If your children are to be treated under the policy,
you may want cover for sleeping overnight at the hospital
Health insurance for individuals comes in a number of forms. The main solution is private medical insurance which covers private consultations, tests, scans and treatment to various extents. The lesser, more restricted solution is health cash plans which pay money partially or in full for the cost of treatment, particularly for private dental and optical treatment, and sometimes physiotherapy.
Cash plan options can be used to cover gaps in private medical insurance cover or as part of a “pick and mix” approach to putting together health covers to suit one’s pocket.
Private medical insurance providers offer various levels of cover relating to outpatient, day patient and inpatient diagnosis and treatment, the aim being to help you keep your premium costs down. Most will also offer no claims discounts. This is in response to consumer resistance to paying what can turn out to be significant premiums for the individual concerned.
Health insurance information for individuals needs to satisfy you about aspects you are particularly concerned about, and sometimes this won't immediately appear to be so. Either you won't quite understand how the wording covers these particular matters, or indeed it simply doesn't. Whichever the case you should ascertain the situation by questioning the insurer or broker yourself, and if necessary ask them to adjust the policy.
Never be afraid to do this. Yes it could mean extra costs but you should ask your insurer or broker how this can be balanced by slightly reducing cover elsewhere or increasing excesses. For instance, do you really need cover for initial consultations which may only cost around £150 or so?
In principle, private medical insurers will not cover pre-existing conditions, although some will offer a degree of flexibility. If the condition has been cured or is under control without recurrence, you could at least enquire about how and when you might be covered.
When you apply for private medical insurance you may be offered the option of either giving full medical details (which could lead to specific exclusions by the insurer of the pre-existing conditions revealed), or signing up on a moratorium basis where you get cover subject to the insurer making a decision on the condition at the time of claim (which could lead to a pre-existing condition being excluded then).
Expecting insurers to cover pre-existing conditions
Brian Walters of broker Regency Health explains: There are three options for individual clients who wish to achieve cover for their pre-existing conditions under a medical insurance plan.
The first is a “flat moratorium”, which covers pre-existing conditions after you have been a member for two years. Only two insurers offer a flat moratorium and applicants have to meet qualifying criteria.
The second is a “rolling moratorium”, whereby pre-existing conditions are excluded until you have gone for a continuous two-year period after enrolment without presenting symptoms or requiring advice, treatment or medication.
Finally, if you enrol on a “full medical underwriting” basis, the insurer may agree to cover a condition—controlled high blood pressure, for example—that would likely be excluded in perpetuity under a rolling moratorium.
Being open about pre-existing medical conditions
Andrew Tripp of the Association of Medical Insurance Intermediaries (AMII)) observes: If you go to a specialist heath insurance intermediary they will ask for information about existing medical conditions. They have to do this to ensure that the most appropriate advice is given. You should expect to be asked about treatments received in the last five years at least, and also any current and ongoing medications or treatments. You should also disclose to your adviser whether there has been any history of major medical problems.
This medical information will help the adviser suggest the most appropriate form of underwriting. A specialist adviser should also have knowledge about the underwriting practices of each insurer and, for certain medical conditions, such as controlled high blood pressure, may be able to suggest particular insurers which would look at that condition more favourably.
It is possible to switch with pre-existing medical conditions
Deborah Kliener-Gaines of broker Best Health UK says: Purchasers of private medical insurance can in fact sometimes have a satisfactory outcome over the matter of pre-existing medical conditions although switching health insurer was not an option a few years ago for individuals. The main consideration now when switching insurer is usually treatment within the past 12 months and whether this treatment is complete.
Mr Smith came to us having had a heart attack 7 years ago. He was paying a very high premium to his current insurer due to his claims history. We reviewed the market and sourced a lower cost insurer to switch his cover to, as they only required details of the past 12 months’ treatment.
Some insurers will not consider taking a “switch” client if they have had any claims in the last 12 months regardless of how small or insignificant the claim was. One of our clients, Mr Green, had been referred to an eye consultant following a routine test but the first insurer we approached would not switch the client without further underwriting, even though the outcome of the appointment was “all clear” with no follow ups! However, we were able to approach another insurer who was happy to accept the switch with no further underwriting, stating that it was a “routine exam”.
As a rule, private medical insurers will only cover acute conditions, i.e. those which can be cured relatively soon. They will not cover chronic conditions which, in effect, cannot be cured within the foreseeable future.
However, insurers will generally provide cover for the diagnosis and immediate treatment (until stabilisation) of chronic conditions, such as heart, stroke and cancer situations. You need to be comfortable about the extent and duration of the treatment and associated care available in dealing with serious chronic conditions which unexpectedly arise.
Some insurers make a particular point of emphasising their cover of heart and cancer treatment, and may even have specific heart and cancer policies. You need to be very careful about what is being covered.
Be clear in your own mind what you want from health insurance and check that you will get it.
Most people have health insurance because they want a prompt response to any medical problems which occur in the future, and they may also prefer the environment of a private hospital. You should decide whether you want a private healthcare response to all medical problems or whether in fact you just have special priorities which you want covered.
Whatever your requirements you should check very carefully that they will be met by the policy you choose. For instance, home nursing and rehabilitation are only sometimes covered. If you also want cover for your children make sure until what age they are covered. If you are opting for an economy or basic policy be sure you fully understand what scans are included. Be happy with any limits on meeting specialists’ fees and diagnostic test costs. If your children are covered, you may want overnight accommodation provided in the hospital.
The separate issues of covering your children and cosmetic surgery
Leila Wilcox of intermediary Sure Insurance Services observes: Many family policies have little or no cover designed for children They are covered, in effect, as a mini adult policy rather than an actual cover designed for children.
Therefore should your child need to claim for things such as physiotherapy, speech therapy, radiotherapy, chemotherapy, dental treatment or receive payouts for emergency care you may find there is little or no cover. Check with your health provider whether they offer any of these or you will instead have to search for stand-alone children’s health insurance.
Then there is the matter of cosmetic surgery insurance. If something goes wrong – are you liable to pay the extra costs? No matter how experienced a surgeon may be, there are known complications with any type of surgery. If an operation has been unsuccessful it is often up to the patient to pay the costs for another operation. You can ask the surgeon about guarantees they may offer, such as a one year protection.
It may be important to you that the insurer offers a health improvement programme which can lead to premium discounts at policy renewal – check on the programmes and rewards as they do vary. If a medical helpline is important to you, check on whether you would be given advice by a GP or nurse.
You may wish to check on your access to drugs which are not available on the NHS.
Private medical insurers will usually offer no claims discounts, and even immediate joining discounts. You need to find out how the no claims discount works and be comfortable with the arrangements – you don’t want to be frightened to get private medical attention for something important because you are worried about losing your NCD. Some insurers have flexible NCD arrangements.
Have a careful look at the options for the extent and level of cover offered (including monetary amounts for consultations, diagnosis etc.) – there could be situations where you would be content to be treated by the NHS. For instance, you may choose to use NHS outpatient services following private treatment.
An option for reducing cost is not to have certain benefits, e.g. complementary medicine or psychiatric treatment. You should also decide whether you need access to more than the insurer’s core hospitals and so dispense with others on its full list. Also significant savings may be achieved if you opt to be treated privately within an NHS hospital, or use the NHS if you can get treatment within six weeks.
You can reduce your premiums by opting for one of the levels of excess offered by the insurer (i.e. the level up to which you have to pay the charge for diagnosis and/or treatment). You may be able to opt for making co-payments (i.e. you and the insurer both paying). Also some insurers give you the cheaper option of cover only for when you can’t get treated within six weeks by the NHS.
You could simply have just your key priorities covered by private medical insurance and possibly also a cash plan element. Having considered all the cover options and excesses, you can still talk to the insurer or your broker and ask how further the cost to you can be reduced.
Make sure you are content with how your premiums might rise as you get older. This is an aspect insurers don’t really talk about but which can be a crucial cost factor for you. If you like what your insurer is offering and the way it looks after you, you don’t want to be forced to go elsewhere later because you are beginning to be heavily rated due to your age.
When you are unwell, especially when you are very ill, the last thing you want is hassle about getting approval for private treatment and slowness in entitlements being paid for. Insurers will promise you quick and efficient authorisation and payment procedures, but you really do need to be happy this will work in reality. So ask searching questions.
Where physiotherapy is included in your policy, be clear about how much treatment you are covered for
When a pre-existing condition thought to have been cured recurs or a chronic condition suddenly flares up seriously, you may still be covered by your private medical insurance policy
Think whether you need home nursing and rehabilitation to be included in your private medical insurance policy