information to evaluate an application for private health insurance to decide whether to accept it and, if so, at what premium rate and with what benefit limits.
The type of underwriting also determines which health conditions are and are not covered. Depending on whether you’re new to health insurance or switching providers, different underwriting options will be available to you.
What You’ll Usually Get Asked About
When applying for insurance or health coverage, you’ll be asked to fill out a form that will serve as the insurer’s basis for a contract and decision. To determine your health status, the most common bits of information you need to disclose honestly are as follows:
- Previous and current medical history: Also usually includes disclosure of treatment dates, medications, symptom frequency, and ongoing consultations and diagnostic tests
- Weight and height: Used to determine your BMI; those who don’t meet the ideal weight and height based on BMI will usually expect an increase in the standard rates or premium
- Inherited conditions or family’s medical history: Helps determine your risks for similar conditions
- Vices: Regular, heavy smoking and alcohol consumption play a significant role in the cost evaluation process due to a high risk for long-term liver and lung diseases
- Occupation: As basic information as it may be, some jobs put an applicant at high risk for particular illnesses and disabilities that can increase their premium for critical illness medical plans and life insurance
What are the different types of medical underwriting?
Moratorium medical underwriting doesn’t require you to declare your full medical history upfront. Instead, it excludes cover for any conditions for which you have had symptoms, advice or treatment during the past five years. However, after a continuous two-year trouble-free period after starting the policy, you will then be entitled to cover such conditions. Bear in mind that the definition of ‘trouble-free’ varies between insurers.
Full Medical Underwriting (FMU)
Full medical underwriting usually requires you to disclose your entire medical history to the insurer, who will then provide a list of specific exclusions based on your disclosed pre-existing medical conditions. However, the FMU route is unique to different insurers, so may not always lead to exclusions. If you want a health insurance policy with black and white terms from day one, this is probably the best option.
Continued Personal Medical Exclusions (CPME)
If you are looking to change your current health insurer, you’ll typically be given the option to switch on a continued personal medical exclusion basis. This often means that your new insurer will retain your current underwriting and continue to cover the same conditions. Each insurer has its own eligibility criteria though, and if you don’t meet its switch requirements, new exclusions may be added to your policy.
Continued Moratorium (CM)/Switch Moratorium
Continued moratorium underwriting is available to those switching health insurance originally underwritten on moratorium terms. It allows you to continue your existing underwriting and it’s possible to carry cover across for the same conditions.
However, it’s important to find out whether the provider will apply their own moratorium terms or honour those of your existing insurer before you switch. For example, if you have met the trouble-free clause with your previous insurer, you’ll want to keep these moratorium terms so you are eligible for cover for this pre-existing condition
Medical History Disregarded (MHD)
Past medical history and pre-existing conditions don’t lead to any exclusions from the moment a group policy begins. Each person on the document will be covered for any pre-existing and new conditions until the end date. MHD underwriting is typically only available on company private health insurance with a minimum group size of 15 employees.
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What are the different types of underwriting decisions?
Standard Coverage Rates
This decision means that the original quote for coverage and premium during the application for health insurance is accepted. The standard coverage or rate decision is usually what most applications for insurance coverage receive, especially when working with companies with a low declination rate.
Exclusion of Coverage
Aptly named, this means the insurance company will not pay for claims for a particular condition resulting from a high-risk activity or chronic disease. These exclusions in the standard coverage usually apply for a critical illness and disability policy or coverage.
If, after a risk status evaluation or underwriting process, they found additional complex risks for claims, then the premium cost increases. Some insurance companies call it the extra mortality loading. Most of them will calculate the additional risk cost as basic premium multiples.
After evaluating the risk factors and the underwriter found that the current risk is too high but expected to improve, the medical insurance application gets postponed. This decision is also common for applications from people awaiting medical examination results and diagnoses.
Denial of Coverage
Unfortunately, some individuals can’t be offered medical plans or coverage because of their very-high risk status. The declinable health conditions will vary from company to company, though. Some companies with a high declination rate usually don’t offer policies to people with heart disease and disease diabetes. On the other hand, others only exclude these diseases or are part of their life insurance’s standard coverage, but with a higher premium.
If you are concerned about NHS wait times, explore private health insurance options
What is the best medical underwriting for my health insurance policy?
Your best medical underwriting choice for health insurance depends on many factors, such as whether you’re switching insurers or have any pre-existing medical conditions. We’ve done our best to explain clearly the differences between each type of medical underwriting, but recognize that you may still have questions. Please get in touch for free advice from one of our experts, who will be able to help you choose the best insurance products for your health profile.
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Medical Underwriting FAQ's
Moratorium underwriting is often used when someone starts private medical insurance. However, even if you have had private medical insurance for many years, moratorium underwriting can still be the most cost-effective option, depending on your medical history. It’s very important to seek professional advice to make sure you’re using the right medical underwriting choice for your unique situation.
The language used by a potential provider can make a huge difference to the medical underwriting process, which is why it is so important to seek advice. This is best illustrated with an example:
Sarah is taking out private health insurance for the first time. She had spinal surgery six years ago and has had no treatment since being signed off five-and-a-half years ago. She has, however, seen a specialist about hip pain in the last 12 months. Her specialist said that it was nothing to worry about and put the pain down to wear and tear.
Two insurers offer to cover back problems from day one but won’t cover anything related to her hip pain. With the first provider, Sarah would meet the trouble-free clause and be able to claim for hip issues after a two-year period without treatment, advice and medication. However, the second provider’s trouble-free clause includes the words “treatment, advice, medication, signs and symptom-free”.
In this case, the first option is more suitable for Sarah. The specialist said her hip pain was down to “wear and tear” — a phrase often used to describe osteoarthritis which is a condition that will likely present signs and symptoms. It would therefore be very difficult for Sarah to successfully claim for this condition on the second policy. Though she probably would not know this herself, an expert advisor (like those here at HCC) would be able to explain the difference and help her make the right choice.
Sometimes you may have to accept new exclusions to switch insurers if you don’t meet the new one’s criteria. We will only ever advise you to consider an additional exclusion if it’s in your best interest in the long term. This will probably require an in-depth conversation with an adviser so that they can get a good understanding of your needs and priorities going forward. Get in touch now to discuss your situation.
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