Private Medical Insurance: Protection and Insurance Advice
Private Medical Insurance gives you peace of mind to know that if you need an operation or treatment, you can have it done privately and claim on your policy for payment. You can also normally choose where the treatment is done, by which specialist and in your choice of hospital.
Private Medical Insurance policies can be tailored to the cover you think is important and also to suit your pocket. There are numerous schemes offered from low cost budget schemes to comprehensive covers and benefits.
It is important to know that all schemes available will make at least some exclusions for which you will not be covered - you need to find out what they are before making any decisions. Conditions that are usually excluded could be any pre-existing complaints you have, visits to your doctor, visits to casualty and long term incurable illnesses.
Premiums for these types of policy will be affected by the level of cover chosen and also the level of excess you decide to pay. The excess on Private Medical Insurance is the same as on your car insurance, if you have an accident and you pay the first £100, your premiums will be cheaper.
Premiums could also be reduced if you take a lower grade of accommodation in hospital and if you choose to pay for certain parts of treatment personally. Your age and past medical history will also affect your premiums.
Some companies will ask you for a medical history declaration but others may ask you for a Moratorium which basically removes the need for medical questions. With a Moratorium, any condition that you have had in say the last five years, is excluded. It is possible for them to be included again if the condition does not arise for say two years after your Private Medical Insurance policy commenced.
1. Private Medical Insurance : Protection and Insurance Advice
Private Medical Insurance has been designed to be complementary to the National Health Services (NHS) and is not a replacement for all these services.
The purpose of Private Medical Insurance is to provide cover for unexpected or unforeseen medical conditions arising after the start of the policy. It does not provide cover for conditions that already existed when your policy commenced (these are described as pre-existing conditions). In this brief guide, we have highlighted some of the key features, which you should be aware of before taking out cover.
What does your policy cover?
Your Policy covers the treatment of acute medical conditions, which are illnesses or injuries that respond quickly to medical or surgical care, and are likely to lead to a full recovery or to restore you to your previous state of health without you needing to receive prolonged treatment.
What is not covered?
It does not cover chronic conditions because the majority of cases are incurable and need long-standing treatment or supervision. There are also other exclusions stated in your Policy Wording, in common with other insurers' policies, as well as pre-existing conditions as determined by the method of underwriting chosen by you (see Moratorium' and 'Full medical Underwriting' below).
What is a chronic condition?
A chronic condition can be defined as a disease, illness or injury, which has at least one of the following characteristics. it continues indefinitely and has no known cure; it comes back or is likely to come back; it is permanent; it means you need to be rehabilitated or specially trained to cope with it; it needs long term medical care (by this we mean regular monitoring, consultations, check-ups, examinations or tests to assess your state of health)
2. Medical Insurance Full Medical Underwriting
Full Medical Underwriting Private Medical Insurance Scheme is the standard type of scheme where you complete a questionnaire that asks for information about your state of health, so that insurers can decide whether to accept your application and, if so, on what terms.
This may involve applying a specific exclusion for any medical condition you have disclosed. In addition, they may only be able to accept you at a modified premium.
For some medical conditions it may be necessary to seek further information from your General Practitioner.
How do you know which conditions are excluded?
Details of any medical conditions specifically excluded for you would be stated in a personalised certificate that would be provided to you for each year of your cover.
Please note that it is essential that you disclose full and accurate medical information in your medical questionnaire as failure to provide this may invalidate the contract and cancel out a claim. If you are in any doubt as to the relevance of any information, you should include this on your application form.
What about new medical conditions?
All unexpected medical conditions that are new to you after your policy has commenced will be covered from the first day of your insurance cover (subject to your chosen level of cover and the standard exclusions listed in the Policy Wording such as alcohol or drug abuse, cosmetic surgery etc.)
A no medical history private medical insurance scheme is also known as a Moratorium Scheme.
With this type of Private Medical Insurance Scheme, you can apply for cover without the need to complete a health questionnaire.
There is simply an automatic exclusion of any pre-existing or related conditions that you and any other member of your family had during the five years immediately before your policy started.
What is a related condition?
A related condition is any medical condition that is considered to be an underlying cause of, or directly related to, a pre-existing medical condition. Examples are: stiffness in joints & arthritis; recurrent sore throats & tonsillitis.
Will pre-existing conditions ever be eligible for cover?
With the exception of certain medical conditions that are specifically excluded under your policy, pre-existing medical conditions may become eligible for benefit providing you have been insured with the company continuously for two years and, during this two year period you or any other member of your family have not, for these conditions, or any directly related condition:
- Consulted a medical professional for medical treatment or advice (including check-ups)
- Taken medication including drugs, medicines or injections - this would include any medication you take regularly to control long-term conditions such as high blood pressure or diabetes
What if I receive medical treatment within the first two years?
The moratorium exclusion will continue to apply until you have been free of any such symptoms, treatment, advice or medication for a continuous period of two years. So, for many conditions you may never be eligible for benefit. The practical effect is, however, no different to completing a full health statement where a permanent exclusion is applied for a pre-existing condition.
We would strongly advise you not to forego necessary medical advice or treatment during the first two years of your insurance, simply to try to obtain cover under your policy. Such a course of action could endanger your health.
4. Compare Medical Insurance Moratorium and Full Medical Underwriting
The advantages of the moratorium method are that it simplifies the process of obtaining cover, as no detailed health questionnaire has to be completed. It also allows for automatic cover of pre-existing conditions providing you have had two consecutive years free of advice, medication and treatment after the start of your policy.
The advantages of the completion of a full health statement are that you would receive a certificate stating any specific exclusions. Therefore you would know precisely what you are not covered for and it enables you to judge before joining whether or not you consider the cover as providing value for money.
However, it is important to understand that when completing the form, you must reveal all important information otherwise a claim could be turned down. the answers you give will be used to assess your application. Failure to disclose material facts which would be likely to influence the acceptance of the application may lead to the non-payment of any future claim and the cancellation of the contract.