Frequently asked questions on private medical insurance

Private medical insurance, also referred to as health insurance, is designed to pay for the expenses of medical treatment in the private sector. Private medical insurance is specifically aimed at paying for the treatment of what is referred to as "acute" medical conditions. Acute medical conditions are illnesses, injuries or diseases that are likely to be able to be treated quickly and are seen as curable. This means that chronic conditions are not normally covered and people with these form of medical conditions will have to receive their treatment on the NHS.

It is important to note that private medical insurance is definitely a luxury, unlike other forms of insurance such as car insurance. This is because we are lucky enough to live in a country that has an extensive National Health Service that will cover most forms of treatment for free. There are three main things that normally cause people to take out private medical insurance plans.

More Choice

The first of these three reasons is the higher level of choice that private medical insurance can offer its policy holders. This choice can range from being a choice of your preferred hospital to a choice of your favoured doctor. This means that people with private medical insurance are more likely to be able to feel comfortable in their environment and medical personnel than those who are on the NHS.

Quicker Access to Treatment

The second reason that people often have for opting for private medical insurance is the speed with which it enables you to receive your treatment. This is because most private hospitals have much shorter waiting lists than NHS hospitals, if they have a waiting list at all. This means that you are sure to receive your treatment as quickly as possible and it therefore often means that the treatment can be more effective.

Higher Quality of Care

The third reason that so many people choose to take out private medical insurance, is the fact that the quality of your care can often be much higher in private facilities than in hospitals run by the National Health Service. This is not to say that you will receive poor medical care from the NHS but simply that the less stretched budgets of private companies allow for a higher standard of hospital. What's more is that you will probably receive a private room if you receive treatment privately, this is often seen as one of the biggest plus points of being treated privately.

Health insurance plans are typically designed to provide cover for the treatment of what are referred to as acute medical conditions. Acute medical conditions are normally defined as short term illnesses, curable diseases or injuries. This means that if you have what is known as a chronic condition, it is more than likely that it will not be covered by your health insurance plan. However it is still possible to take out health insurance plans if you have a chronic condition, the condition itself will simply be excluded from your plan. This means that if you suffer any other conditions that are deemed to be treatable and acute, you will still be covered for anything that is not linked to your pre-existing condition.

It is of the utmost importance that you check with your health insurance plan provider directly, before you decide to sign up to any form of agreement with them. This is because the illnesses covered by such plans are normally different from company to company.

Here are some general things that are normally covered by health insurance plans:

Tests and Surgery

Most health insurance policies will cover you for tests and surgery if you are a day patient or an inpatient. Day patients are individuals who have to go into hospital but do not require an overnight stay, inpatients on the other hand are individuals who require treatment and then stay in the hospital for at least one night.

Accommodation in Hospital

Another thing that most health insurance policies will cover you for is the cost of your stay in hospital, in other words any accommodation fees that you may incur. This will almost always include the cost of any nursing care that you require whilst in hospital.

Acute Stages of Chronic Conditions

Even though the vast majority of private medical insurers will not cover chronic conditions, lots of companies will still cover the acute stages of these conditions. What this means is that insurers will normally cover the costs associated with diagnosing a condition and will also cover the initial steps to try and cure it. If these attempts to cure the condition fail, the treatment will then become more focused on trying to maintain it as opposed to removing the condition entirely. Once treatments move to this stage, they will then no longer be covered by insurance. However, if any new treatment options are developed that offer a renewed chance of a cure, the insurance company is likely to fund these procedures until it becomes clear whether or not they will be successful.

Outpatient therapy, consultations and tests

Many insurance plans will not include these aspects as standard but there are some that will offer these as an optional add-on to your policy. This will cover things such as physiotherapy or other forms of outside treatment. This can be particularly helpful as these types of treatment are not normally found on the NHS. For this reason, opting to choose this additional cover might be a good idea if you are somebody who takes part in sporting activities or other forms of physical pastimes on a regular basis.

Health insurance plans come in many different shapes and sizes and they also come at a varying range of costs. This means that if you want the most extensive level of cover, you are going to have to pay a little bit more for the privilege. However, having said that, there are quite a few simple steps that you can take in order to reduce the costs of your premiums.

Increase Your Excess

One of the most straightforward ways in which you can cut the costs of your health insurance plan is by raising the level of excess that you pay for your policy. The amount of excess that you have on your plan essentially means that if you take out a claim on your health insurance policy, you will pay a predetermined amount before your insurance company starts to help out. This means that if you had an excess of £400 and you had a claim worth £500, you would be required to pay the first £400 and then your insurance company would pay the final £100.

Limit Hospital Choices

Another way in which you can lower the cost of your plan is by opting to limit your choice of hospitals. This means that you would reduce the amount of options that you can choose from in the event that you make a claim. By doing this you free up the insurance company's resources as it allows them to have more flexibility in terms of where they send you, they then pass these savings onto you in the form of lower monthly payments. However, if you are a Londoner, you could stand to lose out because insurance companies often ask you to upgrade in order to receive care from the biggest London hospitals.

Choose NHS When Possible

Health insurance, like most forms of insurance, will offer discounts for people who have claimed less on their plans than others. This means that if you opt for NHS treatment instead of claiming on your insurance for more minor treatments, you are likely to pay less for your insurance in the future. However, it is worth remembering that if you're not going to claim on your health insurance purely to keep the cost down, you're not actually going to get anything back from the amount that you are paying.

Self-Insure

One of the biggest things that people do not consider doing with regards to health insurance is self insuring. This is normally only recommended as an option for people who are fit and in good health, who do not smoke. Self-insurance means that you can cover yourself for private healthcare without having to spend all your money on an expensive health insurance plan. It essentially entails putting your money aside into a high interest savings account and keeping it there for when you need it. This means that you will be able to afford any small treatments or consultations if you so need them. The benefit of this option is that you don't lose out on the money you save if you don't need to claim.

Compare Policies

One thing that you should definitely do before you decide upon any single health insurance plan, is compare the different options available to you. Money Expert offers a free and impartial price comparison service that allows you to instantly compare a huge amount of different health insurance plans from a range of different private medical insurance providers. In just minutes you'll be able to see a wide range of policies listed by price and their level of cover. This price comparison tool allows you to make an informed decision about which health insurance company you choose, so you at least know what else is out there.

Private medical insurance may offer cover for dental treatments, but this largely depends on the specifics of your policy. Typically, basic private medical insurance plans cover emergency dental treatments or dental surgery necessary due to an accident. However, for more comprehensive dental care, including routine check-ups, cleanings, and orthodontics, you might need to opt for a policy that includes a dental cover option or take out a separate dental insurance policy. Always check the details of your insurance plan to understand the extent of dental coverage provided.

Whether you need private medical insurance depends on your personal circumstances and healthcare needs. The NHS provides comprehensive healthcare services to all UK residents, free at the point of use. However, private medical insurance can offer benefits such as shorter waiting times, access to private hospitals, and a wider choice of treatments and specialists. If you value these benefits and can afford the premiums, private medical insurance might be a worthwhile investment for you. Consider your health, family medical history, and financial situation when making this decision.

Private medical insurance typically does not cover cosmetic surgery that is performed for aesthetic reasons only. Most policies are designed to cover treatments that are medically necessary, meaning there must be a health-related reason for the procedure. However, if cosmetic surgery is required as part of reconstructive surgery – for example, after an accident or due to a congenital defect – some level of cover might be available under your policy. It's important to review your insurance documents or speak to your provider for specific details regarding cosmetic surgery coverage.

For individuals, private medical insurance premiums are not typically tax-deductible in the UK. However, if you are a business owner or self-employed, the rules may differ. Employers can generally claim tax relief on premiums paid for employees' medical insurance as a business expense, but it is considered a 'benefit in kind' for the employee, which may be subject to Income Tax and National Insurance contributions. For accurate and personalised advice, consulting with a tax professional or accountant is recommended to understand the tax implications of your private medical insurance.

It's advisable to review your health insurance at least once a year to ensure it still meets your needs, especially as you approach the renewal date of your policy. Additionally, you should reassess your coverage after any significant life changes, such as marriage, having a baby, or a major shift in your employment status. This regular review helps maintain alignment between your insurance provisions and your current healthcare requirements, financial situation, and family dynamics.

Yes, health insurance is available to people of all ages. However, the cover and premiums may vary depending on age. For children and teenagers, health insurance is often added to a family policy. For older adults, particularly those over the age of 65, premiums might be higher, and the policy terms could differ, reflecting the increased likelihood of needing more medical care.

The ability to use your health insurance abroad depends on the specifics of your policy. Some health insurance plans offer international cover or include travel insurance that provides for medical treatment overseas. However, this is not universally standard, and limitations may apply. It’s important to review your policy details or speak to your insurer to understand the extent of cover when travelling.

Even if you have health insurance, it is advisable to see your GP for initial consultations and referrals. Your GP can provide a primary diagnosis, ongoing care, and, if necessary, refer you to specialists covered under your private health insurance. Some health insurance policies might also require a referral from a GP to ensure that specialist treatments are covered. However, other policies may be able to offer treatment without you seeing a GP, so make sure you check your insurance terms before taking out a plan.

Health insurance premiums can be paid either monthly or yearly, depending on the options provided by your insurer and your personal preference. Paying monthly can make the cost of health insurance more manageable over time, whereas paying annually might offer overall cost savings if discounts are provided for paying the full year upfront.