Medical History Disregarded (MHD) Underwriting
The most comprehensive form of group health insurance underwriting in the UK — covering eligible pre-existing conditions from day one.
What is Medical History Disregarded (MHD) Underwriting?
Medical History Disregarded — usually shortened to MHD — is the most comprehensive form of underwriting available for group private health insurance in the UK.
Unlike standard policies that look closely at past health issues, MHD underwriting sets aside an employee's general medical history entirely when the policy is arranged. This means that any eligible pre-existing conditions someone had before joining the scheme are covered from day one, with no waiting periods or automatic exclusions.
It is designed to give businesses and their teams clarity and equality, removing the uncertainty that often comes with other types of health cover.
What Counts as a Pre-Existing Condition?
To understand the value of MHD, it helps to first define what a pre-existing condition means in insurance terms. A pre-existing condition is any illness, injury, symptom, or health concern that:
Existed before the start date of the policy
Was diagnosed, treated, or discussed with a GP or specialist
Appears in medical records, even if no formal treatment was required
With most standard health insurance policies, almost all pre-existing conditions are automatically excluded. MHD changes this by disregarding that history — subject to standard risk checks.
How Does MHD Underwriting Work?
To appreciate how MHD stands out, it helps to compare it against the two most common alternative underwriting methods:
Moratorium Underwriting
No full medical details are needed upfront. However, any condition treated or experienced in the 5 years before joining is excluded for the first 2 years. If the member remains symptom-free and treatment-free during that time, the condition may become covered later. This creates uncertainty, as cover is only confirmed when a claim is made.
Full Medical Underwriting
Members must declare their complete medical history when joining. The insurer will then list exactly what is covered and what is excluded — usually permanently for most pre-existing conditions. While this offers clarity, it means many people with past health issues will not get full cover.
MHD Underwriting
With MHD, no detailed individual medical declarations are required. The insurer does not review past GP records, old injuries, allergies, or minor illnesses. All eligible acute conditions are covered immediately, regardless of when they first appeared. This creates a level playing field for every member of staff.
What Is Not Disregarded? The Risk Filter
While MHD disregards general medical history, it is not completely "no questions asked." All providers apply a standard risk filter to manage high-cost, long-term risks. This is a short set of questions that applies to the whole group.
The filter focuses only on serious, life-altering or chronic conditions:
"In the last 5 years, has any person to be covered been diagnosed, treated, or advised for:
- Cancer of any type
- Heart disease or circulatory conditions (including heart attack, angina, stroke, bypass surgery, or pacemaker fitting)
- Any other chronic or terminal condition requiring ongoing long-term care?"
What this means in practice:
- Fully covered and disregarded: Back pain, asthma, allergies, digestive issues, past injuries, high blood pressure, mental health episodes, and all other minor or resolved conditions — these are fully covered from day one.
- Reviewed only: The specific conditions listed above may be excluded or have special terms, but all other health history is ignored.
- Full privacy: Employees do not need to share their personal medical details beyond these broad categories.
Standard Minimum Group Sizes
MHD is designed for group schemes, so each insurer sets a clear minimum number of members required to qualify:
AXA Health
Minimum 15 members
Aviva
Minimum 15 members
Bupa
Minimum 20 members
Vitality
Minimum 15 members
WPA
Minimum 25 members
Note: MHD schemes generally require the business to offer cover fairly to all eligible employees — you cannot select only those with health issues to join.
What Is and Isn't Covered Under MHD?
MHD follows the same core rules as all private medical insurance — it is designed to treat acute conditions (illnesses or injuries that appear suddenly and can be treated and resolved).
Covered
- New illnesses and injuries
- Eligible pre-existing conditions (excluding those flagged in the risk filter)
- Specialist consultations, diagnostic scans, surgery, and private hospital stays
- Fast access to treatment to reduce time away from work
Not Covered
- Routine pregnancy and childbirth
- Cosmetic surgery or procedures for appearance only
- Addiction treatment
- Experimental or unlicensed medical treatments
- Long-term chronic conditions that require ongoing management rather than a cure (e.g., stable diabetes, ongoing asthma care)
- Emergency care — this remains the responsibility of the NHS
Clarification: If a chronic condition causes a new, treatable acute complication, that complication will usually be covered under MHD, even if the underlying condition itself is not.
Key Benefits of MHD Underwriting
1. Inclusive Cover for All Staff
The biggest advantage is that it removes the barrier of pre-existing conditions. Almost every employee can access private treatment when they need it, regardless of their health history.
2. Attract and Retain Talent
Offering MHD cover is a strong employee benefit. It demonstrates that you value your team equally, helping you stand out as an employer in a competitive market.
3. Protects Medical Confidentiality
Employees do not have to share private health details unnecessarily. This preserves privacy and builds trust across the workforce.
4. Less Admin and Faster Claims
There is no lengthy paperwork at sign-up or when making a claim. The claims process is simpler and quicker because there is no need to investigate past medical history.
5. Supports Business Continuity
Faster diagnosis and treatment mean employees recover and return to work sooner, reducing disruption and lost productivity — a key benefit for any growing business.
Are There Any Drawbacks?
Higher Premiums
Because MHD covers a wider range of risks, premiums are typically 15–35% higher than policies using moratorium or full medical underwriting. Many businesses find this cost is balanced by lower absenteeism and better staff satisfaction.
Only Available for Larger Groups
Due to the minimum size requirements, MHD is not available for very small teams. Businesses with fewer than 10–15 members will usually need to consider other underwriting options.
Potential Complexity When Switching
If you move between providers, each insurer applies its own risk rules. This is why speaking to a regulated broker is recommended — they can explain any differences and help you find the right terms at renewal.
Is MHD Right For Your Business?
MHD is the ideal choice if:
- You meet the standard minimum member requirements
- You want to offer the most inclusive health benefit possible
- You want to avoid disputes over pre-existing conditions
- You value employee privacy and equality
It is less suitable if you have a very small team or are working to a strict budget, where moratorium cover may offer a more affordable starting point.
How to Get Started
Understanding MHD, its rules, and how it compares to other options can be complex. When you enquire, we will explain your options clearly, check if MHD is suitable for your team size, and provide advice tailored to your business needs.