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A Guide To Understanding Medical Insurance Underwriting

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A Guide To Understanding Medical Insurance Underwriting

02 July 2024

A guide to understanding medical insurance underwriting

Key Points Summary
  • Process: Full medical underwriting involves a detailed application with medical history questions and potential record checks. Moratorium is quicker with minimal to no medical questions upfront
  • Premiums: Full medical underwriting might offer lower premiums for healthy individuals. Moratorium often has higher premiums due to less health information.
  • Coverage: Full medical underwriting offers potential coverage for pre-existing conditions if manageable. Moratorium might exclude pre-existing conditions for a set period (moratorium) before full coverage applies and may exclude some conditions unconditionally.

Choosing the right health insurance can feel overwhelming, especially when navigating terms like "underwriting." This guide breaks down the two main types of medical underwriting - full medical underwriting and moratorium underwriting to help you understand their differences, advantages, and disadvantages.

Understanding Medical Underwriting

Think of medical underwriting as the insurance company's way of assessing their risk. They consider your health history, pastime or occupational activities and geographical location to determine the likelihood you'll need medical care and how much it might cost them.

This information helps them set your premium and potentially either exclude certain pre-existing conditions from coverage or charge a higher premium to include existing conditions in the case of a fully underwritten medical insurance plan.

Fully Underwritten Medical Insurance

This type of underwriting will take a close look at your health status and history together with any medications you may be taking or have taken consistently.

The process

  • You complete a detailed medical questionnaire about your health history, medications, and family medical history, geographical location and any hazardous occupational or recreational pastime activities.
  • The insurer may request your medical records for verification.

The advantages

  • Potential for lower premiums: With a detailed picture of your health, the insurer may offer a lower premium if you're generally healthy.
  • Comprehensive coverage: Pre-existing conditions, if deemed manageable, may still be covered.
  • Peace of mind: Knowing upfront what's covered avoids surprises down the road when a claim may be made.

The disadvantages

  • Longer application process: Gathering medical records and completing questionnaires can take time if you have a detailed medical history
  • Potential exclusions: Pre-existing conditions might be excluded or receive limited coverage, leading to higher out-of-pocket costs. In some circumstances pre-existing conditions may be covered subject to a higher premium.
  • Application denial: In rare cases, if the insured risk is deemed too high, your application might be denied by an insurer.

Moratorium (MORI) Underwritten Medical Insurance

This type of underwriting is very quick to set up as there are minimal questions asked at outset. The downside however is that this option can be far more restrictive.

The process

  • A simplified application process with minimal or no medical questions.
  • Medical history isn't considered initially.

The advantages

  • Faster approval: Ideal if you need coverage quickly or have pre-existing conditions that are minor and unlikely to be the cause of a claim.
  • Guaranteed acceptance: You're guaranteed coverage, regardless of your health history.

The disadvantages

  • Higher premiums: Insurers compensate for the lack of medical information by potentially charging higher premiums.
  • Moratorium period: Pre-existing conditions might be excluded for a set period (typically 2-5 years) before full coverage applies.Some pre-existing conditions may never be covered.
  • Limited coverage during moratorium: Treatment for pre-existing conditions during the moratorium period might not be covered.
  • It is during a claim (possibly when you have been admitted to a hospital) that the insurance company will start to check your medical history. A "Guarantee of Payment" for the hospital will therefore be delayed to in meeting the treatment costs. This delay can take some time and be very frustrating when you are an in-patient and the hospital are demanding payment.

Choosing The Right Option

The best option for you and your circumstances depends on your individual health situation and priorities. Consider the following:

Health history

  • Full medical underwriting: If you're generally healthy, full medical could offer lower premiums and potentially cover pre-existing conditions.
  • Moratorium: If you have pre-existing conditions, a moratorium plan might be a better option for quicker coverage, even if it means waiting for full coverage (after 2 - 5 years) and potentially paying higher premiums.
Budget

  • Full medical underwriting: Might offer lower premiums if you're healthy
  • Moratorium: Generally has higher premiums to offset the insurer's risk.

understanding-medical-insurance-underwriting

A Note About Travel Medical Insurance Underwriting

Travel medical insurance contracts generally do not offer full medical underwriting due to their short term nature compared to the longer term nature of medical insurance contracts that are generally used over many years. As such the underwriting that is most used with travel medical insurance plans is that of the moratorium type.

There are however some travel medical insurance plans that do offer a degree of
pre-existing cover. Specifically in the case of the Patriot Platinum plans 'Acute onset of a pre-existing condition' is provided providing the insured is under the age of 69

Additional Considerations

  • Age: Premiums tend to increase with age, regardless of the underwriting type.
  • Lifestyle: Factors like risky hobbies may affect your premium under full medical underwriting and could be excluded under both types of contracts.
  • Availability: Not all insurers offer moratorium plans.

Tips For Choosing

  • Shop around: Compare plans from different insurers offering both full medical and moratorium options.
  • Always be honest: When applying for full medical coverage, be truthful in your disclosures to avoid claim denials later..
  • Seek professional advice: consider consulting a health insurance broker such as ourselves who can help you understand your options based on your specific needs.

Remember

  • Read the fine print: Always carefully review the policy details, including exclusions and limitations, before making a decision.
  • Ask questions: If something is unclear, don't hesitate to ask for clarification.

Conclusion

Choosing between full medical and moratorium underwriting is a personal choice but equally a very important choice. By understanding the advantages and disadvantages of each option, you can make an informed decision that best suits your health needs and budget.

Using an experienced broker such as ourselves that has decades of experience advising and guiding clients to select the most appropriate contract for your specific circumstances can be invaluable, particularly when it is understood that clients do not pay higher premiums for using brokers.

Further Reading

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