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This information is intended as a guide only, to help you with information on how private health insurance works before you choose a policy. The information you receive from companies providing medical insurance should outline the products they are offering, these outlines are intended as an aid for you to compare the various benefits offered with different products and packages. They will give you a brief outline as to what is and is not covered under a particular policy, if you have any questions or need more specific information on a paticular issue the insurer will be able to give you this.
Private medical insurance is designed to cover the costs of private medical treatment for what will usually be described as acute conditions. Most insurers define an acute condition as any disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery. Most people take out private health insurance so that they have the reassurance of knowing that any treatment they may need would be available quickly. Some conditions, however, are not covered by a private health insurance policy, these are ususally the same with most insurers and most policies and generally include any medical conditions you had before taking out the insurance policy (these may be sited on your schedule as pre-existing conditions), also accident and emergency admissions as private hospitals are not generally equiped for these.
Under your medical insurance you are generally classed as a private patient, and as such you can often choose when and to some degree where your treatment will take place and whom you are treated by. Private hospitals usually have a room per patient rather than large wards, these often include en-suite facilities with some home comforts such as television and possible telephone.
If you are taking out private health insurance for the first time here is some general information about terminology and details you may want to consider.
- In-Patient Treatment - This refers to treatment for which you may have to stay overnight (or longer) in hospital.
- Day-Patient Treatment - This is treatment for which you have to go into a hospital or day-patient unit to receive, possible because or equipment required or if you need a period of supervision after received the treatment although you would not need to stay overnight under normal circumstances.
- Out-Patient Treatment - Refers to treatment given at a hospital, clinic or consulting room which can be organised under a basic appointment system and for which you do not need to go in for a day or overnight stay.
There is a large varient of medical insurance schemes available, from low cost schemes which may have limited cover or only cover treatment for which there is an extended waiting period in the NHS, to policies with wide ranging cover and benefits. Most schemes cover in-patient and day-patient treatment but check the details and exclusions for out-patient treatment. Generally policies do not include cover for pre-existing conditions, also treatment for things such as, drug abuse, self inflicted injuries and injuries sustained in the pursuit of dangerous hobbies or extreme sports, HIV/AIDS, infertility treatment, normal pregnancy, cosmetic surgery, sex change, experimental treatment, experimental drugs, organ transplant, mobility aids, kidney dialysis, preventive treatment. Also not all policies include dental treatment.
Whichever insurer you choose initially it is likely that generally your premiums will rise above the rate of inflation. This is due to various factor which effect the way healthcare is provided. As more and more people claim on the health insurance for private medical treatment, the number as well as technical sophistication and costs of treatment steadily increase. Most health insurance policies will cover treatments as the become established commonplace medical practice and are available privately. Initial tests and diagnosis equipment and treatment and also becoming much more complex and sophisticated, MRI scans are now commonplace and widely available, each of these costs about £500. As well as this it is likely that your health insurance premiums will increase with age as insurers recognise that people are more likely to need medical treatment as they get older. For example, a 65 year old could pay up to twice as much as a 45 year old. If you want and idea of the increases in premiums, you can always check what a quote would be for someone with the same circumstances as yourself but say 5 years older.
It is obvious, as with most insurance policies, the level of cover you choose will effect your premium. Very few medical policies will include everything and different insurers group different services together, so make sure you check a variety of options from different companies so that you get the right combination of treatments covered for you and your family. There are ways of reducing your medical insurance premiums if you wish, for example if you do not need a choice of hospitals, if you will wait for 6-12 weeks to receive treatment under the NHS, paying a higher excess or paying for some treatments or part of treatments yourself, for example specialist consultation.
Private health insurance companies will want some details about your current health. As state above some medical conditions and pre-existing conditions are excluded on most medical insurance policies. Generally an insurer will want a Medical History Declaration or Full Medical Underwriting as part of your application for insurance. Some insurers offer another option called the moratorium option.
With a Medical History Declaration you will need to complete a form detailing your medical history. The insurer may wish to write to your doctor for more information in some cases. You must enter all the information you are asked for, otherwise you may find your insurer refuses to pay out for a future claim, or cancel your policy. If you are unsure whether a paticular problem is relevant or not, possibly a medical condition you had many years ago, it is best to safe and declare it. It may only have a small impact on your policy or premiums, or your insurer may issue the policy but exclude that particular condition, sometimes this will only be for an initial period, for example two years after which your policy will revert to normal cover.
In the case of the moratorium option, you would be still be asked to complete a form but not required to give details of you full medical history. Insteat the company you would be asked for details of the last five years and the insurer would not cover medical conditions which exested in that time. Again these conditions may become automatically included if you do not have any symptoms or receive treatment, tests, advice or medication for that condition for a given period, again usually about two years after the start of your policy.
You may at some time want to change insurers, but it is worth remembering that your new insurer may not cover you for any conditions that have occured while under your existing insurance cover, this is because to a new insurer it would come under pre-existing conditions. If you pay your insurance premium annually you could lose anything you have paid up front. If you wish to change insurer due to a better premium or more suitable policy it may be worth explaining this to your existing insurer, you may be able to get them to match the policy you are thinking of changing to.
If you want to make a claim, contact your medical insurance provider to make sure you are covered for the treatment you will receive, your insurance company should set out a step by step procedure and send any relevant claim forms.
Generally you will need to go to your GP in the first instance and get a referral to the appropriate specialist. Your GP and any specialist you are referred to will probably need to complete and sign your claim form, in some cases your GP will make a small charge for this which you will probably not be able to reclaim from your insurance policy. The specialist you are referred to may recommend test initially, keep your medical inurance provider up to date with any planned treatment, this way you can make sure all the treatment you are to receive will be covered. If you admitted to hospital as an in-patient or day-patient your insurer will be able to tell you in advance their way of processing claims, some will have bills sent directly to them for payment, in other cases the bill may come to you for you to forward on with any internal forms.
If for some reason you do get a bill you are not expecting, do not panic, generally you can forward this on to your insurance company or return it to the specialist with information as to where they should send it. If you run into any problems with details of your claim you do not understand you can probably go back and talk to your GP who can check dates and records you need for a claim.