Health Insurance Guide

When should I start a private health insurance policy?
What information regarding my medical history do I have to disclose?
What do I get for my money?
What types of health insurance are there and which one is the best?
Available types of private health insurance policies or plans
Pre-Existing Conditions and exclusions
Duty of Disclosure
How to make a claim

With the NHS becoming more and more overstretched, the average waiting time for NHS outpatients is almost seven weeks. This is one of the reasons that a lot of people are now turning to private health treatment and are taking out private health insurance policies that will cover the cost of private medical treatment in the case of curable or short-term medical conditions, and also guarantee prompt treatment for any such medical conditions when required.
Some people think that it is worth the cost of medical health insurance, just for the fact that it gives them peace of mind knowing that they will receive quick treatment if they are ever unlucky enough to fall foul of an illness or injury.

It is very important not to regard private health insurance as an alternative to the NHS, as most private hospitals do not have the specialist equipment needed for casualty situations. However, what private heath insurance does offer is treatment at a time and place to suit you, along with a host of healthcare options all aimed at benefiting you.

Private health insurance also provides a quick answer or diagnosis as to what may be wrong with you, and if something was found to be amiss, and surgery was required, your name would go straight onto a waiting list.

When should I start a health insurance policy? Top

Although I am a firm believer in the saying ‘you are only as old as you feel’, the professionals within the private health insurance world have a different viewpoint. Most of them (if not all of them) believe that the older you are, the more likely it is that you will require medical treatment, and therefore the cost of private health insurance premiums increase according to age.

In fact, some private health insurance policy providers do not accept new customers who are over a certain age.
Some private health insurance polices are provided by employers as part of a package of benefits associated with the job, other people take private health insurance at significant times in their lives, such as when they get married, start work, of after the birth of their first child, as it is also possible to include the family as part of a private health insurance package.
Another significant time to take out a private health insurance policy is if you are planning to work overseas or travel round the world for a period of time. The last thing you want is to fall ill in some far off land, with no idea of how to apply for treatment.

What information do I have to disclose? Top

The information that you have to disclose regarding your medical history varies depending what your private health insurance policy covers you for. In general, most private health insurers insist that you complete forms showing past and current illnesses and medical conditions. Some may also ask for your permission to contact your GP to confirm the details you have submitted on the proposal form. Now, as with the filling in of all insurance application forms, honesty is the best policy and you must inform the private health insurer of any ailment that you suffer or have suffered from, failure to do this may make any future claim you apply for invalid, (and you certainly don’t want that to happen).

What do I get for my money? Top

This is where good research and due diligence comes into their own, always look for the private health insurer that meets your requirements with your set budget. It is no good having a cheap policy that does not cover you against some of your requirements, it is far better to spend a little more money on premiums for a private health insurance policy that gives you what you need, both in the way of private health cover and peace of mind. Put your strongest reading glasses on and scrutinize the small, smaller and smallest print making sure that you understand exactly what you are covered and not covered for, and what hospitals are available to you for treatment.

Other questions you may wish to find the answer to, are things such as, are there any ways to reduce the monthly premium? Could you pay an excess fee, or take out less comprehensive cover? It should be noted that private health insurance premiums will increase with medical inflation every year.

What types of health insurance are there? Top

There are many different types of health insurance offered by a lot of health insurance policy providers, all claiming that their product is the one for you. As we are all individuals in this world and each one of us has different needs, wants, aspirations etc, so it is with private medical health insurance. There is no one perfect private health insurance plan to suit us all, so your particular circumstances and needs will dictate as to what type of private health insurance plan suits you best.

Available types of private health insurance Top

Private Medical Insurance (PMI)
Private Medical Insurance provides a fund for your consultations, your tests and, if needed, operations. Additional benefits include a private room and no waiting list; you are straight in, no queuing. You can also choose where and when you want to be treated.

Private Medical insurance is available for individuals, couples, and single parents or families. It is worth remembering that the premiums will increase annually with medical inflation and will also increase with age.
There are usually three levels of private medical insurance offered by policy providers: budget, standard and comprehensive.

Budget plans are exactly what their name suggests, they are plans that offer a limited range of hospitals where treatment can be carried out, as well as limiting payouts to a set level. They also exclude certain types of treatment such as physiotherapy.

Standard plans provide a wider range of cover than budget plans, and offer cover for some outpatient treatment, a few complementary medicines and limited ambulance services. Standard plans will also exclude the top hospitals from where you can receive treatment.

Comprehensive (Rolls Royce of plans) offers the full range of private medical health care including; home care, ambulance services, complementary medicines, and full treatment costs.
In most cases a wide range of hospitals are offered as to where you can receive treatment and some comprehensive plans even include treatment by an optician and dentist as well as international cover.
As with all insurance policies it pays to check just exactly what is and what is not covered by the private medical insurance plan.

Cash Plans
Cash Plans are usually cheaper than private medical insurance (PMI) plans, they provide a lump sum for the policy holder, and in some cases, the policyholder’s family’s medical expenses.
Cash plans work on the basis that the policyholder pays a monthly sum to the policy provider. The policy provider holds or invests this capital into a central pot or trust fund. If the policyholder has to spend any time in hospital, the cash plan will provide a lump sum that the policyholder can choose how to spend.
Depending on the type of cash plan, treatment covered may include dental care, optical care, NHS prescriptions, and complementary medicines.

The six-week Cash Plan
This type of cash plan will only pay out if an NHS waiting list exceeds six weeks. There are a number of different variations of the six-week cash plan on offer and most of them are very competitively priced. Always check out what is and what is not covered by the plan.
Critical Illness Plan
With critical illness insurance cover, if the policyholder is suddenly struck down with a severe illness, the critical illness plan will pay out a tax free lump sum that can be used by the policyholder to pay for a variety of things, including repaying debts or leisure activities.
The Health Trust Fund
This type of health insurance plan is fairly new to the marketplace and is designed to replace the traditional health insurance scheme. The plan takes advantage of the UK trust fund laws that permit low cost cover, comprehensive access to medical facilities, no excess payments, no automatic premium increases and no age loading.
Be aware that the Financial Services Authority (FSA) does not regulate heath trust funds at the moment.
Income Protection
If you are self employed, an income protection plan may well be particularly relevant to you. If you become incapacitated and cannot work, an income protection plan will pay up to 65% of your gross income if you are unable to go to work because of illness or suffer an accident.
The cost of the premiums for income protection is calculated by what type of work you are involved in and how soon you require payment. When you return to work, all payment from the income protection policy stops.

Expat Insurance
As the name implies, expat medical health insurance provides medical cover for those people who are working or living abroad for an extended period of time. Premiums are usually paid annually in advance, and in most cases cover includes repatriation and emergency evacuation.

Travel Insurance
For people going away on short or extended trips, it is important to have medical insurance cover in case you have the misfortune to suffer a medical emergency.

Pre-Existing Conditions and exclusions     Top

Exclusions are the types of medical conditions that the providers of health insurance refuse to cover. These include chronic, recurrent or long term illnesses or diseases, pregnancy, infertility or sterility, cosmetic surgery and treatment in other countries.

Asthma and multiple sclerosis and other such illnesses are in general also nor covered.

Pre existing conditions refer to those medical conditions that have been diagnosed and/or treated before signing up for a new private medical health insurance plan. Usually the health insurance policy provider will exclude cover for any condition (or further complication related to the condition) that has existed in the last five years. Many health insurance policy providers make the conditions you have suffered from in the past eligible for cover, if it can be shown that you are completely recovered and clear from the condition after your health insurance policy starts. Recurrent illnesses and diseases that are incurable are in most cases always excluded.

Heath insurance policies will not provide cover for the treatment of alcoholism, drug abuse or HIV/AIDS.

Duty of Disclosure Top

Before you sign on the dotted line, you must disclose to your health insurance company/plan provider any fact or circumstance which is known to you (or ought to be known to you ), which may affect the terms of your policy. It is especially important to disclose any pre existing medical conditions and include them on the application document. If you don’t, this could result in any future claim being denied of even the cancellation or invalidation of the policy.

How to make a claim Top

Make sure you fully understand the claim process that your health insurer favours,
This usually means proving your medical problem or condition, getting a quotation for the treatment in advance. Make sure your medical health insurer is willing to pay the cost of the treatment as quoted, and then proceed.

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