Blog > What does Full Medical Underwriting Involve?

01 December 2016

Medical health insurance like most insurance policies can be quite confusing, especially if you are a first time policyholder. With so many companies offering different health insurance packages it is important that you understand what each policy covers and what is excluded. There are 2 different methods of application that anyone looking for personal health insurance must be aware of. These are Full Medical Underwriting (FMU) and Moratorium (MOR).

Underwriting in relation to health insurance basically involves the disclosure of certain information to an insurance company which they can then access to decide when pre-existing conditions should be excluded from cover. With some policies you will be required to complete an application form that details your full medical history where as with a moratorium policy your medical history will only become an issue at the point you need to make a claim. Policies requiring a medical history declaration, or full medical underwriting, require the applicant to complete an application form that details the full medical history for each applicant. Private health insurance companies consult an applicant's GP in order to verify conditions or to investigate an applicant's medical history further. Having submitted your medical history a decision will be made by the health insurance company as to whether or not they will cover any previous medical conditions.

The rules surrounding your 'Duty of Disclosure' when applying for personal health insurance are quite strict. It is your duty to disclose any fact or circumstance about your health that is known to you at your time of application. The main reason behind this disclosure is to identify if you have any pre-existing conditions that will be excluded from treatment from your health insurance policy. Most health insurance providers will not pay benefits for any conditions that you have been treated for in the past or have arranged treatment for prior to taking out your medical insurance policy. This also includes any chronic conditions that have been diagnosed before the health insurance policy was granted. If you fail to disclose details of any illness at the start of your health insurance application then you could be denied a future claim or your personal health insurance could be deemed invalid.

Some health insurance providers may agree to cover pre-existing conditions in exchange for additional premiums, but this will depend entirely upon the condition in question and its severity, how long you have had it and what treatment you have had or are still having for that condition. Again, each health insurance company is different with different policies so make sure you always do your homework with regards to what is and what is not included.

If you opt for a policy that requires full medical underwriting then all your medical history will be available to your insurers up front enabling them to make an informed judgement before confirming your policy. A moratorium policy is however a little bit different as this type of application process does not require disclosure of medical history when joining. Instead any illness is assessed at the point of making a claim. However, if you do not have any symptoms, treatment, medication, or advice for those pre-existing conditions, and any directly related conditions, for two continuous years after your policy starts, then insurers may reinstate cover for those conditions. With moratorium you do not need to fill in a health questionnaire. Instead, pre-existing conditions for which you (and any dependant included in your application) have received treatment and/or medication, or asked advice on, or had symptoms of (whether or not diagnosed), during the five years immediately before your private health insurance cover started will automatically be excluded from cover. However, if you do not have any symptoms, treatment, medication, or advice for those pre-existing conditions, and any directly related conditions, for two continuous years after your policy starts, then insurers may reinstate cover for those conditions.

When choosing a personal health insurance provider it is vital that you understand the differences between policies and which one is best suited to you and your family. With any insurance company though it is always better to be honest from the outset to avoid any disappointment or hefty medical bills further down the line. With Full Medical Underwriting the boundaries are perhaps clearer as everything will be documented from the outset and assessed by your insurer before the policy is approved leaving you with a clear understanding of exactly what your personal health insurance covers you for.

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