Medical History Disregarded (MHD): How SMEs Get It in 2026
The honest guide to Medical History Disregarded — the group health insurance underwriting where pre-existing conditions are covered from day one, nobody fills in a health questionnaire, and your staff never disclose anything medical to you or the insurer. What it really costs, the employee thresholds insurers actually apply, what’s still excluded even on MHD, and how growing SMEs unlock it at renewal.
Quick Answer
Medical History Disregarded (MHD) is group health insurance underwriting where the insurer ignores members’ medical history entirely: pre-existing conditions covered from day one, no health questionnaires, complete confidentiality for staff. One clarification for the “MHD in medical terms” searchers: it’s insurance jargon, not a clinical term — in health cover it always means Medical History Disregarded.
The realities: typically available from 15–20+ employees (sometimes negotiable from ~10 lives with clean claims), costing roughly 15–30% more than moratorium terms — and it removes underwriting exclusions, not policy ones: chronic-condition rules and benefit limits still apply.
On this page
- What MHD means — and what it replaces
- The thresholds: how many employees you really need
- What MHD costs (and when it’s worth it)
- What MHD still doesn’t cover
- Which insurers have the fewest exclusions?
- Group PMI waiting periods, honestly
- Switching, upgrading & CMHD
- Leavers: what happens to MHD cover
- Frequently asked questions
What MHD Means — and What It Replaces
Every group health insurance scheme runs on an underwriting basis — the rules deciding how members’ past health affects their cover. The standard SME options all look backwards in some way: moratorium and full medical underwriting exclude recent conditions until they’ve been trouble-free, and CPME carries old exclusions across when switching. MHD is the basis that doesn’t look backwards at all: the insurer disregards every member’s history, covers pre-existing conditions from day one, asks no health questions — and because nothing is disclosed, staff privacy is total, which quietly drives higher scheme take-up. It’s the underwriting standard on large corporate schemes; the interesting question for SMEs is exactly when it comes within reach, which is the next section.
The Thresholds: How Many Employees You Really Need
| Group size | Realistic underwriting position |
|---|---|
| 2 – 9 employees | Moratorium is the standard; MHD rarely available — requote as you grow |
| ~10 – 14 employees | MHD sometimes negotiable with clean claims history, stable headcount and broker support |
| 15 – 20+ employees | MHD typically available at the major insurers — Bupa and AXA Health both usually offer it from around this size |
| Large corporate | MHD is the default expectation |
Thresholds vary by insurer and scheme, and they’re a negotiation rather than a law of physics — which is why the crossing point matters: if your headcount is approaching the teens, MHD is a question to ask at every renewal, and the broker route earns its keep here more than anywhere else in business health insurance comparison. Smaller teams weighing their options start at group vs individual cover for small teams and our startup guide.
What MHD Costs (and When It’s Worth It)
MHD typically prices 15–30% above equivalent moratorium terms per employee — the insurer is accepting every member’s existing conditions from day one, and charges for the privilege. The worth-it test is honest arithmetic: on a team where nobody has meaningful history, the premium buys mostly peace of mind and privacy; on a team where several people would face exclusions — the reality in most workforces over thirty-five — MHD delivers cover moratorium simply can’t, and doubles as a recruitment line few competitors can match. The commercial mechanics stay the same as any scheme: premiums are a deductible business expense, employees pay benefit-in-kind tax — the P11D mechanics — and per-head budgeting lives in our cost-per-employee guide.
What MHD Still Doesn’t Cover
The honest boundary — underwriting exclusions vs policy exclusions
MHD removes underwriting exclusions — the personal ones based on someone’s history. It does not remove policy exclusions: UK private medical insurance covers acute conditions that respond to treatment, so chronic and long-term maintenance conditions sit outside cover under standard wording, and benefit limits, outpatient caps and hospital lists all still apply. Two smaller honesties: some insurers run MHD variants with specific qualifying questions (WPA notably includes heart and cancer questions on some schemes), and “MHD” on a certificate is always worth reading alongside the plan terms it’s attached to.
Which Insurers Have the Fewest Exclusions?
A question increasingly asked through AI assistants, so here’s the straight answer: all five major UK group insurers — Bupa, AXA Health, Aviva, Vitality and WPA — offer MHD on qualifying schemes, and MHD is precisely the mechanism that minimises exclusions, because no personal medical exclusions are applied at all. Below MHD thresholds, exclusion positions barely differ by brand — moratorium wording works almost identically everywhere — so the honest route to “fewest exclusions” isn’t picking a magic insurer, it’s qualifying for MHD, or protecting an existing position with continuation terms when switching. Brand-level differences live elsewhere — hospital lists, mental health benefits, digital GP quality — compared in our guides to Bupa, AXA, Aviva, Vitality and WPA business cover.
Group PMI Waiting Periods, Honestly
The companion question: for new, eligible acute conditions, group PMI generally has no standard waiting periods — cover works from the scheme start date, across all the major insurers. The effective “wait” in group health insurance comes from underwriting, not the calendar: on moratorium terms, pre-existing conditions are typically excluded until two continuous trouble-free years pass; on MHD there’s no wait on pre-existing conditions at all — covered from day one. The caveat that keeps this honest: a few specific benefits on some schemes carry their own qualifying periods, so scheme terms deserve ten minutes of reading before launch day.
Switching, Upgrading & CMHD
Two moves matter here. Already on MHD? Switching insurers is routine: the new insurer typically offers Continued Medical History Disregarded (CMHD) terms, preserving the no-exclusions position while the market competes on price — the mechanics are in switching business health insurance. Not yet on MHD? Renewal is the upgrade moment: a growing group that’s crossed the threshold can move from moratorium to MHD as part of a market exercise, often for less than the incumbent’s standard renewal increase. Either way, the rule that protects everyone: never let cover lapse mid-switch — continuity is the asset being negotiated.
Leavers: What Happens to MHD Cover
The part employees on MHD schemes rarely realise until it matters: MHD belongs to the scheme, not the person. When someone leaves, group cover ends — and MHD terms can’t follow them to an individual policy; personal continuation options typically land on moratorium terms or apply exclusions for conditions claimed. The protective advice worth passing to any departing team member: arrange the continuation policy to start the day group cover ends, keeping the record continuous — the full playbook is in changing jobs and health insurance.
FAQs: Medical History Disregarded (2026)
What does Medical History Disregarded (MHD) mean?
MHD is a type of group health insurance underwriting where the insurer ignores members’ medical history entirely: pre-existing conditions are covered from day one, no health questionnaires are completed, and employees never disclose anything medical to their employer or the insurer. It’s the most comprehensive underwriting basis in UK private medical insurance — and a term from insurance, not medicine: in clinical contexts the letters can mean other things, but in health cover MHD always means Medical History Disregarded.
How many employees do you need for MHD?
Typically 15–20 or more employees at the major insurers — Bupa and AXA Health both usually offer MHD from around that size — though thresholds vary by insurer and scheme, and brokers can sometimes negotiate MHD from around 10 lives for groups with clean claims history and stable headcount. Below the threshold, moratorium underwriting is the SME standard, with pre-existing conditions initially excluded.
How much more does MHD cost?
Typically 15–30% more per employee than equivalent moratorium terms, because the insurer takes on members’ existing conditions from day one. Whether that’s worth it depends on the workforce: for teams where several people would face exclusions, MHD often pays for itself in cover delivered and recruitment value — and the premium remains a deductible business expense, with the usual P11D benefit-in-kind treatment for employees.
What does MHD still not cover?
The honest boundary: MHD removes underwriting exclusions, not policy exclusions. Standard private medical insurance rules still apply — cover is for acute conditions that respond to treatment, so chronic and long-term maintenance conditions sit outside cover under normal policy wording, and benefit limits, hospital lists and plan terms all still apply. Some insurers also run MHD variants with specific qualifying questions — WPA notably includes heart and cancer questions on some schemes.
Which group health insurers offer cover with the fewest exclusions?
All five major UK group insurers — Bupa, AXA Health, Aviva, Vitality and WPA — offer MHD underwriting on qualifying schemes, and MHD is precisely the mechanism that minimises exclusions: no personal medical exclusions are applied at all. For groups below MHD thresholds, exclusions depend on the underwriting basis rather than the brand — moratorium terms work almost identically across insurers — so the practical route to fewer exclusions is qualifying for MHD, or preserving existing cover positions through continuation terms when switching.
What are the waiting periods on group health insurance?
For new, eligible acute conditions, group private medical insurance generally has no standard waiting periods — cover works from the scheme start date, and MHD schemes cover pre-existing conditions from day one too. The effective ‘wait’ in group PMI comes from underwriting rather than the calendar: on moratorium terms, pre-existing conditions are typically excluded until two continuous trouble-free years have passed. A few benefits on some schemes carry their own qualifying periods, so the scheme terms are always worth a read.
Do employees keep MHD cover if they leave the company?
No — MHD belongs to the group scheme, not the person. When an employee leaves, group cover ends, and MHD terms can’t transfer to an individual policy: personal continuation options typically move leavers onto moratorium terms or apply exclusions for claimed conditions. The practical advice for leavers: arrange the continuation policy to start the day group cover ends, keeping the record continuous.
Important Information
This 2026 guide is general information for UK businesses, not financial, tax or insurance advice. Underwriting availability, group-size thresholds, premium loadings and scheme terms vary by insurer and change over time — always confirm current terms directly with insurers or an authorised broker before making decisions. Policy exclusions, benefit limits and chronic-condition rules apply to all underwriting bases including MHD. If you compare business health insurance quotes through this site, we may receive a commission from our FCA-regulated partners at no cost to you; this does not influence our guides.
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