PMI Underwriting Tightens Whats New for Risk Assessment
The landscape of private medical insurance in the UK is shifting. As an FCA-authorised expert broker that has helped arrange over 900,000 policies of various kinds, WeCovr has observed a clear trend: insurers are tightening their underwriting criteria. This article explores why this is happening and what it means for you.
Trends in stricter medical underwriting and pre-existing condition policies
If you've looked into private health cover recently, you might have sensed a change. Application forms seem longer, the questions more specific, and the policies around pre-existing conditions more rigid. You're not imagining it. The UK's private medical insurance (PMI) market is undergoing a significant adjustment in how it assesses risk.
Insurers are businesses that manage risk. When the factors influencing that risk change, so do their processes. Today, a combination of pressures—from a strained NHS to rising treatment costs—is compelling providers to look more closely at the health of new applicants. This move towards stricter medical underwriting is a defining trend for 2025, directly impacting who can get cover and what that cover includes.
For you, the consumer, this means that understanding the underwriting process is more crucial than ever. It's the key to finding a policy that genuinely meets your needs and avoids unwelcome surprises when you need to make a claim.
What is Medical Underwriting and Why Does It Matter?
Think of medical underwriting as a health interview between you and your potential insurer. It’s the process an insurance company uses to understand your health status and medical history before they offer you a policy.
The primary goal for the insurer is to assess risk. They need to predict the likelihood that you will need to claim for private medical treatment. Someone with a history of significant health problems is, statistically, more likely to claim than someone who has rarely visited a doctor.
This assessment directly influences three key things:
- Your Premium: The price you pay for your policy. Higher perceived risk can lead to a higher premium.
- Your Policy Exclusions: Specific conditions or treatments that your policy will not cover. These are often related to your medical history.
- Whether They Offer You Cover At All: In some cases, if the risk is deemed too high, an insurer might decline to offer a policy.
Essentially, underwriting protects the insurer from taking on unforeseen high costs, which in turn helps keep premiums stable for the wider pool of policyholders. For you, it provides clarity on exactly what you are covered for from day one.
The Two Main Types of Underwriting: A Clear Comparison
In the UK private medical insurance market, there are two principal methods of underwriting. Choosing the right one for your circumstances is one of the most important decisions you'll make.
1. Moratorium (Mori) Underwriting
This is the most common type, favoured for its simplicity. With a moratorium policy, you don't complete a detailed medical questionnaire. Instead, the insurer applies a blanket exclusion for any pre-existing conditions you've had in a set period (usually the five years before your policy starts).
A "pre-existing condition" is any illness, injury, or symptom for which you have had symptoms, medication, advice, or treatment.
The "moratorium" part refers to a waiting period, typically two years after your policy begins. If you remain completely free of any symptoms, treatment, or advice for a pre-existing condition during this two-year period, the insurer may then agree to cover it in the future. If the condition recurs during the moratorium period, the two-year clock resets.
2. Full Medical Underwriting (FMU)
As the name suggests, this is a more comprehensive process. You will be required to fill out a detailed health questionnaire, providing information about your medical history, including any past illnesses, consultations, and treatments. The insurer may also ask for permission to contact your GP for more information.
Based on your disclosures, the insurer will decide precisely what they will and will not cover. Any pre-existing conditions you declare will typically be listed as specific exclusions on your policy documents. These exclusions are often permanent.
Moratorium vs. Full Medical Underwriting: Which is for You?
The best option depends entirely on your personal situation. A specialist PMI broker can provide invaluable guidance here, but this table offers a clear overview.
| Feature | Moratorium (Mori) Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | No initial health questionnaire. Fast and straightforward. | Detailed health and lifestyle questionnaire is required. |
| Speed of Setup | Very fast. Cover can often be put in place the same day. | Slower. Can take several weeks, especially if GP reports are needed. |
| Clarity on Cover | Initial uncertainty. You may not know if a condition is covered until you claim. | Total clarity from the start. Your policy documents list specific exclusions. |
| Pre-existing Conditions | Automatically excluded if you've had issues in the last 5 years. May become covered after a 2-year clear period. | Declared conditions are assessed individually and typically excluded permanently. |
| Best For... | Individuals with a clean bill of health or minor past issues who want a quick start. | Individuals with a complex medical history who need absolute certainty about what is covered. |
Why is Underwriting Getting Tighter? The Key Drivers
The shift towards more stringent risk assessment isn't arbitrary. It's a direct response to a "perfect storm" of economic and demographic pressures on the UK's health landscape.
1. Unprecedented NHS Waiting Lists
The strain on the National Health Service is a major factor. As waiting lists for diagnosis and treatment grow, more people are turning to private insurance to bypass delays.
- The Data: As of mid-2024, the NHS England waiting list for consultant-led elective care stood at around 7.54 million treatment pathways. This includes millions of individual patients, many waiting for scans, appointments, or surgery.
- The Impact: Insurers see this as a significant increase in "claims risk." A person who might have previously waited for an NHS procedure is now far more likely to use their PMI, leading to a higher volume of claims.
2. Soaring Costs of Medical Treatment
Modern medicine is a marvel, but it comes at a price. New drugs, advanced diagnostic imaging (like PET-CT scans), and innovative surgical techniques are more effective but also significantly more expensive.
- Example: A new generation of cancer drug can cost tens of thousands of pounds per patient per year. A single complex surgical procedure can easily run into five figures.
- The Impact: The average cost per claim is rising steeply. To remain solvent, insurers must either raise premiums for everyone or become more selective about the risks they take on. Stricter underwriting is a key tool for managing this rising cost base.
3. An Ageing Population with Complex Needs
The UK's population is getting older. According to the Office for National Statistics (ONS), the proportion of the population aged 65 and over is projected to continue growing.
- The Data: The ONS projects that by 2045, nearly a quarter of the UK population (24%) will be aged 65 or over.
- The Impact: Older individuals are more likely to develop health conditions and require medical treatment. This demographic shift naturally increases the overall risk pool for health insurers, prompting them to scrutinise the health of older applicants more carefully.
4. The Rise of "Lifestyle" and Long-Term Conditions
Chronic conditions are on the rise. Issues like diabetes, heart disease, and musculoskeletal problems are becoming more prevalent. Furthermore, new long-term syndromes have emerged.
- Long COVID: A significant new factor is Long COVID, with the ONS estimating that around 1.5 million people in the UK were experiencing self-reported long COVID symptoms as of early 2025. The long-term prognosis and treatment costs are still uncertain, making it a difficult risk for insurers to price.
- The Impact: Insurers are becoming more cautious about applicants presenting with symptoms that could indicate an emerging chronic illness. Underwriting now often includes more specific questions about fatigue, respiratory issues, and other symptoms associated with conditions like Long COVID.
Pre-Existing and Chronic Conditions: The Golden Rule of PMI
This is the single most important concept to grasp about private medical insurance in the UK. Failure to understand it is the number one cause of disappointment and rejected claims.
Standard UK private medical insurance is designed to cover acute conditions that arise after you take out your policy.
It is not designed to cover:
- Pre-existing conditions: Any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment before your policy start date.
- Chronic conditions: Illnesses that cannot be cured and require ongoing or long-term monitoring and management. Examples include diabetes, asthma, hypertension, arthritis, and Crohn's disease.
Defining the Terms
- Acute Condition: A condition that is sudden in onset, short-term, and is expected to respond quickly to treatment, leading to a full recovery. Examples include a hernia repair, cataract surgery, or treatment for an infection. PMI is excellent for these.
- Chronic Condition: A condition that is long-lasting, has no known cure, and needs to be managed over time. Examples include diabetes management, routine checks for high blood pressure, or ongoing medication for arthritis. These are managed by the NHS.
An insurer might cover the initial diagnosis of a chronic condition (e.g., the tests that reveal you have diabetes), but they will not cover the long-term management of it. The day-to-day monitoring, medication, and check-ups would remain with your NHS GP.
This fundamental rule is why underwriting has become so important. Insurers are trying to identify any signs of pre-existing or potentially chronic conditions before the policy begins.
What's New in 2025? Specific Changes in Risk Assessment
The general trend is stricter assessment, but what does this look like in practice? Here are the specific changes we are seeing across the private health cover market.
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More Granular Health Questionnaires (FMU):
- The Old Way: "Have you had any heart problems?"
- The New Way: "In the last 5 years, have you experienced or received advice for any of the following: chest pain, palpitations, high blood pressure, high cholesterol, shortness of breath, or a heart murmur?" The questions are more specific and designed to catch issues that might previously have been overlooked.
-
Stricter Definitions of "Advice":
- Insurers are widening their interpretation of what constitutes "advice" for a pre-existing condition. A casual mention of a sore knee to your GP, even if no treatment was given, could now be flagged by an insurer as "advice" and lead to an exclusion if you later claim for knee surgery.
-
Introduction of Mental Health Deep Dives:
- With growing awareness of mental health, underwriting now frequently includes detailed questions about anxiety, depression, stress, and other conditions. Previously, a single episode of mild anxiety might not have been a major factor. Now, it is more likely to lead to a specific mental health exclusion.
-
Targeted Exclusions:
- Instead of broad exclusions like "all musculoskeletal issues," insurers are applying more targeted ones, such as "any condition related to the right knee" or "any treatment for spinal conditions affecting the lumbar vertebrae L4/L5." This is a result of having more detailed medical information.
-
Lifestyle and Biometric Data Integration:
- This is a forward-looking trend. Some insurers are starting to factor in lifestyle data. While not yet standard for initial underwriting, they may offer better renewal terms for those who engage with wellness programmes, share data from fitness trackers, or demonstrate a healthy lifestyle. This is a move from reactive risk assessment to proactive risk management.
How to Navigate Stricter Underwriting: A Practical Guide
The new landscape can feel daunting, but with the right approach, you can secure the cover you need.
- Be Scrupulously Honest: The principle of 'utmost good faith' is central to insurance. Withholding information, whether deliberately or not, is known as 'non-disclosure'. If this is discovered when you claim, your insurer could reject the claim or even void your policy entirely, leaving you with a large medical bill. If in doubt, declare it.
- Review Your Medical Records: Before applying, especially for a Full Medical Underwriting policy, it can be helpful to request a summary of your medical records from your GP. This ensures your memory aligns with the official record.
- Understand the Nuances of Your History: Did you see a physio for a bad back three years ago? Was it a one-off strain, or the first sign of a degenerative disc issue? The context matters. Be prepared to explain it.
- Work With an Expert Broker: This is the single most effective step you can take. An independent broker, like WeCovr, works for you, not the insurer. We understand the different underwriting philosophies of providers like Bupa, Aviva, AXA Health, and Vitality. We can advise you on:
- Whether Mori or FMU is better for your specific history.
- Which insurer is likely to take the most favourable view of your past conditions.
- How to complete the application forms accurately to avoid issues later.
- Our service comes at no cost to you.
The Role of Wellness and Prevention in Modern PMI
Insurers aren't just tightening the gates; they are also building a new road. A major trend running parallel to stricter underwriting is the promotion of health and wellness.
The logic is simple: a healthier customer is less likely to claim.
Many of the best PMI providers now offer comprehensive wellness programmes, including:
- Discounted gym memberships.
- Rewards for hitting activity goals (e.g., free cinema tickets or coffee).
- Access to digital GP services and mental health support.
- Health and nutrition coaching.
This is a win-win. You get tangible benefits and support to live a healthier life, and the insurer reduces its long-term risk.
At WeCovr, we fully support this proactive approach to health. That's why clients who purchase PMI or Life Insurance through us receive complimentary access to CalorieHero, our advanced AI-powered calorie and nutrition tracking app. It’s a powerful tool to help you take control of your diet and lifestyle, complementing the wellness benefits offered by your chosen insurer. Furthermore, clients often benefit from discounts on other types of cover, creating a holistic and cost-effective approach to their protection needs.
Choosing the Right Policy: How WeCovr Can Help
Navigating the complexities of moratorium periods, full medical underwriting, and specific provider niches can be overwhelming. The differences between policies are often buried in the small print.
This is where WeCovr's expertise becomes your advantage. As an FCA-authorised broker with high customer satisfaction ratings, our role is to demystify the market for you.
- We Compare The Market: We have access to policies from all the UK's leading insurers and can quickly compare their cover, benefits, and—crucially—their underwriting stance.
- We Understand Your Needs: We take the time to understand your medical history, your priorities, and your budget. We then match you with the provider and policy type that best fits your unique circumstances.
- We Save You Time and Hassle: Instead of you filling out multiple applications, we handle the process, ensuring everything is done correctly to give you peace of mind.
Our expert advice is free, and there is no obligation to proceed. We find the right private medical insurance UK policy for you, so you can focus on what matters most: your health.
Common Pitfalls and Misconceptions about PMI Underwriting
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"It was a minor issue, so I don't need to declare it."
- False. An insurer's definition of 'minor' might be very different from yours. A series of 'minor' headaches could be seen by an underwriter as a potential precursor to a neurological investigation. Always declare it.
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"If I switch insurers, my moratorium clock resets and my old conditions will be covered."
- Usually False. Most people switch insurers on a 'Continued Medical Exclusions' (CME) or 'Continued Personal Medical Exclusions' (CPME) basis. This means any exclusions you had on your old policy are carried over to the new one. You cannot "game the system" by switching.
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"Moratorium underwriting is always easier."
- Not necessarily. While the application is simpler, the uncertainty can be stressful. If you have a complex medical history, the clarity and certainty of a Full Medical Underwriting policy can be far more reassuring, even if it means having specific permanent exclusions from the start.
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"My premium won't go up if I don't claim."
- False. Premiums are affected by several factors beyond your personal claims history. These include your age (they rise as you get older), medical inflation (the rising cost of treatment), and the overall claims volume of the insurer's entire customer base.
Do I need to declare mental health conditions like anxiety or depression?
What happens if I forget to declare a condition on a Full Medical Underwriting application?
Does using a PMI broker like WeCovr cost me more?
Will my genetic predispositions affect my PMI application?
The world of PMI underwriting is becoming more complex, but it doesn't have to be a barrier. By understanding the trends and working with a trusted partner, you can secure the health cover that gives you and your family security and peace of mind.
Ready to find the right private medical insurance policy for you? Get a free, no-obligation quote from WeCovr today and let our experts guide you through the process.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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