Does Having Two PMI Policies Affect Claims in the UK
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr often encounters questions about the finer points of private medical insurance in the UK. One common query is about holding two policies simultaneously. This guide provides a definitive answer on how it affects making a claim.
WeCovr explains what happens when two insurers both cover you
Having two private medical insurance (PMI) policies might seem like a way to get double the protection, but in the UK insurance market, it doesn't quite work like that. You can't claim the full cost from both insurers and make a profit from your medical treatment.
Instead, when two policies cover the same medical event, insurers apply a long-standing principle called 'contribution'. This means they will communicate with each other to decide how to share the cost of your claim.
While it prevents you from getting paid twice, holding two policies isn't necessarily a bad thing. It can sometimes lead to more comprehensive cover or higher benefit limits. In this article, we'll break down everything you need to know about navigating claims with dual private health cover, ensuring you're fully informed and can make the best decisions for your health and finances.
A Note on What PMI Covers
Before we dive in, it's crucial to understand the fundamental purpose of private medical insurance in the UK. Standard PMI policies are designed to cover acute conditions – illnesses or injuries that are short-term, curable, and arise after your policy has started.
PMI does not cover:
- Pre-existing conditions: Any medical issue you had before taking out the policy.
- Chronic conditions: Long-term illnesses that require ongoing management rather than a cure, such as diabetes, asthma, or high blood pressure.
Understanding this distinction is key to managing your expectations and using your policy correctly.
Why Would Someone Have Two PMI Policies?
It's more common than you might think for an individual to be covered by two separate private health cover plans. This situation usually arises from a few typical life scenarios rather than a deliberate choice to double-insure.
Here are the most frequent reasons:
1. You Have a Personal Policy and a Company Scheme This is perhaps the most common scenario. You might have a personal PMI policy that you've held for years, tailored to your specific needs. Then, you start a new job that offers private health cover as a valuable employee benefit. You might choose to keep your personal policy for continuity, especially if it covers conditions your new work policy doesn't, or if you're concerned about losing cover if you change jobs again.
2. You and Your Partner Both Have Workplace Policies Many company health schemes allow employees to add their partners or family members. It's possible for both you and your partner to have separate workplace policies and to be added as dependants on each other's plans. This can happen accidentally during benefits enrolment or intentionally to maximise potential cover.
3. Overlap When Changing Jobs When you switch employers, there can be an administrative overlap. Your old company's policy might run until the end of the month, while your new employer's cover begins on your first day. This creates a temporary period where you are covered by two different insurers.
4. Using a 'Top-Up' Strategy Some individuals might intentionally take out a second policy to supplement a basic one. For example, a basic company policy might have a high excess or limited outpatient cover. A supplementary personal policy could be used to cover that excess or provide more extensive benefits for consultations and diagnostics.
Example:
- Anya's Situation: Anya has a basic corporate PMI plan through her employer, which has a £500 excess and limited mental health support. She takes out a separate, low-cost personal policy specifically designed to provide comprehensive mental health cover and cover the excess on her main policy.
The Core Principle of Insurance: Indemnity
To understand how claims with two policies are handled, you must first grasp a fundamental concept of all insurance: indemnity.
The principle of indemnity states that an insurance policy should put you back in the same financial position you were in before the loss occurred. It is not designed for you to make a profit.
Let's apply this to private medical insurance:
- If your knee surgery costs £8,000, your insurance is there to cover that £8,000 cost.
- The goal is to ensure you don't have to pay that £8,000 out of your own pocket.
- You cannot, however, claim £8,000 from Insurer A and another £8,000 from Insurer B for the same surgery, thereby 'profiting' by £8,000.
This principle is legally embedded in UK insurance contracts to ensure fairness and keep the system viable. If insurers had to pay out double on every claim, premiums would become unaffordable for everyone. This is where the 'contribution clause' comes into play.
How Insurers Handle Claims with Dual Cover: The Contribution Clause
When you make a claim and your insurer discovers you have another policy covering the same event, they will invoke the contribution clause found in most UK PMI policy documents.
A contribution clause gives an insurer the right to contact another insurer that also covers the risk and agree to share the cost of the claim.
How Does Contribution Work in Practice?
There are two main ways insurers can share the cost:
- Pro-Rata Basis (Proportional Share): Each insurer pays a proportion of the claim based on the level of cover they provide. This is less common in PMI but used in other insurance types.
- Equal Shares: Each insurer simply pays 50% of the claim, up to their individual policy limits. This is the most common method in the private medical insurance UK market.
Let's look at a clear example.
Scenario: Mark Needs a Hip Replacement
- Total Cost of Procedure: £15,000
- Policy A (Workplace): Full inpatient cover up to £1,000,000.
- Policy B (Personal): Full inpatient cover up to £500,000.
Mark informs both insurers about his upcoming surgery. The insurers' claims departments liaise with each other.
| Action | Cost Allocation | Notes |
|---|---|---|
| Total Claim Cost | £15,000 | The full invoice from the private hospital. |
| Insurers Agree Contribution | 50/50 Split | Both policies offer sufficient cover, so they agree to share the cost equally. |
| Insurer A Pays | £7,500 | 50% of the total bill. |
| Insurer B Pays | £7,500 | 50% of the total bill. |
| Cost to Mark | £0 (excluding any excess) | The claim is settled in full directly with the hospital. |
From Mark's perspective, the process is seamless. He gets his treatment without facing a large bill. The "who pays what" is handled entirely behind the scenes by the insurers.
What if One Policy Has a Limit?
Contribution also works when benefit limits differ. Imagine the outpatient diagnostics for Mark's hip replacement cost £2,000.
- Policy A (Workplace): Has an outpatient limit of £1,000 per year.
- Policy B (Personal): Has an outpatient limit of £2,500 per year.
In this case, the insurers would likely handle it as follows:
- Insurer A would pay its maximum of £1,000.
- Insurer B would pay the remaining £1,000.
The outcome is the same for the policyholder: the full cost is covered. Having the second policy with a higher limit proved beneficial.
A Step-by-Step Guide to Claiming with Two Policies
If you find yourself needing to make a claim while covered by two PMI plans, don't worry. The process is straightforward if you follow these steps.
Step 1: Get Your GP Referral As with any PMI claim, the journey starts with your GP. You will need an open referral letter that diagnoses your symptoms and recommends specialist consultation for your acute condition.
Step 2: Notify BOTH Insurers Immediately This is the most important step. When you call to pre-authorise your treatment, you must inform each insurer that you are also covered by another policy. Be ready to provide the name of the other insurer and your policy number. Honesty and transparency are crucial; failing to disclose other insurance can be seen as non-disclosure and could jeopardise your claim.
Step 3: Let the Insurers Decide (or Choose the 'Lead' Insurer) You can either:
- Choose one policy to be the 'primary' insurer. This is often the one with the better benefits or lower excess.
- Inform both and let them sort it out. This is usually the easiest option. Their claims teams are experienced in handling contribution and will manage the process for you.
An expert PMI broker, like the team at WeCovr, can provide advice on which of your policies might be better to lead the claim, based on your specific cover levels and excesses.
Step 4: Insurers Liaise and Agree on Payment Once notified, the insurers will use the details you provided to contact each other. They will confirm the validity of the claim under both policies and agree on how to split the costs, as explained in the contribution section above.
Step 5: Proceed with Your Treatment Once you have a pre-authorisation number from at least one of the insurers, you can go ahead and book your consultation or treatment. The hospital or specialist will have the details they need to bill the insurers directly.
Step 6: Settling the Bill The medical provider will send the invoice to the lead insurer, who will then arrange payment from the other insurer for their share. You will typically only be responsible for paying any excess on your policy. If both policies have an excess, you will usually only have to pay one (typically the higher of the two).
Potential Benefits and Drawbacks of Having Two PMI Policies
While you can't get paid twice, holding dual cover can have its upsides and downsides. It's important to weigh them carefully.
Benefits
| Benefit | Description |
|---|---|
| Wider Scope of Cover | One policy might offer benefits the other doesn't, such as dental, optical, or more comprehensive mental health support. By having both, you get the 'best of both worlds'. |
| Higher Benefit Limits | If you have a condition requiring extensive or expensive treatment, the combined limits of two policies can provide a greater financial safety net. This is especially useful for outpatient therapies or advanced cancer treatments. |
| Continuity of Cover | Keeping a personal policy alongside a workplace one means you won't have a gap in cover if you leave your job. This protects your continuous underwriting terms, which is vital for covering conditions that have developed since you first took out your policy. |
| Covering Your Excess | A second policy could potentially be used to claim for the excess on your primary policy, although this depends on the specific terms and is not always possible. |
Drawbacks
| Drawback | Description |
|---|---|
| Paying for Redundant Cover | The most obvious drawback is the cost. You are paying two premiums every month, a significant portion of which may be for overlapping benefits. This can be financially inefficient. |
| Increased Administration | As seen in the claims process, having two policies adds an extra layer of communication. You need to keep both insurers updated, which can be a hassle during a stressful time. |
| False Sense of 'Double' Security | Some people mistakenly believe they will get a 'double payout'. The reality of the contribution principle can be disappointing if you were expecting to profit from a claim. |
| Complex Policy Management | Juggling two sets of renewal dates, policy documents, and benefit rules requires a good level of organisation. |
For most people, consolidating cover into one comprehensive policy is the most efficient and cost-effective approach. A PMI broker can help you compare the market to find a single plan that meets all your needs without the extra cost and admin of a second policy.
Is a 'Top-Up' Policy a Better Alternative?
Instead of holding two comprehensive policies, a more strategic approach can be to use a second policy to "top up" a primary one. This is a deliberate strategy to fill specific gaps in an existing plan, most commonly a corporate policy.
How a Top-Up Strategy Works:
Let's say your company's private health cover is a solid plan, but has a few weaknesses:
- A high compulsory excess of £1,000.
- A low outpatient limit of £500.
- No cover for alternative therapies like osteopathy or chiropractic treatment.
You could purchase a separate, lower-cost personal policy that is specifically designed to address these gaps. For example, a plan that offers:
- A cashback benefit for excesses paid on other policies.
- A higher outpatient limit or a 'therapy-only' module.
This is a more advanced strategy, and getting the structure right is key to avoiding paying for unnecessary overlap. This is where professional advice is invaluable. At WeCovr, our advisers can analyse your existing company scheme and find the most cost-effective top-up plan from the UK's leading insurers, ensuring you only pay for the extra cover you actually need.
The Role of an Expert PMI Broker like WeCovr
Navigating the complexities of one PMI policy can be challenging enough, let alone two. An independent and FCA-authorised PMI broker acts as your expert guide, simplifying the entire process at no extra cost to you.
Here’s how WeCovr can help:
- Policy Review and Consolidation: We can perform a full review of your existing policies (both personal and corporate). We'll identify overlaps and gaps, and advise you on whether it's more cost-effective to consolidate into a single, superior policy.
- Market Comparison: We use our expertise and technology to compare hundreds of policies from the UK's best PMI providers. We find the plan that offers the best value and the right level of cover for your unique circumstances and budget.
- Hassle-Free Switching: If you decide to consolidate, we handle all the paperwork to ensure a smooth transition with no loss of cover, protecting your underwriting terms wherever possible.
- Claims Assistance: While insurers handle contribution directly, we can be on hand to offer guidance and support throughout the claims process, ensuring you understand every step.
Our high customer satisfaction ratings are a testament to our commitment to providing clear, impartial, and helpful advice.
Managing Your Health Beyond Insurance
While private medical insurance is an excellent tool for accessing fast treatment when things go wrong, the ultimate goal is to stay healthy and minimise the need to claim. A proactive approach to your well-being can pay dividends in the long run.
Here are some wellness tips to complement your health cover:
- Balanced Diet: Focus on a diet rich in whole foods, fruits, vegetables, lean proteins, and healthy fats. Good nutrition is the foundation of good health and can help prevent a range of chronic diseases. As a WeCovr client, you get complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help you stay on track.
- Regular Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, swimming, or dancing. Regular exercise boosts your immune system, strengthens your heart, and improves mental health.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Sleep is when your body repairs itself. Poor sleep is linked to a host of health problems, from weakened immunity to an increased risk of heart disease.
- Stress Management: Chronic stress can have a significant physical impact. Incorporate stress-reducing activities into your routine, such as mindfulness, yoga, spending time in nature, or simply pursuing a hobby you love.
- Stay Connected: Strong social connections are vital for mental and emotional well-being. Make time for friends and family, as these relationships provide a crucial support system.
By investing in your health today, you reduce the likelihood of needing complex medical care tomorrow. Plus, customers who purchase PMI or Life Insurance through WeCovr often receive discounts on other types of cover, helping you protect all aspects of your life.
Do I need to declare my other policy when making a PMI claim?
If I have two policies, do I have to pay two excesses?
Can I choose which policy to claim on?
Is it better to have one good policy or two average ones?
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Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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