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.