Pre-existing conditions and underwriting, explained
IPMIAfrica explains how international private medical insurance handles the conditions you already have: what counts as pre-existing, how full medical underwriting, moratorium, continued personal medical exclusions and switch terms work, and which suits whom.
- A pre-existing condition includes symptoms you had but never investigated, not only diagnosed diseases.
- Under FMU, forgetting to declare something can be treated as non-disclosure and a claim declined or the plan cancelled.
- A chronic condition needing ongoing medication never clears a moratorium, because the medication itself resets the period.
- Switch terms usually require the old plan to be in force and the new cover to be no higher than the old.
- Moving from a local employer plan to an individual international plan is usually a fresh application, not a switch.
What counts as a pre-existing condition
A pre-existing condition is any illness, injury or symptom that you had, were treated for, were advised about or could reasonably have been aware of before the plan started. The definition is wider than most people expect. It is not limited to diagnosed diseases. A back problem you saw a physiotherapist about, a skin lesion a GP looked at, raised blood pressure noted at a check-up, or symptoms you had but never investigated can all count, and so can conditions that are related to or arise from them.
Insurers care about this because international health insurance is annual cover for future events, priced on the assumption that the insured pool is broadly healthy at the start. Without rules on pre-existing conditions, people would buy cover only when they already needed treatment, and the premium would be unaffordable for everyone else.
What matters for you is which method the insurer uses to deal with your history, because it decides what is covered from day one, what is excluded, and what might come into cover later.
Full medical underwriting (FMU)
Under full medical underwriting you complete a medical questionnaire when you apply. You declare every condition, symptom, treatment and consultation you can recall, usually going back a number of years and sometimes without a time limit for serious conditions. The insurer may ask follow-up questions or request a report from your doctor. It then gives you a written decision before you buy.
The decision will say one of four things about each condition: it is covered at standard terms, it is excluded, it is covered with a loading (a higher premium), or the application is declined. Exclusions are usually specific and written into your certificate, so you know exactly where you stand.
- Advantages: certainty from day one. Minor or long-resolved conditions are often covered. There is no argument at claim time about whether something was pre-existing, because it was already assessed.
- Disadvantages: the application takes longer and requires honesty and good records. An exclusion, once written, usually stays unless you apply to have it reviewed. If you forget to declare something, the insurer may treat it as non-disclosure and decline a claim, or in serious cases cancel the plan.
FMU suits people with a known medical history who want to know before they commit what will and will not be covered. It also suits older applicants and anyone who would rather have a clear answer than rely on a rule.
Moratorium underwriting
Under a moratorium you do not complete a detailed medical questionnaire. Instead the insurer applies a rule: any condition you had symptoms of, or treatment or advice for, in a set period before the plan started is automatically excluded for a set period after it started. If you then go a further set period without symptoms, treatment, medication or advice for that condition, it comes into cover.
Because the rule is applied at claim time rather than at application, the insurer looks at your medical records when you claim to decide whether the condition falls within the moratorium. If you have been clear of it for the required period, the claim is paid. If not, it is declined and the clock restarts.
- Advantages: fast and simple to apply for. Conditions can come into cover over time without a new application. Good for people with no significant history who want cover quickly.
- Disadvantages: uncertainty. You do not know for sure whether a condition is covered until you claim. Chronic conditions that need ongoing medication never clear the moratorium, because the medication itself resets the period. Related and recurring conditions can be caught more widely than you expected.
Moratorium suits people with little or no medical history, and people who would struggle to document their history accurately. It is a poor fit for anyone with an ongoing condition they expect to claim for.
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Continued personal medical exclusions (CPME) and switch terms
If you already hold an international plan and want to move to another insurer, you may be offered terms that carry your existing position across rather than starting again.
Continued personal medical exclusions (CPME) means the new insurer accepts you on the same specific exclusions that were written into your existing certificate, no better and no worse. Conditions that were covered under the old plan remain covered; conditions that were excluded remain excluded. This is most common when you were originally fully medically underwritten, because the exclusions are already written down.
Switch terms, sometimes called continuation or transfer terms, is the broader label for moving between insurers without fresh underwriting. Depending on the new insurer it can mean CPME, or it can mean continuing a moratorium with the time you have already served counted, so that conditions that had cleared under the old plan are not re-excluded. Insurers usually set conditions: that the old plan is still in force, that the new cover is no higher than the old, that you have not had a serious condition since the old plan started, and that you supply the old certificate and a recent renewal notice.
- Advantages: you keep what you have. Conditions that developed while insured, which would be pre-existing on a fresh application, stay covered.
- Disadvantages: you also keep any exclusions. Not every insurer offers it, and those that do may limit it to plans of similar level.
If you have been insured for years and have developed a condition in that time, switch terms are the single most important thing to ask for when you compare, because a fresh application would exclude it.
Which method suits whom
| Your situation | Usually the better fit | Why |
|---|---|---|
| Little or no medical history, want cover quickly | Moratorium | Fast, and nothing significant to be caught by the rule |
| Known conditions, want certainty before buying | Full medical underwriting | Written decision up front; minor conditions often covered |
| Ongoing condition needing regular medication | Full medical underwriting | Would never clear a moratorium; FMU may cover with a loading |
| Already insured, condition developed while covered | Switch terms or CPME | Keeps the condition covered; a fresh application would exclude it |
| Older applicant or retiring abroad | Full medical underwriting, or switch terms if already insured | Certainty matters more as the likelihood of claims rises |
| Family with mixed histories | Ask whether members can be underwritten differently | Some insurers allow one method per person |
Not every insurer offers every method, and some offer different methods in different markets. Expatriate Healthcare, whose plans are underwritten by Gen Re / Guardrisk, and the larger international insurers such as Cigna Global, Allianz Care and Bupa Global each set out their approach in their plan documents. The IPMIAfrica insurer pages summarise them.
What is different for applicants in Africa
The underwriting methods are the same everywhere, but a few things matter more for people living in Africa.
- Medical records. FMU and moratorium claims both depend on records. If you have been treated in several countries, or in facilities that do not keep electronic records, gather what you can before you apply and keep copies of everything from now on.
- Common illnesses. Malaria, typhoid and similar infections that were treated and fully resolved are usually not a problem under either method, but declare them under FMU. Recurring episodes may be treated differently.
- Chronic conditions and evacuation. If a condition is excluded, so is an evacuation for it. For someone outside a main city, that is a serious gap. If you have an ongoing condition, FMU with a loading may be worth far more than a cheaper moratorium plan that will never pay.
- Employer plans. Moving from a local employer plan to an individual international plan is a fresh application in most cases, not a switch. Ask whether any insurer will recognise your time on the group plan.
How to prepare an application
- Write down your history before you start: conditions, symptoms, consultations, tests, medication and dates. Include things that seem minor.
- Decide which method you want using the table above, and tell the broker. Nomi asks the questions that point to the right one.
- If you are already insured, have your current certificate and last renewal notice ready, and ask every insurer you compare whether they offer switch terms or CPME.
- Under FMU, declare everything. Over-disclosure costs nothing; non-disclosure can void a claim.
- Read the decision. Check every exclusion, ask what it covers, and ask whether and when it can be reviewed.
Frequently asked questions
What is the difference between full medical underwriting and a moratorium?
Will a chronic condition ever be covered under a moratorium?
What are switch terms and CPME?
What happens if I forget to declare something under FMU?
How does IPMIAfrica handle underwriting?
Does an exclusion also exclude evacuation?
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This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to an experienced broker.