What does private health insurance cover?
Private health insurance (also known as private medical insurance) is not designed to replace all the services offered by the NHS. Some, such as treatment resulting from accidents and emergencies, are beyond the scope of most private hospitals. Most private schemes offer cover for in-patient and day-patient treatment, but not always out-patient treatment.
What doesn't it cover?
In general, the following treatments are not covered under most private medical insurance plans:
- treatment for alcohol and drug abuse
- dental treatment
- GP services
- HIV/AIDS related illnesses
- infertility treatment
- normal pregnancy
- sterilisation
- cosmetic surgery (to solely enhance appearance)
- routine tests
- recurrent, continuing or long-term treatment (see chronic conditions).
Will my premiums go up over time?
Your premiums may rise each year because of medical inflation and because as you get older, you are more likely to need and receive medical treatment.
Will I be covered for existing health problems?
Insurance is there for the unknown. Any existing health condition will usually be excluded. Some existing conditions may become insurable after a waiting period set by the insurer, provided the condition does not reoccur during this period, and you must not receive treatment for this condition during this period either. You will need to state on the application form any current illnesses or chronic ailments such as asthma or eczema.
What factors affect how much I pay?
Your choice of cover and the options you choose will affect the cost of private medical insurance. You can reduce your premiums by:
- Paying an excess.
- Taking out a plan that offers you a no claims discount (although if you make a claim your discount will reduce).
- Receiving treatment under the NHS when it is available within six weeks of the date it should take place.
- Paying annually instead of monthly.
Will private cover include emergency treatment?
In some cases you may still be able to receive private treatment for an emergency after the initial stabilisation, if the NHS hospital has a private wing or a private hospital has the suitable facilities and the treating specialist agrees to this.
Will I need to take a medical?
No. There are two main methods that insurers use to accept your application for cover:
- A medical history declaration - when you are asked to fill in a form giving details of your medical history. If necessary, the insurer may write to your doctor for more information.
- A moratorium - when you are asked to fill in a form, but are not asked for details of your medical history. Instead, the insurer does not cover any medical condition which existed in the last two years (this time period can vary).
How do I make a claim?
Before receiving any treatment privately, you should call our team of Personal Advisers to check that you are covered for that particular treatment. If so, we will normally send you a claim form which your GP and specialist will probably need to fill in and sign.
What if I buy a policy but then change my mind?
Most private medical insurance policies give you a cooling off period of 14 days from when you receive the information detailing the terms of your cover. If you decide not to go ahead within this period, you will get a full refund providing you haven't made a claim.
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