What is private medical insurance?
Private medical insurance (PMI) is a great way to cover the costs of private health care in order to bypass lengthy NHS waiting lists. PMI is designed to cover the costs of receiving private medical consultancy and treatment for curable, short-term illnesses or injuries (known as acute conditions – see below for more details) that occur after a policy begins.
Reasons to buy private medical insurance
- Bypass lengthy NHS waiting lists and quickly receive medical attention for conditions covered by a policy
- To cover the cost of medical bills – all you pay are the premiums
- Private medical care can speed up the recovery process
- Improved hospital experience: a private room instead of a crowded ward, and personal care from a consultant.
- The possibility to choose when and where you are treated in a network of private hospitals
What is covered by PMI?
Acute Conditions
In general, acute conditions refers to curable, short-term illnesses or injuries that are expected to respond quickly to treatment so that the patient can return to health.
Choosing the right cover
When selecting PMI cover, you need to think about two main things: the benefits that are most important to you, and cost. In general, a cheaper PMI policy will offer limited cover, whilst a more expensive policy will be more comprehensive in coverage. Here are the three levels of cover available through Confused.com.
A Basic plan provides in-patient care and usually excludes outpatient cover. In general, diagnostic tests and therapies, consultant's fees, and outpatient care are not covered, unless this results in a later in-patient stay. This option is suitable for customers on a budget and people who are able to cover the costs of things like outpatient consultations.
The mid-range option normally provides full inpatient cover and increased outpatient treatments, such as consultations and diagnostic procedures (subject to an annual cost limit). Complementary medicines and therapies may also be covered.
Comprehensive plans cover in-patient treatment and outpatient specialist consultations, diagnostic tests and scans (usually without cost limit). However, limits may be applied for cancer drugs. Physiotherapy and complementary therapies are usually covered too. As you’d expect, comprehensive PMI is the most expensive option.
What is not covered by PMI?
You will not be covered for certain illnesses and pre-existing or present conditions. Also, problems requiring accident and emergency admission will probably have to go through the NHS.
As PMI is primarily intended to cover treatment for curable, short-term illness or injury, some conditions won’t be covered. These exclusions tend to be chronic problems that require ongoing treatment, and will need to be treated by the NHS.
Typical exclusions include: AIDS/HIV; cosmetic treatment; deliberate self-inflicted injuries; dental care; dialyses; drug abuse; experimental drugs; infertility; injuries from dangerous hobbies; mobility aids; normal pregnancy; organ transplants; outpatient drugs and dressing; pre-existing conditions; sex change; visits to a GP or A&E; war risks.
Disability
You can get PMI if you have a disability, though cover for treatment relating to the disability may not be included in the policy (the insurer has a duty to be reasonable and fair with regards to this). Ask the insurer or check the policy small print to find out more.
What personal health details will I need to disclose?
This depends on the type of underwriting assessment. The insurer should make this clear to you before you buy the cover.
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Full medical underwriting (medical history declaration)
This is when you are asked for your medical history details, and your doctor may be contacted for more information. You must answer questions fully and accurately or risk a possible claim denial in the future, or even policy cancellation. If you disclose a medical condition that may come back, you could still obtain cover, but treatment relating to that condition might not be covered.
This is when you are not asked for medical history details, but you will not be covered for any pre-existing medical conditions (or conditions you have asked advice on or shown symptoms of) that you have had over the past few years. However, pre-existing conditions may become covered if they do not reoccur (including symptoms) after two continuous years from the policy start date. However, some conditions (e.g. chronic conditions) will likely never be covered as treatment is ongoing.
Changing to a new insurer
If you become unsatisfied with your current private medical insurance or you’ve spotted a better deal elsewhere, you are free to cancel the policy and switch to a new provider. However, as PMI is usually bought in yearly contracts, there may be a charge for switching early. Therefore, you may want to consider waiting until your policy renewal date comes around before taking out a new policy.
For further peace of mind
- Before buying a policy, check that the insurance company is FSA (Financial Services Authority) regulated
- Confidentiality - all insurers must treat sensitive and personal information, particularly medical details, with confidentiality.
- You will have 14 days from the receipt of your policy documents in which to decide whether the product is suitable for you. You are entitled to a full refund if you cancel within the stated period.
