Will I need to provide details of my health for an individual scheme?

There are two main methods that insurers can use to accept your application for cover – medical history declaration or moratorium. Here is a description of the two types:-

Medical History Declaration (otherwise known as full medical underwriting) You are normally asked to fill in a form, giving details of your medical history. If necessary, the insurer may write to your doctor for more information. It is essential that you give all the information you are asked for. If you don’t, you may find that your insurer may refuse to pay any claim that you make in the future, or may cancel your policy. If you are not sure whether or not to mention something, it is best to do so. If you have a medical condition which is likely to come back, the insurer will issue a policy, but that condition (and any related to it) may not be covered, either indefinitely, or for a set period of time (usually two years).

Moratorium This is when you are asked to fill in a form, but you are not asked to give details of your medical history. Instead, the insurer does not cover any medical condition which existed in the last (usually) five years. These conditions may automatically become eligible for cover, but only when you do not have symptoms, or receive treatment, medication, tests and advice (from your GP or a specialist) for that condition for a continuous period of (usually) two years, after your policy has started.

Here are two examples: Some time after your cover has started, you go to your doctor for a routine visit and, for example, a heart condition is diagnosed. It has obviously developed during the period before the start of your plan. Would you be covered? Yes you would as the clause only applies to any medical condition or related condition (or both) which you were aware existed in the 5 years before the start of your policy. If:-

• The heart condition was first diagnosed after you joined the policy; and
• You had no previous treatment for any obviously related condition, such as high blood pressure or chest pains; and
• You were not aware of any symptoms; benefit would be available even if it was proved that the condition existed before your policy began

What if you suspect that you are suffering from a condition, for example, you have a lump, but have not seen a doctor for the condition or received any firm diagnosis? Would you be covered if a visit to your doctor after the start of the plan revealed that surgery for that condition was necessary?

Because you were aware of the condition during the 5-year period before the start of the plan, even though you weren’t quite sure what it was, you would be excluded from cover for at least the first 2 years of the plan.

There are some conditions, for example chronic conditions, that will probably never be eligible for this delayed cover because you will always need regular or occasional treatment, medication, tests or advice for them. You should not delay getting medical advice or treatment, simply to get cover.

If your insurer offers a ‘moratorium’, they will give you printed information explaining how their particular moratorium works. You may also want to ask the insurer, or us, to explain further how it works.