Insurance Without Medical Underwriting

Medical underwriting—where insurers review your health history before accepting you—can be a barrier for many expats. If you have health conditions, complex medical history, or simply want privacy, there are options that minimize or eliminate the medical screening process.

What Is Medical Underwriting?

Medical underwriting is the process insurers use to assess your health risk before offering coverage. It typically involves:

• Health questionnaire: Questions about current conditions, medications, past treatments
• Medical records request: Some insurers request doctor's notes or test results
• Underwriter review: A specialist evaluates your application
• Decision: Accept, accept with exclusions, accept with higher premium, or decline

Why People Want to Avoid Underwriting

• Pre-existing conditions: Fear of exclusions or declination
• Privacy concerns: Don't want to disclose health history
• Time pressure: Need coverage quickly
• Previous denials: Been declined by other insurers
• Complex history: Difficult to document or explain

Guaranteed Issue Options

True guaranteed issue means you can't be rejected regardless of health status. In international insurance, this is rare but exists in specific forms:

Group Plans

Some employer or association group plans accept all members without individual underwriting:

• Company-sponsored expatriate health plans
• Professional association group coverage
• Some NGO and missionary organization plans

Country-Specific Guaranteed Issue

Certain countries require insurers to accept all applicants:

• Germany: Statutory health insurance (GKV) must accept everyone
• Netherlands: Basic insurance is guaranteed issue
• Switzerland: LAMal basic coverage is mandatory acceptance
• France: CMU (now PUMa) provides universal access

Moratorium-Based Plans

Moratorium underwriting is the closest thing to guaranteed issue in international private insurance. Here's how it works:

Moratorium Example

You have managed high blood pressure. With moratorium underwriting:

• Day 1: Policy starts, high blood pressure excluded
• Year 1-2: Any hypertension-related treatment paid out of pocket
• After year 2: If you haven't needed treatment, hypertension becomes covered
• If you needed treatment: The 2-year clock restarts

Providers Offering Moratorium

• Allianz Care: Choice between full underwriting or moratorium
• AXA Global: Moratorium option available
• Some BUPA plans: Moratorium available in certain markets

Local Insurance Options

For true guaranteed issue, local insurance in your destination country may be your best option:

Countries with Mandatory Acceptance

Countries with Public Healthcare Access

These countries provide healthcare access to residents regardless of insurance status:

• UK: NHS available to residents
• Spain: Public healthcare for registered residents
• Portugal: SNS access for residents
• Italy: SSN for registered residents

The Trade-offs

Avoiding medical underwriting comes with trade-offs you should understand:

When Underwriting Might Be Better

Full underwriting could be preferable if:

• Your conditions are well-controlled and might be accepted
• You want clarity on exactly what's covered from day 1
• You'd rather pay higher premium than wait 2 years for coverage
• You have good medical documentation

Recommended Providers

These providers offer alternatives to traditional full medical underwriting:

Allianz Care

Allianz offers a clear choice: full underwriting or moratorium. The moratorium option provides guaranteed acceptance with a 2-year exclusion period for pre-existing conditions. Good for those who value certainty of acceptance.

AXA Global

Similar to Allianz, AXA provides moratorium underwriting as an alternative. Strong in Europe and well-regarded for customer service during claims.

SafetyWing

SafetyWing uses simplified underwriting with minimal health questions. They're more accessible than traditional insurers but permanently exclude pre-existing conditions (no moratorium path to coverage).

Getting Accepted: Tips

If You Must Go Through Underwriting

• Apply to multiple insurers: Different underwriters assess risk differently
• Document stability: Show your condition is controlled with recent test results
• Time it right: Apply when your condition is stable, not during a flare
• Use a broker: They know which insurers are more accepting of specific conditions
• Be completely honest: Undisclosed conditions can void your policy later

If Choosing Moratorium

• Budget for out-of-pocket: You'll pay for pre-existing condition care for 2 years
• Keep records: Document the moratorium period in case of disputes
• Understand the terms: Know exactly what resets the clock
• Plan for stability: Avoid claims related to pre-existing conditions if possible

Common Questions

Will I pay more for moratorium underwriting?

Not necessarily. Moratorium plans are often priced similarly to full-underwriting plans because the insurer isn't covering your pre-existing conditions initially anyway. Some insurers charge slightly more; others don't differentiate.

What happens if I need treatment during the moratorium period?

You pay out of pocket for anything related to pre-existing conditions. The moratorium clock may reset, meaning another 2 years before that condition is covered. Unrelated conditions are covered normally.

How do they know what's pre-existing if they don't ask?

When you make a claim, insurers can request medical records. If records show you had the condition before coverage started, it's classified as pre-existing. This is why honesty matters—they will find out.

Can I switch from moratorium to full underwriting later?

Generally not within the same insurer/policy. You'd need to apply for a new policy with full underwriting, and you'd be evaluated based on your current health status.

What if I'm declined by all insurers?

Consider: moratorium-based plans (can't be declined), local insurance in countries with guaranteed issue, or relocating to a country with universal healthcare access. There are always options, though not always ideal ones.

Is travel insurance easier to get than health insurance?

Travel insurance typically has simpler applications but stricter exclusions. Pre-existing conditions are usually excluded entirely with no path to coverage. For long-term expats, proper health insurance is more appropriate.

Does age affect guaranteed issue options?

Age can affect premiums significantly but doesn't usually prevent acceptance for moratorium plans. However, older applicants face higher premiums and may find fewer options. Local guaranteed issue (like German statutory insurance) doesn't discriminate by age.