What Is Medical Underwriting
in Health Insurance?

Learn exactly what medical underwriting means and how it impacts your private health insurance policy.

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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 price and with what limitations.

The type of underwriting also determines which 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 Are the Different Types of Medical Underwriting?

Moratorium 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.

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 conditions. We’ve done our best to clearly explain the differences between each type of medical underwriting, but appreciate 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 option for your health profile.

Private Health Insurance Key Terms

We are here to help you understand the main concepts you’ll come
across in your private health insurance policy.

Why Switch Your
Private Health Insurance Provider?

Even if you already have private health insurance, there are many reasons why you should consider changing your provider:

By switching provider, you can:

* Findings are based on 49 clients, over the last 3 months who already had a live policy in place.

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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