What is medical underwriting for health insurance?
Medical underwriting includes applicant disclosing their past medical history which is the reviewed by the medical team of an insurance company. Based on this, final terms of cover will be provided whether to accept the applicant or apply some special remarks to the cover. Medical underwriting is an essential part of the process of applying for private health insurance in China as an individual.
Key takeaways
In China most insurance plans will follow one of the following underwriting procedures for enrollment: Full Medical Underwriting (FMU), Moratorium Underwriting (Mori), Medical History Disregarded (MHD) and Continued Transfer Terms (CTT). Each mainly depends on if you are a new client for the insurance company or are currently existing member on a different plan. Additionally, some insurance companies can offer CTT terms for members leaving one insurance company and signing up with them instead. Let’s dive int he details. It all comes down to figuring out your health status before you apply for insurance.
Source: US Healthcare Government
Full medical underwriting
This is by far the most popular choice when an expat wants to sign up for an individual or family private health insurance in China. It is available with pretty much all policies currently on the market as well as can be applied to both new members plus existing members of an insurance company. Full medical means you will have to fill out a medical questionnaire, which is usually a part of the enrollment form.
Typically such consists of 10-20 health related questions designed so you can fully disclose your past medical history. Questions are to be answered in a “Yes or No” format. Should there be “Yes” to any of the questions, you will need to provide additional information underneath in a table. You can expect to provide extra information on your:
- diagnosis
- first date of the symptoms
- what’s the ongoing treatment plan/prescriptions look like
Sometime insurance companies in China pay attention to existing medical conditions that happened in the last 5 years only, more often it will be an open ended timeline. Underwriting team will use this information to determine the terms of your coverage.
Moratorium underwriting
With moratorium underwriting for health insurance in China you can expect your pre-existing medical conditions to be excluded for a certain period of time. Usually that refers to 2 years timeframe. Upon competition, insurance provider will re-assess your medical conditions and how those were managed during the 2 years frame. Based on this information, they will decide if it can be covered from the renewal date. Keep in mind, competition of 2 years moratorium doesn’t 100% guarantee you will get cover for the conditions. Only handful of insurance plans now support such enrollment through moratorium.
Medical history disregarded
Such enrollment procedures are very popular for large corporate insurance plans. Usually if you have 20 or more employees together with you on the policy – this will be the enrollment terms you can get. There is no need to tell insurance provider about all the past medical conditions you had, but rather they will only want to know about “catastrophic conditions”. Such can include:
- heart attack and other major cardiovascular issues
- brain strokes and tumors
- Chrohn’s, Parkinson’s and Alzheimer diseases
- HIV/AIDS positive cases
For very large accounts of 100+ employees on cover, it is common for insurance companies even to cover the above conditions. At the end of the day, medical underwriting team will try to forecast the future spending on those conditions versus the total value of the policy you company has.
Continued transfer terms (CTT)
Insurance company will maintain your existing underwriting terms when you sign up for a new plan. Example of such can be if you currently have a group insurance from your employer but upon leaving their employment would like to switch to an individual policy. Sometimes it is also possible to opt for CTT terms when switching insurance providers as well. Great example is when Bupa has left China market in early 2023, many insurance companies such as AXA and Medilink offered continuation of cover for existing Bupa clients if they switch to their own policies.
If you have an insurance plan from a global brand, then it is very possible to switch your cover whenever you relocate. Typically, this does not require medical underwriting. Sometimes special conditions may apply such as you need to keep similar or lower level of plan at relocation.
How do these terms impact my health insurance price?
Once you disclose your past medical history under FMU and MHD terms, insurance provider will review it and offer the terms of cover. Mainly for FMU cases, it is common to see a surcharge on the price based on your existing illnesses. Such as for chronic conditions like asthma or diabetes, insurance provider might be willing to charge you extra 10-20% on standard price but offer full cover on medications and complications. Sometimes it will not be full cover but rather a specific cap limit that you can use per year. You can learn more about pre-existing medical conditions cover in out article here.
In more serious cases, insurance companies can reject your application and thus decline in providing you an offer. This usually applies if a person had some serious sickness very recently such as heart attack within the last 2 years or cancer treatment and currently not yet in remission stage.
Other factors that impact health insurance price in China
Age
Age is the biggest factor that determines price of your insurance policy. Increase in age will also bring increases to your insurance premium at subsequent renewals.
Smoking and drinking
During enrollment with most companies you will need to disclose whether you smoke and/or drink. Special terms can be applied once underwriting team reviews it and find it to be harmful. An example can be smoking more than 1 pack of cigarettes a day.