Choosing between full medical underwriting (FMU) and moratorium underwriting is a crucial step when setting up or joining a UK private medical insurance (PMI) scheme. The decision affects how pre-existing conditions are treated, what evidence you’ll need if you claim, and even how disputes are resolved. Here’s a practical guide to help employees, HR teams, and payroll managers navigate the differences, avoid common pitfalls, and prepare for questions or claims down the line.
Full Medical vs Moratorium Underwriting: Key Differences
Feature | Full Medical Underwriting (FMU) | Moratorium Underwriting |
|---|---|---|
Medical Information Required | Detailed health questionnaire at application | No medical questions at outset; only on claims |
Pre-existing Conditions Cover | Insurer decides upfront what is excluded, based on your disclosures | Automatically excludes any condition with symptoms or treatment in the last 5 years (typically for first 2 years) |
Waiting Period for Pre-existing Conditions | Immediate for new conditions; exclusions are stated | Must be symptom and treatment-free for 2 years from policy start to regain cover |
Common Disputes | Omissions or errors on forms can void cover | Disagreement over what counts as 'symptoms' or 'treatment'—can lead to claim rejections |
Best For | Those with complex medical histories or who want clarity upfront | Faster onboarding, less admin, but more uncertainty on exclusions |
How Pre-existing Conditions and Symptoms Are Handled
Both underwriting types focus on pre-existing conditions, but in different ways:
FMU: You fill out a detailed health questionnaire. The insurer reviews your answers and lists any exclusions (e.g., asthma, back pain). If you forget to mention something—even by accident—it could affect future claims.
Moratorium: No medical questions at the start. Instead, any condition for which you had symptoms, medication, advice, or treatment in the last five years is automatically excluded. If you go two years without symptoms, treatment, or medication for that condition, cover may be reinstated—but you’ll need to prove it.
A Messy, Realistic Example
Sarah joins her employer’s PMI scheme under moratorium underwriting. Three months later, she develops severe knee pain. She claims it’s a new issue. The insurer investigates and finds she had physiotherapy for mild knee discomfort 18 months before joining. Her claim is declined, as the insurer classifies this as a pre-existing condition. Sarah is frustrated—she hadn’t realised her old, minor symptoms would count. She’s asked to provide GP notes, physio records, and pharmacy receipts to prove she was symptom-free for two years. The process is stressful and time-consuming.
Practical Steps and Questions to Ask
Before joining: Ask your HR team or broker which underwriting method is used. Request a copy of the policy wording and any summary of exclusions.
If FMU: Take time to complete the health questionnaire accurately. Ask your GP for a summary of your medical history if you’re unsure. Double-check medication lists and past treatments.
If Moratorium: Make a list of any symptoms, medication, or treatment you’ve had in the last five years—even if you think they were minor. Ask the insurer what evidence would be needed if you claim for a similar issue in the future.
When making a claim: Be ready to provide GP notes, referral letters, prescription records, and any correspondence about symptoms or treatment dates.
If a claim is declined: Request a written explanation referencing the policy terms. If you disagree, you can escalate to the Financial Ombudsman Service, who handle disputes about pre-existing conditions and exclusions.
What Evidence to Keep
Copies of your application forms or health questionnaires
Any correspondence with HR, the insurer, or your broker about your cover
GP summaries, referral letters, and prescription records
Emails confirming periods when you were symptom- or treatment-free
Storing these documents can make future claims or disputes much smoother. If you use Caira by Unwildered, you can upload policy documents, letters, screenshots, emails, medical notes, and bills. Caira can help you compare policy wording, organise your evidence, draft questions or emails to your insurer or HR, and understand your next steps—any time of day. No question is too basic.
Tax, National Insurance, and Reporting
Employer-provided medical insurance is usually a taxable benefit in kind (BIK). Employees generally pay tax on the premiums unless an exemption applies. Employers must report and process these benefits via payroll or, until phased changes from April 2027, via P11D forms, depending on their arrangements. Misreporting can lead to backdated tax bills or penalties. Always check the latest HMRC guidance and ask your payroll team how your benefit will be reported.
Useful Starting Points
This article is general information, not legal, tax, insurance, financial or medical advice.
