FMU vs. MHD: What’s the Right Underwriting Approach for Your International Health Insurance Plan?
When selecting an international health insurance plan for your company, one of the most important (and often overlooked) decisions is how pre-existing medical conditions are treated – and that comes down to the underwriting method. The two most common approaches in group health insurance are Full Medical Underwriting (FMU) and Medical History Disregarded (MHD).
Understanding the difference is essential for protecting both your budget and your staff.
What Is FMU (Full Medical Underwriting)?
FMU requires every member of the group to complete a detailed medical questionnaire. The insurer then uses this information to decide whether to cover, exclude, or load (= increase the premium for) specific pre-existing conditions.
Pros:
- Can result in lower premiums, particularly for small or low-risk groups.
- Gives the insurer more control over claims risk.
Cons:
- Time-consuming onboarding process for staff.
- Can lead to exclusions or coverage limitations – particularly frustrating for employees with ongoing health concerns.
- May create inequity within your employee community if some members are excluded for specific conditions.
What Is MHD (Medical History Disregarded)?
MHD means that pre-existing conditions are fully covered for all members of the group – no medical questionnaires, no exclusions. The insurer simply accepts the group as a whole.
Pros:
- Simpler onboarding – no health questionnaires required; easy to communicate.
- Stronger staff satisfaction and peace of mind.
- Fully inclusive – great for recruitment, retention, and morale.
- Most aligned with the expectations of international employees.
Cons:
- Premiums may be higher, particularly for smaller or high-risk groups.
- Some insurers may require minimum group sizes (10+ or 20+ lives) to offer MHD terms.
What’s Better for International Companies?
At One World Cover, we almost always recommend MHD for international companies – particularly those with more than 10–15 staff on the plan. Why?
- MHD removes barriers to access, ensuring your company is seen as a caring, supportive employer.
- It strengthens your recruitment offering – many potential employees are choosing between companies and benefits play a key role.
- The cost difference is usually outweighed by the increased ROI in the form of happier, healthier, more committed staff.
For smaller companies or budget-sensitive cases, FMU may be worth considering, but it comes with trade-offs. And it’s critical that companies communicate clearly and sensitively if some conditions are excluded due to FMU.
Our Recommendation
- 10+ staff: MHD is the gold standard and is strongly recommended.
- <10 staff or limited budget: FMU may be viable but requires careful messaging and consideration of staff impact.
At One World Cover, we help international companies make the right underwriting decision – balancing cost, risk, and staff wellbeing. We also work directly with insurers to secure MHD terms wherever possible, even for smaller groups. Contact us to learn how.
To learn more please get in touch: [email protected] or click here to contact us.
