Private Medical Insurance Scheme Information

Private Medical Insurance Scheme Information
Tuesday, December 04, 2018

Applescott Insurance has put together a generic view of what can be covered by Private Medical Insurance scheme.

A recent Poll confirms that the vast majority of NHS patients are against increased tax rises to further fund the Health Service. NHS patients are strongly opposed to paying more tax to improve the quality of health care. Many people would rather ban treatment for non-life-threatening conditions than pay more, Just one person in ten is willing to pay an extra £15 a month to boost hospital funding. Most would prefer a major overhaul of how the NHS is run, according to the Sun on Sunday poll.

With this in mind, new and existing purchasers of Private Medical Insurance need to understand what options are available, what will be covered, what is not covered and why getting specialist advice is crucial to their decision making. Applescott Insurance have put together a guide as to what typically constitutes a Private Medical Insurance Plan. We look at what can be expected in benefit terms, how to tailor the cover, and where to look to save on premiums.

In general terms, most Private Medical Insurance plans are modular, which essentially means that clients can add or remove benefits, increase or decrease financial benefit limits, add excesses and as near as possible tailor a plan to suit their own individual needs and budget. Most medical insurance schemes start with a Core cover which generally covers all in-patient hospital treatment, including a private room, surgeons fees, diagnostic fees, operating theatre fees, nursing fees and in-patient drugs and dressings-some Insurers include more than others under the “Core Cover” option.

PMI Premiums

Subscriptions can be paid in any of the following ways: Annual/ or monthly subscription by Direct Debit; Annual onlysubscription can usually be paid by credit card or by cheque or bank transfer. 5% payment Discount is sometimes offered depending on the Provider.

Six-week option

Some Insurance providers offer a “six-week “ option. This option works if the NHS can't give the required treatment within six weeks of when treatment should take place, then the Insurance will enable the client to be treated privately. If the cover includes an out-patient option, the client can immediately go privately for out-patient consultations, diagnostic tests that do not involve surgery, and CT, MRI or PET scans. This option significantly reduces the price from the more comprehensive immediate Private cover option.

The majority of Private Medical Insurance comes with a No Claims Discount

The discount builds every claim free year. If an Insurer pays a claim for anyone on the membership, the discount will be reduced for that person each year following claims.

Underwriting method

The plan may be established on one of the following bases: fully underwritten or full medical underwriting; continuing medical exclusions; medical history disregarded; or moratorium. These underwriting methods are complex and individual circumstances dictate which method is ultimately offered. At Applescott Insurance we feel very strongly that to get the best option for our clients we need to have a full medical history disclosure of each member of the scheme before we can advise on the correct underwriting approach.

Compulsory excess

Some insurance providers operate a compulsory excess of £100 per person per year-Not per claim!

Optional additional excess

Clients can reduce their premium by adding an optional excess and generally choose one of the following of £100, £250, £500, £1,000, £2,000 or £5,000 are available. In most cases excesses are paid per person per year. Excesses are a good way of managing the Premiums paid by the individual or company.

Authorising Claims

All Insurance providers need to pre- authorise claims, usually with a telephone call and confirmation of the illness/ailment from a GP.

Private/Video GP

Due to Increasing waits for NHS GP appointments a number of Private Medical Insurance Providers have added in-house GP consultations to their cover. These video consultations enable clients to get speedy referrals allowing quick access to consultations instead of waiting several days or even a number of weeks to see their NHS GP.

The YouGov poll for Cigna Europe found 16% of people in the UK are waiting 11 days or more to see a GP, with people in London and the South enduring the longest waiting times.

Half (52%) of people said they would be happy to use their smartphone for a GP video consultation about minor ailments, and 17 said they would be happy with this approach for all their appointments.

The survey also found 94% of users who had received a GP video consultation were happy with the experience and 91% felt the technology worked well.

Claims settled direct

Most Insurance providers will normally settle any bills directly with the specialist or the hospital where a client has had treatment. This resolves any issues a client might have paying large bills and then claiming the money back from the Insurer.

Which hospitals can be used with PMI?

All Insurance providers use Private Hospitals throughout the UK, many providers offer different bands of hospital choice which in turn will affect the final subscription depending on which band is chosen.

In-patient nursing and accommodation costs

These are generally paid in full provided the treatment and its location was pre-authorised by the Insurer.

In-patient radio/chemotherapy

Radiotherapy and chemotherapy are covered provided that the Insurance taken covers cancer treatment.

In-patient X-rays (radiology)

Paid in full provided the treatment and hospital is pre-authorised by the Insurer.

In-patient physiotherapy

Paid in full provided the treatment and hospital is pre-authorised.

Psychiatric cover

With all Insurance providers in-patient/day patient psychiatric cover is usually an optional add-on at inception.

In-patient psychiatric treatment

is available as an optional benefit.

Provision of cover for a parent accompanying a child

With most insurance providers the cost of one parent staying in hospital with a child under 16 is paid in full.

NHS cash benefit

£50 a night up to £2,000 a year, depending on the Insurance provider and their individual T&C’s.

Out-patient options

Every Private Medical Insurance provider has their own unique way of covering these benefits, some will cover specialist consultations and Diagnostic tests in full, others will cover Diagnostic tests as a separate add on benefit. This can be a very confusing area for many clients and at Applescott Insurance we explain exactly what is covered and what limitations apply.

Out-patient radiotherapy

Radiotherapy and chemotherapy are usually covered provided cancer cover has been included in the contract.

Out-patient X-rays (radiology)

Most insurance providers offer full cover at a scanning centre, or hospital listed as a scanning centre, in their own published Directory of Hospitals.

Out-patient physiotherapy

This is often an optional add on benefit for most providers.

Alternative treatments

This may be covered as an optional benefit depending on Insurance provider.

Alternative medicine: Osteopath & Chiropractor

With most providers this is an optional benefit.

Cancer cover

Most providers cover cancer treatment, however some have options to increase the cover on a more comprehensive basis -at Applescott Insurance we spend a great deal of time explaining these options.

Pre-existing conditions

Many people wish to take Private Medical Insurance after an Illness or injury has occurred to them, or to someone close to them. The primary concern will be whether pre-existing conditions will be covered either immediately, or at some point in the future. All Private Medical Insurance Providers will assess risk at time of a new person joining and each provider will have their own way of assessing that risk. Typically, there are two forms of underwriting for most new clients-either Full Underwriting or a Moratorium.

Full Medical Underwriting. This means that a client will be required to disclose details of their medical history and the underwriter may ask for a report from their doctor. Any pre-existing conditions will normally be excluded from cover. This process may take more time but provides the certainty of knowing what is covered from the start. Initial exclusions may be removed at renewal, however there is no guarantee.

A Moratorium means that a client will be covered immediately but underwriting will be completed at point of claim. This underwriting works by considering all medical conditions where a person may have had symptoms, advice, knowledge or treatment within the last 5 years. The client will then have a 2 Year period where no claim can be made on these pre-existing conditions. If the client has a reoccurrence of the condition within the first 2 years of being Insured, they will have to wait a further 2 years before a claim can be made.

Many Insured clients may wish to switch Insurance Provider due to cost, or bad service. Usually this switch can be made without further penalty or underwriting-often known as continued medical exclusions. This effectively means that any exclusion listed on the existing Providers Policy will most likely be transferred onto the new Policy.

Applescott Insurance is always on hand to guide clients through this complicated process ensuring that the best possible solution can be agreed.



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01491 613 780

Applescott Insurance
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Cress Cottage,
Brightwell Baldwin,
Oxon OX49 5NP

01491 613 780
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