A guide for an informed Private Medical Insurance (Part 4 of 4)

Can I switch my insurer?

You can switch your Private Medical Insurance Company. However, you are advised to consider comparing the benefits and monetary amounts in both covers. Make sure you fill in all the necessary forms and provide relevant documents like copy of the policy certificate.

Generally, PMI is presented through a twelve-monthly contract. Thus, the best time to switch to a new insurer is at your renewal date. Several insurers will keep your present exclusions, so any treatment for your pre-existing conditions will be excluded from the new cover. They will not include any new ones. Some companies might not cover conditions you have had in the recent past or any illnesses or injuries that you suffer from now, even your current insurer covers those.

Things to remember before changing the insurer

You should check the benefits, policy terms and underwriting position cautiously to know the consequences. The cover offered may be different.

Check whether you have the appropriate cover - you may well have a preference of options.

Give your full and precise details to avoid your policy being cancelled or your claims being refused.

Keep the policy documents safe and read them carefully.  

Make sure to pay the premiums up to date.

You will receive information of amendments to benefits, regulations or premiums before your renewal date. Your cover will not be cancelled just because your health weakened or you have claimed.

Your protection over Private Medical Insurance

The FSA - Financial Services Authority started regulating PMI policies and its tasks are being taken over by the PRA - Prudential Regulatory Authority and the FCA - Financial Conduct Authority.

All insurers offer PMIs, must have their own procedures of complaints in place. They must also be covered by the FOS – Financial Ombudsman Service.

If you are not pleased with how the insurer handled your complaint, the FOS offers an independent and free service to assist settle your dispute.

The FSCS - Financial Services Compensation

Scheme is the UK’s legal fund for consumers of formal financial services firms. The FSCS can pay compensation if a firm is likely to be unable to pay claims against it due to insolvency. The FSCS is an independent organization.

All insurers have to protect medical details and personal information confidentially. You can ask an insurer to see what information they have about you. If you decide to communicate with your insurer using emails, you must use a private email address and it cannot be used or viewed by a third party.

A guide for an informed Private Medical Insurance (Part 3 of 4)

What is covered and what is not?

Private medical insurance is designed to cover acute conditions – short term, curable injuries or illnesses. Following reasons restrict PMI to cover long term treatment for chronic conditions.

The main purpose of private-hospitals is to take care of conditions that can be cured quickly. Most of the NHSs funding goes to treat for patients who need long term treatment. So patients with chronic (long-term) conditions often turn to NHS treatment. Your insurer also has to balance the cover with what you are prepared to pay. So, generally insurance companies do not cover chronic conditions to avoid expensive premiums.

Your Private Medical Insurance might cover – 

Usually your PMI might not cover –

• Visiting a general practitioner

• Going to Accident and Emergency

• Drug misuse

• HIV / AIDS

• Regular pregnancy

• Sex change

• Mobility aids (wheelchairs etc..)

• Organ transplant

• Injuries caused from hazardous pursuits

• pre-existing conditions

• Long term treatment and chronic conditions

• Dental services

• Prescription drugs and dressings, as an outpatient

• Intentionally self caused injuries

• Unproductiveness

• Cosmetic treatment

• Experimental or unconfirmed treatment or drugs

• Kidney dialysis

• War risks

The insurer will provide you the terms and conditions of the policy before the conclusion of the contract. Insurer may furthermore furnish you a summary or Key Facts document before your insurance agreement starts. This Key Facts Document will summarize important or atypical policy limits and the key financial limits. Take your time to read the policy document, as the summary will not give details about the full policy terms / conditions.

What if you have a disability?

You will not be rejected from buying a PMI because you have a disability. Your insurer may exclude cover for treatment needed for the disability, as with other pre existing conditions.

If you furnish a declaration regarding your medical history, you must provide all appropriate detail about your disability. If your plan does not cover pre existing conditions, an existing medical condition causing disability will not be covered.

Will my premiums rise over time?

Your payments are likely to increase above the rate of general inflation, even with the wide range of available PMI policies.  

When the methods used to diagnose conditions become more advanced, when the new drugs become available, and when the technology used in surgical treatment becomes more advanced, the cost of healthcare will increase.

Reducing your premiums

You’ll be able to decrease your payments by selecting from a reduced level of benefits, selecting a list of hospitals provided by the insurer, a surplus on your policy, where you pay the first fraction of any treatment, by selecting a policy that offers discounts for your commitment of health and offers no-claims discounts, and by having treatment by using the NHS.

A guide for an informed Private Medical Insurance (Part 2 of 4)

How to buy a Private Medical Insurance

You can buy a PMI directly from the insurer, through an agent or an independent adviser, through the internet, over the phone, meeting in person or by post.

The application method may differ by insurer. Serch terms of ‘health insurance’ and ‘medical insurance’ should provide you results. An independent insurance adviser will provide you policies with a variety of insurers while a tide agent or an insurer, is only capable to provide you that insurer’s policies only. So, if you choose to buy a policy directly from an insurer or from an agent without an advisor, you hold the responsibility to select a policy that suits you.

You will need to fill an application including information about your health. Application you filled in or any statement you make to your insurer, is extremely important, which forms the basis of your contract with the insurer. Answer the questions as accurately and fully, to the best of your knowledge to avoid rejecting payments or maybe cancellation of your policy. After your application is accepted, you will be informed when the cover will commence.

You will have at least 14 days after you receive policy documents – known as a cooling off period -, to choose whether this policy is suitable for you.

You must cancel your policy within the declared period if you think you should cancel the policy, and usually you’ll receive a full refund of any payments you made, if you haven’t made a claim.

What are the details needed about my health?

All Private Medical Insurance companies will provide ‘Full Medical Underwriting’ (medical history declaration) option.

Here, you will be asked to furnish details of your medical history. In some cases, the insurer may contact your doctor for more info. And, you are required to provide all the info you are asked for to the best of your knowledge. Your insurer may conclude your policy, or decline your forth coming claims, if you don’t provide the required information. 

Some PMI companies have another option – Moratorium Underwriting. Here, you don’t need to provide information of your medical history. But you won’t be covered for any conditions that you had in the past five years.

These conditions may become eligible after a continuous period of two years of your policy has started. But this will only take place when you don’t receive treatment, medication, investigation, advice (from your general practitioner a specialist) or have symptoms of that condition. Your insurer will explain you how their moratorium underwriting works.

Choosing the appropriate cover

First, you should find out if you have a Private Medical Insurance cover already. Some employers include insurance cover for you and your family members as an additional benefit.  

If you are not covered, and you are willing to have one yourself, you need to consider what are the most important benefits you’ll need. The more benefits you add, it is highly likely your premium will raise. You should consider:

1. How much are you willing to spend as premium?

2. Are you equipped to pay for some part of the treatment?

3. As an out patient, do you want to include consulting a specialist and having diagnostic tests?

4. Would you be satisfied to have necessary treatment in a hospital accessible from a narrow range selected by your insurer or do you want your choice of hospitals?

5. What you don’t wish to be covered?

Policies range from low cost, limited covered ones to policies that offer higher benefits and wide ranged cover for higher premiums.  

The following illustration gives you an example of how you might receive private treatment.

How do you start to claim...

A guide for an informed Private Medical Insurance (1 of 4)

Association of British Insurers has published a complete guide for the individuals who want to buy a Private Medical Insurance (PMI). You may read a summarized guide of it in these upcoming four posts.

The ABI has designed it to help the individuals who want to buy a PMI to make an informed decision before buying a policy. And the guide is also useful for the companies who offer PMI, mainly to avoid miss-communication. ABI informs you to contact the company or agent for any questions regarding your Insurance Policy.

What exactly are you buying?

Private medical insurance ranges according to premium levels and cover levels. You may have the options of about the varieties of treatment covered and for what levels, where treatment is offered, and the payment you might be willing to pay to the cost of the treatment (the excess).

Take your time to consider the requirements of your health and to compare the cover limits and the benefits for an equal premium of each insurer.

Generally, you would like to know about the monetary limits on the policy (if any), what stages of cancers and treatments are covered, any discounts for no claims, and what happens when I reach my cover limit. Clarify about what happens if you reach the cover limit – whether you can return to NHS or you’ll need to pay to continue private treatments.

PMI is frequently called ‘health insurance’ and, income protection, health cash plans, and critical illness plans can sometimes be confused with PMI.

Private Medical insurance – what really is it?

PMI is intended to cover the expenditure of private medical treatment for diseases, illnesses or injuries that are expected to respond quickly to treatment that intended to return you to the health level you were in before it or which guides to your full healing. These conditions are called acute conditions. Ask the insurer if there is any cover for longer term conditions called as chronic conditions.

Some PMI policies may provide coverage for long-term treatment or maybe even treatment for chronic conditions, which is not typically the main intention of PMI.

This is designed to work together with and not to replace all the services obtainable from the NHS, and policy holders preserve their right to use the National Health Service in all the cases.

People can have timely admittance to healthcare, select preferred treatment options and consultation, comfortable and high quality services when they buy a PMI. If you select to use NHS, PMI will opt to pay you cash benefits.

Before a medical treatment start from a referral by a general practitioner for specialist treatment, you should check whether you are covered by calling your insurer. Your pre-existing conditions and treatment for some illnesses may not be covered by your private medical insurance. It’s very important to continue communicating with your insurer at each stage of treatment.  

Private Health Insurance – How it Works?

By now you may know about private health insurance but do you know how it is proven to work? This brief article will provide a summery of what it can do for you. Later we’ll discuss about ups and downs of different providers, plans and online insurance quotes.

Curable injuries or short-term illnesses are covered by private medical insurance. Should we become injured or ill, it’s always good to know that we have quick access to the relevant treatment we need.

By getting a medical insurance policy, we can gain access to private medical treatment for previously chosen circumstances. We will regularly be taken care of more swiftly than on the NHS, and will have a vast preference on where and when we are treated.

On the other hand, private health insurance is not essentially a total substitute to being treated on the NHS. Private medical plans do have some areas which are not covered, but we can still use the NHS to be treated.

On a quantity of health insurance plans, we are given the liberty to choose to be treated whether on the NHS or privately. Whenever we don’t decide to be treated privately, our medical insurance provider will send us an equivalent payout.

Medical Insurance Types

By considering carefully and making inquiries to find out what is the policy type we need and what we would like to get covered, we can choose a suitable insurance policy out of many different plans of insurance providers.

Most of private health insurance policies cover overnight stays and in-patients. For additional costs, we can get a plan that covers out-patients appointments like Scans, Tests and consultations.

We also must decide whether we want our plan to cover our overseas treatments if necessary as well. Remember to get the full picture of what are the areas covered by the policy chosen.

     

Health Insurance for the Patients with Pre Existing Conditions

We still can get a suitable private health insurance plan even with an existing medical condition. But typically we will need to have not received treatment for a medical condition for a long period of up to five years and not showing symptoms.

Almost all the private medical policies do not cover HIV/AIDS, normal pregnancy, cosmetic surgeries and gender change, and infertility etc.

Over all, we must check the policy in detail, and try to seek independent recommendation, and always ask for extra clarification on what we have in our new private health insurance plan.