Private Medical Insurance (PMI), is designed to cover the cost of private medical treatment. It allows you to avoid long waiting times for treatment on the NHS and ensures you get the most appropriate care as quickly as possible.
In exchange for monthly payments, your insurer will cover some if not all of the cost of private treatment (depending on your coverage).
Our expert guide will help you better understand the nuts and bolts of how Private Health Insurance works and how to get the best policy for your circumstances.
Private Health Insurance policies cover certain types of conditions and treatments. Most our modular with many insurers providing options to increase or decrease cover as you wish to tailor your policy to your specific needs.
Medical Insurance is designed to cover acute conditions only.
Acute conditions can be reversed through treatment and are not permanent.
For example, hip pain due to the need for a joint replacement would be considered an acute condition because it can be treated surgically.
Chronic conditions, which are long-term afflictions that can only be managed rather than treated, are not usually covered by Health Insurance policies. These include conditions like diabetes, asthma, or psoriasis.
However, acute symptoms of chronic conditions may be covered by your policy and insurers typically cover any medical attention necessary in the lead up to the diagnosis of a chronic condition. This will all be at your insurer’s discretion.
Typically, Health Insurance ‘core’ cover allows you to receive inpatient treatments only. These are treatments where you require a hospital bed, such as after surgery.
Outpatient cover can be added to your policy separately to increase the level of cover under your Health Insurance.
Outpatient cover typically involves all treatment where you don’t need a bed, such as diagnostic tests (x-rays, MRIs, blood tests, CT scans) or physiotherapy.
Premiums are the regular payments that you make to your insurer in order to maintain your policy. Usually these are paid on a set day each month.
The cost of a health insurance policy depends on a range of factors. For the most part, your personal situation will have the biggest effect on the cost of your premiums. When you apply for a policy, your insurer will ask you for the following information:
You’ll also have a range of policy options to choose from that will change the way in which your Health Insurance premiums work:
It is very likely that over time the cost of your private medical insurance premiums will change.
This is because at the end of every year, your policy is renewed and your premiums will be changed to fit your new circumstances as well as your insurer’s new circumstances.
Some of the main reasons why you may see your Health Insurance premiums increase are as follows:
The underwriting of your policy determines the conditions you will be covered for.
There are different types of underwriting that can make a significant difference the conditions you are covered for.
FMU is the most basic type of underwriting as well as usually the cheapest.
When you’re fully medically underwritten, you provide your medical information to the insurer before your policy has been put in place.
The insurer will use this information to look at your medical history and decide whether or not they’re willing to cover any pre-existing medical conditions.
Pre-existing conditions that insurers are not willing to cover will be added to your policy’s list of exclusions and you will not be able to claim for them.
This will typically apply for the entire term of your policy, but some insurers may be willing to negotiate having conditions taken off your exclusions if you have had the policy for a while and not claimed for them.
Moratorium Underwriting is more complex and usually more expensive compared to FMU.
Rather than giving your medical history at the start of your policy, insurers will look at it when you make a claim.
There are typically two types of Moratorium underwriting that will determine whether or not you will be able to claim for a condition when the time comes.
Rolling Moratorium involves all conditions that you have suffered from in the past 5 years being automatically excluded. But they will be taken off of your list of exclusions if you have served 2 years on your PMI policy without receiving any advice, medication or treatment for the condition.
Fixed Moratorium is the more lenient option but is no longer offered by many insurers. While all of your conditions in the last 5 years will still be excluded, your insurer will consider adding the condition after 2 years with the policy, regardless of whether you have received treatment for it.
One of the most confusing areas for people who don’t know how Private Health Insurance works is how people make a claim or what happens when they claim.
Exclusions are conditions that you are not able to claim for.
Most Medical Insurance providers have their own standard exclusions that they place on their policies which you will find in your policy terms and conditions. Common exclusions that you will find on UK PMI policies include the following:
In addition to these exclusions, your insurer may add any pre-existing conditions you may have suffered to your policy’s exclusions during the underwriting process.
Finding the Best Private Medical Insurance policy involves a lot of comparing and shopping around.
Below is the general process you need to undertake to ensure you get the best policy and premiums for your circumstances.
Buying Health Insurance is a process that shouldn’t be rushed and can often be confusing with all the options.
Rather than tackling the task alone, if you need some help just pop us a call on 02074425880 or email help@drewberry.co.uk.
Nadeem Farid
Head of Employee Benefits at Drewberry
Private Health Insurance can be a complicated policy to purchase because there are so many different options available.
If it is all getting a little confusing and you need some help then please don’t hesitate to turn to us for some Private Health Insurance advice.
We started Drewberry™ because we were tired of being treated like a number.
We all deserve a first class service when it comes to issues as important as protecting our health. Below are just a few reasons why it makes sense to talk to us.