At WeCovr, an FCA-authorised broker that has helped arrange over 800,000 policies, we know that navigating the world of private medical insurance in the UK can feel complex. This expert guide breaks down moratorium underwriting—one of the most common ways to get health cover—explaining exactly how it works for you.
How PMI providers use moratoriums and their effects on claims
Private Medical Insurance (PMI) providers use underwriting to assess the risk of insuring a new customer. It's the process they use to decide what they will and won't cover, particularly concerning your past medical history.
One of the most popular methods in the UK is moratorium underwriting.
In simple terms, a moratorium is a "wait-and-see" approach. Instead of asking you to complete a long medical questionnaire upfront, the insurer automatically excludes treatment for any medical conditions you've had in a set period (usually the five years) before your policy began.
However, this exclusion isn't always permanent. If you then go for a specified period after your policy starts (typically two years) without having any symptoms, treatment, medication, or advice for that condition, the insurer may agree to cover it in the future.
This method has a significant effect on claims. When you need to make a claim, your insurer will investigate your medical history to determine if your condition is new or relates to something you've had before. This means the administrative work happens at the point of a claim, not at the application stage.
What Exactly Is Moratorium Underwriting?
Think of moratorium underwriting as drawing a line in the sand. When you take out your policy, the insurer essentially says: "We won't cover any medical conditions you've had recently. But if you stay symptom-free for a while, we'll reconsider."
Here’s the typical process, often referred to as the '2-5-2 rule' by those in the industry:
- The Look-Back Period (5 Years): The insurer will not cover you for any conditions for which you have had symptoms, sought medical advice, or received treatment in the 5 years leading up to your policy start date.
- The Qualifying Period (2 Years): After your policy begins, you must complete a 2-year continuous period without experiencing any symptoms, needing treatment, or seeking advice for that specific pre-existing condition.
- The Outcome (Cover Added): If you successfully complete this 2-year "trouble-free" period, the condition will no longer be considered pre-existing and may become eligible for cover under your policy terms.
If, however, your symptoms return or you need advice for the condition during this 2-year window, the clock resets. You would need to start another 2-year continuous trouble-free period before it could be considered for cover.
A Real-Life Example: David and His Back Pain
Let's imagine David is looking for private health cover.
- Medical History: Two years ago, David saw his GP for a bout of lower back pain. He was given some painkillers and advice on stretching. He hasn't had any trouble since.
- Policy Start: David takes out a moratorium policy in January 2025. Because he had advice for back pain within the last five years, his policy will automatically exclude treatment for it.
- Scenario 1: Cover is Added. David remains free of back pain. He doesn't see a doctor, take medication, or have any symptoms related to his back. By January 2027 (two years later), his back condition is no longer a pre-existing exclusion. If he develops a new back problem after this date, his PMI policy should cover it.
- Scenario 2: The Exclusion Remains. In June 2026, David's back pain returns, and he visits a physiotherapist. Because he has sought advice for the condition within the 2-year moratorium period, the "clock" on his back pain exclusion resets. It will remain an excluded condition.
This simple example shows the core trade-off with moratorium underwriting: you get a quick and easy application, but there's a degree of uncertainty about what's covered until you need to make a claim.
The Two Main Types of Underwriting: Moratorium vs. Full Medical Underwriting (FMU)
Moratorium isn't the only option. The other main method is Full Medical Underwriting (FMU). With FMU, you provide detailed information about your medical history by completing a comprehensive questionnaire when you apply.
The insurer assesses your application and tells you from day one exactly what is and isn't covered. Any conditions you declare may be permanently excluded, or the insurer might charge a higher premium to cover them.
Here’s a comparison to help you understand the difference:
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|
| Application Process | Quick and simple. No medical forms to fill in. | Detailed questionnaire about your medical history. |
| Upfront Declarations | None. Your history is assessed at the point of claim. | You must declare all past conditions and treatments. |
| Speed of Setup | Very fast. Cover can often be set up the same day. | Slower. The insurer needs time to assess your application. |
| Certainty of Cover | Less certainty. You don't know what's covered until you claim. | High certainty. You get a definitive list of exclusions from the start. |
| Claims Process | Can be slower. Insurer needs to check medical records. | Generally faster, as underwriting was done at the start. |
| Cover for Past Conditions | Possible to gain cover after a 2-year trouble-free period. | Pre-existing conditions are usually permanently excluded. |
| Best For... | People who are generally healthy with no recent medical issues. | People with a known medical history who want upfront clarity. |
Choosing the right underwriting is a crucial step. An expert PMI broker, such as WeCovr, can explain these options in detail and help you decide which method best suits your personal circumstances and health profile, all at no cost to you.
Critical Point: PMI is for Acute, Not Chronic Conditions
This is the single most important concept to understand about private medical insurance in the UK.
Standard UK PMI policies are designed to cover acute conditions that arise after you take out your policy. They are not designed to cover the ongoing management of chronic conditions, nor do they typically cover pre-existing conditions from the outset.
Let's break this down:
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, joint replacement, or appendicitis. PMI is excellent for getting fast access to treatment for these issues.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, it has no known cure, it is likely to recur, or it requires palliative care. Examples include diabetes, asthma, high blood pressure, and Crohn's disease. The day-to-day management of these conditions is handled by the NHS.
- Pre-existing Condition: Any ailment for which you have experienced symptoms, received medication, or sought advice before the start date of your policy.
While PMI won't cover the routine management of a chronic condition like diabetes, it may cover an acute flare-up if you have been symptom-free for the required moratorium period. The specifics depend entirely on your insurer and policy wording.
The Claims Process with a Moratorium Policy
So, you have a moratorium policy and you need medical treatment. What happens next?
- Visit Your GP: Your health journey almost always starts with your GP. The NHS remains your first port of call.
- Get an Open Referral: If your GP believes you need to see a specialist, they will write you an 'open referral' letter. This confirms the need for specialist consultation without naming a specific doctor.
- Contact Your Insurer: You call your PMI provider's claims line with your policy details and the referral information.
- The Investigation (The Crucial Step): This is where the moratorium aspect kicks in. The insurer will likely ask for your consent to access your medical records from your GP. Their medical underwriters will review your history to check if the current issue is:
- A brand-new condition.
- Related to a pre-existing condition you had in the 5 years before your policy started.
- A condition that was previously excluded but has since passed the 2-year trouble-free period.
- Authorisation: If the insurer determines the condition is eligible for cover, they will authorise your treatment. They will provide a list of approved specialists and hospitals from their network.
- Treatment: You proceed with your consultation and any subsequent treatment, with the bills being settled directly by your insurer.
- Denial: If the investigation reveals the condition is pre-existing and still within its moratorium period, the claim will be denied. You would then need to seek treatment through the NHS or pay for it yourself.
This investigation stage can sometimes cause delays and anxiety, which is the main drawback of moratorium underwriting.
Advantages of Moratorium Underwriting
Despite the uncertainty, moratorium policies are incredibly popular for several good reasons:
- Speed and Simplicity: It's the fastest way to get private health cover. With no forms to fill out, you can often be insured on the same day you apply.
- Less Intrusive: You don't have to recall and declare every single doctor's visit or prescription from the last decade. This is a huge plus for people who value their privacy or simply don't have perfect records of their medical history.
- Potential for Future Cover: This is a key benefit. A condition that might be permanently excluded under an FMU policy has a chance of becoming covered under a moratorium policy after the 2-year symptom-free period.
- No Premium Loading for Past Conditions: With FMU, an insurer might agree to cover a minor past condition but charge you a higher premium for it. This doesn't happen with a moratorium policy.
Disadvantages and Potential Pitfalls
It's equally important to be aware of the downsides:
- Uncertainty: You don't have 100% clarity on what's covered until you make a claim. This can be stressful when you're unwell.
- Delays at Claim Stage: The need for the insurer to investigate your medical history can slow down the authorisation process.
- Potential for Rejection: There is a risk that a claim could be rejected if the insurer links it to a past condition, which can be upsetting and unexpected.
- Administrative Burden: The "work" of underwriting is shifted from the application stage to the claim stage, and it falls on you to provide the necessary information and consent when you are unwell and least want the hassle.
Who Is Moratorium Underwriting Best For?
Moratorium underwriting is an excellent choice for many people, but it's not for everyone. It generally suits individuals who are:
- Young and Healthy: If you have had little or no reason to see a doctor in recent years, a moratorium policy is a simple and logical choice.
- Unsure of Their Full Medical History: For those who can't remember the exact dates of minor past ailments, moratorium underwriting avoids the stress of trying to complete a detailed FMU form accurately.
- Wanting Cover Quickly: If you've decided you want PMI and want it in place immediately, a moratorium policy is the fastest route.
- Hopeful of Covering a Past Condition: If you have a historical condition that has now resolved, a moratorium offers a pathway to getting it covered in the future.
Conversely, if you have a complex or recent medical history and want absolute clarity before you commit, Full Medical Underwriting might be a better fit.
How WeCovr Can Help You Navigate Your Underwriting Options
Choosing between moratorium and full medical underwriting is one of the most significant decisions you'll make when buying PMI. The right choice depends entirely on your unique health profile and preferences.
This is where working with an independent, FCA-authorised broker like WeCovr provides immense value.
Our expert advisors can:
- Explain the Nuances: We talk you through the pros and cons of each underwriting method in the context of your personal situation.
- Compare the Market: We have access to policies from all the UK's leading insurers, including AXA Health, Bupa, Aviva, and Vitality. We can find the best provider and policy for your needs.
- Save You Time and Money: Our service is completely free to you. We do all the research and comparison work, presenting you with clear, no-obligation quotes.
- Provide Ongoing Support: We are here to help you not just at the start, but also if you have questions about claims or at renewal.
As a WeCovr client, you also get complimentary access to our AI-powered nutrition app, CalorieHero, to support your wellness goals. Plus, clients who purchase PMI or life insurance can benefit from discounts on other types of cover, like home or travel insurance.
Staying Healthy: A Note on Wellness and Prevention
Private medical insurance is there for when things go wrong, but the best strategy is always to stay healthy in the first place. Many PMI providers, like Vitality, now actively incentivise healthy living with rewards and discounts.
Taking proactive steps to manage your health can reduce your need to claim and help keep your future premiums down.
| Wellness Area | Key Recommendations for Adults in the UK |
|---|
| Diet & Nutrition | Aim for a balanced diet rich in fruits, vegetables, and whole grains. The NHS "Eatwell Guide" is a great resource. Stay hydrated by drinking 6-8 glasses of water a day. |
| Physical Activity | The NHS recommends at least 150 minutes of moderate-intensity activity a week (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or tennis). |
| Sleep | Most adults need 7 to 9 hours of good-quality sleep per night. Poor sleep is linked to a range of health issues, including a weakened immune system and high blood pressure. |
| Stress Management | Chronic stress can impact your physical health. Make time for hobbies, mindfulness, or simply spending time in nature to help manage stress levels. |
Taking care of your wellbeing is the best insurance policy of all.
Do I need to declare my medical history for a moratorium policy?
No, you do not need to provide your medical history upfront when you apply for a moratorium policy. This is its main appeal. However, you must be aware that the insurer will investigate your medical history at the point you make a claim to determine if the condition is new or pre-existing.
What happens if a pre-existing condition comes back during the moratorium period?
If you experience symptoms, seek advice, or receive treatment for a pre-existing condition during the two-year moratorium period, the 'clock' for that condition resets. You would need to start a new, continuous two-year trouble-free period from the date of that last event before the insurer would consider covering it.
Is moratorium underwriting cheaper than full medical underwriting?
Not necessarily. The price of a private medical insurance policy is primarily based on risk factors like your age, your location, and the level of cover you choose (e.g., hospital lists, outpatient limits). The underwriting method itself does not usually have a direct impact on the initial premium.
Ready to explore your private medical insurance UK options and find the right cover for you?
Get a free, no-obligation quote from WeCovr today and let our experts guide you to the perfect policy.