Choose full medical underwriting if you want certainty about exactly what is excluded from day one, and a moratorium if you have little recent medical history and want cover in place quickly with the chance that older conditions become eligible for cover again after two trouble-free years. The honest answer is that it depends on your medical history, and the two options behave very differently at the moment you claim.
Every personal private medical insurance application in the UK comes down to this choice, and it is usually presented as a box to tick rather than a decision with consequences. Here is what each one actually does.
How a moratorium works
You usually complete no medical questionnaire, although some insurers offer moratorium variants that ask a short declaration in exchange for a discount. Instead, the insurer applies a standard rule, which on personal policies is almost always the same: any condition you had symptoms of, or received treatment, medication or advice for, in the five years before your start date is excluded. That exclusion is not necessarily permanent. Under the standard rolling moratorium, if you then go two continuous years on the policy without treatment, medication, advice or symptoms for that condition, it can become eligible for cover again. Company schemes sometimes use a fixed moratorium instead, which works differently.
The subtlety is in the word symptoms. The two year clock needs you to be genuinely clear of the condition, not just undiagnosed. A repeat prescription, an annual check up for that condition, or a recurring symptom you never saw a doctor about can all keep the clock from completing. The exact scope of the test also varies by insurer: some count diagnostic tests, routine check ups or even over the counter medicines towards it, so the policy wording is worth reading on this point.
How full medical underwriting works
You complete a health questionnaire covering your medical history, and the insurer tells you up front, in writing, exactly which conditions are excluded. Everything not excluded is covered on the policy's normal terms from day one. Some insurers will formally reconsider a named exclusion if you ask, typically after one or two clear years, though that is at their discretion and generally not for chronic conditions.
The difference that matters: when you claim
This is the part most explanations miss. With full medical underwriting, the insurer made its decisions before the policy started, so a claim is assessed against a known list of exclusions. With a moratorium, nobody has looked at your history yet. The insurer decides whether a claim relates to a pre-existing condition at the point you claim, usually by asking your GP for records, and some insurers can require up to five years of medical records to assess a claim. A claim for a condition you believed was new can be declined because the records show related symptoms four years ago.
Neither approach is a trick, but they place the uncertainty in different places. Full medical underwriting puts the uncertainty up front, where you can read it. A moratorium defers it to claim time.
Who each option tends to suit
- Moratorium tends to suit people with little or no medical activity in the last five years. There is nothing to declare, cover starts quickly, and the standard exclusion costs them little because there is nothing recent to exclude.
- Full medical underwriting tends to suit people with some history: a past condition that is resolved, an isolated episode, something specific they want a clear answer on. A resolved condition may attract no exclusion at all, and where there is an exclusion, at least it is named and known.
- For a company scheme, the equivalent choice includes a third option, medical history disregarded, which is covered in our guide to pre-existing conditions.
Three things people get wrong
Treating the moratorium as cover for everything undeclared. Not declaring is not the same as being covered. The five year look back applies whether or not anyone asked you about your history.
Assuming the two year clock always completes. For a condition that needs ongoing medication or monitoring, the trouble-free period may never finish, and the condition remains excluded indefinitely. For conditions like that, full medical underwriting at least tells you where you stand.
Choosing on price. The premium is often similar for both, though some products do price the difference. The difference is not what you pay, it is how the policy behaves around your particular history, which is exactly the kind of judgement an adviser is for.
Changing your mind later
The underwriting basis you choose follows the policy. If you later switch insurer, the new insurer can usually continue your existing basis through switch terms, which we explain in our guide to switching without losing cover. Moving from one basis to the other mid stream is sometimes possible but needs care, because done badly it can restart exclusions you had already cleared.
The questions we ask before recommending either
When has anything last been treated, prescribed or investigated, and is anything unresolved? Is there a condition you specifically want certainty on? Are you likely to switch insurer later, where the basis you choose now will follow you? And is speed a factor, since a moratorium can start immediately while full medical underwriting waits on a completed questionnaire? Five minutes on those questions usually makes the choice obvious, and when it is not obvious, that is itself useful information, because it means the decision deserves advice rather than a default.
This guide is general information rather than advice. If you tell us your history, we can tell you which basis, and which insurer's version of it, actually fits; different insurers apply these rules with meaningfully different wording, and the differences only show up when you need them.