What is CPME or private health insurance with continuing personal medical exclusions?

Roman Danaev

19 December 2024

If you’ve been with the same private health insurance for a while, renewing it could be a good chance to look around. Other insurers might have better coverage or a lower price that could work in your favour. However, if you’ve already used your current plan for treatment, you might be wondering — what exactly is continued personal medical exclusions (CPME) underwriting, and how does it help?

Let’s break it down and see what’s in it for you.

What is CPME?

Insurance with continued personal medical exclusions is a handy option if you’re thinking about switching to a new insurer. With CPME underwriting, you can take the terms of your current plan with you.

So, you get to keep coverage for certain conditions that your current insurer already covers, even as you move to a different provider. Any exclusions from your existing policy still come along for the ride.

How does continued personal medical exclusions underwriting work?

If you’re thinking about switching from a CPME medical underwriting policy, here’s what you’ll need to gather:

• Your most recent insurance certificate (copy)
• Details on any claims you’ve filed during the policy period
• Some basic personal details, including your medical history

The insurer will want your medical history — not to create a new policy but to see if they can keep your coverage the same and assess any potential risks.

CPME underwriting lets you hold onto your existing exclusions. Just keep in mind that it only applies when you switch to a new insurance company, and it won’t cover any new conditions that weren’t included in your old plan.

How CPME differs from other underwriting methods

Here’s a rundown of how continued personal medical exclusions (CPME) are different from other underwriting methods you might find in private health insurance.

Comparison with moratorium underwriting

With moratorium underwriting (not to be confused with continued moratorium underwriting), any pre-existing medical conditions won’t be covered for a specific period right at the start of your policy.

The upside is that you usually don’t have to fill out a medical questionnaire, which makes getting health insurance a lot easier. Once the waiting period is over, there’s a good chance your policy will start covering those pre-existing conditions.

Comparison with full medical underwriting (FMU)

If you choose full medical underwriting, you’ll need to fill out a medical questionnaire about your health history when you apply for the new health insurance plan. This takes a bit longer than other types of underwriting because you’ll have to provide more details.

The underwriter will go through your health questionnaire answers to determine what your coverage will look like, including any exclusions that might apply. It’s a detailed process, but it helps make sure you get a plan that really fits your needs.

Comparison with medical history disregarded (MHD)

Medical history disregarded is something you’ll often see in corporate international health insurance plans. It means that most pre-existing medical conditions won’t affect the underwriting process. This usually applies only to acute conditions, like broken bones or viruses, not chronic ones like arthritis or cancer.

The main benefit of MHD is that it covers pre-existing conditions, which makes claims easier, but it tends to be more expensive because of that coverage.

What conditions are not covered by CPME underwriting?

There are specific conditions and treatments that are typically excluded under CPME underwriting. Here’s a list of common ones:

• Long-term conditions like diabetes or heart disease, since they require ongoing treatment
• If you’ve recently had an injury or illness, like a broken bone or surgery
• Pre-existing mental health issues, such as depression or anxiety
• Treatments considered cosmetic, like plastic surgery, for aesthetic reasons (breast augmentation or rhinoplasty)
• Any treatments that are experimental or not widely accepted
• Conditions that need regular check-ups or management, such as certain autoimmune diseases, musculoskeletal conditions, and chronic pain syndromes
• New conditions diagnosed during the waiting period

Each provider offers a detailed list, like this one.

Who should consider CPME?

Individuals:

• Managing a chronic illness or recovering from surgery? CPME underwriting allows you to retain your coverage when switching insurers and avoid new exclusions in the process.
• Found a new insurer with better benefits or lower premiums? You can make the switch while keeping your existing coverage intact.
• Finished treatment for a minor health issue and now fully recovered? CPME helps you maintain coverage for that condition as you explore new insurance options.
• Need ongoing care for a pre-existing condition? CPME allows you to change insurers while keeping your necessary treatments covered.

Businesses:

• Is employee health a priority for your business? Using continuing personal medical exclusions guarantees ongoing support for staff members with health concerns.
• Looking to offer more affordable or comprehensive health insurance? Or do you have employees dealing with chronic illnesses? CPME helps them maintain their coverage when switching health plans.
• In an industry where retaining employees is crucial? Consider CPME to support those with health issues to increase satisfaction and loyalty.

When do I need CPME health insurance underwriting?

CPME underwriting is a solid option for individuals who have already received treatment for a previous medical condition. For instance, if you’ve had a knee injury and are switching insurers, your new provider won’t look back at your medical history. So, you’ll keep your coverage without new exclusions.

Also, if you’ve found cheaper premiums or better terms, it makes sense to switch providers.

For businesses, if your company is looking for a better deal while keeping existing employee coverage intact, CPME policies can help, too.

Example of when you can switch with CPME

Let’s say you’ve just finished treatment for a minor issue, like a sprained ankle, and you’re feeling great — no ongoing claims or doctor visits for that anymore.

In this situation, you can switch to another health insurance provider using continued personal medical exclusions (CPME). The new insurance company will honour the same exclusions, so you can keep similar coverage while possibly getting better monthly premiums or extra benefits.

Example of when you cannot switch with CPME

Consider a scenario where you’re currently undergoing treatment for a serious condition, such as cancer, and you’ve just filed a claim for expensive chemotherapy sessions.

In this case, you won’t be able to switch to a new insurance provider using continuing personal medical exclusions. Because you have ongoing claims, most insurers will likely decline your application due to the associated risks. You may need to wait until your treatment is completed and a certain period has passed before you consider switching insurers. It can be frustrating, but it’s important to focus on getting the care you need right now.

Advantages of CPME health insurance

Here are the key advantages of continuing personal medical exclusions (CPME) health insurance:

• Continuous coverage for existing conditions
• No new exclusions when switching insurers
• Simplified transition to a new plan
• Flexibility to explore better benefits or lower premiums
• Better financial security against unexpected medical costs

Are continuing personal medical exclusions (CPME) affected by switching my health insurance policy?

So, you’re a private medical insurance policyholder thinking about switching things up. You might be asking yourself whether your treatments will still be covered if you change plans.

How to change insurers

To switch insurers while keeping your continuing personal medical exclusions in place, start by reviewing your current policy. Take note of any exclusions and benefits you have.

Next, research health insurance providers that offer CPME and compare their plans, carefully reading the small print to find one that suits your needs. Once you have a shortlist, contact the new insurer to confirm they accept CPME and ask about any necessary documentation, like a copy of your current insurance certificate and details of any claims you’ve made. You may also need to summarise your medical history, especially for pre-existing conditions.

Submit your application to the new insurer, and make sure to indicate that you want to switch under CPME. Before cancelling your old policy, double-check that everything is in place with your new insurance provider to avoid any gaps. Finally, contact your previous insurer to cancel your old policy, and keep all documents related to both policies handy for future reference.

What happens if I switch my medical insurance cover?

If you decide to switch your health insurance under a CPME plan, your new insurer will take on the responsibility of covering you with the same terms as your previous health insurance policy. For example, you’re preparing to renew your policy next month and considering whether there are better options available.

How does medical history and CPME work for treatment?

Let’s say you develop a medical issue in your first year and receive treatment for it. If you then take out a new health plan that doesn’t have CPME underwriting, that treatment won’t be covered. But if you switch with CPME, any future flare-ups of that condition would still be covered because the new insurer has agreed to honour the risks from your previous policy.

So, is CPME worth it?

For many individuals and businesses, the answer is yes. Health insurance policies with continuing personal medical exclusions provide a way to switch insurers that focus on coverage for pre-existing conditions remaining intact. This is especially valuable for those who have ongoing health needs.

However, if you’re generally healthy, you may find better value in a plan that doesn’t include CPME and pay less for coverage you don’t need.

Final words

Hopefully, we’ve answered your questions about continued personal medical exclusions. Make sure to carefully evaluate different insurers, your health needs, and your financial situation to determine if CPME is the right choice for your new health insurance policy.