PRIVATE MEDICAL INSURANCE

Medical advances mean doctors can treat many more conditions, but new procedures, diagnostic methods, drugs and technology mean medical costs are increasing all the time. In addition, the population is growing larger and living longer, which is putting extra demands on the NHS in terms of both time and costs. Coping with this increased demand is a growing problem for the NHS. This is where the Private Medical Insurance comes in to help with this. Department of Health statistics on waiting lists show more people than ever are waiting for surgery or hospital appointments and pressure is also on NHS GP services.

TYPES OF POLICY AVAILABLE

Outpatient treatment

This is any appointment at the hospital that doesn't require an overnight stay. Your first meeting with the consultant will be an outpatient appointment.

There are three main types of PMI policy.

Low cost policies tend to provide comprehensive cover only if the treatment isn't available from the NHS usually within six weeks. A budget policy will not usually include outpatient treatment or complementary therapy or physiotherapy.
Comprehensive policies are the standard policies that usually include hospital stays, surgeon, nursing and anaesthetist costs, X-rays, outpatient and day-care treatment linked to hospital stays.
Premium policies offer additions to comprehensive policies, such as critical illness cover, cover overseas, dental cover and a hospital cash plan.

Closeup shot of a stethoscope resting on a laptop with an unrecognizable doctor working in the background

Exclusions

The following conditions are usually not covered by PMI.

Accident and emergency admission or outpatient treatment.
Private GP services.
NHS prescriptions.
Normal pregnancy and childbirth.
Chronic (long-term) conditions such as diabetes and asthma that required prolonged treatment.
Pre-existing conditions (you can't insure yourself after it happens).
Routine dental treatment.
Cosmetic surgery, except for a disfiguring illnesses or an accident.
Routine health checks.
Outpatient drugs or dressings.
Transplants (except skin grafts and corneal).
Drug and alcohol abuse.
HIV and AIDS, with some exceptions.
Voluntary sterilisation, with some exceptions.
Fertility treatment, with some exceptions.
Services sought without referral from a family doctor.
Appliances (eg wheelchairs).
Some forms of psychiatric care.
Preventive treatments.
Experimental treatments.

There can be exceptions to these rules. For example, a company may agree to cover the cost of voluntary sterilisation if becoming pregnant would put a woman's health at risk.

Moratorium underwriting - Pre-existing conditions

If you do have a recurring illness, seek medical help for it straight away. It's not worth risking your health by waiting for two years so you can claim privately via a PMI policy as there is usually a clause that says they won't pay for treatment if you 'ought reasonably' to have sought treatment or advice in this time. You don't give details of your medical history when you apply, but you won't be covered for any medical condition you've received advice or treatment for in the last few years (usually five, but it does vary between insurer).

Any medical problems that are related to a pre-existing condition are also excluded. But because the insurer will only ask about your medical history at the point you apply for treatment, some pre-existing conditions might be included in your policy in the future. Usually this is when you haven't had any symptoms or treatment for at least two years after your policy starts. So, this type of policy may give you better cover if you've had a condition in the past that may flare up in the future - just remember that some conditions will always be excluded. Any insurer offering moratorium underwriting must also offer full medical underwriting.

Always seek authorisation from your insurer before undergoing treatment, otherwise you may end up with a large bill that you will have difficulty paying.

Advantages of Private Medical Insurance

No queues

Waiting times on the NHS can be months or years between referral and treatment, you won't have to wait this long for private treatment.

Peace of mind

If the worst happens, your treatment will be as quick as it can be. Many people are also concerned about the problem of standards in NHS hospitals.

Choice

You can choose your consultant and where you want to be treated, with the proviso that some policies restrict treatment to set lists of hospitals.

Private room

You don't have to worry about being on a mixed-gender or noisy ward. Depending on your policy, you may have an ensuite bathroom.

Unrestricted visiting hours

You can be visited by your family anytime.

Personal care

A retinue of medical students won't accompany your appointment with the consultant, you won't be kept waiting for hours to see them and you will have more time to discuss your symptoms.

Continuity of care

You are likely to be seen by the same consultant throughout your treatment.

Specialist claim team

Your insurer may have a team that deals specifically with a certain type of condition, such as cancer, who can help advise you.

Disadvantages of PMI

Not all conditions are covered

It depends on your policy and any previous medical conditions, but most policies only cover short-term illness or injury.

Some appointments and treatments are not covered

Once you've got a referral from your GP, you need to call your insurance company to check they will cover the costs before you see the consultant or arrange any treatment.

It can be difficult to know which PMI policy suits you

With so many companies offering PMI, it's worth talking to an independent financial adviser, who can help you see the differences between the policies. Advisers at insurance companies can only discuss their own policies and can't give you advice on how it compares with others.

You get what you pay for

The more cover you want, the higher your premium will be.

Premium costs can rise above the level of inflation

Medical treatment costs are rising each year. When insurers' costs rise, premiums tend to rise in line with the costs.

You can't predict illness

You might develop a condition that isn't covered.

Expertise

Private hospitals might not have the same depth of expertise found in teams within the NHS or all departments on one site. So if you have a problem with your mouth, it might not be easy to coordinate treatment between a dental department and the ENT (ear, nose and throat) unit.

Time constraints

If your consultant also works in the NHS, your treatment will need to be given in the time he or she has free from the NHS.

Many different companies offer private medical insurance (PMI) in the UK, the main insurers are BUPA and Axa Healthcare who between them have a significant market share. So although there is competition, it isn't keeping monthly premiums as low as policyholders might like. Premiums are also linked to claim costs. This may be offered by referral to a partner firm.

CONTACT US

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Lawson Financial Ltd is a broker and not a lender

Your home may be repossessed if you do not keep up repayments on your mortgage

Lawson Financial Services will charge a fee for their services. Find out about our fees here.

Lawson Financial Ltd is directly authorised by the FCA

Lawson Financial Ltd is a broker and not a lender

Your home may be repossessed if you do not keep up repayments on your mortgage

Lawson Financial Services will charge a fee for their services. Find out about our fees here.

Lawson Financial Ltd is directly authorised by the FCA

Registered Office: Lawson Financial Ltd, 8 Biscay Close, Hill Head, Fareham, Hampshire PO14 3RG | Registered Company Number: 09000180 | Registered in England and Wales.