Private Health Insurance
Find private health insurance that is tailored to you. No matter your question or query we are here to offer advice.
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What is Private Health Insurance?
Private medical insurance focuses on providing fast treatment for acute conditions.
Acute Conditions – Have a rapid onset but can typically be resolved within six months. Examples of acute conditions are a broken bone, heart attack or a stroke.
Chronic Conditions – Have a long-term impact and can rarely be cured. Examples of chronic conditions include Asthma, Diabetes and Parkinson disease.
People choose to put private health insurance in place for a number of reasons;
- Helps to avoid waiting times through the NHS.
- It can cover the cost of medical treatment or investigations you receive. This treatment will usually be undertaken at private healthcare facilities. It is worth noting private medical insurance doesn’t cover you for everything, its focus is to treat acute conditions not chronic ones.
- It gives you the freedom to choose consultants and hospitals that come highly recommend.
- In most cases it allows you to access private wards or private rooms allowing you to recover in peace.
- Removes concern over NHS budgets for specialist drugs and treatments.
Private health insurance is designed to work alongside the services the NHS offer, but has a major focus on providing fast treatment for acute medical conditions. You can still use all the services the NHS provide, but with increasingly stretched resources health insurance allows you to gain control over when and where you receive treatment. As a private patient you will normally have your own room to recover in, unrestricted visiting hours and even access to drugs and treatments that are not available on the NHS.
Private medical insurance allows you to pick your own specialist, giving you the freedom of choice rather than having to go with the allocated option. This is appealing for many people as it allows them to research and pick a highly rated specialist. Different providers work with different specialists, to check which provider would be best for you speak to an adviser.
- Core Cover: Your core cover is often referred to as Inpatient cover or Daypatient cover. Treatment that requires you to need a hospital bed or overnight stay in hospital is usually covered by a provider’s core cover. The options offered by medical insurance providers under core cover, are in large the same with all providers, some may have small differences such as the NHS cash benefit. Some people prefer to only take out a “core cover only plan”. This is where a client only wants cover for the treatment and is not worried about waiting for diagnostic tests or consultations pre-treatment or is prepared to self-fund that part of care. If you are looking for a “core cover” only plan please get in touch and we can quickly run through the options for you and advise on which provider would best suit your needs.
- Outpatient Cover: This covers you for the cost of diagnostic tests and consultations when a hospital bed is not required. The target wait on the
NHS for non-urgent diagnostic tests or treatment is up to 18 weeks. This is just a target, they do not hit this in every area of the country, with private medical insurance you should be seen a lot quicker than this.
- Private GP: Getting a GP appointment has become increasingly hard for many. Some health insurers are now offering access to a GP face to face within 24 hours. Additionally, some insurers use video GP appointments, so you don’t even need to take the time out of your day to have a consultation.
- Cancer Cover: You can choose to have extensive cancer cover added on to your policy, however, many providers choose to cover this in full as standard. Check before you buy a policy, which you have been given. Having Cancer cover gives you access to cutting-edge treatments, that are not always available on the NHS. Having some level of outpatient benefit can also be important when it comes to cancer care, as getting a quick firm diagnosis can be key. If you have concerns about cancer cover and want to ensure you have what you need at point of claim, please get in touch for advice.
When taking out a private medical insurance policy you can choose to add on a number of things, such as:
Dental & Optical Cover: This is generally either a cash-back add on, that offers some cover towards specific dental care and in most cases a limit for optical care. There is also sometimes the option to have dental covered in full, which is designed to cover most eventualities, the cost difference between the two is vast. For more information or questions about the dental add on, get in touch and speak with an adviser who can discuss your options in detail.
Mental Health Cover: This is currently a hot topic among most insurers, the waiting times under the NHS have risen sharply over the last few years as a result of funding cuts. Mental health has become something that the private insurers are trying to improve cover for. No-one wants to be in a position where they are at a low point, struggling with something and not being able to get access to someone to speak to. The cover offered by each provider varies, some providers choose to put a financial cap on mental health care. Some policies offer cover in full, but only for so many visits or days, others offer full cover with no time limits.
Additional Therapies: This is often overlooked by people taking out cover for the first time in our opinion. Some see it as a needless addon because they would in the event of a strain, or an ache just choose to self-fund a few visits to a therapist. Most people don’t realise that a few providers have made therapies a very easy benefit to use. Some offer over the phone triage care and a quick referral without the need to visit a GP. One provider in particular AXA PPP, has chosen to make therapies a “free claim”. This is because if more people visit therapists, it stands to reason that less people will need to have surgery later down the line.
Travel Cover: This is an addon offered by most but not all insurers. There are several benefits to having travel cover as part of your medical insurance rather than as a standalone policy;
1) Some travel plans when taken out alongside your medical insurance are on MHD (medical history disregarded) terms. Meaning even if you have exclusions on the medical insurance itself the travel policy will come with none. This can be hard to find on standalone plans once you have pre-existing conditions.
2) Travel cover can be difficult to find for people with pre-existing conditions once you are over 65. By adding it to your medical insurance provider before your sixty-fifth birthday you are covered, and this cannot be taken away provided you keep your policy in place and stay with the same insurer.
3) Cost – with most providers the cost is calculated as a percentage of the total annual premium you pay on the medical cover, this means that the price should stay inline with your UK cover.
Six-week Option: This is a cost saving option, it restricts access to treatment at the point of claim, should you be offered treatment under the NHS within 6 weeks of referral. This option works well for some people who want to keep the price down and who are happy using the NHS for treatment.
In our experience this is an option that many people have, but don’t necessarily know how it works and don’t find out until they come to claim against the plan.Some people who have had cover for a long time add the six-week option as a way of bringing down the premium, without first seeking advice on how it would work for them. If you have this add-on and want to discuss your options in more detail and make sure it is right for you, please get in touch and we are happy to offer some advice. VitalityHealth for example do not offer the 6-week option and are currently running a switch and save offer. It allows clients to remove the 6-week option from their existing cover without getting a large hike in premium. We feel that the 6 week option is such an important topic we have a whole page dedicated to how it can effect clients –
If you are new to private medical insurance, you will be given two options with regards to underwriting. Your medical underwriting will determine what your insurer will and won’t cover you for. It is especially important to get this right as a first-time buyer, which is why we urge people to contact us for free advice.
Full Medical Underwriting
This generally requires completing a form either over the phone or via post outlining any pre-existing conditions. These will then be assessed by the insurer and potentially excluded from the policy. If you are thinking you would prefer black and white terms, speak to an adviser to declare your medical history and they will be able to help decide which insurer would offer the most favourable terms for you.
With this underwriting a pre-existing condition will be covered after a moratorium period (usually 2 years) if you have gone 2 years “trouble free”*. *Trouble free is defined differently by each provider, for advice on which provider has the best terms on offer for your medical history and ongoing needs please get in touch.
Not seeking advice: When purchasing medical insurance for the first time it may seem like an obvious choice to go through the insurers directly. However, you may be unaware that most direct sales teams are non-advised. Meaning they can only present you with information not advise you on what is the best decision for you. This can result in clients taking out cover with one provider when they could have achieved much better terms elsewhere, or just not understanding the options available to them.
Too Focused on Price than Cover: At Healthcare Clarity we understand that price and affordability is important. However, we would rather tell a client that they cannot afford the cover they need than set them up with a policy that does not cover their concerns. By focusing on price rather than the level of cover, you may not realise how your choices effect your cover.
Choosing the wrong outpatient levels for your needs: If speed of diagnosis, access to consultants for consultations scans and tests, is important to you then you will need to add some level of outpatient cover to your policy. Sometimes clients can be asked what their budget is before discussing cover and they are sold full cover as it is within budget although they may only require a limited outpatient option.
Choosing the wrong underwriting: As mentioned, when taking out private medical insurance for the first time you have two underwriting choices. By not seeking advice on this you risk having an exclusion put on your policy that could be avoided. One of the main types of conditions that can be overlooked when taking out cover are conditions that require long term medication like Hypertension(High blood pressure) or Raised Cholesterol. These types of conditions are considered in large to be minor and treatable by your GP. For insurance purposes these can easily be wrongly underwritten. By going with the wrong provider this could result in exclusions for the whole heart and cardio vascular system. Many people do not realise that this is the case until point of claim, which unfortunately can be many years later. If you have a medicated but controlled condition and you are thinking of putting a policy in place, check first with your adviser. There are a number of providers that will cover these sorts of pre-existing conditions if the right underwriting method is used, and the conditions declared pre-sale.
Seeking cover for a single pre-existing condition: Some people never consider taking out medical insurance, until a condition arises. Unfortunately, if you have sought advice or treatment for the condition, you will in many cases not be able to get it covered under your medical insurance immediately. At this point you may decide you don’t want medical insurance if the condition in question isn’t covered. Dismissing medical cover altogether can be an unwise decision, as if you have additional conditions arise in the future these will also not be covered. There are however some notable exceptions to this rule;
1) Hypertension(High blood pressure) cover can be included with most providers provided under control and correct underwriting applied.
2) Raised Cholesterol – cover can be included if under control with most providers on FMU(full medical underwriting) terms.
3) Underactive Thyroid – cover can be included if under control with some providers on FMU(full medical underwriting) terms.
4) Diabetes – one provider offers cover for those with diabetes on new underwriting terms, that is General and Medical for more information on this option please visit our General and Medical page or give us a call.
Not checking hospital & specialist access: It is important to mention when taking out your policy if you have a particular hospital or specialist preference, as hospital lists vary between providers and between policies.
Not fully understanding the claims process: Make sure when you take out a plan that you have asked your adviser about your insurers claims process. This is to make sure that you fully understand what is expected of you at point of claim and to ensure that you do not have unrealistic expectations. As a general rule the insurer will require the following to asses a claim;
1) Access to a GP report about the condition.
2) A referral letter from your GP.
3) To have had a conversation with the member where possible to understand the nature of the claim.
There are many factors that determine the price of your private medical insurance. Some factors like age and postcode you will have little or no control over. There are however options you can choose that will impact on your health insurance premium, for example the amount of excess you choose.
To find out more about factors impacting on cost of health insurance and for a rough indication – Read our guide >> How much does health insurance cost?
* Findings are based on 49 clients, over the last 3 months who already had a live health insurance policy in place.