Private medical insurance (PMI) is an increasingly popular choice for a wide range of people who want more say in when and where they are treated for a variety of illnesses and injuries.
While the National Health Service remains an essential safety net for all, many of us are increasingly seeing the benefits of taking out private medical insurance. Such cover can supplement what is available on the NHS, giving peace of mind that we will be taken care of to a high standard without undue delay.
Taking out private medical insurance doesn’t mean making a choice between the NHS and the private system. With PMI, you’ll still have the same access to the NHS, but you won’t have to join a long waiting list to receive non-emergency treatment. Private treatment is available without insurance, but it can cost you more, especially if you need repeat appointments or long-term care.
You won’t have to join a long waiting list to receive non-emergency treatment
What private medical insurance provides is an increased number of options. You can use the NHS facilities that are available, but you can also shop around with greater access to specialist treatments and reduced waiting times.
The following guide answers some of the most commonly asked questions about PMI. It will help you decide if it’s right for you.
What is private medical insurance?
Private medical insurance is a health insurance policy that will pay for some or all of your medical bills if you decide to be treated privately. As with any insurance policy, the type of cover can vary between providers, and there are often add-ons that can be selected for an additional premium.
What does it cover?
PMI is designed to cover short-term, acute conditions. Ones where after treatment, the condition will be fixed and you will return to a similar state of health as before the treatment was needed.
Most policies cover the majority of in-patient treatments and day care surgery. Some also cover outpatient treatment, such as appointments with specialists and consultants.
What isn’t covered?
A standard private medical insurance policy generally won’t cover you for any illnesses or injuries resulting from a pre-existing condition. Failing to inform your providers about such a condition may invalidate the policy when it comes time to claim.
This means chronic conditions such as diabetes or epilepsy – conditions that aren’t curable but are managed with medication – are exempt. Regular childbirth, non-essential cosmetic surgery and organ transplantation are also exempt.
However, some pre-existing conditions can be covered after a set amount of time if you chose moratorium underwriting. One of the main advantages of purchasing PMI through an established healthcare specialist is that we can help tailor a policy that’s completely personal to your circumstances.
As an established healthcare specialist, we can help tailor a policy personal to your circumstances.
How much is a policy going to cost?
The cost of a policy depends on two main factors; your circumstances and the policy options and levels of cover that you choose.
‘Your circumstances’ refers to your age, where you live and how many people you want to policy to cover. It will also take into account things like your lifestyle choices, whether you smoke or not, for example. The policy options refers to the extent of cover you choose – the more additional benefits, the higher the premium.
Will I need to complete an extensive medical form?
The medical form you’ll need to fill in depends on the type of underwriting you chose.
You can chose full medical underwriting which will require details of any medical treatment or conditions you have. There’s also the option for moratorium underwriting. This allows the insurer to access your medical records when you claim, removing the need for you to fill in a long form.
Can I add my family?
Yes. Whether you have an individual PMI policy or are part of a group policy you can add your family. Note that adding family members will increase your premium. If you are adding family members to a group policy, employers usually deduct this through salary sacrifice.
You can add family members, whether you have an individual PMI policy or are part of a group scheme
Group medical insurance
Businesses often take out group medical insurance so that some or all employees are covered. This is considered an attractive benefit in any employment contract. As well as helping the company to attract the best employees, making sure they have access to the best healthcare can also increase productivity and reduce absence. Different levels of cover can be made available within the company, with the policy tailored to suit.
How does the policy work if I need to claim?
When you visit your GP, ask for an Open Referral letter – this will explain what treatment you need. Then you’ll need to contact your broker or insurer to find out if your insurer will agree to cover the treatment. You may also need to pay an excess, depending on what you agreed when you took out your policy.
Once your insurer agrees, you can either ask them to book an appointment with a specialist for you, or go ahead and book it yourself. Then you will receive the consultation and treatment. All the fees will be paid directly by the insurer to the consultant and hospital.
All fees will be paid directly by the insurer to the consultant and hospital.
Why health insurance is important
Having a private medical insurance policy means that everything you’re entitled to is clearly specified in the terms and conditions. There’s no doubt or uncertainty as to whether a particular course of action can be afforded.
As such, health insurance is about taking control of your life and assuming responsibility for your own well-being. It provides peace of mind not only for you but also for your family. If you fall seriously ill or are badly injured, your loved ones will worry about NHS treatment delays or limitations. PMI removes that worry. With private medical insurance, you know that you’re covered and the treatment you need will be paid for.