What is Medical History Disregarded (MHD) Underwriting
As an FCA-authorised expert broker that has arranged over 900,000 policies, WeCovr is perfectly placed to demystify the world of private medical insurance in the UK. One of the most important, yet often misunderstood, topics is underwriting—specifically, Medical History Disregarded (MHD) underwriting. This guide explains exactly what it is and who it’s for.
WeCovr explains MHD and when it applies to switching group PMI policies
Navigating the landscape of private health cover can feel complex, with jargon and different policy types to consider. At its heart, private medical insurance (PMI) is designed to give you and your family (or your employees) fast access to high-quality medical care for acute conditions that arise after you take out a policy.
The process an insurer uses to decide what they will and won't cover based on your health is called underwriting.
Medical History Disregarded, or MHD, is the most comprehensive type of underwriting available. As the name suggests, an insurer agrees to "disregard" your past medical history when you make a claim for an eligible new condition.
However, this premier level of cover is not available to everyone. It is almost exclusively used for group private medical insurance schemes—policies that businesses take out for their employees. Understanding MHD is especially critical when a company decides to switch its group PMI provider, as it directly impacts the continuity of cover for every member of the team.
What is Underwriting in Private Medical Insurance?
Before we delve deeper into MHD, it's essential to understand the role of underwriting. Think of it as the insurer's risk assessment. When you apply for insurance, the provider needs to understand the likelihood of you making a claim. This helps them set a fair price and be clear about what is covered from the outset.
The most important rule in the UK private medical insurance market is this:
Standard PMI is designed to cover acute conditions that arise after your policy begins. An acute condition is an illness or injury that is expected to respond quickly to treatment and from which you can make a full recovery.
Crucially, PMI does not cover pre-existing conditions or chronic conditions.
- Pre-existing Condition: Any illness, injury, or symptom you have had before the start of your policy.
- Chronic Condition: A condition that is long-term and cannot be cured, only managed (like diabetes, asthma, or high blood pressure).
Underwriting is the mechanism insurers use to identify and exclude these conditions, ensuring the policy functions as intended. There are three main ways they do this.
The Three Main Types of PMI Underwriting Compared
Each underwriting method offers a different balance of convenience, cost, and comprehensiveness. Choosing the right one depends on your circumstances, whether you're buying a policy for yourself, your family, or your company.
Here’s a clear comparison of the three main types:
| Feature | Full Medical Underwriting (FMU) | Moratorium (MORI) | Medical History Disregarded (MHD) |
|---|---|---|---|
| What is it? | A detailed health declaration is made at the start. | A "wait and see" approach. Pre-existing conditions from the last 5 years are excluded for a set period (usually 2 years). | The insurer ignores your previous medical history for eligible acute conditions. |
| Medical Questionnaire? | Yes, a comprehensive one. | No, not at the start. | No. |
| Cover for Pre-existing Conditions? | No. Specific exclusions are applied from day one and are usually permanent. | Potentially, after a continuous 2-year period on the policy without symptoms, treatment, or advice for that condition. | Yes, for acute flare-ups of a pre-existing condition. Chronic conditions are still not covered. |
| Claims Process | Relatively fast, as exclusions are already defined. | Can be slower, as medical history is checked at the point of every claim to see if it's pre-existing. | Fast and simple. The insurer doesn't need to investigate your past history for the claim. |
| Best For... | Individuals who want absolute clarity on what is and isn't covered from the start. | Individuals and small groups who want a quick and easy setup. The most common type for personal policies. | Medium to large corporate groups (typically 20+ employees) seeking a premium, hassle-free benefit for their staff. |
| Availability | Individuals, families, and groups. | Individuals, families, and groups. | Almost exclusively for corporate groups. Very rarely available to individuals. |
Full Medical Underwriting (FMU): The Detailed Approach
With Full Medical Underwriting, you provide the insurer with your complete medical history by filling out a detailed application form. You'll be asked about past illnesses, treatments, consultations, and medications. The insurer might also ask for your permission to contact your GP for more information.
- Pros: The biggest advantage of FMU is certainty. From the moment your policy starts, you have a document that clearly lists any specific exclusions. There are no grey areas. When you need to make a claim, the process is generally straightforward because the decision on what’s covered has already been made.
- Cons: The application process can be lengthy and feel intrusive. Furthermore, any exclusions applied are typically permanent and will not be reviewed in the future, even if you have been symptom-free for years.
Moratorium (MORI) Underwriting: The "Wait and See" Option
Moratorium is the most common type of underwriting for individual and family private medical insurance policies in the UK because it's so quick to set up. There are no medical forms to fill in at the start.
Instead, the policy automatically excludes treatment for any medical condition you have experienced symptoms of, or received treatment, medication, or advice for, in the five years before the policy began.
This exclusion is subject to a "rolling" two-year period. If you go for two continuous years on the policy without needing any treatment, advice, or medication for that condition, it may become eligible for cover in the future.
Real-Life Example:
- David takes out a moratorium policy in January 2025. In 2023, he had physiotherapy for a shoulder injury.
- This shoulder problem is now a pre-existing condition and is excluded from his new policy.
- If his shoulder remains completely trouble-free (no pain, symptoms, or consultations) until January 2027 (two full years), he could then be eligible for cover if a new acute problem develops with it.
- However, if he experiences any pain or sees a doctor about it in 2026, the two-year waiting period resets from that date.
The main drawback of moratorium underwriting is the lack of certainty. You only find out for sure if a condition is covered when you try to make a claim, which can sometimes lead to delays and disappointment.
Medical History Disregarded (MHD): The Gold Standard
Medical History Disregarded is the most generous and straightforward underwriting option. When a policy is on MHD terms, the insurer agrees to cover eligible acute medical conditions, even if you have suffered from them before.
This means no medical questionnaires and no automatic exclusions for pre-existing conditions. It provides employees with peace of mind that if they fall ill, they will be covered for eligible treatment without worrying about their past medical history.
However, its high cost and the level of risk it presents to an insurer mean it is almost exclusively offered to corporate groups, where the risk is spread across many people.
A Deep Dive into Medical History Disregarded (MHD) Underwriting
MHD is the most sought-after type of underwriting for businesses looking to offer a truly competitive benefits package. It removes the single biggest barrier to claiming on a PMI policy: a person's prior medical history.
How Does MHD Actually Work?
With an MHD policy, the usual rules about pre-existing conditions don't apply. An employee can claim for treatment for an acute condition, regardless of whether they’ve had it before.
Example Scenario: MHD vs. Other Underwriting Imagine a new employee, Laura, who joins a company with a group MHD scheme. Five years ago, she had surgery for a hernia.
- On an MHD Policy: If Laura's hernia reoccurs, she can use the company PMI scheme to get it treated privately. The insurer disregards the fact it's a pre-existing condition.
- On a Moratorium Policy: The hernia would be excluded for the first two years of her cover. She would have to wait until she had been symptom-free for two years before it could be considered for cover.
- On an FMU Policy: She would have declared the hernia on her application form, and the insurer would have placed a permanent exclusion on it. It would never be covered.
This demonstrates the immense value of MHD for employees, especially those who have had health issues in the past.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the most critical point to understand about MHD and all UK private medical insurance. Even with MHD underwriting, chronic conditions are not covered.
PMI is there to help with conditions that can be resolved. It is not a substitute for the NHS in managing long-term illnesses that require ongoing care but have no known cure.
| Aspect | Acute Condition | Chronic Condition |
|---|---|---|
| Definition | An illness, injury or disease that is likely to respond quickly to treatment and lead to a full recovery. | A condition that is long-term and has one or more of the following traits: it is recurrent, has no known cure, or requires ongoing management. |
| Duration | Short-term. | Long-term or lifelong. |
| Goal of Treatment | To cure the condition and return the patient to their previous state of health. | To manage symptoms, slow progression, and maintain quality of life. |
| PMI Coverage | Covered. This is the primary purpose of PMI. | Not covered. Management is typically provided by the NHS. |
| Examples | • Hernia repair • Cataract surgery • Joint replacement (e.g., hip, knee) • Gallstone removal • Broken bones • Infections requiring hospitalisation | • Diabetes • Asthma • Arthritis • High blood pressure (Hypertension) • Crohn's disease • Multiple Sclerosis |
So, what does MHD cover? It covers acute flare-ups or acute treatments related to conditions that might otherwise be considered pre-existing. For instance, while it wouldn't cover the daily management of arthritis (a chronic condition), it could cover a joint replacement surgery needed to resolve an acute level of pain and immobility caused by it.
Who is Eligible for MHD Underwriting?
MHD is a feature of the corporate PMI market. It is generally available to businesses that want to insure a group of employees, typically with a minimum headcount.
- Minimum Group Size: This varies between insurers but often starts at around 15 or 20 employees. For smaller groups, insurers may still require some form of medical declaration.
- Why for Groups? Insurers can offer MHD to groups because of the principle of "risk pooling." With a large number of people in one scheme, the risk of claims becomes more statistically predictable. The premiums of the healthy majority help to cover the costs of the minority who need to claim, making the overall scheme financially viable for the insurer.
- Individuals and Families: MHD is almost never offered to individuals or families. The risk for an insurer to take on a single person with an unknown medical history is too high. The premiums would have to be astronomically expensive to make it viable.
The Benefits and Drawbacks of MHD for Businesses and Employees
For companies that can meet the criteria and afford the premiums, offering an MHD scheme is a powerful statement about how they value their workforce.
Advantages of MHD
For Employees:
- Total Peace of Mind: Removes the worry that a past health issue could prevent them from getting private care when they need it. This is hugely reassuring.
- Inclusive and Fair: Everyone in the scheme is covered on the same terms, regardless of their medical background. This makes it a very fair and equitable benefit.
- Hassle-Free Claims: The claims process is simple and fast. There's no need for the insurer to request medical records to check for pre-existing conditions, meaning authorisations are usually granted quickly.
- Access to Top Care: Like all PMI, it provides fast access to leading specialists and hospitals, helping employees get back on their feet sooner.
For Employers:
- A Premium Employee Benefit: In a competitive job market, a group PMI scheme with MHD terms is a significant differentiator that can attract and retain top talent.
- Reduced Sickness Absence: Faster diagnosis and treatment mean employees spend less time waiting for care and more time being productive at work. The latest ONS figures show a record 185.6 million working days were lost to sickness or injury in 2022, costing the economy billions. A robust health insurance plan can help mitigate these costs.
- Improved Morale and Engagement: Providing comprehensive health cover shows that the company genuinely cares about the wellbeing of its staff, fostering loyalty and a positive workplace culture.
- Simplified Administration: With no individual medical declarations to manage, the scheme is simple for HR teams to administer.
Disadvantages of MHD
For Employers:
- Higher Cost: MHD is the most expensive underwriting option. The premium per employee will be significantly higher than for a moratorium or FMU policy because the insurer is taking on more risk.
- Eligibility Requirements: It is not an option for very small businesses or start-ups, who will need to consider moratorium or FMU underwriting instead.
For Employees:
- Tied to Employment: The biggest drawback is that this exceptional level of cover is tied to their job. If they leave the company, they lose their place on the MHD scheme. They would then need to source their own individual cover, which would be subject to standard moratorium or FMU underwriting, meaning any conditions they had previously would now become pre-existing and likely be excluded.
Switching Your Group PMI Scheme: The Role of MHD
Companies regularly review their benefits packages to ensure they are getting the best value and service. When it comes to PMI, switching providers is common. However, it must be handled carefully to protect the employees' continuity of cover. This is where an expert PMI broker like WeCovr is invaluable.
What Happens to My Cover if My Employer Switches Provider?
When a business switches its group PMI provider, employees are rightly concerned about what will happen to their cover, especially if they are in the middle of treatment or have existing health conditions.
Insurers have a specific process for this, often called "protected switching terms" or "Continued Medical Exclusions" (CME / CPME)". The goal is to move the group from the old insurer to the new one with no loss of cover.
- Switching on "Like-for-Like" Terms: The new insurer agrees to take on the group with the same underwriting style as the old policy.
- MHD to MHD: If your company scheme is already on MHD terms, your broker will negotiate with new insurers to ensure they also offer MHD. This is a standard request for large corporate schemes, and it ensures employees retain their comprehensive cover seamlessly.
- Moratorium to Moratorium: If the scheme is on moratorium underwriting, the new insurer will typically continue this. Crucially, they will honour the original start date of the moratorium period for each employee, so they don't have to "re-serve" their two-year waiting period for pre-existing conditions.
- FMU to FMU: The new insurer agrees to honour the same personal medical exclusions that were on the old policy.
What if I Leave a Company with an MHD Scheme?
This is a vital point for any employee on a corporate plan to understand. When you leave your job, your group PMI cover ceases. The generous MHD terms cannot be transferred to a personal policy.
You will have two main options:
- Take out a new individual policy: This will be underwritten on Moratorium or FMU terms. Any medical conditions you have, including those that were covered by the MHD scheme, will now be classed as pre-existing and will almost certainly be excluded from your new policy.
- Continue with the same insurer: Some insurers offer a "group leaver" option, allowing you to continue your cover on a personal plan without a full re-underwriting. However, the terms will change. They will typically switch you to a moratorium policy or apply exclusions for any conditions you have claimed for.
The key takeaway is that the benefit of MHD is tied to your employment in that specific company scheme.
The Cost of MHD: Is It Worth It?
There is no doubt that MHD underwriting comes at a premium. But for many businesses, the value it delivers in employee wellbeing, talent retention, and productivity far outweighs the additional expense.
Below is an illustrative table showing how premiums might differ. Please note these are not quotes and are for guidance only. Costs vary based on age, location, level of cover, and the insurer.
Illustrative Monthly Premiums for a 40-Year-Old Employee (Comprehensive Cover)
| Underwriting Type | Illustrative Monthly Premium | Key Feature |
|---|---|---|
| Moratorium (MORI) | £65 | Fast setup, pre-existing conditions excluded for 2 years. |
| Full Medical Underwriting (FMU) | £60 | Cheaper due to specific exclusions, but more admin at the start. |
| Medical History Disregarded (MHD) | £90 | Most expensive, but covers acute flare-ups of pre-existing conditions. |
For a company with 100 employees, the difference between a Moratorium and an MHD scheme could be over £30,000 per year. However, if that investment prevents just a few key employees from being on long-term sick leave, or helps attract a crucial new hire, the return on investment becomes clear.
Enhancing Your Wellbeing Alongside Your PMI Policy
While having a great insurance policy is a fantastic safety net, the best approach to health is a proactive one. Most modern private medical insurance UK providers include a range of wellness benefits and services to help you stay healthy.
The WeCovr Advantage: More Than Just Insurance
At WeCovr, we believe in supporting our clients' holistic wellbeing. That's why when you arrange your health or life insurance through us, you get more than just a policy.
- Complimentary Access to CalorieHero: All our clients receive free access to our partner AI-powered calorie and nutrition tracking app, CalorieHero. Managing your diet is a cornerstone of good health, and this tool makes it simple to track your intake, understand your nutritional balance, and work towards your health goals.
- Discounts on Other Cover: We value our clients' loyalty. When you take out a PMI or life insurance policy with us, we offer attractive discounts on other types of insurance you may need, such as home or travel cover, helping you save money while staying protected.
Simple Steps for a Healthier Life
Incorporate these simple habits into your daily routine to support your physical and mental health:
- Balanced Diet: Focus on whole foods, including plenty of fruits, vegetables, lean proteins, and whole grains. Staying hydrated by drinking plenty of water is also key.
- Regular Exercise: The NHS recommends adults aim for at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or swimming) a week.
- Quality Sleep: Aim for 7-9 hours of quality sleep per night. It's vital for mental clarity, immune function, and physical recovery.
- Stress Management: Find healthy ways to manage stress, whether it's through mindfulness, meditation, yoga, or spending time in nature. Many PMI providers now offer access to mental health support lines and apps.
How WeCovr Can Help You Navigate Your Group PMI Options
Whether you are a business owner looking to set up your first group scheme, or an HR manager wanting to review your existing provider, the choices can be overwhelming. This is where we come in.
WeCovr is an independent, FCA-authorised broker. Our service is completely free to you. We receive a commission from the insurer you choose, but our advice is always impartial and focused on your best interests.
- Expert, Impartial Advice: We specialise in the UK private health cover market. We'll listen to your needs, explain your options in plain English, and help you understand the nuances of different underwriting types.
- Market Comparison: We work with all the leading UK PMI providers. We'll compare policies and prices to find the optimal solution for your company's budget and your employees' needs.
- Seamless Switching: If you're switching a group scheme, we manage the entire process for you. We ensure your team's cover is continued seamlessly, negotiating the best possible "continued medical exclusions" or "MHD-to-MHD" terms on your behalf.
- Ongoing Support: Our service doesn't stop once the policy is in place. We're here to help with renewals, claims queries, and any adjustments you need to make to your scheme as your business evolves.
Frequently Asked Questions (FAQs)
Can I get Medical History Disregarded (MHD) underwriting on a personal policy?
Does MHD cover chronic conditions like diabetes or asthma?
What happens to my MHD cover if I leave my job?
Is MHD underwriting more expensive than other types?
Ready to explore the best private medical insurance options for your business or your family? Speak to a WeCovr expert today for a free, no-obligation quote and find the perfect cover for your needs.
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
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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!
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Why is it important to get private medical insurance early?
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