Private Medical Health Insurance (PMI)

What is private medical health insurance?

Private medical insurance (PMI), or health insurance as it's sometimes known, is designed to pay for the expenses of medical treatment if you wish to go private instead of using the NHS. PMI is specifically aimed at paying for acute medical conditions. An acute medical condition is an illness, injury or disease that is probably curable and able to be treated quickly. For more medical conditions that are longer lasting, you will have to receive your treatment through the NHS.

 

How does private medical insurance work?

If you have private medical insurance, you can arrange to receive fast private treatment in a few easy steps:

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1. If you suspect something is wrong with your health, visit your GP and tell them that you have private health insurance.

2. If you need treatment, your GP will be able to immediately refer you to a leading specialist and private hospital of your choice.

3. You must inform your insurance company that you want to make a claim on your policy and confirm your cover.

4. When your health insurance company provide approval, your GP will book your appointment with the specialist. This will be paid for by your insurer.

 

Health insurance will not cover medical emergencies. If you require emergency treatment you will need to visit Accident and Emergency on the NHS as normal. However, once your health is stabilised your health insurance will cover your continued private treatment.

 

Should I have private medical insurance?

Firstly, the higher level of choice that private medical insurance can offer to a policy holder. You can choose from a range of hospitals or a preferred hospital or even a favoured doctor. Some people prefer the overall environment and experience with private medical insurance, than they would with the NHS.

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Secondly, you will probably experience a faster service in which you receive your treatment. This is because most private hospitals have much shorter waiting lists than NHS hospitals. This means that the treatment can be more effective.

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Thirdly, the quality of your care can often be much higher in private facilities than in hospitals run by the National Health Service. This is not to say that you will receive poor medical care from the NHS but private companies invest more in staffing and hospitals to ensure higher quality. You will probably receive a private room if you receive treatment privately, this is often seen as one of the best benefits of having private medical insurance.

It is important to note that private medical insurance is a luxury, unlike other forms of insurance such as car insurance etc.

 

What is treated on private medical health insurance plans?

Private Medical Insurance plans are designed to provide cover for the treatment of acute medical conditions. If you have what is known as a "chronic condition", it is more than likely that it will not be covered by your plan. Illnesses covered by the plans can also vary from provider to provider.

 

The below ARE normally covered by private medical plans:

• Tests and Surgery

• Accommodation in Hospital

• Acute Stages of Chronic Conditions - Even though most private medical insurers will not cover chronic conditions, lots of companies will still cover the acute stages of these conditions.

• Outpatient therapy, consultations and tests

 

 

What types of private medical insurance policies are available?

• Budget policies are the cheapest, but they will normally only provide cover for in-patient and day-patient treatment with limits on the amount you can claim.

• Most mid-range policies cover full in-patient and day-patient treatment and selected outpatient treatments. These are a good option if you want the benefits of private healthcare at an affordable price.

• Comprehensive health insurance policies are the most expensive option but provide full in-patient, day-patient and outpatient cover, with benefits like psychiatric cover and complementary therapy included.

 

However, not all insurers use these terms to classify their health insurance products. This is why it is advised to speak to one on our protection specialists who will do a comparison for most of the providers. This will highlight the full details of every policy to help you compare quotes.

 

What hospitals can I use with my medical insurance cover?

Every private medical insurance policy comes with a list of approved hospitals which may vary, depending on how much you pay. Make sure you are happy with your hospital list before buying your health insurance policy, especially if there is a particular private hospital you would want to use.

 

How can I make my health insurance premiums cheaper?

There are a range of discount schemes which can be applied to your health insurance policy to make it more affordable without sacrificing on the cover you need. These include:

 

Six week option: If the NHS is able to provide treatment within six weeks, you will be treated on the NHS. However, if the NHS cannot guarantee treatment within six weeks you can use your health insurance policy to be treated straight away.

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Excess: You can volunteer to pay the first part of any claim, which will be agreed when the policy is purchased. The higher the excess on your policy, the lower your premiums.

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Co-payment: You can volunteer to pay a percentage of any claim which will reduce your premium.

 

Reduced hospital list: Choosing this option means you will not pay for hospitals you do not need.

 

 

What will private medical insurance (PMI) not cover?

PMI is not designed to cover emergency medical treatment, but it will cover your treatment once your condition has alleviated. It will not provide cover for any of the following; pregnancy, fertility treatment, cosmetic treatment, gender reassignment or any other voluntary medical treatment.

It does not usually cover the treatment of chronic conditions, but it may provide healthcare to stabilise a chronic condition if there is a serious flare-up of the condition.

 

Can pre-existing conditions be covered?

PMI is designed to cover conditions that you develop after taking out your policy. However, the type of underwriting you choose will determine whether your pre-existing conditions are covered in the future. There are three main types of underwriting:

 

Moratorium: these policies will normally exclude cover for any condition you have experienced in the previous 5 years. However, if you receive no symptoms, treatment or advice for that condition in the first two years of the policy you will regain cover for it.

 

Full medical underwriting (FMU): these require you to provide your full medical history on application. Usually your insurer will exclude cover for pre-existing conditions, but you will be made aware of these exclusions before you commit to buying the policy.

 

Switch: this underwriting allows you to change insurers without losing cover for conditions you have suffered since taking out your old policy.

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Will my private medical insurance payments change?

Your health insurance premiums may increase as you get older as you are more likely to claim on your policy. The level of increase will vary depending on your insurer and policy. It is worth reviewing your policy every year to make sure you are getting the right level of cover for the lowest price.

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