Your underwriting choices explained
With WPA you have a choice of two ways of applying for private medical insurance (PMI),involving different levels of medical information.
This applies to Flexible Health essentials, premier and elite customers only.
1. Full medical underwriting
This is based on you completing a health questionnaire (also called Full Medical Underwriting or a Medical History Declaration) when you first apply for cover.
If you choose this option, you will be asked a number of questions about your health. This will enable us to understand your lifestyle, medical and family history (and that of any member of your family whom you wish to insure). It is important that you consider the questions carefully, for each person to be covered, and answer them fully. We will review your details and decide the basis on which we can accept you for cover. If necessary, we may need to ask your doctor for further information.
If you have a pre-existing condition that may need treatment in the future we will usually exclude it from cover, along with any conditions related to it. We will show any exclusion(s) on your Certificate of Registration. If we exclude any pre-existing condition, we may review it should you wish us to do so.
Of course, any new medical conditions arising after the start of your policy will be covered immediately, subject to the policy terms.
Note: You must ensure that you provide full and accurate information in answer to the questionnaire. Failure to do so may mean that we cannot cover a claim or even that your policy is void. If you are unsure whether we would want to know about a particular condition, you should tell us about it.
What is the advantage of full medical underwriting?
Although this option involves more of your time when completing your application, it does mean that, when you receive your policy documentation, you will have certainty as to what is covered at the point of joining rather than when you need to make a claim.
2. Moratorium underwriting
With this option you do not need to fill in a medical history declaration on joining, however, you will need to satisfy the following joining criteria:
You (and any applicant) must satisfy the following criteria to join on a moratorium basis:
- Have not been diagnosed with heart disease, stroke, diabetes, cancer or undergoing regular screening for cancer owing to your family history, nor had a surgical procedure/arthroscopy for a joint or back condition.
- Applicants over 18 must have a Body Mass Index (BMI) between 19 and 32.
If you satisfy the above criteria, we will apply an automatic exclusion advising that any pre-existing conditions will not be covered for which you (and any family member included in your application):
- have received treatment and/or medication for,
- asked advice about,
- or had symptoms of (whether or not diagnosed)
during the five years immediately before your PMI cover started.
However, these conditions will be covered if you do not have any symptoms, treatment, medication, or advice for those pre-existing conditions, and any directly related conditions, for two continuous years after your policy starts.
You should understand that your policy will probably never cover any pre-existing long-term medical conditions such as high blood pressure, which (even if symptoms were under control) are likely to require regular or periodic treatment, medication or advice. This is because the moratorium period starts each time you receive such treatment, so it´s unlikely you´ll ever have two consecutive years free of treatment.
We strongly advise you not to delay seeking medical advice or treatment for a pre-existing condition during the moratorium period.
Of course, as with full medical underwriting, new medical conditions arising after the start of your policy will be covered immediately subject to the policy terms and conditions.
Whilst you are not required to provide full medical details when you first apply for cover, we will request more detailed information from your GP for each new condition you claim for.
What is the advantage of moratorium underwriting?
If you choose this option you will only be asked to provide basic information about you and any members of your family you wish to insure when you first join the plan. You will not be asked to disclose details of your medical history, but we rely on you to remember that if you have had any symptoms, treatment, medication or advice for any medical conditions or undiagnosed symptoms these will be excluded from cover. The two year criteria outlined above (for pre-existing conditions) means that treatment for pre-existing conditions will automatically be covered if they later reoccur, subject to the policy terms.
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