Buying international health insurance isn’t just form filling. For many clients, the medical questionnaire can feel intrusive and confusing – a hurdle between them and the cover they want in place.
Underwriting is what determines whether a policy is offered on standard terms, whether exclusions or premium loadings apply, or whether cover is postponed or declined.
How the questionnaire is completed can have real consequences later, including around claims and continuity of cover.
As a broker, you sit in a careful middle ground: you help the client gather facts and present them clearly, but you can’t influence the underwriter’s decision or “coach” someone into changing their story.
Your support is practical and process-led – explaining why disclosure matters, helping clients obtain (and, where needed, translate) records, managing timeframes and following up – while maintaining strict confidentiality.
This guide sets out how to do that ethically and effectively.
We refer to general legal and regulatory concepts, such as duties of disclosure/fair presentation and data protection requirements.
The common thread is straightforward: be accurate and complete, and treat health information with the care it deserves.
Help the client recall, record and present their medical history clearly – dates, diagnoses, treatment, outcomes and supporting documents.
Insurers set terms based on their assessment and evidence. You can clarify questions and coordinate submissions, but you can’t change the decision or promise an outcome.
- Thorough questionnaires matter: Underwriters base decisions on the information disclosed. In many jurisdictions, applicants have a duty to present all material circumstances, not just answer the questions asked. Incomplete or inaccurate answers can lead to loadings, exclusions, delays or a decline. [1]
- Brokers support; they don’t influence: Your role is to clarify what’s being asked, organise medical evidence and help with translations. You can’t alter underwriting decisions or guarantee outcomes. Clients remain responsible for their disclosures.
- Honesty protects the client: Material facts are those a prudent insurer would want to know. Misrepresentation can affect cover and, in some circumstances, how claims are handled. [1]
- Sensitive data needs safeguards: Health information is special category data. Regulations require additional conditions and protections (often including explicit consent), data minimisation and strong security arrangements when processing it. [2][3][6]
- Outcomes vary: Underwriters may offer standard terms, apply premium loadings, impose condition-specific exclusions, postpone cover or decline altogether. This depends on the insurer’s risk assessment, not broker negotiation.
- Ethics and confidentiality: Brokers should act objectively and independently, treat client information as confidential and obtain consent before sharing data. [5]
- Prepare early: Gathering records, arranging translations and managing timelines reduces stress. Clear communication about process, outcomes and next steps helps maintain trust.
Why complete medical questionnaires thoroughly
Medical questionnaires exist for a simple reason: insurers need enough information to assess risk and set terms. If a client’s answers are incomplete, vague, or don’t line up with the supporting evidence, underwriting is more likely to slow down. That can also lead to avoidable follow-up requests – or an outcome that feels abrupt to the client.
Your role is to reduce friction by helping the client produce a clear, factual record. In practice, that means making it easy for the insurer to understand what happened, when it happened, what treatment took place, and the client’s current status.
The duty of fair presentation
Depending on the jurisdiction (and the type of contract), applicants may have a legal obligation to disclose information that could influence an insurer’s assessment of risk. This is sometimes referred to as a duty of fair presentation. Marsh notes that, even where a proposal form is used, the duty is not confined to answering the specific questions; the insured must disclose all material circumstances. “Material circumstances” are those that would influence the judgement of a prudent insurer when setting premium and terms, or deciding whether to accept the risk. [1]
Material facts might include pre-existing conditions, ongoing treatment, past operations, chronic or serious illness, mental health history, and any condition for which medical advice, diagnosis or treatment has been sought. Even if something wouldn’t necessarily lead to a higher premium, it can still be material. Depending on the applicable rules and policy terms, similar duties can apply at inception, at renewal and when changing cover mid-term.
A failure to make a fair presentation can have serious consequences. [1] In some circumstances, an insurer may treat the policy as void (as if it never existed), or apply other remedies that affect cover or claims. The safest approach is to disclose anything that may be relevant, and to provide supporting evidence where it helps the underwriter assess the risk fairly.
Encourage clients to answer every question honestly and fully. Don’t guess. If they’re unsure about a medical detail, ask them to check with their clinician, or provide the best-supported information (with context) rather than leaving it out. Remind them that omissions or misstatements can create problems later, including at claims stage. [1]
Why underwriting relies on thorough questionnaires
Underwriters are usually working from documents, not conversations. A strong questionnaire reads like a simple timeline: condition → diagnosis → treatment → outcome → current status. That makes it easier to assess risk without repeated requests for clarification.
Thoroughness also protects the client. If a future claim relates to a condition the insurer believes wasn’t properly disclosed, the client may face delay while evidence is reviewed. Clear disclosure at the outset reduces that risk.
Why clients hesitate – and how to respond
Hesitation is common. Many clients worry that disclosure will increase cost, result in exclusions, or lead to a decline. Others worry about stigma (particularly around mental health), or simply can’t remember dates and details.
Your job isn’t to persuade them to disclose less. It’s to explain why accuracy matters, how confidentiality is handled, and how to gather the evidence they need to answer confidently.
How brokers prepare clients (gathering records, translation)
The smoothest underwriting submissions start before the client even opens the questionnaire. Preparation reduces “unknowns” and makes guesswork less likely.
Preparing before the questionnaire
Start by setting expectations. Underwriting typically needs two things: (1) clear answers and (2) supporting evidence where the history is complex, recent, unclear, or ongoing.
Practical steps that help most clients:
- Create a simple health timeline: diagnoses and symptoms, consultations, tests, treatment changes, hospital admissions, and outcomes.
- List current medication: name, dose, frequency, purpose, start date, and prescribing clinician.
- Identify record sources: GP/primary care, specialists, discharge summaries, labs, imaging centres, and (where relevant) pharmacy print-outs.
- Plan translations early: if records aren’t in the insurer’s working language, decide how they’ll be translated and by whom.
Good practice is to collect only what’s necessary for underwriting and to use secure channels when exchanging medical records. [2][3]
Underwriting questionnaire support workflow
The checklist below shows a typical workflow from first contact through to placing cover. Adapt it to the insurer’s requirements and your internal compliance process.
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Intake and consent
- Explain the underwriting process and the broker’s role.
- Provide a privacy/fair-processing notice: identify the data controller, the purpose, and likely recipients. [2]
- Obtain explicit consent (or confirm another valid basis/condition) to collect and share medical information. [2][3]
- Agree communication preferences (channels and language).
-
Evidence gathering
- Help the client prepare a medical history timeline and medication list.
- Request supporting documents (medical reports, test results, consultant letters).
- Confirm whether translations are needed; arrange professional translation if appropriate.
- Encourage the client to confirm dates/details with their clinician rather than guessing.
-
Questionnaire completion
- Provide the insurer’s questionnaire and set time to work through it together.
- Clarify what’s being asked without second-guessing the insurer’s intent; remind the client that the answers are their responsibility. [5]
- Ensure all sections are completed; sense-check that every disclosed condition is explained (diagnosis, dates, treatment, outcome/current status).
- Attach supporting medical evidence via secure submission routes. [2]
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Submission
- Submit the questionnaire and supporting evidence via the insurer’s portal or secure email (as instructed). [2]
- Confirm receipt and request an indication of next steps/timeframes.
- Keep an audit trail of what was submitted and when.
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Follow-ups
- If the insurer requests further information, coordinate with the client to provide it promptly.
- Where specialist reports are required, explain what is being requested and support the client in obtaining it.
- Share any additional information securely. [2]
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Decision
- Receive the underwriting outcome: standard terms, loading, exclusion, postponement or decline.
- Review the terms carefully and arrange a call to explain them clearly to the client.
- Reinforce that the decision sits with the insurer and isn’t something a broker can “push through”.
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Placement or alternatives
- If the client accepts the terms, proceed to issue the policy (in line with the insurer’s process).
- If terms are unsuitable or cover is declined, explore alternatives such as different plan levels, different insurers, or (where appropriate) group schemes.
- Record the outcome and lessons learned for continuous improvement.
Encourage clients to start early. Obtaining medical records and translations can take weeks. Delays in providing information may push back the intended start date and, in some cases, can mean underwriting has to be revisited.
Practical tips on translation (without overpromising)
Translation is a common bottleneck. Underwriters need clarity; poor translation creates follow-up. Where possible, help clients prioritise key documents: diagnosis summaries, discharge notes, specialist letters and medication lists.
- Confirm requirements: some insurers accept informal translations; others may require certified translations (verify).
- Keep originals: send the translation alongside the original unless the insurer says otherwise.
- Prioritise key fields: dates, diagnosis terms, procedures, medication names/doses, and current status.
Explaining underwriting terms
Underwriting terminology can easily confuse clients. A short glossary helps demystify the process. Make it clear these definitions are general – insurers may use different wording and apply terms differently.
Plain-English glossary
Cover is offered without any special restrictions or additional premium.
An additional percentage added to the standard premium to reflect higher risk. For example, controlled hypertension might attract a modest loading, sometimes without a condition-specific exclusion (depending on the insurer and evidence).
A specific condition or body part isn’t covered. Exclusions can be permanent (for example, chronic back problems) or time-limited (for example, a knee injury excluded for two years).
Under a moratorium approach, pre-existing conditions are automatically excluded, but may become eligible after a defined “clean” period without symptoms or treatment. This is often around 24 months, but varies by insurer/policy.
The applicant completes a detailed questionnaire; the insurer assesses the disclosed history and sets terms at outset.
The insurer defers offering cover until a condition has stabilised or more time has passed. This is common after recent surgery or where investigations are still ongoing.
The insurer decides not to offer cover. This is often where the risk sits outside the insurer’s underwriting appetite.
A set period after inception during which certain benefits (for example, maternity) aren’t payable. Waiting periods are separate from moratorium periods.
Typical medical history areas and possible underwriting outcomes
| Medical history area | Possible underwriting outcome* |
|---|---|
| Mild, well-controlled asthma | Standard terms or a small premium loading; often no exclusion if there have been no recent hospital admissions |
| High blood pressure controlled with medication | May attract a moderate loading; sometimes reviewed after 12–24 months of stable control |
| Previous surgery (e.g., uncomplicated appendectomy) | Often standard terms once fully healed and discharged from follow-up |
| Past mental health treatment (e.g., depression) | May lead to a mental health-related exclusion or a loading; clear evidence of stability and treatment history helps underwriting assess fairly |
| Chronic conditions (e.g., diabetes, rheumatoid arthritis) | May result in exclusions for complications and/or higher loadings; insurers may request regular medical reports |
| Cancer history | Depending on type, stage and time since remission: postponement for a period, an exclusion for the specific cancer, or a decline if recurrence risk is assessed as high |
| Ongoing investigations or undiagnosed symptoms | Often leads to postponement until a diagnosis is confirmed and the position is clearer |
*These outcomes are illustrative. Each insurer applies its own underwriting approach and may reach different conclusions. The table is intended to set expectations while emphasising that the insurer makes the decision.
Use careful language (“may”, “often”, “it depends”). Underwriting outcomes aren’t guaranteed. If a client asks whether a condition will be covered, explain you can share general expectations, but only the insurer can confirm terms.
Advising on disclosure vs confidentiality
Clients sometimes confuse disclosure with “losing privacy”. Your job is to separate the two: the insurer needs relevant health facts to underwrite, but the client still has rights over how their data is handled.
Balancing transparency and privacy
Disclosure is about accuracy and completeness. Confidentiality is about controlling access and sharing. You can support both by helping clients disclose what’s asked (and what’s material), while limiting the spread of sensitive information beyond the underwriting process.
- Use the questionnaire as the starting point: answer what’s asked, then add context that makes the answer accurate and clear.
- Don’t speculate: if something is undiagnosed, say so, and provide the evidence that exists (tests, referrals, clinician notes).
- Keep an audit trail: what was disclosed, what documents were submitted, and when.
Protecting sensitive health data
The UK GDPR and similar frameworks treat health information as special category personal data. [2][3] It needs additional protection because mishandling can cause real harm, including distress and discrimination. The European Commission similarly lists health data as sensitive and subject to specific processing conditions. [6]
Under data protection rules, organisations should: [2][3]
- Obtain explicit consent (or another valid condition): many broker processes capture written consent before collecting or sharing medical records. [2][3]
- Use the data only for specified purposes: health data should be used for underwriting and closely related administration only.
- Apply data minimisation: collect only what’s necessary and familiarise yourself with the insurer’s evidence requirements. [2]
- Keep it secure: use appropriate security controls (secure portals, encrypted email where appropriate, and access controls). [2]
- Be transparent: tell clients who will receive their information and why. [2]
Don’t send medical records via insecure channels or share them with anyone not involved in underwriting. Collect only what’s needed, and share only what’s required, with clear client consent. [2][3]
What to disclose
The safest stance is to support truthful, complete disclosure in line with the questionnaire and the policy’s disclosure standard. If the client is unsure whether something is relevant, treat that as a prompt to gather evidence and clarify – not to omit it.
- Disclose diagnoses and symptoms (even if resolved) where asked.
- Disclose consultations and investigations where the questionnaire asks about tests, referrals, or ongoing monitoring.
- Disclose medication and treatment history with dates and current status.
- Disclose mental health history where asked – supported with factual evidence (dates, treatment, and current position).
If you work across jurisdictions, disclosure standards and look-back periods can differ. Keep “Points to verify” in mind before setting expectations.
Managing sensitive conditions
Some medical history areas need extra care – not because they are “worse”, but because they can be emotionally sensitive, easily misunderstood, or more likely to trigger underwriting follow-up.
Pre-existing conditions strategy
“Pre-existing conditions” isn’t a universal definition. It’s a contractual definition in the policy wording. Your support should focus on facts and evidence – not on trying to reframe a condition.
- Keep it factual: diagnosis name (if known), when symptoms started, when diagnosed, treatment received, and current status.
- Show stability where relevant: include clinician notes confirming control/stability, discharge status, or “no treatment since” statements where available.
- Handle ongoing investigations carefully: if the client is being investigated, disclose that clearly and provide current evidence. Avoid guessing the eventual diagnosis.
- Don’t “optimise” dates: if the client can’t remember, help them verify. If it remains unclear, disclose the best-supported approximation and explain the uncertainty.
Sample broker prompts
These are illustrative prompts you can use to help clients remember relevant information. They are not insurer questionnaire wording.
Use prompts like these to help clients recall facts. They are not insurer questionnaire wording.
- “Have you seen a GP, therapist or specialist in the last five years? What for, and when?”
- “Have you had any operations, hospital stays or procedures in the past ten years? Please list dates and outcomes.”
- “Are you currently taking any prescribed or over-the-counter medicines? What are they for, and what doses do you take?”
- “Have you had any symptoms that haven’t yet been assessed (for example, recurring pain or headaches)?”
- “Have you been referred for tests or investigations that haven’t happened yet, or that you’ve delayed?”
- “Have you ever been diagnosed with a mental health condition (for example, anxiety or depression)? If yes, what treatment did you receive, and when?”
Mini-script: what to say to a client who is anxious about disclosure
“I understand this can feel uncomfortable. Insurers need an accurate picture to assess your application fairly and set terms. It isn’t about judgement – it’s about making sure your policy reflects your actual health history. Holding information back can backfire by delaying claims or, in some cases, affecting the validity of cover. Our role is to help you organise your history and present it clearly. We treat what you share as confidential, and we only send it to the insurer for underwriting with your consent. If you’re unsure about a detail, we’ll help you get clarity rather than guess.”
Confidentiality and lawful sharing of health data should be based on clear client consent (or another valid lawful basis) and appropriate safeguards. [2][3][5]
Mental health history is health data and should be disclosed where asked. Some clients worry about stigma; reassure them that clear, factual disclosure (including evidence of stability where available) helps underwriting assess fairly.
Communicating outcomes and options
Underwriting outcomes can feel personal, particularly where exclusions or loadings are applied. Your role is to explain the outcome clearly, keep communication calm, and help the client consider options without overpromising.
Understanding underwriting outcomes
Underwriting decisions typically fall into a few categories:
- Standard terms (no special restrictions)
- Premium loading (higher premium reflecting higher risk)
- Exclusion (specific condition or body part not covered)
- Postponement (insurer defers a decision pending stability/clarity)
- Decline (insurer doesn’t offer cover)
Even within these categories, the detail can vary: exclusions can be narrow or broad, loadings may or may not be reviewed, and postponements can last weeks or months. It depends on the insurer’s assessment and the evidence available.
Explaining decisions without promising
Avoid presenting underwriting as a “negotiation”. You can explain what the insurer has offered and help the client respond (accept, provide further evidence, or consider alternatives). But you shouldn’t imply you can change the decision by “pushing”.
Compliant phrases that help:
- “This is the insurer’s decision based on their assessment and the evidence submitted.”
- “We can ask what further evidence would be needed for a review, but we can’t guarantee a different outcome.”
- “If these terms don’t work, we can look at other options and see how other insurers assess the same facts.”
Keep clear records of what you’ve communicated, and provide the client with written confirmation of the terms they are accepting.
Ethical considerations
Ethical underwriting support is straightforward in principle: support accurate disclosure, protect confidentiality, and stay within role boundaries. In practice, it takes discipline – especially when clients are anxious or seeking reassurance.
Professional conduct
Guidance for European insurance intermediaries emphasises that brokers should provide advice objectively and independently. [5] They should use their skill in the client’s best interests, explaining differences and relative costs of suitable options. Brokers should not withhold documentation from policyholders without adequate reason and should respect a client’s decision to terminate the relationship.
Brokers should treat information supplied by a prospective policyholder as confidential and should not disclose it outside the normal course of arranging, maintaining or renewing a policy, unless the client has consented. [5] When helping with proposal forms, they should make clear that answers remain the client’s responsibility, and that incorrect information can create problems at claims stage. Brokers’ independence should be exercised – and be seen to be exercised.
Data-protection principles
Medical questionnaires involve sensitive data. Your process should make privacy controls practical:
- Collect only what you need: the minimum evidence required to complete the questionnaire accurately. [2]
- Use secure routes: secure portals or appropriate encryption and access controls. [2]
- Document consent: keep consent records and explain who receives the data and why. [2][3]
- Be disciplined on retention: keep information only as long as needed for the purpose (verify your retention policy and local rules). [2]
What brokers should not do
The line between “helping” and “coaching” matters. Avoid:
- Rewriting or reframing answers to make risk appear lower than it is.
- Encouraging omission of relevant facts or suggesting “disclose it later”.
- Guessing dates or diagnoses where evidence exists (or can reasonably be obtained).
- Sharing medical records informally (for example, via unsecured messaging apps) or sending more information than the insurer has asked for.
- Implying special access to underwriting or suggesting you can “get it approved”.
Ethical support means helping the client present accurate facts and evidence. It does not mean influencing an insurer’s underwriting decision. When in doubt, document what you did and why, and keep the client in control of their final answers.
Get Started
If you want a clear, compliance-safe process for supporting medical questionnaires – including secure document handling and clear role boundaries – BIG can support you as a broker/partner.
- Operational support: structured intake, document checklists and timeline management – so submissions are complete and traceable.
- Communication support: we help you explain outcomes and next steps clearly, without implying any influence over insurer decisions.
- Support for existing cover: if a client already has a policy, we can help you review terms and renewal considerations before changes are made.
Start here: Brokers & Partners • For existing policies: Already Covered (Review my existing policy)
Further reading
Points to verify
The details in this guide are general. Always verify the following points, which can vary by jurisdiction, insurer or policy:
- Disclosure standards: time look-back periods and definitions of “material facts” differ. Some questionnaires ask about the last five years; others include lifetime questions.
- Underwriting approach: full medical underwriting, moratorium underwriting and hybrid models have different disclosure and evidence requirements.
- Translation requirements: whether medical documents must be certified, and which language is acceptable.
- Secure transmission and retention: accepted methods for sharing medical data and typical retention periods.
- Pre-existing condition definitions: policies define “pre-existing condition” differently. Check wording to understand how symptoms, diagnoses and treatment are treated.
- Turnaround times: underwriting timelines vary; service-level guarantees are unusual.
- Escalation paths: procedures for reviews, appeals and complaints.
