UK Private Health Insurance Conversion

Your Essential Guide to Converting Employer Cover to Individual Policy in the UK

UK Private Health Insurance Converting Your Employer Policy to Individual Cover – What You Must Know

For many professionals in the UK, private health insurance is a valued perk, often provided as part of an employee benefits package. It offers peace of mind, access to swift diagnoses, and choice over specialists and hospitals, bypassing potential NHS waiting lists. However, what happens when your employment changes, your employer's policy alters, or you reach a certain age no longer covered by the group scheme? The prospect of losing this valuable benefit can be daunting.

Converting your employer-provided private medical insurance (PMI) to an individual policy is a critical process that, if not handled correctly, can leave you exposed or facing significantly higher costs. This comprehensive guide will equip you with the essential knowledge, insights, and steps required to navigate this transition smoothly, ensuring continuity of your health coverage. We'll delve into the nuances of underwriting, the importance of timing, cost implications, and how to make an informed decision for your future health.

Understanding Employer-Provided Private Medical Insurance (PMI)

Before considering a conversion, it's vital to understand the nature of your current employer-provided private medical insurance. Group schemes differ significantly from individual policies, primarily in their underwriting and scale.

How Employer PMI Schemes Work

Employer PMI schemes are typically arranged by a company for the benefit of its employees. They can vary widely in their scope, benefits, and how they are funded.

1. Group Underwriting: One of the most significant advantages of employer schemes is group underwriting. For larger groups, insurers often offer "Medical History Disregarded" (MHD) underwriting. This means that, within the scope of the policy, pre-existing medical conditions are generally covered, subject to the policy's terms and conditions and the acute nature of the condition. For smaller groups, a simpler form of underwriting (like Moratorium) might apply, or a "full medical declaration" might be required upon joining.
2. Benefit Levels: Employer policies can range from basic inpatient-only cover to comprehensive plans that include extensive outpatient benefits, mental health support, therapies, and even international cover. The level of cover is determined by the employer based on their budget and what they wish to offer their workforce.
3. Cost Efficiency: Due to the pooled risk and larger number of policyholders, group schemes often secure better rates than individual policies for comparable levels of cover. This cost-effectiveness is a major draw for employers.
4. Automatic Inclusion: Employees (and often their eligible dependants) are typically added to the policy automatically or with minimal enrolment requirements, making access to cover straightforward.

Types of Employer PMI Schemes

• Fully Insured Schemes: The most common type, where the employer pays premiums to an insurer, and the insurer takes on the full risk of claims.
• Administrative Services Only (ASO) / Self-Funded Schemes: Larger employers might opt for this, where they fund the claims themselves but pay an insurer an administrative fee to manage the scheme (e.g., claims processing, network access). The financial risk lies with the employer, not the insurer.
• Healthcare Trusts: An independent trust is set up by the employer to hold funds and manage healthcare benefits. This offers greater flexibility and potential cost savings, especially for very large organisations.

Benefits of Employer PMI

• Faster Access to Treatment: Bypassing NHS waiting lists for specialist consultations, diagnostics, and elective surgeries.
• Choice of Specialist and Hospital: Often allowing you to choose where and by whom you are treated from a defined network.
• Comfort and Privacy: Access to private hospital rooms and facilities.
• Peace of Mind: Knowing you have options for your health needs.

Limitations of Employer PMI

• Lack of Control: The employer dictates the policy's terms, benefits, and chosen insurer. You have little to no say in the specifics.
• Tied to Employment: Your cover ceases if you leave the company or if the company decides to stop offering the benefit.
• Taxable Benefit: Employer-provided PMI is typically considered a "benefit in kind" and is subject to income tax.

Why Convert? Common Scenarios

The decision to convert your employer's private health insurance to an individual policy usually arises from significant life or employment changes. Understanding these triggers is crucial for timely action.

1. Leaving Employment

This is the most common reason for conversion. When you leave a job that provided PMI, your cover under the group scheme will terminate. This can happen due to:

• New Job Without Benefits: You've secured a new role, but it doesn't include private medical insurance, or the benefits offered are less comprehensive than what you're used to.
• Redundancy: Unfortunately, redundancy means the immediate loss of your employment benefits, including PMI.
• Retirement: Upon retirement, you lose access to your employer's group scheme. This is a particularly crucial time, as age significantly impacts individual health insurance premiums.
• Career Break or Starting Your Own Business: If you decide to take time out of the workforce or become self-employed, you'll need to arrange your own cover.

2. Changes in Employer Policy

Even if you remain employed, your company might make changes to its benefits package, prompting you to consider individual cover:

• Reduced Benefits: Your employer might downgrade the level of cover, for instance, removing outpatient benefits or reducing mental health support, making the existing policy less appealing.
• Increased Employee Contribution: Some employers may introduce or increase the employee's contribution towards the premium, making it less cost-effective than arranging your own policy.
• Removal of Dependant Cover: An employer might decide to only cover employees, no longer extending the benefit to spouses or children.

3. Dependants No Longer Covered

Children often "age out" of their parents' employer-provided scheme when they reach a certain age (e.g., 21 or 25, especially if no longer in full-time education). If your child still wishes to have private cover, they'll need their own policy. Similarly, a divorce or separation might mean one spouse is no longer covered by the other's employer policy.

4. Desire for More Control and Customisation

You might simply want more control over your health insurance, allowing you to tailor benefits, excesses, and hospital lists to your specific needs and budget, something often not possible with a group scheme.

The Critical Window: Timelines and Urgency

Acting quickly is paramount when converting your employer policy to individual cover. There's a specific, often narrow, window during which you can leverage your existing group underwriting terms, a process known as Continued Personal Medical Exclusions (CPME) or ‘continuity of cover’. Missing this window can have significant financial and coverage implications.

The Importance of Acting Quickly

Most insurers offer a limited timeframe – typically 30 or 60 days from the date your group cover ends – during which you can apply for a new individual policy and potentially benefit from CPME. Some insurers might extend this slightly, but it's not guaranteed.

Consequences of Delay

1. Loss of CPME: This is the most significant consequence. If you apply outside the specified window, you will almost certainly be subject to full medical underwriting (FMU) or moratorium underwriting for your new individual policy. This means any conditions that developed or became symptomatic during your time on the group scheme and were covered by it, could now be excluded from your new individual policy.
2. Higher Premiums: Delaying could mean that if your health deteriorates, subsequent applications might result in higher premiums or more exclusions under standard underwriting.
3. Gap in Cover: A delay creates a period where you have no private health insurance, leaving you reliant on the NHS or self-funding for any new medical issues.

What to Do Immediately

As soon as you know your employer cover is ending:

• Find out the exact end date of your cover.
• Identify your current insurer.
• Contact your current insurer to inquire about their "group leavers" or "conversion" options.
• Gather all relevant documentation: your current policy number, your policy start date with your employer, and any medical history documentation you have.

Remember, even if you don't intend to stay with your current insurer, understanding their conversion terms is a good starting point for comparison.

Key Considerations Before Converting

Before diving into quotes and applications, take a moment to assess your individual needs and understand the core aspects of private health insurance that will impact your new policy.

1. Your Health Status (Pre-existing Conditions are Key)

This is perhaps the single most critical factor. Private health insurance in the UK primarily covers acute conditions that arise after your policy begins and are not deemed pre-existing.

• Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and restore you to your previous state of health. Examples: broken bone, appendicitis, cataract removal.
• Chronic Condition: A disease, illness, or injury that has at least one of the following characteristics: it needs long-term management, has no known cure, is likely to come back, or needs rehabilitation. Examples: diabetes, asthma, epilepsy, certain types of arthritis.

Crucially, chronic conditions are generally NOT covered by private medical insurance. This applies to both employer and individual policies. The focus of PMI is on acute episodes or flare-ups of chronic conditions, but not the long-term management or medication associated with the chronic condition itself.

When converting, your current health status and any conditions you have, or have had, will significantly influence the underwriting of your new policy, particularly if you cannot secure CPME.

2. Coverage Needs vs. Budget

What level of cover do you actually need?

• Inpatient vs. Outpatient: Do you primarily need cover for hospital stays and surgeries (inpatient), or do you also want cover for specialist consultations, diagnostic tests (MRI, CT scans), and therapies that don't require an overnight stay (outpatient)? Outpatient cover adds significantly to the premium.
• Mental Health: Is mental health support important to you? Policies vary widely in the level of mental health cover offered.
• Therapies: Do you want cover for physiotherapy, osteopathy, or chiropractic treatment?
• Cancer Cover: While usually included, check the specifics of cancer care, including radiotherapy, chemotherapy, and palliative care.
• Hospital List: Insurers offer different hospital networks. A broader network, particularly including central London hospitals, will increase your premium. Choose a list that includes hospitals convenient to you.

3. Underwriting Methods: Moratorium, FMU, and CPME

The underwriting method applied to your new individual policy will determine how pre-existing conditions are treated. This is arguably the most complex and critical aspect of conversion.

• Moratorium Underwriting: This is the most common and often simplest underwriting method for individual policies. You don't need to declare your full medical history upfront. Instead, the insurer automatically excludes any medical condition (and related conditions) you've had symptoms of, sought advice or treatment for, or received medication for, in the 5 years before your policy starts. After your policy has been active for a continuous period (usually 2 years) without any symptoms, advice, or treatment for a specific condition, that condition may then become eligible for cover. However, the onus is on you to prove that the condition meets the moratorium criteria when you make a claim.
• Full Medical Underwriting (FMU): With FMU, you declare your complete medical history when you apply. The insurer reviews this and may request further information from your GP. They will then provide you with specific terms, which might include:
  • No exclusions (rare if you have any history).
  • Specific exclusions for certain conditions.
  • A higher premium to cover certain risks.
  • Postponement of cover for certain conditions. FMU offers more certainty about what is covered and excluded from day one, but it can be a more involved application process.
• Continued Personal Medical Exclusions (CPME): This is the most advantageous underwriting method for those converting from a group scheme. It allows you to carry over the underwriting terms you had from your group policy to your new individual policy.
  • The Benefit: If you were on a group scheme with Medical History Disregarded (MHD) underwriting, or if conditions developed during your time on the group scheme and were covered by it (because they were acute and met the group's policy terms), CPME aims to continue this coverage on your individual policy. It essentially means your medical history prior to joining the group scheme (or the inception of the group scheme) is largely ignored for new exclusions, provided the condition was covered by the group policy and remains acute.
  • The Nuance: CPME is designed to ensure continuity of coverage for conditions that were already covered under your employer's plan. It does not magically make currently active pre-existing conditions (that were not covered by the group policy, or if you were on a group moratorium scheme and they hadn't become coverable) suddenly insurable. If a condition was excluded under your employer's scheme, it will remain excluded under CPME. If a condition has become chronic, it will no longer be covered.
  • Availability: Not all insurers offer CPME, and those that do have strict time limits (typically 30-60 days from the end of group cover) for you to apply. You also typically need to be moving from a group scheme of a certain size or underwriting type (e.g., MHD).

Understanding these underwriting methods is crucial because they directly impact what medical conditions your new policy will cover.

Understanding Underwriting for Conversions

Let's delve deeper into the underwriting methods, especially CPME, as this is where most of the complexity and benefit of converting lies.

Moratorium Underwriting in Detail

• How it Works: When you apply, you answer basic health questions. The insurer then applies a "moratorium" period (usually two years) during which any condition you've had in the last five years is automatically excluded. If, after those two years, you haven't experienced any symptoms, sought advice, or received treatment for that specific condition, it may then become eligible for cover.
• Claiming: If you make a claim, the insurer will review your medical history (often requiring a GP report) to determine if the condition falls within the moratorium period. This "wait and see" approach can be a source of uncertainty for policyholders.
• Best For: Individuals with a relatively clean recent medical history, or those who are happy with the potential for conditions to become coverable after a waiting period. It's often quicker to set up than FMU.

Full Medical Underwriting (FMU) in Detail

• How it Works: You complete an extensive medical questionnaire, detailing all your past and present conditions, treatments, and medications. The insurer underwriter reviews this information. They may contact your GP for further details (with your consent). Based on this, they will offer terms.
• Outcome:
  • No exclusions: If your health history is very clear.
  • Specific exclusions: Common for past injuries, allergies, or stable conditions.
  • Premium loading: An increased premium to cover certain conditions that are seen as a higher risk.
  • Postponement: If you have an active condition or are undergoing investigations, cover for that condition might be postponed until it's stable.
• Best For: Individuals who want absolute clarity on what is covered and excluded from day one. It can be beneficial if you have a complex medical history and want to negotiate specific terms, or if you're concerned about the uncertainty of moratorium.

Continued Personal Medical Exclusions (CPME) in Detail

As highlighted, CPME is the gold standard for those converting from an employer scheme.

• The Core Principle: CPME aims to give you continuity of your underwriting status from your group scheme to your individual policy. It essentially allows the individual policy to take into account the duration you've been covered under a group scheme, and how conditions were treated under that scheme.
• When It's Most Powerful: This method is most beneficial if you were on a large group scheme with Medical History Disregarded (MHD) underwriting. Under MHD, your pre-existing conditions were typically covered from day one of the group policy (unless they were chronic). If you then develop an acute condition during your time on the group policy, CPME aims to ensure that this acute condition can continue to be covered under your new individual policy, provided it remains acute and within policy limits.
• Example Scenario: Imagine you join a company with MHD PMI. Five years later, you develop acute back pain, which is treated and covered by the employer policy. If you leave your job and secure a CPME conversion, that back pain (if it remains an acute issue) would likely still be covered on your individual policy, even though it's technically a "pre-existing" condition to your individual policy. If you went for Moratorium or FMU, that back pain might be excluded.
• Limitations:
  • Time Sensitive: Must apply within the strict window (typically 30 or 60 days).
  • Chronic Conditions: Still not covered. If the back pain from the example above became a chronic condition, it would cease to be covered by any PMI.
  • Excluded by Group: If a condition was already excluded by your group scheme (e.g., if the group scheme itself had exclusions for certain conditions, or if you joined on a group moratorium that hadn't cleared), it will remain excluded under CPME.
  • Insurer Specific: Not all insurers offer CPME, and their interpretation or criteria can vary. Some may require a minimum number of years on the group scheme.

Table: Comparison of Underwriting Methods for Conversions

Step-by-Step Guide to Converting Your Policy

Navigating the conversion process can seem daunting, but breaking it down into manageable steps makes it much clearer.

Step 1: Gather Information

Before doing anything else, compile all the relevant details about your current employer policy:

• Exact End Date of Your Group Cover: Crucial for the CPME window.
• Current Insurer Name and Policy Number: This will be needed for any enquiries.
• Level of Current Cover: Understand what your employer's policy currently covers (e.g., inpatient only, full outpatient, mental health, specific benefit limits, hospital lists). This helps you benchmark your needs for a new policy.
• Your Medical History: Even if you're hoping for CPME, have a good understanding of your health history, including any conditions you've had, treatments, and when they occurred. This will be vital for any underwriting method.

Step 2: Contact Your Current Insurer

Your first port of call should be your current employer's insurer. Many insurers have specific "group leavers" or "conversion" teams.

• Inquire about their individual policy options for those leaving a group scheme.
• Specifically ask about Continued Personal Medical Exclusions (CPME) and their eligibility criteria (e.g., how long you need to have been on the group scheme, the time limit for application).
• Obtain a quote for a comparable level of cover. This will give you a baseline.

Step 3: Explore Options with Other Insurers (Broking the Market)

While your current insurer might offer a conversion option, it might not be the best value or the most suitable policy for your needs. This is where a health insurance broker becomes invaluable.

• Market Comparison: A broker (like WeCovr) has access to policies from all major UK health insurance providers. We can compare quotes and benefits across the entire market, not just with your current insurer.
• Expert Guidance: We understand the nuances of underwriting, especially CPME. We can advise which insurers are most likely to offer CPME based on your specific group scheme and medical history.
• Tailored Advice: We help you assess your current cover and your individual needs, ensuring the new policy truly fits.

Step 4: Compare Quotes and Benefits

Once you have a few quotes (either from your current insurer or via a broker), compare them meticulously:

• Premium: The headline cost.
• Benefit Limits: Compare like-for-like. For example, is outpatient cover capped at the same amount? Are cancer care limits comparable?
• Hospital List: Does the hospital list include facilities convenient for you? Are there any restrictions?
• Excess: How much will you pay towards a claim before the insurer pays out? A higher excess reduces the premium.
• Underwriting Method: Crucially, understand which underwriting method each quote is based on (CPME, Moratorium, FMU) and what this means for your specific medical history.
• No-Claims Discount (NCD): Understand how NCD works and if it's transferable or if you start from scratch.

Step 5: Make an Informed Decision and Apply

Once you've compared everything and feel confident in your choice:

• Choose your preferred insurer and policy.
• Complete the application form accurately and honestly. It is paramount to declare all relevant medical information. Failure to do so could invalidate your policy later.
• Confirm the start date of your new individual policy to ensure there is no gap in cover from your employer's scheme ending.
• Cancel any direct debit or payment arrangements for your employer's scheme (if you were contributing).

Step 6: Ongoing Management

• Review Annually: Health insurance policies and your needs can change. Review your policy annually to ensure it still meets your requirements and budget.
• Keep Medical Records: Maintain records of your medical history and any claims, especially if you are on a moratorium policy.

What Happens to Pre-existing and Chronic Conditions?

This section is vital and often misunderstood. Let's be unequivocally clear: Private Medical Insurance (PMI) in the UK is primarily designed to cover acute conditions that develop after your policy has started and are not defined as pre-existing under the specific terms of your policy. It does not cover chronic conditions.

Acute vs. Chronic Conditions - Revisited

• Acute Condition: A new, sudden, or temporary illness or injury that is expected to respond to treatment and restore you to your prior state of health. Examples: an appendectomy, a broken arm, a cataract operation, or a new diagnosis of cancer requiring active treatment.
• Chronic Condition: A long-term condition that has no known cure, requires ongoing management (e.g., lifelong medication, regular monitoring), or is likely to recur. Examples: Asthma, diabetes, epilepsy, high blood pressure, some forms of arthritis, multiple sclerosis.

PMI explicitly excludes chronic conditions. While your employer's policy might have covered an acute flare-up of a chronic condition (e.g., an asthma attack requiring hospitalisation), it would not cover the ongoing management or medication for the asthma itself. This principle remains true for individual policies.

Pre-existing Conditions (PEC)

A pre-existing condition is generally defined as any disease, illness, or injury for which you have received medication, advice, or treatment, or experienced symptoms, prior to the start date of your policy.

How Different Underwriting Methods Handle PECs for Conversions:

1. Moratorium Underwriting:

   • Outcome: Any condition (and related conditions) for which you had symptoms, sought advice/treatment, or received medication in the 5 years before your individual policy starts will be automatically excluded.
   • Potential Coverage: It may become covered after a continuous 2-year period of no symptoms, advice, or treatment for that specific condition.
   • Impact on Conversion: If you delay and lose the CPME window, and you have recent medical history, this is likely what you'll face. Conditions that were covered by your employer's MHD scheme might now be excluded for at least two years.

2. Full Medical Underwriting (FMU):

   • Outcome: Based on your full medical disclosure, the insurer will make specific decisions:
     • They might place an exclusion on a specific pre-existing condition.
     • They might apply a premium loading if they consider the condition a higher risk but are willing to cover it.
     • They might postpone cover for a condition until it's stable.
   • Impact on Conversion: Provides clarity from day one. If a condition was already being managed on the NHS (e.g., you had a hip replacement and now need the other hip done, and it was a pre-existing issue when you joined the group policy and wasn't covered there), it will likely be excluded.

3. Continued Personal Medical Exclusions (CPME):

   • The Big Advantage for PECs: This is where CPME shines for conditions that developed during your time on the group scheme and were covered by it because they were acute and met the group's policy terms (e.g., under a Medical History Disregarded group scheme).
   • Outcome: CPME aims to continue the underwriting terms you had with your employer's group policy.
     • If an acute condition developed while you were on the group scheme, and was covered by it, CPME generally allows this condition to continue to be covered on your individual policy, provided it remains acute and falls within the new policy's limits. This means your medical history prior to joining the group scheme is generally not re-evaluated for new exclusions.
     • If a condition was already excluded from your group scheme (e.g., a pre-existing chronic condition that was never covered), it will remain excluded under CPME.
     • If a condition became chronic during your time on the group scheme, it will not be covered under CPME, as PMI does not cover chronic conditions.
   • Impact on Conversion: This is the ideal scenario for anyone with an acute health issue that arose and was covered during their group scheme tenure, as it prevents those conditions from becoming new exclusions on an individual policy.

In summary: If you have active pre-existing conditions, particularly chronic ones, they are highly unlikely to be covered by a new individual PMI policy. CPME offers the best chance to maintain cover for acute conditions that were already being covered by your employer's scheme. Always be honest and transparent about your medical history during the application process to avoid future claims being rejected.

Cost Implications of Individual Private Health Insurance

Moving from a subsidised or fully-paid employer policy to an individual one will almost certainly mean higher premiums. Understanding the factors that influence these costs can help you manage your budget.

Factors Influencing Premiums

How to Manage Costs

1. Adjust Your Excess: Opting for a higher excess (e.g., £500 or £1,000) can significantly reduce your annual premium. Just ensure you can comfortably afford to pay it if you need to make a claim.
2. Select a Restricted Hospital List: If you don't need access to central London hospitals or a nationwide network, choosing a regional or smaller hospital list can save money.
3. Consider an Inpatient-Only Policy: While less comprehensive, if your primary concern is covering serious surgeries or hospital stays, an inpatient-only policy is considerably cheaper than one with extensive outpatient benefits.
4. Limit Outpatient Cover: If you want some outpatient cover, you can choose a policy with a lower annual limit for consultations and diagnostics, rather than unlimited cover.
5. Exclude Specific Benefits: If certain benefits (e.g., psychiatric cover, complementary therapies) are not essential to you, some insurers allow you to exclude them for a premium reduction.
6. Maintain Good Health: While not always controllable, a healthier lifestyle can potentially lead to fewer claims over the long term, helping you build a higher No-Claims Discount.
7. Review Annually with a Broker: Premiums often increase at renewal. We can review your policy each year, compare it against the market, and advise if switching insurers (even if it means potentially restarting NCD) could save you money without compromising on essential cover.

Comparing Insurers: What to Look For

Once you understand your needs and the cost factors, it's time to compare specific policies. Beyond the premium, several crucial elements differentiate one insurer and policy from another.

1. Network of Hospitals and Facilities

• Choice: Does the insurer offer a hospital list that includes facilities convenient for you, both near home and work?
• Access: Are there specific restrictions on which consultants or hospitals you can use within their network? Some policies have "guided care" where the insurer directs you to specific providers.

2. Benefit Limits and Specific Coverage

• Overall Annual Limits: Is there an overall cap on claims per year?
• Outpatient Limits: Is there a separate limit for consultations, diagnostics (MRI, CT scans), and pathology tests? Is it per condition or per year?
• Therapies: What are the limits for physiotherapy, osteopathy, chiropractic, etc.? Is it per session, per condition, or an overall annual limit?
• Mental Health: What level of inpatient and outpatient mental health support is included? Are there limits on the number of sessions or monetary value?
• Cancer Cover: While most policies cover cancer, check the specifics: is it comprehensive (radiotherapy, chemotherapy, biological therapies, palliative care)? Are there limits on new drug treatments?
• Dental/Optical: Rarely included comprehensively, but some policies offer a small cash benefit for routine check-ups.
• Travel Cover: Some policies offer emergency medical cover abroad, but this is usually basic and not a replacement for dedicated travel insurance.

3. Excess Options

• Review the range of excesses offered and how they impact the premium. Choose an excess you are comfortable paying.

4. No-Claims Discount (NCD) Structure

• How many NCD levels are there? How quickly can you build up a high NCD? What happens if you make a claim – how many levels do you drop? Some insurers offer protected NCDs for an extra premium.

5. Customer Service and Claims Process

• Reputation: Research the insurer's reputation for customer service and claims handling. Online reviews and independent ratings can be helpful.
• Ease of Claiming: Is the claims process straightforward? Can you submit claims online or via an app?
• Direct Settlement: Does the insurer typically settle directly with the hospital or consultant, or do you have to pay first and then claim back?

6. Additional Benefits (Value-Added Services)

Many insurers now offer extra perks that can add value:

• Digital GP Services: Access to virtual GP appointments, often 24/7.
• Health and Wellbeing Apps: Tools for fitness, mental health, and healthy living.
• Discounts: Partnerships for gym memberships, health screenings, or travel.
• Second Medical Opinion Service: Access to an independent second opinion on a diagnosis or treatment plan.

The Role of a Health Insurance Broker (like WeCovr)

Navigating the complexities of private health insurance, especially when converting from an employer scheme, can be overwhelming. This is where the expertise of a health insurance broker becomes invaluable.

Why Use a Broker?

1. Whole-of-Market Access: A good broker (like WeCovr) isn't tied to a single insurer. We have access to policies from all the leading UK private medical insurance providers. This means we can compare options objectively, ensuring you get the best cover for your needs and budget. Trying to do this yourself would involve hours of research and individual applications with each insurer.
2. Expert Knowledge of Underwriting: This is particularly crucial for conversions. We understand the nuances of CPME, Moratorium, and Full Medical Underwriting. We can advise which insurers are most likely to offer CPME based on your specific group scheme's history and your medical profile. We know the subtle differences in how insurers apply these rules, which can make a significant difference to what's covered.
3. Tailored Advice, Not Just Quotes: We don't just provide quotes; we take the time to understand your individual health needs, your budget, and what you valued most from your employer's scheme. We then translate this into a policy recommendation that truly fits.
4. Simplifying Complexity: We break down complex policy jargon, explain the small print, and highlight what's truly important for your situation.
5. Saving You Time and Effort: We handle the legwork – gathering quotes, comparing policies, and often assisting with the application process itself. This saves you significant time and stress.
6. Advocacy and Support: If you have questions about your policy, need to make a claim, or have issues at renewal, we are there to provide ongoing support and act as your advocate with the insurer.
7. No Direct Cost to You: Critically, using a broker like WeCovr typically comes at no direct cost to you. We are paid a commission by the insurer once a policy is taken out, and this commission is already factored into the premium regardless of whether you use a broker or go direct. You pay the same premium, but gain expert guidance and support.

We pride ourselves on offering independent, unbiased advice, helping thousands of clients every year secure the right health insurance. Our goal is to empower you to make informed decisions about your health coverage, ensuring you don't lose out on valuable benefits during your transition.

Common Pitfalls and How to Avoid Them

Even with the best intentions, it's easy to fall into common traps during the conversion process. Being aware of these can help you avoid costly mistakes.

1. Delaying Action

• Pitfall: Waiting until the last minute, or even after your employer cover has ceased, to start exploring individual options.
• Consequence: You'll almost certainly miss the critical 30-60 day window for CPME, forcing you onto less favourable underwriting terms (Moratorium or FMU), potentially excluding conditions that were previously covered. You also risk a gap in cover.
• How to Avoid: As soon as you know your employer cover is ending, or you're considering a change, start the research and application process immediately. Even if your exact end date isn't set, get preliminary information.

2. Not Understanding Underwriting

• Pitfall: Assuming all individual policies are the same or not fully grasping the implications of Moratorium vs. FMU vs. CPME for your specific medical history.
• Consequence: You might end up with a policy that excludes conditions you thought were covered, or you pay too much for a policy that doesn't meet your needs.
• How to Avoid: Educate yourself on the different underwriting methods. If in doubt, consult a broker who can explain how each method applies to your unique situation and potential claims.

3. Under-insuring or Over-insuring

• Pitfall: Buying the cheapest policy without considering adequate benefits (under-insuring) or paying for benefits you'll never use (over-insuring).
• Consequence: Under-insuring leaves you exposed to high out-of-pocket costs if you need treatment not covered. Over-insuring means wasted money on unnecessary premiums.
• How to Avoid: Honestly assess your likely needs. Do you need extensive outpatient cover, or is inpatient-only sufficient? Balance comprehensive cover with your budget.

4. Not Disclosing Full Medical History (FMU)

• Pitfall: Intentionally or unintentionally omitting parts of your medical history when applying for FMU, or when answering questions for Moratorium.
• Consequence: This is a serious risk. If an insurer later discovers you withheld material information, they can refuse to pay claims or even void your policy entirely, leaving you with no cover and potentially responsible for all costs.
• How to Avoid: Always be completely honest and transparent. If you're unsure whether to disclose something, disclose it anyway. It's better to be safe than sorry.

5. Assuming Automatic Continuation

• Pitfall: Believing your employer's insurer will automatically roll your cover over to an individual policy, or that your CPME is guaranteed without application.
• Consequence: You'll find yourself without cover, possibly after the CPME window has closed, and facing new underwriting terms.
• How to Avoid: Proactively contact your employer's insurer and/or a broker. Understand that any conversion is a new application process that you must actively manage.

6. Focusing Only on Premium

• Pitfall: Making a decision solely based on the lowest premium without comparing benefits, excesses, hospital lists, or the small print.
• Consequence: A cheaper policy might have significantly higher excesses, limited benefits, or a very restricted hospital list, making it less useful when you need it most.
• How to Avoid: Look at the overall value. A slightly higher premium for better benefits or more favourable underwriting might be a more cost-effective long-term solution.

Case Studies/Real-Life Examples

To illustrate the importance of these considerations, let's look at a few hypothetical scenarios.

Case Study 1: The Proactive Professional (Successful CPME Conversion)

• Scenario: Sarah, 45, worked for a large corporation with a comprehensive "Medical History Disregarded" (MHD) group PMI scheme for 10 years. During her employment, she had an acute appendectomy, fully covered by her employer's policy. She decided to take a career break.
• Action: Two months before her last day, Sarah contacted her employer's insurer and also an independent broker. She explicitly asked about CPME options. Within 3 weeks of leaving her job, she applied for an individual policy.
• Outcome: Both her existing insurer and a competing insurer (via the broker) offered her a new individual policy under CPME. Her acute appendectomy from 5 years prior was deemed covered, as it was under her employer's MHD scheme and remained an acute condition. She secured comprehensive cover, albeit at a higher individual premium, but with continuity for her past condition.

Case Study 2: The Delayed Decision (Moratorium Imposed)

• Scenario: Mark, 50, was made redundant from his role, which provided group PMI for 7 years. During his employment, he had an acute knee injury that required surgery and physio, all covered by the group policy. He was stressed by the redundancy and put off thinking about health insurance for 3 months.
• Action: When he finally started looking, he contacted his old insurer, but the 60-day CPME window had passed. He then tried another insurer via a broker.
• Outcome: Mark could only apply for a new individual policy under Moratorium underwriting. His past knee injury, although fully recovered, was technically within the 5-year moratorium look-back period. It was now an excluded condition for the first 2 years of his new policy, meaning if he had any new issues with that knee in that period, it wouldn't be covered. He regretted the delay.

Case Study 3: The Chronic Condition Reality (Exclusion Maintained)

• Scenario: Emily, 55, had employer PMI for 15 years. Before joining the company, she had been diagnosed with Type 2 Diabetes, a chronic condition. While her employer's MHD policy did cover acute complications related to diabetes (e.g., an infection needing hospitalisation), it never covered the ongoing management or medication for the diabetes itself. She retired.
• Action: Emily diligently applied for a CPME conversion within the 30-day window.
• Outcome: While her new individual policy was successfully set up under CPME, her diabetes remained explicitly excluded. This was consistent with how it was treated under her employer's policy (PMI doesn't cover chronic conditions) and the general principles of PMI. Emily understood this limitation and continued to manage her diabetes through the NHS, valuing her private policy for acute needs.

These examples underscore the importance of timing, understanding underwriting, and having realistic expectations about what PMI covers.

Frequently Asked Questions (FAQs)

Q1: Can I keep my existing insurer when converting?

Yes, usually. Most major insurers offer a "group leavers" option to convert to an individual policy. However, it's always advisable to compare their offer with other insurers (ideally via a broker like WeCovr) to ensure you're getting the best value and most suitable cover.

Q2: Will my premium be higher than what my employer paid?

Almost certainly, yes. Group schemes benefit from pooled risk and often a large member base, leading to more favourable rates. Individual policies are priced based on your personal risk factors (age, postcode, medical history, chosen benefits), and you'll be paying the full premium yourself, which can be significantly higher.

Q3: What if I have pre-existing conditions?

As discussed extensively, pre-existing conditions are a key consideration.

• If you apply within the CPME window, and the condition was acute and covered by your employer's group policy (especially MHD schemes), it may continue to be covered.
• If you miss the CPME window, or the condition was not covered by the group policy, it will likely be excluded under a new Moratorium or FMU policy.
• Chronic conditions are generally not covered by any private medical insurance.

Honesty in your application is paramount, regardless of the underwriting method.

Q4: How long does the conversion process take?

The application process itself can be relatively quick, sometimes completed within a few days or weeks, especially if you use a broker. However, the critical window to apply for CPME is typically 30 to 60 days from your employer cover end date. Do not delay.

Q5: Can my family be included in the new individual policy?

Yes. You can usually include your spouse, partner, and dependent children on your new individual policy. Each family member's age and medical history will be factored into the overall premium and underwriting. Be aware that adding family members will significantly increase the total premium.

Q6: Do I lose my No-Claims Discount (NCD) from my employer's policy?

Group policies typically don't have individual NCDs. When you convert to an individual policy, you will usually start at the lowest NCD level (e.g., 0% or 10%). Some insurers may offer a small introductory bonus, but you generally build your NCD from scratch on an individual policy.

Conclusion: Empowering Your Health Journey

Converting your employer-provided private health insurance to an individual policy is a significant step, and one that demands careful planning and understanding. While the prospect of higher premiums and new underwriting terms might seem daunting, taking proactive steps can ensure a seamless transition and continuity of crucial health coverage.

Remember the critical window for CPME, the nuanced implications of your medical history, and the various factors that influence costs and benefits. By gathering information, comparing options diligently, and leveraging expert advice from a health insurance broker like WeCovr, you can secure a policy that provides peace of mind and access to quality private healthcare tailored to your individual needs. Your health is your most valuable asset; protect it wisely.