Health Insurance covers you for treatment of acute medical conditions in private healthcare facilities
It provides you with faster access to healthcare treatment with no waiting lists, in hospitals with facilities such as private rooms and round-the-clock visiting hours.
Most Private Health Insurance covers inpatient treatment as standard; depending on how comprehensive your policy is, you may also have outpatient treatment covered.
Medical treatment is split into two key components:
Some people choose inpatient-only Health Insurance coverage because they’re looking for a cheaper policy.
The advantage is that inpatient-only Health Insurance is a low cost option however the downfall of this is that you’ll need to use the NHS for outpatient care, which could delay your treatment.
What’s generally referred to as ‘Comprehensive Medical Insurance‘ will tend to cover both inpatient and outpatient care in full. Given you’re far more likely to need outpatient treatment than a serious inpatient medical intervention the level of outpatient cover has a significant impact on the cost of your Medical Insurance.
Private Health Insurance policies are there to cover acute conditions rather than chronic ones.
Broadly speaking, the difference between chronic and acute conditions is that acute conditions can be cured with treatment, but chronic conditions remain with you forever.
Acute conditions include:
Chronic conditions include:
Acute conditions may lead to chronic conditions. For example, someone who has a heart attack might later go on to develop congestive heart failure due to damaged heart muscle. Heart failure is a chronic condition as it can’t be reversed.
The difference between chronic and acute conditions isn’t severity – it’s the likely outlook for that condition with treatment.
For example, although one is far more severe than the other, both a cold and a heart attack are acute conditions because, assuming you receive the necessary medical care, both can respond to treatment and then pass.
Head of Employee Benefits at Drewberry
In some cases, the boundaries are blurred between what’s considered a chronic condition and what’s an acute condition.
For example, although asthma is a chronic condition, an asthma attack is deemed an acute phase of the illness.
This is because with medical intervention/hospitalisation, such as inhalers, steroids, oxygen and nebuliser treatment, the asthma attack can be treatable and you can be returned to your previous state of health, although you’ll still have the underlying chronic condition.
In this instance, admittance to hospital to treat a severe asthma attack may be covered by Private Health Insurance, but it’s best to check with your provider or ask an expert.
If you develop symptoms of a chronic condition, Health Insurance will cover you to see specialists and consultants up to the point of diagnosis of your chronic health condition.
However, at that point insurance providers won’t pay for the ongoing care for that chronic illness.
So while you’ll be covered to see a private consultant to get diagnosed with arthritis, if you require ongoing medication and GP reviews as a result, this won’t be covered by PMI.
Depending on the provider, you may be able to get extra cover with a selection of policy ‘add-ons’. This could increase your entitlement to medical care under the policy.
Some Health Insurance policies cover psychiatric treatment as standard, but for most it will be an optional add-on to the policy.
It’s worth noting that how much treatment you’re entitled to under any psychiatric element of your policy will vary from provider to provider and on a case-by-case basis.
This is because some psychiatric conditions may be deemed long-term and chronic, which could mean they’re not covered along with other chronic conditions.
Even if conditions are deemed chronic, some insurers may still pay for initial treatment but only up to a set limit.
This limit might be a cost limit, a limit on the number of days a patient can spend as an inpatient, or the number of outpatient consultant appointments available.
Whether or not your Health Insurance covers dental care will depend on your provider and the terms and conditions of the policy.
Most policies cover emergency dentistry, which might kick in if you’ve had a tooth knocked out or severely damaged. Another common dental cover is oral surgery, such as wisdom teeth extraction.
However, routine dental – which would cover you for everyday dentistry such as checkups, filings and crowns – is often an optional added extra to PMI.
The same is true for optical care. While surgery to remove cataracts would be covered by most PMI policies, everyday eye care (checkups and glasses etc.) are not typically covered unless you choose an add-on.
The main four therapies covered by Medical Insurance providers are:
These will only be provided as standard by the best Health Insurance plans that offer a good level of outpatient cover.
Alternatively if it is not included by default some insurers will allow you to add therapies cover to your plan for an additional cost.
UK health insurance is not designed to provide all medical treatment. Some of the things PMI won’t cover include:
This represents some of the most common exclusions from PMI policies but isn’t an exhaustive list. What’s covered will vary by provider and the type of cover you buy.
There’s so much to consider when you’re buying PMI in terms of what will and won’t be covered.
That’s why, given the complexity that comes with setting up the most suitable Health Insurance policy, it can be invaluable to speak to an expert who knows the market.
We started Drewberry because we were tired of being treated like a number and not getting the service we all deserve when it comes to things as important as protecting our health and our finances. Below are just a few reasons why it makes sense to talk to us.
We are here to offer impartial and, most importantly, fee-free Health Insurance advice.
If you want to talk through your options to make sure you are looking at the most suitable cover then don’t hesitate to pop us a call on 02084327333.
Health & Wellbeing Expert at Drewberry
Great service assisting me obtain the right product. Would happily recommend Drewberry following their professional and efficient way of working.