Health insurance for professionals - underwriting options

0800 298 9 588

Multi-Family
Healthcare Plan

Why not insure your whole (extended) family - across the generations

Find out more >

Your underwriting choices explained

For Flexible Health essentials, premier and elite customers only


With WPA you have a choice of three ways of applying for private medical insurance (PMI), involving different levels of medical information. This page explains these choices - please read it carefully before applying.

Please note that you can only apply for Flexible Health essentials, premier and elite online on a Moratorium basis. To apply on a Full Medical Underwriting or Switch basis please phone us.

Explanation

PMI, like other insurance policies, provides cover against an unexpected event happening after the start of the Policy. In health insurance this means cover for the cost of unforeseen private medical treatment of acute medical conditions arising after the Policy starts and after any deferment period that may apply.

Your Policy is not intended to cover the cost of medical conditions/symptoms and related conditions that arose before the start of the Policy - these are called ´pre-existing conditions´ (unless declared to and agreed in writing by WPA under the underwriting terms outlined below). A related condition is one that is caused by, or could be the cause of, another condition.

To prevent customers from joining with the foreknowledge of a claim, your Policy also does not cover any medical conditions/symptoms, whether diagnosed or not, which arise in the first 14 days of cover (90 days for cancer conditions - also referred to as deferment period). If you have private medical insurance with another insurer and this offers comparable cover we may be able to waive these 14 and 90 day deferment periods. Your Policy does not cover the cost of all medical treatments and you should check your Policy carefully so you know which treatments are covered, and any limits on this cover.

Understanding your PMI underwriting options

Underwriting is the process by which an insurer decides on what terms it will accept a person for cover based on the information they supply. The following explains the three methods by which you can apply for cover, so that you can decide which one best suits your requirements.



Your choices - 3 ways to apply

1. Moratorium underwriting

With this option you do not need to fill in a medical history declaration on joining, however, we may request more detailed information from your doctor or the doctor of any family member(s) for each new condition claimed for.

You and any family member(s) included on the Policy must satisfy the following criteria to join on a moratorium basis:

  • Have never been diagnosed with any disease/abnormality of the heart or cardiac function, stroke, cancers or undergoing regular screening for cancer owing to your family history.
  • For joint and back conditions: have never had a surgical procedure/arthroscopy (keyhole surgery).
  • Have a Body Mass Index (BMI) below 35.

Benefit will not be provided for at least two years for any pre-existing condition(s) which you or any family member(s) have had during the five years before your Policy starts, or any new symptoms/conditions that start in the first 14 days of your Policy.

Pre-existing conditions are medical condition(s) and other directly related conditions, for which treatment was received and/or medication was prescribed or professional advice was sought or where symptoms existed (whether the underlying condition has been diagnosed or not).

If you or any family member(s) do not have symptoms, treatment, medication or advice for pre-existing conditions for two continuous years after your Policy starts, then benefit may be provided within the terms of your Policy.

Your Policy will not provide benefit for pre-existing long-term medical conditions (and associated conditions) which 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. Conditions include:

  • Diabetes
  • Chronic Fatigue Syndrome/ME
  • Ulcerative Colitis
  • Fibromyalgia
  • Uncontrolled hypertension
  • Crohn’s disease
  • Lupus (SLE)
  • Polymyalgia Rheumatica
  • Multiple Sclerosis (MS)
  • Rheumatoid Arthritis
  • Ankylosing Spondylitis

It is important that you or any family member(s) do not delay seeking medical advice or treatment for any condition during the moratorium period.

Why some customers choose 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 Policy. 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.

Click here to see an example

2. 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 and lifestyle. 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. In some cases we can review your personal medical exclusion(s) in the future if you ask us to do so.

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 or symptom, you should tell us about it.

Why do some customers choose 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.

Click here to see an example

3. Switch

Switch with Continued Personal Medical Exclusions

If you are currently insured and have not had a break in insurance since you were fully medically underwritten, you may be able to transfer on a Switch basis. We will apply any personal medical exclusions that your current insurer applies to the Policy you have now and you will also need to let us know some additional medical information.


Switch with Continued Moratorium

If you are currently insured and were underwritten on a Moratorium basis, you may be able to transfer on a Continued Moratorium basis. The existing Moratorium underwriting terms will apply, but you will need to satisfy supplementary joining criteria.



Find out more about the benefits that our health insurance offers you.

Our comprehensive FAQ section provides answers to many common questions.


* For full terms click here.

^ A 20% professional discount is available up to the age of 55, which then diminishes by 2% every year until the age of 65. i.e. no discount after the age of 65. This professional discount applies to policyholders and any members on your policy.



For more information

Call us about our plans

0800 298 9 588