Medical underwriting
Medical underwriting is the process where a health insurance company evaluates an applicant’s health information to decide whether to approve the application, set premium rates, and determine benefit limits. It’s essentially a risk assessment based on the individual’s medical history and lifestyle. This process helps insurers determine the potential cost of insuring someone and ensures they can offer coverage that’s both sustainable for the company and fair to the policyholder.
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Medical Underwriting
When you’re exploring private medical insurance options, it’s really helpful to understand medical underwriting. Doing so can help you find the best coverage at a great price. In this blog, we’ll happily answer questions like ‘what is a moratorium?’ and guide you through the different types of underwriting available.
Medical underwriting evaluates a potential policyholder’s medical history, health status, and lifestyle to determine risks. This affects your coverage options, premiums, and any exclusions for pre-existing conditions. Private insurers use this process to align coverage with the risks presented by new policyholders.
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What is a pre-existing condition?
What is a Pre-Existing Condition?
A pre-existing medical condition is any health issue that existed before applying for a private medical insurance policy, including chronic conditions such as asthma or diabetes, prior surgeries, or minor health problems. Insurance companies generally require detailed information about any previous or ongoing conditions or illnesses during the underwriting process to decide if they will be covered under the new policy.
How does Medical Underwriting work?
How does Medical Underwriting work?
Medical underwriting involves three steps: initial application, assessment, and policy offering.
Application: The first step in medical underwriting is to apply for private health insurance by filling out a form and getting a quote either online or over the phone
Assessment: During medical assessment, insurers use the medical information you have supplied to assess your risk level. You will know which pre-existing conditions are accepted or excluded and the terms of your policy.
Policy Offering: After assessing your application, insurers will set the terms of your policy. Some applications will be accepted without exclusions, others will receive specific exclusions. Each application may result in different terms being offered by different insurers.
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6 Types of Medical Underwriting
Full medical underwriting (FMU)
FMU is a type of health insurance underwriting where the insurer assesses your past and present medical history to determine coverage. This involves completing a detailed questionnaire about your medical background and potentially providing access to your medical records. The insurer will then decide whether to insure you and what pre-existing conditions, if any, will be excluded from your policy. You'll need to provide comprehensive information about your past and current medical conditions, including dates of treatment, symptoms, and any investigations or tests you're undergoing.
Continued Personal Medical Exclusions (CPME)
CPME is designed to make it easier for individuals with pre-existing medical conditions to switch insurers without having their medical history reassessed and potentially facing new exclusions or higher premiums. You must be transferring from a current Private medical Insurance policy. There can be no gaps in cover, and cover is offered subject to acceptance. To switch using CPME, you'll usually need to provide your new insurer with your previous policy details, including any claims you've made and information about your medical history and existing exclusions.
Continued Specific Exclusions (CSE)
In some cases, insurers will accept an application to continue terms and medical exclusions from a previous policy, but they will add additional specific new exclusions. This may be beneficial where a disclosed current condition is perhaps being treated through the NHS, and a large premium reduction, for accepting the exclusion, is worth considering.
Moratorium underwriting (MORI)
For the first two years of membership, pre-existing medical conditions with symptoms, medication, treatment, or advice in the last five years before joining will not be covered. After two years, if free of symptoms, medication, treatment, and advice for that condition, coverage will begin.
Continued moratorium (CMORI)
Continued moratorium, also known as switch moratorium, is offered when switching from a policy originally underwritten on moratorium terms. This allows continuation of previous underwriting and coverage for the same conditions. It is important to verify whether the new provider will honor the previous policy's terms.
Medical history disregarded (MHD)
With medical history disregarded underwriting, the insurer does not consider medical history when assessing risk and offering coverage. MHD is usually available for companies with policies over a certain size. Individuals who leave such a company policy may continue coverage individually, though premiums are usually higher.
To ensure you receive the best rates and coverage, consider using our compare and switch process, which offers free policy reviews and expert advice.
How does Medical Underwriting impact my policy?
How does Medical Underwriting impact my policy?
Medical underwriting significantly affects your Private Medical Insurance. By evaluating your medical history, current health status, and lifestyle, insurers determine your risk level and adjust policy premiums accordingly. For instance, individuals with no major health issues may receive a more competitive quote with comprehensive coverage. Conversely, those with pre-existing conditions may face higher premiums or exclusions for certain conditions.
Heritage Health is a specialist Private medical Insurance broker. If you would like a free, independent assessment of your medical insurance, please feel free to complete the medical declaration below.