Insurance Underwriting

Health insurance is underwritten in two major ways. The two forms are known as moratorium underwriting and full underwriting. Insurance underwriting is a review of the risks of your policy.

Your policy will not cover conditions which you already have when your policy starts, or have had in the recent past-these are called 'pre-existing conditions'. Nor does the policy usually cover conditions which are related to pre-existing conditions. A related condition means one which is caused by, or could be the cause of, another condition.

Types of Insurance Underwriting

You have a choice between two ways of applying for cover:

Full medical underwriting - based on completing a health questionnaire

If you choose this option, your answers to the questionnaire are designed to enable the insurer to understand your medical history (and that of any member of your family whom you wish to insure). It is important that you consider the questions carefully, for each person to be covered, and answer them fully. The insurer will review your details and decide the basis on which they can accept you for cover. If necessary, they will ask your doctor for any further information.

If you have a pre-existing condition that is likely to need treatment in the future, they will usually exclude it from cover and any condition related to it. The insurer will show any exclusion on the schedule you receive from them after they have processed your application. The same process will also apply for any members of your family included in your application.

If the insurer excludes treatment for a pre-existing condition when your policy first starts, they will, in some cases, review the exclusion in the future, if you wish. Usually, they will not remove an exclusion for a long-term medical condition which is always likely to need regular or periodic treatment. Of course, any unexpected medical conditions arising after the start of your policy will be covered immediately, subject to policy terms and conditions.

You must ensure that you provide full and accurate information in answer to the questionnaire. Failure to do so may mean that the insurer cannot cover a claim or even that your policy is void. If you are unsure whether we would want to know about a particular fact, we advise you to tell us about it.

Moratorium

With this option, you do not need to fill in a health questionnaire, instead the insurer automatically excludes any pre-existing conditions which you (and any member of your family included in your application) have received treatment and/or medication for, or asked advice on, or had symptoms of during the five years immediately before your policy started.

However if you do not have any treatment, medication, or advice for those pre-existing conditions, and any related conditions, for two continuous years after your policy starts, then the insurer will reinstate cover for those conditions. This two year period is known as the moratorium

Please understand that your policy will probably never cover long term medical conditions which are likely to continue to need regular or periodic treatment, medication, or medical advice. This is because each time you need any such treatment, the moratorium period starts again, so it is unlikely that there would ever be two clear years during which you remain free of all treatment, medication and advice. Of course, any unexpected medical conditions arising after the start of your policy will be covered immediately, subject to policy terms and conditions.

Which underwriting option should I choose?

The choice is entirely yours. Both options have a similar outcome: they cover unexpected medical conditions arising after you join, but not pre-existing medical conditions. If you are still unsure, the following points may help:

Full medical underwriting

This option involves more of your time when completing your application form. But it does mean that, when you receive your policy documents, the insurer will confirm which conditions will be excluded from cover. Otherwise, treatment for a pre-existing condition will only be covered if you ask them to review the exclusion and they agree to remove it.

Moratorium

With this option, you will be asked to give only basic information about yourself and any members of your family whom you wish to insure. The insurer will not ask you to give details of your medical history, but will rely on you to understand that they will not cover any pre-existing conditions. As stated earlier, the only exception is when you remain free of all treatment, medication and advice for the condition, and any related conditions, for two years after you join.

If you are unsure about which type of underwriting will be best for you, please feel free to call us where we will be pleased to be of any assistance.

Understanding the different forms of underwriting means you can understand your insurance policy.