TL;DR
Choosing a private medical insurance (PMI) policy in the UK can feel complex, but understanding one key step—underwriting—makes it much clearer. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, we believe in empowering you with knowledge. This guide demystifies the underwriting process.
Key takeaways
- What is covered: Specifically, whether conditions you've had in the past will be eligible for treatment.
- Your policy exclusions: These are the specific conditions or treatments your policy will not pay for.
- Your premiums: In some cases, your medical history can influence the price you pay.
- An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, or a broken bone requiring surgery.
- A chronic condition is a long-term health issue that cannot be cured, only managed. Examples include diabetes, asthma, high blood pressure, and arthritis.
Choosing a private medical insurance (PMI) policy in the UK can feel complex, but understanding one key step—underwriting—makes it much clearer. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, we believe in empowering you with knowledge. This guide demystifies the underwriting process.
Detailed guide on Moratorium, Full Medical Underwriting, CPME, and how each influences cover for pre-existing conditions in 2025
Navigating the world of private health cover can feel like learning a new language. Terms like "moratorium," "exclusions," and "underwriting" are thrown around, but what do they actually mean for you and your family's health?
The single most important factor determining what your policy will and won't cover is its underwriting type. Underwriting is simply the method an insurer uses to assess your medical history and decide the terms of your cover. It’s the gatekeeper that determines how pre-existing conditions are handled.
This guide will walk you through everything you need to know, in plain English, so you can make an informed decision for 2025 and beyond.
What is Underwriting in Private Medical Insurance?
Think of underwriting as a health interview for your insurance policy. It's the insurer's process of reviewing your health and medical background to understand the level of risk they are taking on by insuring you.
The outcome of this process directly impacts:
- What is covered: Specifically, whether conditions you've had in the past will be eligible for treatment.
- Your policy exclusions: These are the specific conditions or treatments your policy will not pay for.
- Your premiums: In some cases, your medical history can influence the price you pay.
The Golden Rule of UK PMI: Acute vs. Chronic Conditions
Before we dive into the types of underwriting, it's vital to understand a fundamental principle of all standard UK private medical insurance policies.
PMI is designed to cover acute conditions that arise after you take out your policy.
- An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, or a broken bone requiring surgery.
- A chronic condition is a long-term health issue that cannot be cured, only managed. Examples include diabetes, asthma, high blood pressure, and arthritis.
Standard PMI policies do not cover the routine management, check-ups, or medication for chronic conditions. They are designed for short-term, curative treatment to get you back to your previous state of health.
Understanding this distinction is the first step to having realistic expectations of what your private health cover can do for you.
The Two Main Types of Underwriting: A Clear Comparison
For most individuals buying a new policy, the choice will come down to two main underwriting methods: Moratorium and Full Medical Underwriting.
| Feature | Moratorium (MORI) | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple. No medical forms. | Detailed medical questionnaire required. |
| Pre-existing Conditions | Automatically excluded for a set period (usually 5 years). | Declared upfront and assessed by the insurer. |
| Clarity of Cover | Less certainty at the start. Exclusions are not specified. | Full clarity. Exclusions are listed in your policy documents. |
| Claims Process | Can be slower, as medical history is checked at the point of claim. | Generally faster, as underwriting is already complete. |
| Potential for Cover | Pre-existing conditions may become eligible after a 2-year symptom-free period. | Exclusions are typically permanent, but you know this from day one. |
| Best For | Healthy individuals wanting a fast application process. | Those who want absolute certainty about what is and isn't covered. |
Let's explore each of these in more detail.
Moratorium Underwriting (MORI): The "Wait and See" Approach
Moratorium underwriting is the most common type for individual PMI policies in the UK because it's fast and straightforward.
How does it work? With a moratorium policy, you don't fill out any medical questionnaires. Instead, the insurer applies a simple rule: any medical condition for which you have had symptoms, treatment, medication, or advice in the five years before your policy start date is automatically excluded from cover.
However, these exclusions aren't necessarily permanent. They are subject to a "rolling moratorium" period, which typically works like this:
- The Exclusion: Your pre-existing condition from the last 5 years is not covered.
- The Observation Period: You must then complete two continuous years on the policy.
- The Condition: During these two years, you must not experience any symptoms, seek medical advice, or receive any treatment or medication for that specific pre-existing condition.
- The Outcome: If you successfully meet this 2-year requirement, the condition may become eligible for cover in the future.
Example:
- Sophie had physiotherapy for shoulder pain 18 months before buying a moratorium PMI policy.
- Her shoulder pain is automatically excluded from the start.
- For the first two years of her policy, she has no symptoms, consultations, or treatment for her shoulder.
- In her third year of cover, she develops a new shoulder problem. When she makes a claim, the insurer will investigate. If they determine it is related to her original issue, it will now likely be covered because she passed the 2-year symptom-free period.
Pros of Moratorium Underwriting:
- Speed and Simplicity: The application can be completed in minutes.
- Less Intrusive: No need to recall and disclose your entire medical history.
- Potential Future Cover: It offers a pathway for pre-existing conditions to eventually be covered.
Cons of Moratorium Underwriting:
- Lack of Certainty: You don't have a clear list of what's excluded. This ambiguity is only resolved when you need to make a claim.
- Slower Claims: The insurer will need to investigate your medical history at the point of claim to determine if the issue is new or pre-existing, which can delay authorisation for treatment.
Full Medical Underwriting (FMU): The "Full Disclosure" Approach
Full Medical Underwriting is the opposite of a moratorium. It's a more detailed process that provides complete transparency from the very beginning.
How does it work? With FMU, you complete a comprehensive application form, answering specific questions about your medical history and that of your family. You must disclose all previous conditions, treatments, and consultations.
The insurer's underwriters then review this information and make a decision. They will either:
- Accept your application with no special exclusions.
- Accept your application but add specific personal medical exclusions to your policy. These will be clearly written on your policy certificate.
Example:
- John has a history of gout and declares it on his FMU application.
- The insurer assesses his application and issues his policy with a specific exclusion: "No cover will be provided for treatment, tests, or consultations relating to gout."
- John now knows with 100% certainty that his PMI will not cover his gout. However, he also knows that any new, unrelated acute condition (like a need for a hip replacement) will be covered according to his policy terms.
Pros of Full Medical Underwriting:
- Absolute Clarity: You know exactly what is and isn't covered from day one. There are no grey areas.
- Faster Claims Process: Since the underwriting is done upfront, the insurer already knows what's excluded. This means claims for eligible conditions are often processed more quickly.
- Peace of Mind: Many people prefer the certainty that FMU provides, especially if they have a known medical history.
Cons of Full Medical Underwriting:
- Lengthy Application: The questionnaire can be long and requires you to remember details from your past.
- Permanent Exclusions: The exclusions applied are usually for the life of the policy and are rarely reviewed.
- Potentially More Exclusions: If you have a varied medical history, you may end up with a longer list of exclusions compared to the blanket approach of a moratorium.
Switching Insurers? The Vital Role of CPME Underwriting
What if you already have a PMI policy and want to shop around for a better price or improved benefits? This is where a third type of underwriting becomes crucial.
Continued Personal Medical Exclusions (CPME) Underwriting
CPME underwriting is specifically designed for people switching from one PMI provider to another without a gap in cover. It is one of the most valuable but often overlooked options in the market.
How does it work? CPME allows you to carry your original underwriting terms over to your new insurer. This means:
- Any exclusions on your old policy will also be on your new policy.
- Crucially, any new conditions that developed and were covered under your old policy will continue to be covered by your new one. You don't have to start a new moratorium period.
Example:
- Priya has held a PMI policy with Insurer A for six years.
- Three years ago, she developed a heart arrhythmia, which was diagnosed and treated under her policy (as it was a new acute condition).
- She now finds a cheaper policy with better hospital access from Insurer B.
- By switching on a CPME basis, Insurer B agrees to continue covering her heart arrhythmia, just as Insurer A did. She avoids a new moratorium period where her heart condition would have been excluded for another two years.
Why is CPME so important? Without CPME, switching insurers would mean starting from scratch with either Moratorium or FMU underwriting. Any condition you were treated for under your old policy would now be considered "pre-existing" and would be excluded by your new provider. CPME protects your continuity of cover.
An expert PMI broker like WeCovr is invaluable here. We can compare the market and manage the CPME switch for you, ensuring your hard-earned cover is not lost.
How Your Choice of Underwriting Affects Your Premiums in 2025
The link between underwriting and price is not always direct but is important to understand.
- Moratorium Premiums: These are generally based on factors like your age, location, and the level of cover you choose (e.g., your excess, hospital list). The price is not personalised to your health history at the start because the insurer hasn't assessed it.
- Full Medical Underwriting Premiums: Because the insurer has a complete picture of your health, they can price the policy more precisely. In some cases, if you have a number of exclusions applied, your premium might be slightly lower than a moratorium equivalent, as the insurer's potential liability is reduced. Conversely, some conditions may attract a premium loading (a higher price), although this is less common than an outright exclusion.
The UK PMI market is competitive. With NHS waiting lists in England remaining stubbornly high—with millions of treatment pathways waiting to be completed according to the latest NHS data—more people are looking to private options. Insurers are constantly adjusting prices and benefits to attract customers. This is why using a broker to compare the whole market is the most effective way to secure the best value.
Proactive Steps for Better Health & Well-being
While insurance is there for when things go wrong, taking proactive steps for your health can improve your quality of life and potentially reduce your need to claim. Many insurers now actively support and reward healthy living.
Here are a few tips endorsed by health authorities like the NHS:
- A Balanced Diet: Focus on a diet rich in fruits, vegetables, lean proteins, and whole grains. Reducing your intake of processed foods, sugar, and saturated fats is one of the best things you can do for your long-term health. As a WeCovr client, you get complimentary access to our AI-powered nutrition app, CalorieHero, to help you track your diet and make healthier choices.
- Regular Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or tennis) per week.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Good sleep is essential for mental and physical recovery, immune function, and cognitive performance.
- Manage Stress: Chronic stress can negatively impact your health. Techniques like mindfulness, yoga, or simply spending time in nature can make a huge difference.
By investing in your well-being, you not only feel better day-to-day but also partner with your health insurance to create a holistic approach to your health.
Furthermore, at WeCovr, we believe in rewarding our customers. When you purchase a Private Medical Insurance or Life Insurance policy through us, you can unlock exclusive discounts on other types of cover, such as home or travel insurance, adding even more value.
Expert Tips for a Smooth PMI Application
- Always Be Honest: The most important rule is to be truthful on your application. Deliberately withholding medical information (known as 'non-disclosure') can lead to your claim being rejected and your policy being cancelled.
- Review Your History: If choosing Full Medical Underwriting, take some time to think about any doctor's visits, symptoms, or treatments you've had in the last five years.
- Understand the Wording: Pay close attention to how "advice" is defined. A casual mention of a symptom to a GP, even if no treatment was given, can count as a "consultation" for underwriting purposes.
- Don't Go It Alone: The world of PMI underwriting is nuanced. A specialist broker can be your greatest asset. The team at WeCovr has helped thousands of UK customers navigate this process. Our advice is independent, and our service comes at no cost to you. We work for you, not the insurer. Our high customer satisfaction ratings reflect our commitment to finding the right policy for each client's unique needs.
Do I need to declare mental health conditions on a PMI application?
What happens if I forget to mention a condition on a Full Medical Underwriting application?
Is private medical insurance worth it if I have several pre-existing conditions?
Can a moratorium exclusion ever be removed?
Ready to Find Your Perfect Policy?
Choosing the right underwriting path is the most critical decision in your PMI journey. It dictates the very foundation of your cover and your peace of mind. While this guide gives you the knowledge, applying it to your personal situation is the next step.
Let the experts at WeCovr help. Our specialist advisors provide free, no-obligation advice tailored to your needs. We'll compare leading UK providers and underwriting options to find the perfect balance of cover and cost for you.
Contact WeCovr today for your free, personalised health insurance quote and let us make the complex simple.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.
