Contents7 sections
The decision the comparison sites name but never explain
Insurance comparison sites are explicit that the underwriting route is one of the most important things to get right when moving between international health insurers, and they list continuity transfers alongside moratorium and full medical underwriting as the options. Then they stop. What continuity actually transfers, on what conditions, and what happens when it is declined are not explained anywhere in the consumer market with any precision.
That silence is expensive, because the thing being transferred is not a discount or a service level. It is the accumulated position of your medical history against a policy — years of moratorium time already served, or a set of exclusions that were negotiated once and never have to be argued again. Rebuilding it takes years. Losing it takes one badly sequenced cancellation.
This guide sets out what the published wordings say the route does, what makes it fail, and the order in which to do a switch so that failure is discovered while you still have a policy. The existing guide to CPME underwriting covers the concept in general terms; the concern here is the mechanics.
What continuity terms are, in the words insurers use
The market has no single name for this. Three different labels describe substantially the same arrangement.
AXA Global Healthcare calls it continuing medical exclusions, and describes it as carrying on your exclusions for medical conditions from your previous health insurer, adding that this normally means it only asked you a few brief medical questions. That is the clearest plain-English statement of the mechanism published by a large carrier: the exclusions travel, the questioning shrinks.
Allianz Care names CPME and CTT (previously MORI) on its group pages, with a 24-month waiting period attaching to pre-existing conditions. The acronyms appear on Allianz's own material; their full expansions were not spelled out on the pages reviewed, so they should not be treated as settled where Allianz is concerned.
William Russell's plan agreement expands CPME as Continued Personal Medical Exclusion, noting the alternative label Continued Medical Underwriting, and describes it as available to members switching from another recognised international insurance provider who have no break in cover from their previous policy. Now Health International publishes a continuity route as well — and is one of very few providers to do so on an individual product — but frames it as being able to carry across underwriting terms or exclusions given by your existing insurer. Morgan Price offers separate full medical underwriting and moratorium application routes alongside a stated switching route for customers moving from another insurer.
The variation in naming is not cosmetic. It is a signal that this is a negotiated concession rather than a standardised product feature, and concessions are written differently by everyone who grants them.
What actually carries across depends on what you had
Continuity does not transfer "your cover". It transfers the underwriting outcome, and the shape of that outcome differs by the basis your old policy was written on.
| Previous policy basis | What transfers under continuity | What you still have to do |
|---|---|---|
| Full medical underwriting | The medical exclusions and any premium loadings applied by the previous insurer | Answer a short set of questions on serious conditions and recent history |
| Moratorium | The start date of the previous policy, so accrued time counts towards the new insurer's clock | The same short questions; the trouble-free requirement continues to run |
| Medical history disregarded (group) | Nothing at individual level — no personal assessment was ever made | Face individual underwriting unless a named continuation route exists |
| A break in cover of any length | Generally nothing; eligibility for the route is usually lost | Apply on full medical underwriting or moratorium terms from scratch |
The third row is the one that catches internationally mobile employees, and it is dealt with separately in medical history disregarded and the group cover cliff and in leaving your employer's medical scheme.
There are also eligibility conditions that have nothing to do with your medical history. William Russell's plan agreement sets an under-70 age limit at the date of entry for its continuity route, against under-76 for full medical underwriting, and requires the previous policy to have been written on either full medical underwriting or moratorium terms. A previous policy on some other basis does not qualify.
Continuity is a discretion, not a right
This is the point on which everything else turns, and it deserves to be stated without hedging: no international health insurer is obliged to accept your existing terms. Continuity is offered where the incoming insurer judges the risk acceptable, and it is refused where it does not.
The published wordings say so plainly if you read them for what they withhold. "May be able to carry across" is a statement of capability, not commitment. An application that is still subject to acceptance is still an application, however few questions it contains. And the requirement for unbroken cover means the concession depends on a fact you control — but only until you stop controlling it.
Two conditions recur across every provider that publishes a route. The first is unbroken cover: a gap between policies generally removes eligibility, and it does so regardless of why the gap arose. The second is the outgoing insurer supplying the terms. The incoming insurer is carrying across exclusions it did not write, so it needs those exclusions in a form it can rely on — typically a statement of the underwriting basis, the exclusions applied, any loadings, and the original start date. If the outgoing insurer is slow, unresponsive, or has itself been acquired and re-administered, that document can be difficult to obtain. The consequences of a carrier change on the outgoing side are covered in when your insurer is acquired or rebranded.
What resets when continuity is refused
Refusal does not put you back where you started. It puts you at the beginning of three separate clocks at once.
The lookback restarts. The new insurer assesses your medical history against its own definition of a pre-existing condition, commonly measured over the five years before the new cover begins. AXA's definition captures anything you received medication, advice or treatment for in that window, or experienced symptoms of, whether or not it was ever diagnosed. Conditions that had already been examined and accepted — or that had simply aged out of relevance at your old insurer — come back into scope.
Any moratorium clock restarts from zero. Eighteen months of trouble-free running at the old insurer counts for nothing at the new one, and the two-year minimum begins again from the new date of entry. The mechanics of that clock, and what quietly restarts it, are in how the moratorium clock actually works.
Benefit waiting periods restart. These are the ones that ruin plans, because they attach to benefits people buy the policy for. Published routine maternity waiting periods run to twelve months at Cigna Global and Allianz Care and eighteen months at Bupa Global, which also applies eighteen months to fertility benefit. Dental benefit commonly carries its own waiting period. A couple who timed a pregnancy against a policy that had been running for three years can find themselves outside cover on a policy that has been running for three weeks. The comparison across providers is set out in maternity and fertility waiting periods compared.
The sequence that protects you
The order of operations is the single most effective control available, and it costs nothing.
Ask your existing insurer, in writing, for a statement of your underwriting basis, your exclusions and loadings, and your original start date. Do this first, because it is the document the new insurer will need and the one most likely to be delayed.
Apply to the new insurer on a continuity basis explicitly, naming the route rather than assuming it. Answer every question asked, on the same standard you would apply to a full application — a short form does not carry a reduced duty, and the consequences of an inaccurate answer are set out in disclosure, non-disclosure and voided cover.
Read the terms actually issued. Check three things: that the continuity basis is recorded on the certificate of insurance, that the exclusions match the ones you had rather than a wider set, and that the start date carried across is the original one where a moratorium is involved. Where an exclusion has been widened or a new one added, that is a repriced offer, not a continuation, and it should be treated as one.
Only then cancel. Never give notice on the old policy before the new terms are in your hands in writing. This is not general caution. It is the specific structural point that continuity routes depend on there being no break in cover, so a premature cancellation can destroy the eligibility you were relying on and leave you applying to the new insurer from scratch — as a person who now has a gap in their insurance history.
Before you act
What to ask before you commit
Put four questions to the incoming insurer and get the answers in writing: whether the continuity route is available on the specific plan and in your country of residence; what documentation it requires from the outgoing insurer and by when; whether accrued moratorium time or existing exclusions will carry across in your particular case; and whether benefit waiting periods for maternity, dental and any other timed benefit are waived or reapplied.
Then ask one question of yourself. If continuity is refused and everything resets, is the new plan still worth buying? If the honest answer is no, then the switch was never really about the plan — it was about the price, and the price of restarting three clocks is rarely visible in a premium comparison. Structural differences between the major carriers are summarised in the comparison of Bupa Global, Cigna, AXA and Allianz plans, and the separate question of which entity actually carries the risk behind the brand is covered in who carries the risk. Renewal-side protections that reduce the need to switch at all are in annual renewability and guaranteed renewal.
Frequently asked questions
7 questions
Is continuity of underwriting terms a right when I switch insurer?
No. It is a concession granted case by case at the incoming insurer's discretion. Now Health International, one of the few providers to publish a continuity route at all, states only that it may be able to carry across underwriting terms or exclusions given by your existing insurer. William Russell's plan agreement describes continuity as available to members switching from another recognised international provider with no break in cover, and still makes acceptance conditional on the answers given at application. Nothing in that framing obliges an insurer to offer it.
Link to this questionWhat is CPME?
The abbreviation is used across the market for the arrangement under which a new insurer carries your existing underwriting terms across rather than assessing you from scratch. William Russell's plan agreement expands it as Continued Personal Medical Exclusion and notes the alternative label Continued Medical Underwriting. AXA Global Healthcare describes the same idea in plain words as continuing medical exclusions, meaning it is carrying on your exclusions for medical conditions from your previous health insurer. Allianz Care names CPME and CTT, previously MORI, on its group pages.
Link to this questionDo I still have to answer medical questions on a continuity application?
Usually yes, but far fewer of them. AXA states that continuing medical exclusions normally means it asked only a few brief medical questions. William Russell describes asking about serious medical conditions and recent medical history. The reduced questioning is the point of the route, but it is not an absence of underwriting, and the same duty of accuracy applies to the questions that are asked. An inaccurate answer on a short form has the same consequences as one on a long form.
Link to this questionWhat happens to accrued moratorium time when I switch?
Where continuity is granted and the previous policy was written on a moratorium basis, the practice described in William Russell's plan agreement is to give the start date of the previous policy to the new policy, so time already served carries across rather than restarting. Where the previous policy was fully underwritten, it is the exclusions and any premium loadings that carry across instead. Where continuity is refused, neither happens and you begin again from the new policy's start date.
Link to this questionWhat resets if the new insurer refuses continuity?
More than most people expect. You face a fresh assessment of your medical history against the new insurer's lookback period, which is commonly five years. Any moratorium clock restarts from zero. Benefit-level waiting periods restart too, and these are long on the benefits people plan around: routine maternity waiting periods of twelve months at Cigna Global and Allianz Care, and eighteen months at Bupa Global, are published figures. A pregnancy planned around an existing policy can fall outside cover entirely.
Link to this questionWhen should I cancel the old policy?
Only after the new insurer has issued the underwriting terms in writing and you have read them. The reason is structural rather than cautious: continuity routes are generally conditional on there being no break in cover, so a gap created by cancelling early can itself remove your eligibility for the terms you were relying on. Confirm the new start date, the exclusions applied, and that the continuity basis is recorded on the certificate before you give notice on anything.
Link to this questionDoes an employer scheme count as previous cover for continuity purposes?
Sometimes, but it is the case where continuity matters most and is least certain. Group schemes underwritten on a medical history disregarded basis have no individual exclusions to carry across, because no individual assessment was ever made. AXA does publish a route offering comparable cover without the need for additional medical underwriting on leaving an employer's scheme, which is a genuine mitigation. It is worth asking the scheme's insurer about it well before the employment ends rather than after.
Link to this questionThis guide is general information only and does not constitute financial, legal, medical or tax advice. Global Investments is not authorised by the Financial Conduct Authority. Insurance products, benefit schedules and premiums are revised regularly, and mandatory health insurance requirements change frequently — in several jurisdictions they are described differently even between official sources. Nothing here is a recommendation of any product or insurer. Confirm the legal position with the relevant regulator or a locally qualified adviser, and confirm cover terms with the insurer, before acting.
