Navigating the world of private medical insurance (PMI) in the UK can feel complex, but understanding one key concept—medical underwriting—is the first step to clarity. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr simplifies this process, ensuring you find the perfect cover.
Technical guide to underwriting options, advantages of each approach, how medical history affects coverage, and strategic selection based on health status
Choosing a private health insurance policy is one of the most significant decisions you can make for your and your family's wellbeing. With NHS waiting lists in England remaining a concern—with over 7.5 million treatment pathways incomplete as of early 2025 according to NHS England data—more people than ever are exploring the speed and choice offered by the private sector.
At the heart of any PMI application is the process of medical underwriting. This guide will demystify the two primary methods used by UK insurers: Moratorium and Full Medical Underwriting (FMU). We will explore what they are, how they differ, and most importantly, how to choose the right one for your personal circumstances.
What is Medical Underwriting for Private Health Insurance?
In simple terms, medical underwriting is the process an insurance company uses to understand your medical history and assess the level of risk they are taking on by insuring you. It helps them decide what they can and cannot cover.
It is absolutely vital to understand a fundamental principle of the UK private health insurance market from the outset:
Standard private medical insurance is designed to cover new, acute conditions that arise after your policy begins. It does not cover pre-existing conditions or chronic conditions.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery (e.g., a broken arm, appendicitis, or a cataract removal).
- Chronic Condition: An illness that is long-lasting or recurring, which cannot be cured but can be managed (e.g., diabetes, asthma, arthritis, or high blood pressure). PMI will not cover the ongoing management of these conditions.
Underwriting is the mechanism insurers use to identify these pre-existing and chronic conditions to exclude them from your cover.
The Two Main Types of Underwriting: A Head-to-Head Comparison
UK insurers primarily offer two paths for underwriting your policy. Let's compare them side-by-side before diving into the details of each.
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|
| Application Process | Quick and simple. No medical questionnaire. | Detailed medical questionnaire. May require GP report. |
| Speed of Cover | Almost instant. Cover can start the same day. | Slower. Can take several weeks to get a decision. |
| Privacy | Less intrusive. No need to disclose history upfront. | More intrusive. Requires full disclosure of your medical past. |
| Clarity of Cover | Potential ambiguity. Exclusions are decided at the point of claim. | Complete clarity. You know exactly what is excluded from day one. |
| Pre-existing Conditions | Automatically excluded for a set period (usually 2 years). Can become eligible for cover later if you remain symptom-free. | Explicitly excluded from the start, usually permanently. |
| Claims Process | Can be slower, as the insurer investigates your history at the time of the claim. | Generally faster and smoother, as underwriting is already complete. |
| Best For... | People who are generally healthy, have no recent medical issues, and prioritise a quick start. | People with a complex medical history who want absolute certainty about their cover from the outset. |
Deep Dive: Moratorium Underwriting Explained
Moratorium underwriting is the most common type offered in the UK, favoured for its speed and simplicity. It's often called the "wait and see" approach.
How Does a Moratorium Work?
With a moratorium policy, you don't fill out a medical questionnaire. Instead, the insurer applies a blanket exclusion for any medical conditions for which you have experienced symptoms, received medication, or sought advice for in a set period before your policy started (typically the last 5 years).
This exclusion isn't necessarily permanent. The "moratorium period" comes into play, which is usually two years.
Here’s the key rule: If you go for two continuous years after your policy starts without having any symptoms, treatment, medication, or advice for that pre-existing condition, it may become eligible for cover under your policy.
Example: Sarah's Knee Pain
- Before PMI: In 2024, Sarah visited her GP for occasional knee pain. She was advised to take ibuprofen and rest it.
- Starts PMI: In January 2025, Sarah takes out a policy with moratorium underwriting. Her knee condition from 2024 is automatically considered pre-existing and is not covered.
- The Moratorium Period: Sarah's knee feels fine. She doesn't see a doctor, take any medication, or have any symptoms related to her knee for two full years.
- After Two Years: In February 2027, she starts experiencing severe knee pain again. Because she has passed the two-year clear period, she can now make a claim. The insurer will likely cover the investigation and treatment for this new flare-up.
However, if her knee had troubled her at any point during 2025 or 2026, the two-year "clock" would have reset.
Advantages of Moratorium Underwriting
- Fast and Simple: You can often get cover in place on the same day you apply.
- Less Intrusive: You don't have to dig through your medical records or try to remember every single doctor's visit from the past five years.
- Potential for Cover: It offers a pathway for past conditions to become covered in the future, which is not usually possible with FMU.
Disadvantages of Moratorium Underwriting
- Uncertainty at Claim Time: You only discover for sure if a condition is covered when you need to make a claim. This can lead to stress and disappointment if the claim is denied.
- Slower Claims Process: When you claim, the insurer will investigate your medical history to see if the condition is pre-existing. This can delay your access to treatment.
- The "Rolling" Nature: Any symptom or piece of advice, no matter how minor, can reset the two-year waiting period for that condition.
Deep Dive: Full Medical Underwriting (FMU) Explained
Full Medical Underwriting is the traditional, more detailed approach. Think of it as laying all your cards on the table before the policy begins.
How Does FMU Work?
When you apply for an FMU policy, you must complete a comprehensive questionnaire about your medical history and that of your family. You will be asked about:
- Past illnesses and injuries
- Surgeries you have had
- Medications you have taken
- Any symptoms you have sought advice for
Based on your answers, the insurer's underwriting team will review your application. They may also ask for your permission to obtain a report from your GP for more detail.
They will then issue their terms with specific, named exclusions on your policy certificate. For example, it might state, "No cover for any conditions related to the right knee" or "No cover for investigation or treatment of acid reflux."
Example: David's Past Back Injury
- Before PMI: David suffered a slipped disc in 2023, which was resolved with physiotherapy.
- Starts PMI: In 2025, David applies for a policy with Full Medical Underwriting. He declares the slipped disc on his application form.
- Underwriting Decision: The insurer reviews his history. They issue a policy with a clear, written exclusion: "No cover will be provided for any conditions relating to the lumbar spine."
- Certainty: David knows from day one that any future back problems will not be covered. However, if he develops an unrelated condition, like a hernia, he can claim with confidence, knowing the process will be straightforward as his back history is already accounted for.
Advantages of Full Medical Underwriting
- Complete Clarity: You know precisely what is and isn't covered from the moment your policy starts. There are no surprises at the point of a claim.
- Faster Claims: Because the underwriting work is done upfront, the claims process is generally much quicker and smoother. The insurer doesn't need to investigate your past history when you claim.
- Potentially Better Terms: In some cases, an underwriter might review a minor, historic condition and decide not to apply an exclusion, giving you better cover than you might have had under a moratorium policy.
Disadvantages of Full Medical Underwriting
- Slower Application Process: It can take several weeks to get your policy documents, especially if the insurer needs a report from your GP.
- More Intrusive: You have to provide detailed and sometimes sensitive personal medical information.
- Permanent Exclusions: The exclusions applied are typically permanent and will not be reviewed in the future.
Strategic Selection: Which Underwriting Type is Right for You?
The best choice depends entirely on your personal health profile, your attitude to risk, and your priorities.
You Should Consider MORATORIUM Underwriting If...
- You are in good health with no significant medical history in the last five years.
- You haven't seen a doctor or received treatment for anything other than minor, short-lived ailments (like a common cold).
- Your priority is getting cover in place as quickly as possible.
- You are comfortable with a degree of ambiguity in exchange for a simpler application process.
You Should Consider FULL MEDICAL UNDERWRITING (FMU) If...
- You have a history of medical conditions, even if they were resolved some time ago.
- You want absolute certainty and peace of mind about what your policy will pay for.
- You prioritise a smooth and fast claims process over a fast application process.
- You are concerned that a moratorium policy might lead to a claim being unexpectedly rejected.
An expert PMI broker is invaluable at this stage. At WeCovr, we help thousands of people navigate this exact choice. By discussing your health and preferences with you, we can recommend the underwriting type and insurer that best fits your needs, all at no cost to you.
| Your Situation | Recommended Underwriting Type | Why? |
|---|
| Young, fit, and healthy | Moratorium | Quick, easy, and you're unlikely to have pre-existing conditions that cause issues. |
| Had a sports injury 3 years ago | Full Medical Underwriting | Provides clarity on whether the joint/injury will be excluded. You avoid a nasty surprise later. |
| Anxious about paperwork and forms | Moratorium | The application is significantly simpler and less demanding. |
| Want total peace of mind | Full Medical Underwriting | Certainty is the main benefit. You know exactly where you stand from day one. |
| Switching from another provider | Continued Personal Medical Exclusions (CPME) | A special type of underwriting that allows you to carry your existing cover terms to a new insurer. Ask a broker about this. |
How Your Health History Directly Affects Your Cover
Regardless of the underwriting type, your past health is the single biggest factor in determining your coverage. Insurers are particularly interested in conditions that have the potential to recur or require future treatment.
Common areas that lead to exclusions include:
- Musculoskeletal issues: Back pain, joint problems, sports injuries.
- Cardiovascular conditions: High blood pressure, high cholesterol, heart murmurs.
- Mental health: History of anxiety, depression, or stress.
- Gastrointestinal problems: IBS, acid reflux.
- Respiratory conditions: Asthma.
Remember, the goal of private medical insurance in the UK is to complement the NHS by providing prompt access to treatment for new, unforeseen acute conditions, not to replace its role in managing long-term and pre-existing illnesses.
Proactive Health Management: A Partner to Your PMI
While insurance is there for when things go wrong, taking proactive steps for your health is always the best strategy. Many of the best PMI providers now actively encourage this by offering a range of wellness benefits, including:
- Discounted gym memberships
- Access to digital GP services
- Mental health support lines
- Rewards for hitting activity goals
Living a healthy lifestyle not only reduces your chances of needing to claim but can also lead to lower premiums over time. Key pillars of good health include:
- A Balanced Diet: Focus on whole foods, fruits, vegetables, and lean proteins. Good nutrition is foundational to preventing many chronic diseases.
- Regular Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, or swimming.
- Prioritising Sleep: Aim for 7-9 hours of quality sleep per night. It's crucial for mental and physical recuperation.
- Managing Stress: Techniques like mindfulness, meditation, or simply spending time in nature can have a powerful positive impact on your mental and physical wellbeing.
As a WeCovr client, you get complimentary access to our AI-powered nutrition app, CalorieHero, to help you manage your diet effectively. Furthermore, clients who purchase PMI or Life Insurance often receive discounts on other types of cover, helping you protect your entire life for less.
Frequently Asked Questions (FAQs)
Do I need to declare mental health conditions like anxiety or depression?
Yes, absolutely. If you opt for Full Medical Underwriting, you must declare any past or present mental health conditions for which you have sought advice or treatment. With a Moratorium policy, any mental health issues from the last 5 years would be automatically excluded for the initial 2-year period. Non-disclosure can invalidate your policy.
What happens if I forget to declare a condition on an FMU application?
This is known as 'inadvertent non-disclosure'. If an insurer believes you made an honest mistake, they may treat the claim as if you had declared the information initially, meaning they might apply a retrospective exclusion and reject the claim for that specific condition. However, if they suspect you deliberately withheld information (fraudulent non-disclosure), they have the right to void your entire policy from the start and refuse all claims. Honesty is always the best policy.
Can I ever get private cover for a chronic condition like diabetes or arthritis?
Standard UK private medical insurance does not cover the routine management, check-ups, or medication for chronic conditions. However, a complication might be covered. For example, if you have well-managed diabetes (a chronic condition) and then need a joint replacement (an acute condition), your PMI policy would typically cover the joint replacement, provided it wasn't a pre-existing issue. The day-to-day management of your diabetes would remain under the care of the NHS.
Is moratorium underwriting always cheaper than full medical underwriting?
Not necessarily. The price (premium) is calculated based on several factors, including your age, location, the level of cover you choose (e.g., hospital lists, outpatient limits), and your excess. The underwriting method itself doesn't usually have a direct impact on the initial price. The key difference is not the cost, but the *certainty* of cover.
Take the Next Step with Confidence
Choosing between moratorium and full medical underwriting is a crucial step in securing the right private health cover. While a moratorium offers speed and convenience, FMU provides invaluable clarity and peace of mind.
The best way to make an informed decision is to speak with an expert. Our team at WeCovr has helped countless individuals and families find the perfect policy. We compare plans from across the market, explain the fine print, and guide you to the best solution for your unique needs and health history—all at no cost to you and with a track record of high customer satisfaction.
Ready to find the right private medical insurance for you? Get a free, no-obligation quote from WeCovr today and gain access to the care you deserve, when you need it.