What is private medical insurance?

20 July 2020

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Private health cover

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In most instances, private medical insurance (sometimes referred to as private health insurance or private healthcare cover) covers the cost of private medical treatment for acute conditions that develop after your policy has started (depending on the details of your plan). Treatment for chronic conditions usually isn’t covered by private medical insurance.

What does private medical insurance usually cover?

As mentioned above, private medical insurance typically covers the cost of private medical treatment of acute conditions that develop after your policy has begun. An acute condition is defined as a disease, injury or illness that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, injury or illness, or which leads to your full recovery.

Private medical insurance doesn’t typically cover the cost of treatment for chronic conditions. A chronic condition is a disease, illness or injury that has one of more of the following characteristics:

  • It needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests
  • It needs ongoing or long-term control or relief of symptoms
  • It requires your rehabilitation or for you to be specially trained to cope with it
  • It continues indefinitely
  • It has no known cure
  • It comes back or is likely to come back

The acute conditions that are covered by your plan will depend on a number of factors including your medical history, the underwriting option you select and the cover options that you choose. At AXA PPP healthcare, we offer a range of small business health insurance cover options for you to choose from so you can build a plan that works for you, your team and your budget.

How does private medical insurance differ from other health plans?

Private medical insurance is designed to cover the cost of private treatment for eligible health conditions. This differs from a number of other health plans that are available, including:

  • Critical illness cover: Critical illness cover differs from private medical insurance in that rather than covering the cost of private treatment, it pays out a lump sum if you’re diagnosed with a specified critical illness. 
  • Health cash plans: Health cash plans can be used to spread the cost of everyday, routine healthcare bills including dental check-ups and eye tests. 
  • Accident, sickness and unemployment cover/income protection: This provides a set monthly payment if you’re out of work due to accident, sickness or unemployment to help you cover the cost of bills and mortgage payments etc.

Small business guide to health insurance

If you’ve considered offering small business health insurance to your team, it’s likely that you have questions around how it works. You’ll want to make sure that you’re getting the cover that will best suit your business and your budget, so you can support the health and wellbeing of your team. That’s why we’ve created our small business guide to health insurance.

Our small business guide to health insurance covers a number of frequently asked questions, including:

  • How does private health insurance impact tax?
  • How might employees benefit from small business health insurance?
  • What underwriting options are available and what can’t I claim for?
  • How does the claims process work?

Read our small business guide to health insurance

Small business guide to health insurance

If you've considered offering small business health insurance to your team, it's likely that you have a lot of questions around how it works. That's why we've created our small business guide to health insurance. 


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Start taking care of yourself and your team today and get a quote for our small business health insurance.