FAQs
1 - What is Private Medical Insurance?
Private Medical Insurance is designed to cover the costs of private medical treatment for acute medical conditions.
2 - What is an acute condition?
Most insurers define an acute condition as a 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.
3 - What If I have a long term medical condition, which cannot be completely cured?
These conditions are known as Chronic conditions. As your PMI is designed to cover treatment for acute conditions it does not usually cover long term treatment of Chronic conditions where the purpose of the treatment is primarily to keep the symptoms under control.
When you first become ill with a chronic condition the insurer will pay for any specialist consultations and diagnostic tests you need to have in order to find out the cause of the symptoms [providing the benefits of your chosen plan covers these]. The insurer will also pay for any initial hospital treatment you require to stabilise your condition. There may then come a point when the treatment you are receiving is only monitoring your state of health or keeping the symptoms of your condition in check rather than curing it. At this stage the insurer will usually look to obtain further information from your GP or consultant before making a decision as to whetther the cover will be withdrawn.
It is important to note that that if cover is withdrawn by the insurer in relation to a chronic condition it does not mean the cover has been permanently withdrawn. If your condition suddenly worsens and you need to be hospitalised in order to have short term treatment to stabilise your symptoms again, then the insurer will look to cover this treatment.
4 - What is included in a standard policy?
Most policies include the costs for the following areas for UK based treatment.
- Hospital Accomodation
- Nursing Care
- Surgery as an inpatient or daypatient
- Inpatient diagnostic tests
It is important to note that PMI is not designed to replace all services offered through the NHS. For example accident & emergency treatment is not available through most private hospitals.
5 - What about treatment before & after hospitalisation?
This area of treatment is known as outpatient treatment and includes areas such as initial consultations & diagnostic tests on referral from your GP or follow up consultations after hospitalisation. These areas are not automatically included with all policies and it is important to establish whether the plan you are taking includes outpatient benefits.
6 - What is usually not covered?
Conditions you had before taking out the insurance [Referred to as Pre-existing medical conditions]
GP Services
Cover for long term chronic conditions [as outlined previously]
Also normally outside the scope of cover are: Drug abuse, Self inflicted injuries, outpatient drugs and dressings, HIV/AIDS, Infertility, normal pregnancy, cosmetic surgery, gender reassignment [also known as sex-change], preventive treatment, kidney dialysis, mobility aids, experimental treatment, experimental drugs, organ transplants, war risks, injuries arising from dangerous hobbies [often called Hazardous Pursuits].
7 - Will I need to give details of my Health?
As described above pre-existing medical conditions are not usually covered. There are two main methods that insurers can use to accept your application - Full Medical Underwriting [Also known as Medical History Declaration] and Moratorium.
Under Full Medical Underwriting you are normally asked to fill in a form giving details of your medical history. If necassary the insurer may write to your doctor for more information. It is Essential that you give all the information you are asked for. If you dont you may find that your insurer may refuse to pay any claim that you make in the future or may cancel your policy. If you are not sure whether or not to mention something it is best to do so. If you have a medical condition, which is likely to come back, the insurer will issue a policy, but that condition [and any condition related to it] may not be covered, either indefinately, or for a set period of time.
Under a Moratorium you are asked to fill in a form but you are not asked to give details of your medical history. Instead the insurer does not cover any medical condition, which existed in the last [usually] five years. These conditions may automatically become eligible for cover, but only when you do not have symptoms, or receive treatment, medication, tests and advice [from your GP or Specialist] for that condition for a continuous period of [usually] two years after your policy has started. There are some conditions, for example chronic condition, that will probably never be eligible for this delayed cover because you will always need regular or occasional treatment, medication, tests or advice for them.
8 - How Do I Make a claim?
Apart from emergency admissions to NHS hospitals all medical treatment has to start with a referral by your GP to an appropriate specialist. Before you receive any treatment privately you should call your insurer to check that you are covered for the treatment that you will receive. Your insurer will give you all the guidance you need, confirm what your cover includes and if necassary, send you a claim form. If a claim form is required it would probably need to be completed and signed by either your GP or specialist. Your GP may charge a small fee for this which will probably not be covered by your insurance. Once the form has been received by the insurer they will asess it before confirming the cover is available and advising you whether the treatment you plan to receive is within the scope of your cover.
Your insurer will tell you how they pay claims. Remember, if you have chosen to pay an excess, you will have to make a payment. Most hospitals and some specialists have their bills paid directly by the insurer. Others will send the bills to you.
9 - Will my premiums go up?
Whichever scheme you choose, your premiums may rise above the rate of general inflation. This is because of factors which affect how healthcare is provided in all western economies. You should also note that most insurers increase premiums as people get older. This is because statistically people are more likely to need and receive medical treatment as they get older.
10 - Can I Change Insurer?
As a specialist and independent PMI intermediary we advise our clients each and every year at renewal whether their policy is still the best for their investment or whether there is a better deal available. However, it is important to note that your new insurer may not cover any previous, or existing medical conditions, which your current insurer does cover and in this situation it is highly likely we would not recommend a change.