Health insurance
How does medical underwriting work?
The short answer
Medical underwriting is how an insurer decides what your medical history means for cover. Most UK policies use either a moratorium, which automatically sets aside recent conditions, or full medical underwriting, where you declare your history and the insurer lists exclusions before you buy. Underwriting decides what is excluded, not usually the price.
Written by Emma Leadbetter. Reviewed by Stuart Hendy.
Published . Last reviewed . Next review due .
- Claims paid, 2024
- £4 billion [2]
- Commercial insurance law
- 2015 Act [4]
- People covered, 2024
- 6.5 million [2]
- Governing consumer law
- 2012 Act [3]
What you need to know before you apply
- Underwriting sets the boundary of your cover before you ever make a claim. Read more
- Moratorium is quicker to buy; full medical underwriting tells you where you stand in writing. Read more
- Under a moratorium, an excluded condition can come back into cover after a clear period. Read more
- The law asks consumers to take reasonable care not to make a misrepresentation. Read more
- Switching insurers is where underwriting terms matter most, and where they are most often lost. Read more
What underwriting actually decides
Underwriting is the step where an insurer decides what your medical history means for the cover it is prepared to offer. On most UK private medical insurance it does not set your premium in the way that a motor insurer prices a driving record. Age, postcode, hospital list, excess and the modules you choose do most of the pricing. Underwriting decides something narrower and more important: which parts of your own history sit outside the policy.
Anything that falls outside is a pre-existing condition as your insurer defines it, and the definition in the wording is the one that counts. That is why two people with identical medical histories can end up with materially different cover simply because they applied to different insurers on different underwriting terms.
The two main routes
| Moratorium | Full medical underwriting | |
|---|---|---|
| What you complete at application | No medical questionnaire in most cases | A detailed declaration of your medical history |
| When exclusions are known | At the point of claim | Before you buy, in writing |
| What is set aside | Conditions in a defined recent period, commonly five years | Specific conditions the insurer names |
| Can an exclusion end? | Yes, after a continuous clear period, commonly two years | Only if the insurer agrees to review it |
| Best suited to | People with a straightforward history who want cover quickly | People who need certainty about a known condition |
Choosing between the two routes
What works well
- Moratorium: no questionnaire, faster to put in place
- Moratorium: conditions can return to cover over time without you doing anything
- Full underwriting: you know exactly what is excluded before you pay anything
- Full underwriting: fewer arguments at claim, because the boundary is already written down
What to watch
- Moratorium: the first time you learn a condition is excluded may be when you claim
- Moratorium: the clear period restarts if you seek advice or treatment for that condition
- Full underwriting: the application is longer and the insurer may ask your GP for a report
- Full underwriting: a named exclusion is normally permanent unless reviewed
How a moratorium works in practice
Under moratorium underwriting the insurer does not ask about your history at the start. Instead the wording sets aside anything you have had symptoms of, sought advice about, taken medication for or received treatment for during a defined period before the policy began — five years is the common figure, but the wording governs. If you claim for something inside that window, the insurer investigates at that point, usually by asking for your medical records.
The trade-off is that the exclusion is not necessarily permanent. If you go a continuous period — commonly two years — without symptoms, advice, medication or treatment for that condition, it typically comes back into cover. Many people therefore find that a moratorium policy quietly widens over time. The risk sits at the other end: you may not discover what is excluded until the moment you need it.
How full medical underwriting works
Under full medical underwriting you complete a declaration covering your medical history, and the insurer responds with the terms it will offer. Those terms may be standard cover, cover with named exclusions, cover with a condition excluded for a set number of years, or occasionally a decline. The point of the exercise is certainty: you know before you pay a premium whether the condition you are worried about is inside or outside the policy.
It takes longer, and the insurer may write to your GP for a report with your consent. For anyone with a significant history who is buying cover precisely because of that history, the delay is usually worth it, because a written exclusion list is far easier to plan around than an open question resolved at claim.
“Moratorium suits someone whose history is uncomplicated and who wants cover quickly, because nobody has to go through the detail up front. Full medical underwriting is worth the extra effort when the history is complicated, or when someone needs certainty about a particular condition before they commit. The trade is simple: full underwriting asks the awkward questions now, moratorium asks them at the point of claim. If not knowing would keep you awake, take the version that answers it in writing at the start.”
What the law asks of you
For consumer policies, the Consumer Insurance (Disclosure and Representations) Act 2012 replaced the old duty to volunteer everything material with a duty to take reasonable care not to make a misrepresentation when answering the insurer’s questions. [3] In plain terms: answer what you are asked, honestly and carefully. The Act also sets out what an insurer may do if you do not — the remedy depends on whether the misrepresentation was careless or deliberate, and on what the insurer would have done had it known.
Business and group policies sit under the Insurance Act 2015 instead, which imposes a duty of fair presentation of the risk on the commercial buyer. If you are arranging cover for a company scheme rather than for yourself, that is the framework the insurer is working to.
| Type of misrepresentation | Typical consequence |
|---|---|
| Honest and reasonable | The claim is treated as though the answer had been correct |
| Careless | A proportionate remedy: the claim may be reduced, or terms applied as they would have been |
| Deliberate or reckless | The insurer may avoid the policy and refuse claims |
Switching insurers and transferred terms
When you move insurer, the new insurer decides afresh what your history means. Some will offer continued personal medical exclusions — carrying across the exclusions you already have rather than underwriting you from scratch — which protects conditions that developed while you were insured. Others will apply new underwriting, and anything that has happened since you first took cover can then be set aside. This is the single most consequential decision in a switch, and it is easy to lose by accident when shopping on price alone.
Before you move, ask the prospective insurer in writing which underwriting basis is being offered, and get the answer before you cancel anything. Read what private health insurance covers alongside this, because a wider policy on worse underwriting terms is often a worse policy.
How underwriting sits against price
Underwriting shapes what is payable; the rest of the quote shapes what you pay. Market-wide, claims volumes are rising: the Association of British Insurers reported a record £4 billion of individual and workplace claims for 2024, up from £3.57 billion in 2023, with 6.5 million people covered. [2] Rising claims costs feed into renewal pricing across the market, which is a reason to review both the price and the underwriting basis each year rather than only the price.
| 2023 | 3.57 bn |
|---|---|
| 2024 | 4 bn |
What to do before you apply
- Write your history down first Dates, conditions, medication and consultations. Accuracy at this stage prevents most later disputes.
- Ask which underwriting basis is on offer And whether the insurer will consider transferring your existing exclusions.
- Read the definition of a pre-existing condition It differs between insurers and it is the clause that decides borderline claims.
- Keep a copy of every answer you give If an insurer later questions a claim, your record of the application matters.
- Check how to complain Insurers must have a complaints process, and the Financial Ombudsman Service can review the outcome.
Firms must give you appropriate product information in good time before you commit, [5] and under the Consumer Duty they must support your understanding rather than simply disclose. [6] If an application process leaves you unclear about what is excluded, that is a reason to ask again in writing, not a reason to proceed and hope.
Check who you are dealing with
Underwriting decisions carry weight for years, so it is worth knowing that the firm making them is authorised. Every insurer and every broker arranging a UK policy appears on the Financial Services Register, where you can confirm the legal entity, its permissions and its trading names before you answer a single medical question. [8] The conduct of both firms — how they ask their questions, how they explain the terms and how they handle the resulting claims — is supervised by the Financial Conduct Authority. [1] Ask which entity is underwriting the policy as well as which firm is arranging it, because they are rarely the same, and the underwriting terms come from the insurer. Keep the application you submitted and the terms you were sent in reply: if a claim is later questioned, that pair of documents is the evidence of what you disclosed and what was accepted.
Common questions
- Which is better, moratorium or full medical underwriting?
- Neither is better in the abstract; they answer different needs. A moratorium suits someone with a straightforward recent history who wants cover in place quickly and is comfortable that recent conditions are set aside for now, with the prospect of them returning to cover after a clear period. Full medical underwriting suits someone with a known condition who needs to know, before paying anything, whether it is covered. If your worry is one specific thing in your history, full underwriting usually gives a better night’s sleep, because the answer arrives in writing rather than at the point of claim when you are already unwell and already committed.
- How far back does a moratorium look?
- Commonly five years, but the period and the trigger are both set by the wording rather than by any statutory rule, so they must be checked policy by policy. The trigger usually covers symptoms, advice, medication and treatment, which is broader than most people expect: a conversation with a GP that led to nothing can still start the clock. The related question is how long a clear period must run before the condition returns to cover, commonly two years of no symptoms, advice, medication or treatment. Both figures appear in the wording under the definition of a moratorium or of a pre-existing condition.
- What happens if I get a medical question wrong?
- It depends on how the error arose. Under the Consumer Insurance (Disclosure and Representations) Act 2012 [3] an honest and reasonable mistake is treated as though you had answered correctly. A careless misrepresentation produces a proportionate remedy: the insurer may apply the terms it would have applied, or reduce the claim. A deliberate or reckless misrepresentation can allow the insurer to avoid the policy altogether and refuse claims. The practical advice is simple: if you realise after applying that an answer was incomplete, tell the insurer straight away in writing, before any claim arises.
- Does underwriting change my premium?
- On most UK private medical insurance, no — or not directly. The premium is driven by age, where you live, the hospital list, the excess, the modules you select and the insurer’s claims experience. Underwriting changes the scope of cover instead, by naming exclusions or setting aside recent conditions. There are exceptions at the margins: some insurers will offer cover for a declared condition on loaded terms, and some group schemes are priced on the claims experience of the whole group. If a quote appears to be loaded for your history, ask the insurer to say explicitly what the loading is for.
- Will the insurer contact my GP?
- Under full medical underwriting it may, with your written consent, ask your GP for a report about a particular condition. Under a moratorium it will not normally ask anything at application, but it may request your medical records when you make a claim that falls inside the moratorium period, again with your consent. Refusing consent does not usually make the question go away; it generally means the insurer cannot assess that claim. If you are concerned about what a report might contain, you are entitled to see it before it is sent in most circumstances, and it is worth asking the insurer how that process works.
- Can an excluded condition ever be covered later?
- Under a moratorium, yes, and usually without you doing anything: once you have completed the required continuous clear period for that condition, it comes back into cover under the terms of the policy. Under full medical underwriting the exclusion is normally permanent, but insurers will sometimes review a named exclusion after a period free of treatment if you ask and provide evidence. Reviews are discretionary and not all insurers offer them. Ask about the review policy before you buy if you expect the condition to resolve, because it is very difficult to negotiate afterwards.
- What is a switch on continued personal medical exclusions?
- It means the new insurer takes on the exclusions you already have, rather than underwriting you again from the beginning. The value is that conditions which developed while you were insured stay covered instead of becoming pre-existing under the new policy. Not every insurer offers it, and those that do may limit it by age, by the type of policy you are leaving or by requiring continuous cover with no break. It is the right first question when you are thinking about moving. Read what private health insurance covers before comparing, so you are comparing cover and terms together rather than price alone.
- Who can I complain to about an underwriting decision?
- Start with the insurer’s own complaints process and ask it to explain, with reference to the wording and to the answers you gave, why the decision was reached. If you are unhappy with the final response, or if eight weeks pass without one, you can take the complaint to the Financial Ombudsman Service, which handles medical insurance complaints for consumers free of charge and can direct a firm to put things right. [7] You can also check that the firm you are dealing with is authorised on the Financial Services Register. [8]
Sources
- Financial Conduct Authority. About the FCA. Accessed 14 September 2026 (primary source)
- Association of British Insurers. Insurers process record £4bn across individual and workplace health schemes (2024 data). 21 January 2026 (primary source)
- UK Parliament (legislation.gov.uk). Consumer Insurance (Disclosure and Representations) Act 2012. Enacted 8 March 2012 (primary source)
- UK Parliament (legislation.gov.uk). Insurance Act 2015. Enacted 12 February 2015 (primary source)
- Financial Conduct Authority. ICOBS 6: Product information (FCA Handbook). Accessed 14 September 2026 (primary source)
- Financial Conduct Authority. The Consumer Duty. Accessed 14 September 2026 (primary source)
- Financial Ombudsman Service. Complaints about medical insurance. Accessed 14 September 2026 (primary source)
- Financial Conduct Authority. The Financial Services Register. Continuously updated; accessed 14 September 2026 (primary source)