What is private medical insurance for?
Private medical insurance is designed to cover the costs of private treatment for unexpected (acute) medical conditions. By paying a regular amount (premium) to an insurance company, you can avoid having to pay the potentially expensive, unexpected costs and you gain access to fast medical treatment from your choice of the UK’s private providers. Many insurers describe the types of conditions that they will pay for as those that are short-term and respond to treatment. They will not generally cover the costs of treating on-going conditions that you were aware of before you were insured.
What is not covered by private medical insurance?
Private medical insurers will usually not cover you for any conditions that were diagnosed, treated, or for which you sought medical advice before your insurance started. They will also usually not cover the costs of treating chronic, incurable conditions although they will sometimes cover acute flare-ups of chronic conditions. In addition there will be a list of exclusions on your policy – these commonly include GP services, prescriptions, and A&E admissions
Are there limits on what I can claim each year?
Depending on the policy you have, there may be limits on the total amount you can claim for certain types of treatments. This is common for such treatments as physiotherapy, chiropractics, osteopathy etc. Check your policy documents or contact your insurer to find out if you have limits to bear in mind.
Could my premiums go up if I make a claim?
Some policies do reward members who do not claim on their private medical insurance policies.
Even if you make no claims, however, the cost of your annual premium is likely to rise over time reflecting your age and the rising costs of providing medical care – new drugs and technologies in hospitals are often expensive.
What details of my health will I need to provide to have PMI?
When you apply for medical insurance our experienced consultants will advise on the most appropriate way to apply for a new insurance plan. In most instances you will not be required to complete a health declaration, but on occasion you may be required to fill out a simple health questionnaire disclosing pre-existing medical conditions. If you have any pre-existing conditions they will not normally be covered by your new policy for a set period of time – perhaps two or five years.
Can I get private medical insurance if I have a disability?
Yes. Your insurer may not cover treatments you require as a result of your disability since they involve a pre-existing condition.
Can I move to a new insurer?
Yes it is possible to change insurer. Speak to our experienced Healthcare Consultants and they will be able to advise you about the way switching will affect the terms and level of your cover.
How do I make a claim on my private medical insurance?
It is usually necessary to go to your GP and get a referral for private treatment in order to make a claim to your insurer. Often a claims form will need to be signed by your GP or the specialist you are referred to. If you do not have a claims form you should request one from your insurer. Once you have a referral from your GP simply contact your insurer to confirm that they will cover you – this is called claims authorisation. You can also clarify with them how they will pay for the claim and what to do next.
If I am insured, will I have to pay towards my hospital treatment?
Under most private medical insurance policies you will need to pay an excess charge on each claim, although this is completely optional, while the insurer will cover the costs of eligible treatment under that claim. Some policies also require you to meet a proportion of treatment costs up to a specified limit. Again this is completely optional. You will need to consult the claims department of the insurer Heritage Health has placed you with.
What is a co-payment?
A co-payment is when you share some of the costs of your treatment with your insurer. The amount you need to co-pay will depend upon your policy, the location and type of treatment you are having. When you contact your insurer for authorisation of a claim you can check if any co-payment will be required.
Is private medical insurance regulated?
Yes, the Financial Conduct Authority (FCA) regulates the sale of all types of insurance including medical insurance. If an insurer or insurance broker is a member of the General Insurance Standards Council (GISC) they will also be bound by the regulations of that body.
Where can I get advice on buying private medical insurance?
Heritage Health offers free impartial advice on the different products available and will be able to recommend an appropriate product to suit your requirements.
The Association of British Insurers (ABI) publishes a free guide to purchasing medical insurance, designed to help you understand more about how private medical insurance works.
Given that private medical insurance can be a difficult product to understand, we suggest that you discuss your concerns with one of our experienced consultants who will be able to advise based on your own situation.