Medical underwriting explained

In this guide, we'll walk you through the different types of medical underwriting you might come across when applying for health insurance. We'll also explain how the process works, and what kind of questions you might be asked. Also, what happens if you switch providers.

By the end, you'll have a clear understanding of how underwriting affects your cover, your premium, and what's included in your policy so you can make confident, informed choices about your health insurance.

What is medical underwriting in health insurance?

When applying for private health insurance, insurers need to understand your health background to determine what cover they can offer and how much it will cost. This process is known as medical underwriting.

It typically involves reviewing factors such as your age, medical history, and any previous claims. To do this, insurers may ask you a series of questions about your health and lifestyle, such as:

• Your height and weight
• Any past or pre-existing medical conditions
• Your general health and wellbeing
• Smoking and drinking habits

The goal is to assess the insurance risk and decide which conditions can be covered, which may be excluded, and what your premium will be. Medical underwriting helps ensure that your plan is tailored to your individual health needs. While it may sound complex, it's simply a way for insurers to offer fair and appropriate cover based on your personal circumstances.

Why do health insurance providers use medical underwriting?

Medical underwriting is a key part of how insurers assess risk. It helps them understand how likely you are to make a claim on your policy, which in turn influences the cost of your premiums.

By evaluating factors like your age, medical history, and any previous claims, insurers can offer cover that's fair and appropriate for your individual circumstances. This means:

• People who are more likely to claim may pay higher premiums
• Those with lower risk may benefit from more affordable cover

Medical underwriting also allows insurers to tailor cover to each person. Even if you have an existing condition, underwriting makes it possible to still be insured - sometimes with specific exclusions, but often with clarity and peace of mind about what's covered.

What are the different types of medical underwriting?

When it comes to private health insurance, not all underwriting works the same way. There are several types available, each with its own approach to assessing your health and determining what cover you can get.

The type of underwriting you choose can affect how quickly you're covered, what's included in your plan, and how much detail you'll need to provide about your health. Some options are designed for new applicants, while others are tailored for people switching from another insurer or joining through a company scheme.

Let's take a closer look at how each type works and what it could mean for your cover.

Full Medical Underwriting (FMU)

Full Medical Underwriting (FMU) involves providing a complete picture of your health when you apply for private medical insurance. It's a thorough process where the insurer assesses your medical history before confirming what cover they can offer.

You'll be asked to complete a detailed health questionnaire, which typically includes:

• Your past and current medical conditions
• Dates and types of treatments you've received
• Frequency and severity of symptoms
• Any ongoing investigations or tests
• Your family's medical history, including known hereditary conditions

In some cases, you may also be asked to give the insurer access to your medical records. This helps them make an informed decision about whether to offer you cover, and whether any pre-existing conditions can be included.

If your medical history is complex or unusual, the process may take a little longer. But the benefit is clarity: you'll know exactly what is and isn't covered before your policy starts. This can make the claims process quicker and less stressful.

As part of the assessment, you may also be asked to:

• Complete a full medical questionnaire
• Consent to the insurer reviewing your medical records

This type of underwriting is ideal for people who are comfortable sharing their full medical background and want certainty from the outset. It may also allow cover for some pre-existing conditions that would typically be excluded under other types of underwriting, such as Moratorium.

With FMU, your premium is calculated based on your individual risk profile, which can result in more accurate pricing. And if a condition is excluded, you'll be informed upfront including any related conditions that medical professionals consider linked.

In short, FMU offers peace of mind and transparency. Perfect if you value knowing where you stand from day one.

Moratorium (Mori) Underwriting

Moratorium Underwriting is designed for simplicity and speed. When you apply for medical insurance, you don't need to complete a health history questionnaire or disclose your full medical background. Instead, your medical history is only reviewed if and when you make a claim.

This makes it a popular choice for people who want to get covered quickly and with minimal paperwork. But it's important to understand how it works in practice, especially when it comes to pre-existing conditions.

How it works:

• Any condition you've had in the five years before joining will be automatically excluded from health cover.
• If you go two continuous years without receiving treatment, medication, or medical advice for that condition, it may then be covered.
• You'll only find out whether a condition is covered at the time of claim, which can delay the claims process compared to other underwriting types.

Example: Sue had back pain treated with physiotherapy four years ago. Because this occurred within the five-year window, any claim for back pain during the first two years of her plan would be excluded. But, if she remains symptom-free and doesn't seek treatment for two years, she may be eligible for cover if the issue returns later.

Additional considerations:

• No upfront exclusions are listed, which can make it harder to know exactly what's covered until a claim is made.
• Related conditions may also be excluded if they are medically linked to a pre-existing condition.

Moratorium Underwriting offers a balance between ease of access and conditional coverage. It's especially useful for those who want to avoid lengthy forms and get started quickly, but it does come with some uncertainty around claims for past conditions.

Continued Personal Medical Exclusions (CPME)

Continued Personal Medical Exclusions (CPME) underwriting is designed for individuals who are already covered under a private health insurance plan and wish to switch health insurance providers, typically from a plan that uses Full Medical Underwriting or CPME itself.

When you switch to a new insurer, your existing personal medical exclusions are carried over. These exclusions are usually based on pre-existing conditions or symptoms and may also include related conditions, those that medical professionals consider linked to the original exclusion. While this helps maintain continuity of cover, your new insurer may apply additional exclusions depending on your health status and their assessment.

This type of underwriting is particularly useful for people with long-term conditions who want to avoid going through the full medical assessment process again. It ensures that your cover continues without interruption and without the need to re-disclose your entire medical history.

Vitality offers a Switch and Save option for those moving from another provider. This allows you to transfer your cover under Continued Personal Medical Exclusions (CPME) while potentially receiving a discount on your premium. The process involves answering a few simple health and lifestyle questions. Based on your responses, Vitality may offer a lower premium than your current provider, helping you save money while maintaining your existing level of cover.

Other types of underwriting

Continued Moratorium

If you already have health insurance on a moratorium basis, you can usually switch providers on the same basis. You'll then be subject to the terms and conditions of your new insurance plan.

A continued moratorium allows you to carry over any progress you've made towards the two year exclusion period. This is especially useful if you have a pre-existing condition that could be covered again when the exclusion period ends. If you didn't have a continued moratorium, you'd have to count down the exclusion period from the start.

Medical History Disregarded (MHD)

Medical History Disregarded (MHD) underwriting offers the most inclusive form of cover. With this type of underwriting, you don't need to declare any pre-existing conditions when you join. The policy covers all conditions, even those you already have.

This means there are no personal medical exclusions applied, making it a highly attractive option for individuals with ongoing or complex health issues.

However, MHD underwriting is typically only available through workplace schemes as part of an employee benefit. So, this type of underwriting won't be available to you as an individual looking for cover.

How does medical underwriting work?

Here's how it typically works:

Step 1 – Application

Start by getting a quote online and completing your application. You'll need to choose the type of underwriting that suits your situation. If you're not sure, speak to one of health insurance experts.

Here's what happens depending on the underwriting type:

• Full Medical Underwriting (FMU): You'll fill out a detailed health questionnaire, including information about past and current medical conditions, treatments, symptoms, and any ongoing investigations.
• Moratorium Underwriting: You won't need to disclose your full medical history upfront. You'll just provide basic details like your date of birth and postcode. Any conditions you've had in the last five years will be excluded unless you've been free from treatment, medication or advice for two years.
• Continued Personal Medical Exclusions (CPME): You'll complete a short health declaration and provide details about your previous insurer. Your existing exclusions will carry over, and you may be eligible for a premium discount.

Step 2 – Assessment

Once you've submitted your application, insurer will review your answers. If anything needs further clarification, your application may be passed to an underwriter for manual review.

Depending on your underwriting type, you might be asked to:

• Complete a full medical questionnaire
• Give consent for the insurer to access your medical records

Step 3 – Decision

After assessment, the insurer will decide whether to accept your application and on what terms:

• Moratorium applications are usually accepted on standard terms, as pre-existing conditions are automatically excluded.
• FMU applications may also be accepted on standard terms, but sometimes with exclusions or limitations for certain conditions.
• CPME applications typically carry over existing exclusions and may include new ones depending on your health status.

How does medical underwriting affect your health insurance?

The type of medical underwriting you choose plays a big role in shaping your health insurance policy. It affects:

• What you'll pay – your monthly premium
• What's covered – including any exclusions for pre-existing conditions
• When you're covered – especially for conditions you've had before

When your application is accepted, your insurer will confirm any exclusions. These are usually based on your medical history and the type of underwriting you've chosen.

In general, long-term or chronic conditions, like diabetes or arthritis, are usually excluded from cover. These are conditions that can be managed but not cured.

Acute pre-existing conditions, like a broken bone or a short-term illness, might be excluded for a period of time, but could be covered later if you've recovered and no further treatment is expected.

• Full Medical Underwriting (FMU): You'll know upfront what's covered and what's excluded. Some acute conditions may be reviewed after a year.
• Moratorium Underwriting: You won't know what's covered until you make a claim. Pre-existing conditions are excluded for two years but may be covered after that if you've been symptom- and treatment-free.
• CPME (Switch Underwriting): Your existing exclusions carry over from your previous insurer. New exclusions may be added depending on your health status.

How does underwriting impact premiums and cover?

Moratorium Underwriting often results in lower premiums because pre-existing conditions are excluded by default. But this also means you may not be able to claim for anything you've had in the last five years—unless you've been completely symptom- and treatment-free for two years.

Full Medical Underwriting takes your medical history into account. The insurer knows what they're covering and can price your premium accordingly. They may also apply exclusions depending on whether your condition is chronic or acute.

If you're concerned about the cost, you can adjust your plan by increasing your excess (the amount you pay towards a claim). This can help reduce your monthly premium.

At Vitality, our Core Cover starts at £44 per month¹. However, the most accurate way to determine your health insurance costs is to get a quote.

What are the possible outcomes of medical underwriting?

When a decision is made about whether a customer can be covered by health insurance, it usually falls into one of five categories.

• Standard terms. If you're accepted on standard terms, then your application is accepted as quoted. Your medical disclosures are considered to be acceptable without any exclusions necessary.
• Accepted but with exclusions. This means that the insurer will provide cover, but certain conditions will be excluded. This is usual for pre-existing conditions.
• Decision deferred. The insurer won't take on the risk of insuring you at the moment. For example, they may wish to defer the decision until the results of medical tests are known.
• Application declined. Cover isn't offered because the risk is too high. Applications are only usually declined for serious and ongoing medical conditions.

Key takeaways

• Medical underwriting helps insurance companies understand your health background so they can offer you the right cover at the right price.
• It looks at things like your age and medical history to decide what’s included in your plan.
• There are three main types of medical underwriting: Full Medical Underwriting (FMU), Moratorium Underwriting (Mori), Continued Personal Medical Exclusions (CPME).
• Full Medical Underwriting (FMU) – You share your full medical history when you apply. This means you’ll know exactly what’s covered before your plan starts. Some existing conditions may be covered, depending on your health history.
• Moratorium Underwriting (Mori) – You don’t need to share your full medical history upfront. This means your plan won’t cover pre-existing conditions you’ve had in the last five years unless you’ve been symptom- and treatment-free for two years.
• Continued Personal Medical Exclusions (CPME) – If you’re switching from another insurer, your existing exclusions will carry over.

¹ Price is based on the following criteria: a 35-year-old based in Peterborough, plan start date April 2025, Full Medical Underwriting, Consultant Select hospital option, £250 excess and £500 out-patient benefit and includes Insurance Premium Tax (IPT)