Medical History Disregarded (MHD) Explained for SMEs: When You Can Qualify (2026 UK Guide)
If your business wants private medical insurance that covers pre-existing conditions for staff, Medical History Disregarded (MHD) may be available. This guide explains how MHD underwriting works, which SME groups qualify, cost impact, and how it differs from other underwriting types.
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What is MHD (Medical History Disregarded)?
MHD means no medical history questions are asked for employees when joining a group policy — and pre-existing conditions are covered immediately, subject to the plan’s general terms (e.g., chronic exclusions).
This is standard for large corporate PMI schemes and sometimes available for smaller SMEs (2–249 lives) under special underwriting or continuation rules.
How it differs from other underwriting types
| Type | Who it suits | Pre-existing cover? | Notes |
|---|---|---|---|
| MHD | Medium–large SMEs, corporate | Yes (most conditions covered) | No health questions; higher premium |
| FMU (Full Medical Underwriting) | Micro employers / individual policies | No (excluded initially) | Health questions and exclusions |
| CPME (Continued Personal Medical Exclusions) | Switching from another insurer | Existing exclusions remain | Prevents re-underwriting |
| MORI / Switch terms | SMEs moving from existing group cover | Depends on prior cover | Common route for smaller teams |
When SMEs can qualify for MHD
- Group size: usually 10–20+ employees minimum (varies by insurer).
- Existing cover: easier if transferring from another group plan with continuous cover.
- Clean claims history: low utilisation and stable headcount increase approval odds.
- Employer funding: must typically be company-paid, not salary sacrifice or voluntary.
- Employee eligibility: all eligible staff offered the same level of cover (no cherry-picking).
Which insurers offer MHD (indicative 2026)
| Insurer | MHD availability | Minimum lives | Notes |
|---|---|---|---|
| Bupa | Yes | 10+ | SME select options; switch route available |
| AXA Health | Yes | 10–15+ | Case-by-case; may allow partial MHD |
| Aviva | Limited | 20+ | Usually switch-only for smaller groups |
| Vitality | Limited | 15+ | Occasional underwriter discretion |
| WPA | Yes | 10+ | Flexible SME policies with MHD possible |
| The Exeter / Freedom | Selective | 20+ | Depends on previous cover & risk data |
Cost impact vs standard underwriting
- MHD premiums can be 15–35% higher initially due to higher risk acceptance.
- Renewal impact depends on claims ratio — insurers may adjust after year 1.
- Tax treatment: same as other PMI — P11D benefit for employees, business expense for employers.
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Advantages & drawbacks
| Pros ✅ | Cons ⚠️ |
|---|---|
| Pre-existing conditions covered from day one | Higher initial premium cost |
| No medical questionnaires or declarations | Underwriter may remove MHD at renewal if claims spike |
| Easier onboarding — all staff treated equally | May require minimum group size or prior cover |
How to apply for MHD
- Collect basic staff census (age, gender, roles, postcode).
- Gather claims summary if switching insurers.
- Ask brokers/insurers to quote on MHD and CPME bases for comparison.
- Request written confirmation of eligibility & terms — some policies apply “pseudo-MHD” (e.g., moratorium override).
Alternatives if you don’t qualify
- CPME (switch): keeps old exclusions, still avoids re-underwriting.
- Moratorium: automatic cover after 2 years symptom-free.
- Group continuation: sometimes offered for smaller SME renewals as hybrid underwriting.
Example scenarios
- 10-person consultancy switching from Aviva CPME → Bupa: underwriter grants MHD due to clean claims & stable size.
- 4-person tech startup: too small for MHD; opts for moratorium cover initially, re-quotes next year when growing to 8+ lives.
- 25-person legal firm: MHD granted on renewal, with premium loading of ~20% over standard switch terms.
Ready to check eligibility?
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FAQs
Does MHD cover all pre-existing conditions?
Usually yes, except chronic or long-term maintenance conditions excluded in standard PMI wording. Always confirm with the insurer.
What happens if my SME grows or shrinks?
If staff drop below the minimum headcount, insurers may revert to CPME or moratorium terms. Larger growth can strengthen your renewal position.
Can individuals join later under MHD terms?
Yes, if they meet eligibility rules (e.g., probation complete). New joiners are usually covered on the same MHD basis automatically.
Disclaimer: This 2026 UK guide is for general information only and not financial advice. Underwriting and MHD availability depend on insurer criteria, group size and claims data. Always confirm current terms in writing before making business insurance decisions. Going Private UK is not a broker or insurer.
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