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Medical Underwriting

Providers... - Health-on-line

Underwriting of Risks:

Many insurers calculate their premium rates based on wide age bands, which results in cross-subsidisation between different age groups. Health-on-Line operates a much fairer charging structure based on the age of each individual adult member, where they live and a flat rate for each child.

They offer a choice to the applicant of either electing to complete a full medical questionnaire and have specific terms offered, or choosing the moratorium method whereby pre-existing medical conditions are automatically excluded.

Moratorium Underwriting:

Full Medical Underwriting:

Examples of how both Options work:

The following is an extract taken from the leaflet sent to all joining customers entitled 'Your guide to Applying for Cover', which covers full medical underwriting, moratorium and the examples.

Q. I had an operation on my right knee recently. Will I be covered for any further treatment to it after my policy starts?
A. If you choose the moratorium option you would not be covered for any further treatment relating to your knee operation, or the condition for which it was performed, during your first two years of continuous cover with us. After that time provided you have had no treatment, medication or medical advice, including postoperative checks, for your knee problem in the preceding two years then you would be covered for any further treatment.
If you choose to have a full medical assessment then you would be excluded from benefit for any further investigations and treatment related to your knee operation.

Q. Some time after my cover begins; I go to a doctor for a routine visit. A heart condition is diagnosed and it must have started to develop before my policy began. What is the position?
A. If you choose the moratorium option you would be covered provided there were no symptoms evident by the time your policy commenced and you had no previous treatment for any related medical conditions, such as high blood pressure or chest pains. If you choose to declare your medical history you would be covered provided there were no symptoms relating to your heart condition and you had no previous treatment for any related medical conditions, such as high blood pressure or chest pains which you should have disclosed to us at the time your policy commenced.

Q. What if I suspect I am suffering from a condition (for example, I have a swelling in the groin area) but have not seen a doctor about it, nor received any firm diagnosis before my cover starts? Will I be covered if I need to have any investigations or treatment for the condition once my policy has started?
A. Under the moratorium option you would not be covered for any treatment you would have to have because of the swelling. This is because it was in existence before you took out the policy. If you declared your medical history to us then we would expect you to declare all symptoms you were suffering from, whether or not a doctor had been consulted, and this would include the existence of the swelling. Those symptoms, the underlying cause of them and any related conditions would be excluded from benefit. It is probable that we would ask for a medical report from your doctor, when you applied to join so that you and we would know exactly what was being excluded from benefit.

Q. How do regular check-ups affect the moratorium?
A. It depends what the check-ups are for. For example: If you have a specific condition before your policy starts and your doctor, or specialist, recommends that you continue to have check-ups for that condition, then we will not cover the cost of private treatment received for that condition for a period of two years from the time your policy started. Cover will then only apply once you have been discharged from care and have no further treatment, medication or advice for a continuous period of two years.
In the same situation described above, if you choose to continue having check-ups for your own peace of mind even though you have been discharged from care, we will cover you for that condition (though not the routine check-ups) if you do not need any medication, treatment or advice for a continuous period of two years. If you have general health check-ups simply in the interests of maintaining good health and not for any particular condition, we ignore them when applying the moratorium.
Note: We do not pay for check-ups in any of the circumstances described above.

Q. I have been taking medication every day to control my blood pressure since before I joined HOL. How does this affect my cover?
A. Because you need continuous medication for your medical condition, cover for this or any related heart condition would be continually excluded. This would be applicable if you chose the moratorium option or the full medical assessment option.