Frequently Asked Questions
What is Private Medical Insurance?
Private Medical Insurance is designed to allow you to receive treatment privately, avoiding delays through the NHS in securing treatment for eligible medical conditions.
Private Medical Insurance (PMI) provides cover for acute, treatable medical conditions.
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Are there any conditions that are normally excluded?
Yes In general, most medical plans do not cover the following:
- Normal
pregnancy, drug abuse, infertility, GP fees, any medical prescriptions,
normal dentistry, alcohol abuse, self inflicted injuries, AIDS, chronic
long term illness such as diabetes or asthma, cosmetic surgery or
regular renal dialysis.
- Medical
conditions suffered prior to joining a new plan are known as
pre-existing conditions. All plans for individuals and their families
exclude pre-existing conditions either permanently, or for a given
period of time.
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How does the insurance company decide what to exclude?
When you complete the application form for membership you are generally
offered two alternative styles of what is called "Underwriting", in
other words the means by which the company reviews and accepts your
application.
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What is Moratorium Underwriting?
With moratorium underwriting, the insurance company will take on each
individual covered by the policy, but will exclude any medical
condition where medical advice, medication, or treatment has been
sought in a given period, usually five years before joining the plan.
Once
the individual has been free of all medication, treatments,
consultations and symptoms for that condition, or any related
condition, for a given period after joining the plan, usually 2 years,
they will automatically be covered for that condition.
There
are some pre-existing conditions, such as heart problems, cancer and
psychiatric conditions that will never be covered by the plan, as the
member will have regular checkups and/or medication.
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What is Full Underwriting?
With Full Underwriting, a medical declaration is given by each person
to be covered by the plan. This information is then put before an
underwriter, who will assess the risk factors for each person.
Normally, any previous serious medical conditions, and possibly
non-serious conditions, will be permanently excluded from cover. In
extreme cases, cover may be refused.
Usually
you are offered the choice of these two methods although some insurers
only offer Full Underwriting. Regardless of underwriting styles it is
important that all questions are answered in full as failure to
disclose information could invalidate the policy.
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Do all the insurance companies offer the same sort of benefits?
No, benefits do vary significantly from one insurer to the next.
Comparing policies is a little easier now because all companies have to
offer a benefits table laid out in the same format.
In general terms there are two types of scheme:
- BUDGET PLANS,
these cover inpatient and day case costs, but won't cover outpatient
consultations and tests. Some of them cover limited outpatient costs if
they relate in some way to inpatient procedures.
- COMPREHENSIVE PLANS,
these cover outpatient costs as well as inpatient costs, but check the
benefit table carefully, sometimes there are limits to the amount you
can claim in any one year.
Benefit tables for the plan or plans recommended will be enclosed with your documents.
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Which policy is recommended for me?
The policy or policies suggested will depend on a number of factors:
- Do you want a comprehensive plan or are you willing to pay for any outpatient costs yourself to reduce the monthly premiums.
- What is your age, some schemes are good value for younger age groups but get very expensive as you get older.
- Where do you live, some plans are good value in the provinces but more expensive the nearer you live to London.
- Do you have any specific requirements such as cover for complementary therapies?
- Are there any specific hospitals you want the insurer to include?
- Are
you happy to have a voluntary excess on the plan to reduce monthly
premiums, or even pay a proportion of the claim yourself to reduce
premiums still further?
Taking
into account the above, quotations and Key Features documents of
specific plans should be included with this document together with a
computer listing of alternatives in ascending order of premium. Your
pack should also enclose a listing of the benefits of all the
comparable policies.
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Do premiums increase in the future?
The answer in almost all cases is "Yes". All the others review their
premiums regularly in light of claims experience, increasing them at
your annual renewal with a percentage known as medical inflation,
medical inflation is currently averaging around 8%. In addition with
the exception of just three insurance companies your premium increases
as you get older. Some companies offer a premium for each individual
age, others have a premium for what is called an age band, e.g. between
30 and 34 or 35 to 39.
Medical
costs are increasing in all western economies, each year more and more
people claim on their insurance and the sophistication of treatments
and diagnostic tests is increasing the cost of claims.
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What do I do if I have a complaint?
A written complaints procedure is available from your IFA. This relates
to the quotation and administration of the IFA. If you have any
complaints about any specific insurance company, perhaps about the
claims process, you will need to complain to them directly. If you need
advice about this please ask.
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What happens after I've completed the application forms?
The
application form will be sent to the Insurer immediately. As soon as
possible thereafter, the insurer will produce policy documents and a
welcome pack and either send them directly to you or via your IFA. The
time this takes does vary considerably from one insurer to another. If
however you have not received these documents within two weeks please
let us know so that we can chase them.
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Can I change my mind when I read the policy documents?
Yes, the insurance companies will not draw any money from you for 14
days, if you decide not to proceed let us know within that period. As
long as you have not made a claim you can cancel the policy without
incurring any costs. If you change your mind within 14 days but paid
the first premium by cheque, the sum paid will be refunded.
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How do I pay my premiums?
The most popular means of payment is a monthly direct debit although
some people pay annually in advance by direct debit or cheque.
Some
insurance companies do ask for the first month's premium by cheque, if
so you will be asked to enclose a cheque with your application form.
The cheque must always be made payable to the insurance company, not
the IFA or the introducer. Never make payments in cash.
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Who looks after me in the future?
Your IFA will look after all the commercial aspects of your plan. He
will usually be the one that send out renewal notifications. If you
wish to add or remove anyone on the plan let us know, if in the future
you wish to change an excess level, again let us know.
It is extremely important that you let the Insurer know if any circumstances that affect your policy, change in the future.
For
confidentiality if you need to make a claim this will be done directly
with the insurance company. There will be a card in the welcome pack
with a freephone or local rate number for all claims enquiries.
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So how do I go about making a claim?
All claims start when your GP considers that a medical condition
requires further investigation or treatment. If you are told by your GP
that you need to be referred, telephone the claims line immediately,
they will ask basic details and will usually send you a claims form.
Your GP will fill in one section, you the other. Return it as quickly
as possible to the insurance company who will then authorise treatment.
If
necessary, the approval process can be speeded up by using the fax, but
if the treatment is of an urgent nature the approval process can take
place after the event. However for peace of mind always try to get the
claim pre-authorised.
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Do you give my name and address to other companies?
No, your IFA is registered under data protection legislation, your name
is not given to marketing companies or any other third party. Personal
files are kept in a locked alarmed environment. If at any time you
wished to see a copy of your file please let us know.
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