Medical History Disregarded (MHD) Underwriting
The most comprehensive form of group health insurance underwriting. Cover eligible pre-existing conditions from day one for your employees.
Louis has over 12 years' experience advising businesses on group health insurance and medical history disregarded underwriting.
One of the biggest concerns when arranging private medical insurance for a business is whether employees with existing medical conditions can obtain meaningful cover.
The good news is that, depending on the size of your business, the insurer you choose and your employees' circumstances, there may be underwriting options available that are far more flexible than many people expect.
What is MHD Underwriting?
Medical History Disregarded (often referred to as MHD) is an underwriting approach where employees joining a company health insurance scheme are not individually assessed on their previous medical history before cover begins.
Rather than completing detailed medical questionnaires, eligible employees can join the scheme without their past medical history affecting their acceptance onto the policy.
This can make joining a company health plan much simpler and provide valuable peace of mind for employees.
Medical History Disregarded (MHD) is the most comprehensive type of underwriting available for group private health insurance. As the name suggests, the insurer disregards individual medical histories, meaning eligible pre-existing conditions are covered from day one.
Unlike other underwriting methods, there are no individual health declarations required. Designed for larger groups (typically 15+ employees), MHD provides total equality and clarity for all staff members, ensuring everyone receives the same high standard of cover regardless of their past medical history.
Underwriting at a Glance
See how Medical History Disregarded compares to the other two main underwriting methods available for business health insurance.
Moratorium (MORI)
Medical History Required?
No initial forms.
When Is It Assessed?
At the point of claim.
Pre-Existing Conditions
Excluded for the first 2 years (typically).
Clarity of Cover
Low upfront certainty.
Application Process
Simple.
Best For
Small, generally healthy groups.
Full Medical Underwriting
Medical History Required?
Yes, full health questionnaire per employee.
When Is It Assessed?
Before the policy starts.
Pre-Existing Conditions
Explicitly excluded in writing.
Clarity of Cover
High upfront certainty.
Application Process
Some administration to complete.
Best For
Groups wanting absolute clarity on exclusions.
Medical History Disregarded
Medical History Required?
No individual forms.
When Is It Assessed?
Group risk filter only.
Pre-Existing Conditions
Covered from Day 1 (subject to risk filter).
Clarity of Cover
Total clarity and equality.
Application Process
Seamless.
Best For
15+ employees wanting comprehensive, inclusive cover.
What counts as a Pre-Existing Condition?
In health insurance terms, a pre-existing condition is broadly defined as any illness, injury, or health concern where you have received treatment, sought advice, experienced symptoms, or been taking medication prior to the start date of your policy.
Under standard policies (like Moratorium or FMU), treatment relating to these conditions is strictly excluded. This can cause frustration for employees who discover they cannot claim for a recurring joint issue or a previously diagnosed condition.
MHD changes the rules. By disregarding medical history, those previous diagnoses and historical injuries become eligible for private treatment, provided they meet the insurer's standard criteria for acute conditions (and pass the initial risk filter).
Does MHD mean all existing conditions are automatically covered?
Not necessarily.
This is one of the most common misconceptions.
While some insurers may offer cover for certain pre-existing conditions from the start of the policy under specific circumstances, others may apply exclusions, waiting periods or different underwriting terms.
Every insurer has its own underwriting philosophy, and the outcome can vary depending on factors such as:
- The insurer selected
- The size of your company
- The type of scheme being arranged
- The underwriting basis chosen
- The individual's medical circumstances
Because of these differences, it's important not to assume that every insurer will provide identical cover.
Different insurers, different approaches
The UK health insurance market is competitive, and insurers can take very different approaches when assessing employer-funded schemes.
For example, when we obtain quotations for our clients, some insurers may offer terms that include cover for certain existing medical conditions from day one, while others may provide alternative terms or exclusions.
In some cases, we may even request more than one quotation from the same insurer using different underwriting options, allowing you to compare how each approach affects both cover and premium.
Our role is to explain these differences clearly, helping you understand exactly what is and isn't included before you make a decision.
Minimum Group Sizes for MHD
Because MHD absorbs more risk, insurers require a minimum number of employees to spread that risk across the group. Here are the thresholds for leading UK providers.
AXA Health
Strong corporate proposition with excellent mental health pathways.
Aviva
Highly competitive MHD rates with strong digital wellbeing integration.
Vitality
Rewards-based MHD schemes that encourage a healthier workforce.
WPA
Premium not-for-profit provider requiring larger groups for disregarded history.
Note: Group sizes reflect minimum total employees enrolled, not necessarily the entire company headcount.
Illustrative MHD and moratorium pricing comparison
To illustrate how underwriting can affect the cost of business health insurance, Elective Health obtained two quotations from the same insurer for the same illustrative 20-person, Guildford-based business.
The employee profile, location, insurer, product, selected benefits, excess and quotation date remained the same. The material difference between the two quotations was the underwriting basis.
| Cost comparison | Moratorium | MHD | Difference |
|---|---|---|---|
| Monthly premium | £783.63 | £1,455.46 | £671.83 more for MHD |
| Annual cost if paid monthly | £9,403.56 | £17,465.52 | £8,061.96 more for MHD |
| Annual payment quotation | £8,933.47 | £16,592.29 | £7,658.82 more for MHD |
| Average monthly cost per employee | £39.18 | £72.77 | £33.59 more for MHD |
| Relative price difference | Baseline | 85.7% higher | This example only |
What does this comparison show?
In this example, Medical History Disregarded underwriting increased the quoted monthly premium from £783.63 to £1,455.46.
This represents an additional £671.83 per month, or £8,061.96 over 12 months when premiums are paid monthly.
The higher premium reflects the different way in which existing medical history is treated. It does not mean that MHD is automatically the better option. Employers should consider whether the broader treatment of existing medical history is valuable for their workforce and whether it justifies the additional cost.
Under MHD, existing medical history is generally disregarded for underwriting purposes. Cover remains subject to the insurer's benefits, limitations, chronic-condition provisions and general exclusions. MHD does not mean that every medical condition or treatment will be covered.
Under the moratorium terms used in this quotation, recent pre-existing conditions and related symptoms were initially excluded. They could potentially become eligible after the insurer's required continuous membership and trouble-free periods had been satisfied. Moratorium wording and qualifying periods can differ between insurers.
Important information
This is an anonymised educational example based on two quotations obtained from the same insurer on 21 September 2026. It is not an indication of the price your business will pay and should not be treated as a market average.
Premiums and underwriting options depend on factors including group size, employee ages, membership composition, business location, selected benefits, excess, medical history, insurer criteria and the quotation date.
MHD availability and minimum group-size requirements vary between insurers. All cover is subject to the insurer's policy terms, limitations and exclusions. A personalised quotation and assessment are required.
What Is and Isn't Covered?
Even with MHD, private health insurance is designed for acute (curable) conditions, not lifelong maintenance.
What Is Covered
- New illnesses and injuries
- Eligible pre-existing conditions (excluding risk filter exclusions)
- Specialist consultations and tests
- Diagnostic scans (MRI, CT, PET)
- Private surgery and hospital stays
- Cancer cover (if not previously diagnosed/treated)
What Is Not Covered
- Routine pregnancy and normal childbirth
- Cosmetic or aesthetic surgery
- Treatment for drug or alcohol addiction
- Unproven or experimental treatments
- Long-term chronic conditions requiring lifelong management (e.g. diabetes maintenance)
- Accident and Emergency care (always NHS)
Key Benefits of MHD
Inclusive Cover
No employee is left behind. Everyone receives the same high standard of healthcare regardless of past illnesses.
Attract & Retain Talent
MHD is the 'gold standard' of health insurance. Offering it gives you a major advantage in recruitment.
Protects Confidentiality
HR doesn't need to distribute or collect detailed medical questionnaires from staff.
Faster Claims
Because medical history isn't assessed at the point of claim, approvals are incredibly fast and frictionless.
Business Continuity
Get key personnel treated for ongoing or recurring issues immediately, reducing long-term sickness absence.
Workforce Equality
Avoids a two-tier system where healthy staff get full cover and older/unwell staff face exclusions.
Potential Drawbacks
We believe in giving you the full picture. MHD isn't the perfect fit for every single business.
Higher Premiums
Because the insurer takes on significantly more risk by covering pre-existing conditions, MHD premiums are typically 35% and upwards higher than standard Moratorium policies.
Minimum Size Rules
You generally need at least 15 to 25 employees to qualify. Smaller businesses and micro-SMEs will have to utilise Moratorium or FMU underwriting instead.
Complexity When Switching
If you want to move an existing MHD scheme to a new insurer, different providers have varying rules on accepting a 'switch' depending on past claims history.
Is MHD Right for Your Business?
Medical History Disregarded can be an excellent option for many SMEs, particularly where retaining and supporting employees is a priority.
However, it isn't always the most suitable underwriting choice. Depending on your business, workforce and objectives, another underwriting method may provide better value or more appropriate cover.
That's why we take the time to compare the available options rather than recommending a one-size-fits-all solution.
MHD is ideal if you:
- Have 15 or more eligible employees
- Want truly inclusive benefits with total equality
- Wish to avoid pre-existing condition disputes
- Value employee medical privacy and reduced admin
It may be less suitable if:
- You have fewer than 15 employees (not permitted)
- You are on a very strict, restrictive budget
- You have a very young, exceptionally healthy workforce
Speak to an SME Health Insurance Specialist
Every business is different, and so is every insurer's underwriting approach.
If you're considering company health insurance and would like to understand how Medical History Disregarded could work for your business, we'd be happy to talk you through the options.
We'll compare the market, explain the underwriting methods available, and help you find a solution that balances comprehensive cover with competitive premiums, without the jargon.
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