Medical underwriting

What is medical underwriting?

Medical underwriting is the process we use to assess the risk of insuring you.

When you apply for a health insurance policy, we ask you about your medical history to predict your likelihood of making claims. If your medical history indicates that you’re more likely to make claims, you represent a higher risk.

This doesn’t necessarily mean we can’t provide you with health insurance, but it does sometimes translate into higher premiums or special restrictions on certain types of treatment.

Most insurance relies on some form of underwriting. Your motor insurer, for example, wants to know how many kilometres you drive each year. If you drive a lot, this means more time at risk on the road and more wear and tear for your vehicle. In turn, this means a higher risk of you claiming.

When you apply for a policy with us, we ask you questions about your medical history. If you’re generally fit and health with no pre-existing medical conditions, you represent a lower risk and we’re more likely to provide your policy with no special restrictions.

If you do have pre-existing medical conditions, they might indicate a greater risk of you claiming. This could mean that we exclude cover for certain pre-existing medical conditions and related conditions or increase your premium. Sometimes, we might reject your application because your risk is too high.

Why is it called underwriting?

The term ‘underwriter’ derives from the practice of having each insurer write their name under the total amount of risk they were willing to accept for the agreed premium. Though the mechanics have changed over time, underwriting remains a key part of the insurance world.

What questions do we ask during medical underwriting?

The form you complete when you apply for health insurance includes a questionnaire that includes questions about your medical history and lifestyle.

Here’s an example of some of the questions we ask:

1. Your age
2. Your height and weight
3. Smoking and drinking habits
4. Medical conditions you’ve had in the past
5. Your general health and well-being

Who needs to undergo medical underwriting?

Anyone applying for a health insurance policy must undergo medical underwriting. This is true for all providers of health insurance, though the questions each provider asks will differ.

What is a pre-existing medical condition?

A pre-existing medical condition is an illness or injury that you’ve experienced during your life. It could be something serious, like cancer or cardiac issues; or it could be something less serious, like asthma or an arm you fractured in your childhood. It could also be something undiagnosed, like a knee complaint that’s troubled you for years, but for which you’ve never sought medical treatment or the advice of a doctor. 

When you apply for health insurance, we ask questions about your medical history to find out if you have any pre-existing medical conditions. If you have a pre-existing medical condition, it doesn’t mean you can’t purchase a health insurance policy. It just means we may exclude cover for that condition or increase your premium.

It’s hard to say exactly what we will and won’t exclude, because everyone’s medical history is different. It’s best just to apply and our underwriting team will do their best to offer you a policy.

Your policy doesn’t cover treatment related to other, less serious, pre-existing medical conditions that you’ve experienced in the five-year period before application, unless we’ve agreed otherwise.

Types of medical underwriting

There are three types of medical underwriting:

1/ Full medical underwriting

With full medical underwriting, your health insurance policy won’t cover the treatment of pre-existing medical conditions unless you’ve told us about them and we’ve agreed to cover them.

When you apply, we ask you questions about your medical history. Based on your responses, we’ll give you terms on which we can accept your application for a health insurance policy. If you’re generally fit and health with no pre-existing medical conditions, we’re likely to accept your application with standard terms.

If you do have pre-existing medical conditions, we might exclude cover for certain conditions and/or increase your premium.

Full medical underwriting is the cheapest of the three types of underwriting. It’s also the only option if you’re age 55 or above when you apply, or if you have suffered from serious medical conditions in your past.

2/ Moratorium underwriting

With moratorium underwriting, we may cover your pre-existing medical conditions if:

• You haven’t consulted a doctor;
• you haven’t taken medication; or
• you haven’t experienced symptoms of them for 2 years

Your policy won’t cover any pre-existing medical conditions that you have experienced in the last 2 years.

There are some pre-existing medical conditions that your policy will never cover, regardless of how long ago you experienced them.

Moratorium underwriting is a good option for people who’ve suffered from a non-serious or non-chronic medical condition in the past, but who want it covered should it recur in the future. However, premiums for a policy with moratorium underwriting are about 4% more expensive than premiums for a policy with full medical underwriting.

You can only choose moratorium underwriting if you’re under age 39 or under and you’ve selected a Bronze or Silver plan.

If you do take out a health insurance policy with moratorium underwriting and you need to make a claim, we’ll assess your medical condition to confirm whether it was pre-existing or not. This means that making a claim takes longer, since our team needs to check your medical history in full.

3/ Switch underwriting

Switch underwriting, also known as Continued Personal Medical Exclusions (CPME), is when you transfer the terms of your health insurance policy with your previous provider to your new policy with William Russell.

Premiums for a policy with switch underwriting are more expensive than premiums for policies with full medical or moratorium underwriting.

How does medical underwriting work?

Once you’ve decided you wish to apply for a health insurance policy, you can:

1. Complete our digital application form
2. On the form, we’ll ask you questions about your medical history
3. When you submit your application form, our underwriting team will review your responses to our questions
4. Our underwriting team will then decide the terms on which we can provide you with a health insurance policy
5. This decision comes in the form of an acceptance invitation, which sets out the terms of your proposed policy that go beyond the standard T&Cs (if any) and the premium you’ll need to pay

What are the possible outcomes of medical underwriting?

Medical underwriting has four possible outcomes for you:

• Acceptance on standard terms – We’ve accepted your application for health insurance with standard terms and premiums.
• Acceptance with a premium loading* – We’ve accepted your application for health insurance with standard terms, but with a higher premium.
• Acceptance with special terms* – We’ve accepted your application for health insurance, but we’ve excluded certain medical conditions from your policy.

• No terms possible – We’re unable to accept your application for health insurance.

*It’s also possible to receive acceptance with both a premium loading and special terms.

Do you need to re-underwrite my policy each time it renews?

No. Once you’ve purchased your policy, you can renew it for as long as you need it—even as you get older or if your health deteriorates—with no further medical underwriting.

However, if you want to upgrade your policy (eg. switch to a more expensive plan or decrease your excess), you may need to re-undergo medical underwriting.