Frequently Asked Questions

Medical Insurance FAQs

Below is a list of the most frequently asked questions regarding Private Medical Insurance -

Why Should I Buy Private Medical Insurance?

Treatment can be made very quickly which can cut the time needed to recuperate and mean less time suffering from the affects of the condition.
Having a choice of the hospital in which they are treated and a choice of specialist.
The privacy of an en-suite private room and other home comforts are included in the policy benefits.

Private medical insurance will cover the costs of private medical treatment, for ‘acute conditions’. Insurers, in general, define an acute condition as a disease, illness or injury that is likely to respond quickly to treatment.

How Can I buy Private Medical Insurance?

You can only buy a Private Medical Insurance policy directly from an insurer or through an agent or advisor. An agent can include a bank, building society or a supermarket. You can do this face to face or over the telephone. Your documents can be sent via the post or through email.

If your contact is an agent who sells policies on a specific insurer’s behalf, they will not be able to offer advice on a wider range of other insurers policies. If your contact is an independent adviser, they will be able to offer policies from a range of insurers. Your advisor will explain what they are able to sell, whether they are independent or able only to sell one insurance company’s policies. You do not have to accept any advice offered but it is your responsibility to choose the correct policy.

You will need to fill out an application form which will ask questions about your health, it is necessary to be completely honest about your health and to mention any existing medical conditions when asked. If your application is accepted you will be given a policy start date and be notified of the cancellation period. You will then receive your policy documents. If you decide to cancel the policy, you must do so within the stated period and tell the insurer that you want to cancel your cover. If you have made any payments you will usually receive a full refund unless you have made a claim.

Is Private Health Insurance Regulated?

Private medical insurance is regulated by the Financial Services Authority. The FSA has produced a set of rules by which intermediaries have to abide when selling and providing general insurance.

All insurers must treat sensitive and personal information with confidentiality, this is the law as stated in the Data Protection Act 1998. When askeded for information you will be told what it is used for and who will be given access to it and in what circumstances. You can ask to see any information held about you. Totally anonymous statistical information may sometimes be provided to some outside organisations to enable them carry out research. Insurers might use email to communicate with you and if this is how you prefer to communicate with your insurer, you should make sure your email address is private.

Insurers and anyone advising on private medical insurance, must have their own complaints procedure in place and they must be covered by the Financial Ombudsman Service (FOS). If customers have any problems with any part of the cover they should in the first instance speak to their advisor or insurer first. If the complaint is not handled in a satisfactory way, the customer should contact the FOS who offer a free service.

Will I Need to Provide Medical Details about Myself?

Pre existing medical conditions will not normally be covered on a Private Medical Insurance policy. An existing condition is one that you are already aware of before you apply for a PMI policy. You will need to be completely honest and fill out the application form to the best of your knowledge. If a claim should arise, the insurers will contact any medical professionals you have been in, specifically your GP, to discover the back ground of any condition to validate your claim in a fair and timely manner.

There are two main methods that PMI companies use to deal with an application for cover.

Full medical underwriting;

Private Medical Insurance companies will usually underwrite their prospective customer’s application by using the full medical underwriting option. This means they will ask for a full medical history declaration. They may also write to their GP for more detailed information. Customers must give all the information asked for otherwise the insurer may refuse to pay any claim that arises in the future and they can cancel your policy entirely. If someone has a medical condition that is likely to come back, the insurer will issue a policy without cover for the pre existing medical condition. Cove for this may be excluded completely or may be excluded for a period of time.

Moratorium underwriting

Some Private Medical Insurance companies will offer the moratorium option where you are not asked to give details of your medical history. The insurer will not include cover for the treatment of any medical or related condition that you have received treatment for, taken medication for, asked advice on or had symptoms of. The cover will exclude any condition that has existed in the past few years. The exclusion is usually for a five years period. There is a chance that the conditions may automatically become eligible for cover when you do not have symptoms of, or receive treatment, medication, tests and advice (from your GP, a healthcare professional or a specialist) for that condition, usually for a continuous period of two years after your policy has started. This means that when you take out your policy, you do not need to tell your insurer about your medical history. There are some conditions these are chronic conditions and this is because you will always need treatment, medication, tests or advice for them.

How do I Choose the Right Level of Cover?

Choose the right type of Private Medical Insurance you need by considering which benefits are most important to you. There are a range of benefits and differing levels of cover. Not all of the benefits are relevant to everyone that takes out a PMI policy and cost is often the deciding factor. There are lower cost policies which have a limited range of benefits but still include relevant treatments. Most policies will include cover for inpatient and day-patient treatment, but may not include diagnostic tests and outpatient treatments. You can choose to pay part of the treatments and choose to exclude others such as blood test and X-rays. You could limit the cost of the policy by accepting a limited choice of hospitals chosen by your insurer. There is the option to pay a higher excess which will reduce the overall percentage of the cost of the policy.

What if I Have a Disability?

Having a disability does not mean you will be refused Private Medical Insurance. You will not necessarily be able to cover your treatment for the condition(s) through your policy. Your insurer will be able to offer a full explanation as to why this is. When you sign your declaration about your medical history you will have been obliged to give any relevant information about yourself and any conditions you already have. If your policy does not offer to cover your pre existing condition, an existing medical condition causing disability, or arising from it, will not be covered.

Will my Premiums Increase?

It is far more likely that premiums will increase as medical procedures and advances in modern medicine affect costs, policies will in general; rise above the rate of inflation. Private Medical Insurance will always try to keep up with new technology in medical procedures and developments and there is a cost to this. New drugs come on to the market and these are often priced at a premium such as in the case of drugs such as Herceptin and Avastin which aid the victims of cancer. As policy holders become older there may also be an increase in charges due to the increase in the risk of needing medical attention.

Can I Decrease my Premium Cost?

It may be possible for you to reduce premiums by reducing the number or range of benefits. You may want to look at the following areas of cover that could be reduced and decide how this would affect you before making any decision.

By reducing the level of benefits such as having a more limited outpatient cover.

By reducing the choice of hospitals you can visit for treatments.

By increasing the excess amount paid on each and any claim.

Opt for a ‘co-insurance’ by agreeing to pay a set percentage of any claims whilst the insurer pays the balance until the yearly amount has been paid (after this the insurer pays 100%).

By opting for a no-claims discount policy or a policy where a discount is only offered if you agree to commit to keeping healthy by leading a healthy lifestyle.

By accepting treatment on the NHS if it is available within 6 to 12 weeks of the diagnosis rather than in a private hospital.

By receiving a discount when changing your payment method.

Can I change my Insurer?

If you would like to switch your Private Medical Insurer you will need to consider key main areas. Some policies may not include illnesses, injuries and conditions that you have had in the past or are suffering from now regardless of whether they are currently covered by your current policy. Your new insurer may not match your current exclusions. When comparing your cover like for like, you should compare the benefits of the insurers and compare any cover limits, excess payments and monetary amounts.

You should also investigate thoroughly how the cover works and the conditions of cover. Your existing paperwork will vary from any new insurers and you may need to provide a copy of your current policy as proof of your cover. It is likely that your PMI will have been issued under an annual contract basis, therefore you should check when your renewal date falls to see whether you would lose out on any payments.