Private Health Insurance
Private medical insurance, often referred to as PMI, is a way for individuals or families to take control of their medical needs
With PMI, you get faster access to specialists, skip the long public healthcare queues, and enjoy more comfortable hospital stays, ensuring you receive top-notch care when you need it most
How It Works
Pay your premium and then make claims for any private healthcare you receive. Depending on the options you’ve chosen, your policy will cover some, or all of the costs of private treatments.
Benefits
Private health insurance comes with several advantages, including speedy access to private healthcare and expedited treatment. Numerous providers grant access to digital GP apps, allowing you to swiftly secure medical assistance and secure referrals for additional private care.
Some plans offer direct access to services like physiotherapy or mental health specialists without the necessity of waiting for a GP referral, ensuring you receive prompt treatment and support.
What is Covered
Here’s what private medical insurance typically covers:
Hospital Stays: If you need to go to the hospital for surgery or treatment, PMI can cover the costs, including your room, meals, and the medical care you receive there.
Specialist Consultations: When you need to see a specialist doctor, like a cardiologist or orthopedic surgeon, your insurance can help pay for their expert advice and care.
Diagnostic Tests: From X-rays to MRIs and blood tests, PMI often covers the cost of getting these important tests done.
Prescription Medications: If your doctor prescribes medications, your insurance can help you pay for them, making sure you can afford the medicines you need.
Cancer Treatment: PMI can assist with the costs of cancer treatments such as chemotherapy and radiation therapy.
Physiotherapy: If you need physical therapy to recover from an injury or surgery, your insurance can often help cover these sessions.
Mental Health: Some policies also cover mental health services, including therapy and counselling.
Outpatient Treatment: Even if you don’t stay in the hospital, PMI can still help with costs when you visit a specialist or have outpatient procedures.
Dental and Optical Care: Some policies include benefits for routine dental and eye care, like check-ups and eyeglasses.
Remember, the coverage can vary depending on your specific insurance plan and what you’ve chosen to include. Speak to one of our advisers to help you understand your options.
Cancer Care
Most health insurance providers understand the importance of covering cancer, and they offer different ways to do it.
Here’s how it usually works: You can either have cancer coverage included in your main policy or add it on for a bit more money.
When it comes to what’s covered, it can vary from one insurance company to another. But in general, they take care of things like tests, doctor appointments, surgeries, and treatments like radiation and chemotherapy. They’ve got your back for in-patient costs and even the care you might need afterwards.
Some insurance companies go above and beyond by helping with pricier treatments or new medications. Plus, they might let you pick from a wider range of hospitals.
Before you decide which insurance company to go with, it’s a good idea to ask for all the details on what they cover. That way, you’ll know exactly what you’re getting and can make the best choice for your needs.
Who Can Have Cover
Individuals
Look after your health with your own policy
Joint
Private health insurance plans that are there to cover both you and your partner
Family
Ensure your loved ones are protected and get the chance to receive quick treatment
Business
Keep your employees happy and healthy with a private medical insurance plan
Still Have Questions?
How Much Does Private Health Insurance Cost?
The cost of private medical insurance can vary significantly from person to person due to a range of factors. Some of these factors are within your control, while others are not.
Age: Premiums typically increase with age because insurers associate higher age with a greater risk of making claims.
Medical History: People often assume that their medical history makes insurance unaffordable. While some insurers may adjust premiums based on your medical history, not all of them do.
Postcode: Certain insurers consider your postcode when determining your premium. They take into account which private hospitals are available in your area. However, not all insurers use this criterion.
Excess: You can lower your premium by opting for an excess, which is the amount you contribute toward your treatment costs.
Hospital List: When purchasing a policy, you’ll need to choose a hospital list. These lists vary among insurers. If you select a list that includes top London hospitals, it may increase your premium.
Additional Therapies: Adding extra coverage for therapies such as physiotherapy or mental health treatment can affect your premium.
Outpatient Cover: The level of outpatients cover you choose can have a significant impact on your premium.
As you can see, there is no ‘one size fits all’ when it comes to pricing. It’s important discuss all the options available to you with your adviser so they can help you understand the cost of your policy.
I have a pre-existing condition, will it be covered?
A pre-existing medical condition refers to any illness or health issue for which you have sought treatment or advice prior to initiating your private medical insurance policy.
It’s unlikley, though not entirely impossible, for the same condition to be covered by a private medical insurance policy when you first take out the cover.
Insurance providers typically exclude coverage for conditions that have received medical advice or treatment within the past five years. However, it’s a common practice for insurers to consider covering a condition after a two-year period if you have not saught advice or had treatment for during that time and have maintained an active policy.
With that said there are some conditions that can be covered if you are new to insurance, even if they are pre-existing. This depends on the medical underwriting you have chosen and the condition itself.
What is Medical Underwriting?
Medical underwriting is the behind-the-scenes process where the insurance company looks at your medical info to decide if they’ll cover you, and if so, how much you’ll pay and what they’ll cover.
The underwriting process also decides which health issues they’ll take care of and which ones they won’t. If you’re new to health insurance or thinking about switching providers, you’ll have different options for how you are underwritten. It’s all about finding the best fit for you!
New Applications
With moratorium medical underwriting, there’s no need to disclose your entire medical history upfront. Instead, it excludes coverage for any conditions you’ve experienced symptoms for, sought advice on, or received treatment for in the last five years. However, if you maintain a trouble-free period of two years after starting the policy, you’ll become eligible for coverage of those conditions. It’s important to note that the definition of “trouble-free” may differ among insurance providers.
Full Medical Underwriting typically involves the need for you to share your complete medical history with the insurer. In return, the insurer will provide a list of particular exclusions related to your disclosed pre-existing medical conditions. However, it’s important to note that the specifics of full medical underwriting can vary among insurers, and it may not always result in exclusions. If you prefer a health insurance policy with clear-cut terms right from the start, this is likely the most suitable choice for you.
If you’re a business and setting up a group scheme for the first time you can choose Previous History Disregarded underwriting. With this type of underwriting, previous medical records and existing health conditions do not result in any exclusions right from the start of a group policy. Every individual included in the policy will receive coverage for both pre-existing and newly emerging conditions until the policy’s expiration date. Generally, this type of underwriting is an option limited to corporate private health insurance plans, typically requiring a minimum group size of 15 employees.
Switching Providers
When considering a change in your current health insurer, you’ll usually have the opportunity to transition with a Continued Personal Medical Exclusion approach. This typically entails your new insurer maintaining your existing underwriting and continuing coverage for the same medical conditions. However, it’s essential to keep in mind that each insurer has its specific eligibility criteria. If you do not meet their switching requirements, they may introduce new exclusions to your policy.
For those who are transitioning from health insurance initially underwritten on moratorium terms, the option of Continued Moratorium underwriting is available. This choice enables you to maintain your current underwriting, potentially allowing you to retain coverage for the same medical conditions.
However, it’s crucial to determine whether the new provider will apply their own moratorium terms or uphold those established by your current insurer before making the switch. For instance, if you have fulfilled the “trouble-free” clause with your previous insurer, you’ll likely want to maintain these moratorium terms to ensure eligibility for coverage of your pre-existing condition.
Are there any other options?
When you decide to purchase a private health insurance policy, you have the flexibility to add various additional coverages, including dental and optical coverage, mental health support, and travel insurance.
You can also opt for appointments with physical therapists and consider a six-week option, which limits access to private medical treatment if it’s available through the NHS within six weeks of referral.
