What is underwriting?
When it comes to health insurance, we use the term underwriting to explain the process of looking at your employees ages, medical history and any previous claims to decide what cover we can offer.
Amongst other factors, underwriting determines how we treat pre-existing medical conditions.
It’s important that you and your employees know which underwriting option applies to you, so that you know when you are and aren’t covered by your plan.
What is a pre-existing medical condition?
We define a pre-existing condition as any disease, illness or injury that:
- You have received medication, advice or treatment for before the start of your cover, or
- You have experienced symptoms of before the start of your cover: whether or not the condition was diagnosed
Which underwriting options does AXA Health offer?
Full medical underwriting
Full medical underwriting means we’ve taken your medical history into account to decide what cover we can offer you. Medical conditions that you had before you joined us won’t usually be covered. Any medical conditions you have after your plan starts will be covered in line with the terms of your plan.
Before you claim, we may need to check that your claim isn’t for a pre-existing condition or linked to any other medical conditions you had before you joined which might be causing or associated with the condition.
Example
David has been having chest pains for over a year. A few months after joining, David goes to the doctor about his symptoms and is diagnosed with a heart condition. As David had been experiencing symptoms of the condition prior to joining, he wouldn’t be covered for treatment under the terms of his membership.
Moratorium
As with Full Medical Underwriting, pre-existing conditions are not covered. However, this only applies to medical problems that you had in the five years before you joined us. Additionally, although cover is not immediately available, it will become available as soon as:
- You’ve been a member for two years in a row, and
- You’ve had a period of 12 consecutive months since you joined that have been trouble-free from that condition
What does trouble-free mean?
Trouble-free means that for your medical condition you haven’t:
- Had a medical opinion from a medical practitioner, including a GP or a specialist
- Taken medication (including over the counter drugs)
- Followed a special diet
- Had medical treatment, or
- Visited a clinical practitioner, therapist, homeopath, acupuncturist, optician or dentist
Example
Jane’s had a bad knee on and off since she was young. Today, she’s been a member of AXA Health for two years in a row and hasn’t had any treatment, medication or medical advice for her knee problem for 12 consecutive months since her membership started, so she’s covered if it flares up again.
Continuing medical exclusions
If you’ve joined us on these terms from another provider, it means we’re carrying on the underwriting you had with them for your medical conditions. Any exclusions or special terms will be on your membership certificate. Cover will be subject to the terms of the plan and the cover options chosen.
Example
Mike had been receiving treatment for an acute heart condition on his business health insurance plan with his previous provider. He recently switched his plan to AXA Health and chose the continuing medical exclusions underwriting option. This means that Mike can continue to be covered for treatment for his condition with us, subject to the terms of his plan.
Medical history disregarded
Medical history disregarded means that we accepted any pre-existing medical conditions you may have had when you joined us, so you don’t need to worry about any underwriting exclusions. Your cover will be in line with the new terms of your plan with us.
Example
Natalie is an employee at a small business who has had business health insurance as part of their employee benefits package for the last 6 months. Last year, Natalie received physiotherapy treatment for a bad back. Recently, her back has started to become painful again and she has been referred for physiotherapy treatment by her GP. As Natalie has the Therapies cover option as part of her plan and has medical history disregarded underwriting, she is covered for physiotherapy treatment on her plan.
Can my employees have different underwriting on my business health insurance plan?
Yes, your employees can have different underwriting on your plan. However, there are some limitations to this. If you would like to find out more, you can call us on 0800 389 7413*.
