The National Health Service (NHS) provides treatment for UK residents, offering various services, some free and others requiring payment. While the NHS caters to most healthcare needs, some individuals opt for private medical insurance (PMI) to access additional benefits and services. This guide aims to assist individuals in understanding the key considerations before purchasing PMI.
Private Medical Insurance (PMI) or Private Health Insurance serves to cover expenses related to private medical care and treatment for short-term, curable conditions. The purpose is to avoid paying for treatment out-of-pocket and to have access to expedited care when needed.
It is crucial that the PMI cover you buy ensures the following when you need treatment:
Before purchasing PMI, it's essential to ask your adviser and yourself pertinent questions to make an informed decision. Here are some crucial inquiries to consider:
What Benefits Are Included?
Understand the coverage provided, including consultation fees, in-patient care, imaging, laboratory tests, second opinions, and more.
What Are the Different Types of Health Insurance?
Learn about the types of cover available, such as moratorium underwriting, full medical underwriting, and switch underwriting.
Does the Policy Have Any Exclusions?
Understand what conditions or treatments are not covered by the policy, including chronic conditions and emergency care.
What Will the PMI Cover/Not Cover?
Clarify what types of conditions and treatments the policy includes, such as acute conditions, elective surgery, and chronic conditions.
Does the Insurance Policy Cover Care in Any Hospital, and if You Are Abroad?
Determine if the policy covers treatment in all private medical facilities in the UK and abroad, considering travel implications.
What Are the Plan’s Restrictions on Cover for Pre-existing Conditions?
Understand if pre-existing conditions are covered and any waiting periods or exclusions associated with them.
Does the Plan Exclude Specific Conditions or Illnesses?
Inquire about specific conditions or illnesses excluded from coverage.
Will I Have the Freedom to Choose the Doctor I Wish to See?
Ensure flexibility in choosing consultants and hospitals, without unnecessary restrictions.
Regulation, Revalidation, and Practising Privileges
Understand how doctors' practices are regulated and if your preferred consultants are recognized by the insurer.
Where Can I Find More Information About Doctors or Hospitals?
Explore resources like the Private Health Information Network (PHIN) for additional information.
Will I Be Given the Choice to Top Up Payments from My Insurance Policy?
Understand the flexibility to top up payments for preferred treatments or consultants.
How Is the Policy Premium Determined?
Consider factors like age, medical history, lifestyle, and postcode that influence premium rates.
What is the Maximum Number of Claims You Can Make in a Year?
Inquire about claim limits and any cost limits for consultations and investigations.
How Much Will I Have to Pay for the Insurance Cover?
Understand the premium costs and if any discounts are available for family members insured together.
How Does the Insurance Company Handle Disputes Over Claims?
Learn about the company's procedures for appealing denied claims and the average turnaround time for resolving disputes.
What Are PMI Managed Care Initiatives or Clinical Care Pathways?
Understand the impact of managed care initiatives on treatment decisions and patient choice.
Can I Make a Claim Within the First Few Weeks of Taking Out My Policy?
Clarify any waiting periods or limitations on making claims after policy initiation.
What is the Key Thing to Consider if I Am Switching PMI Provider?
Ensure continuity of coverage and understand any implications for pre-existing conditions when switching providers.
Is There an Alternative to PMI Providers?
Explore self-funding options and understand the potential cost savings compared to PMI.
How Do I Complain About My PMI Provider?
Know the process for lodging complaints and escalating issues, including involvement of regulatory bodies like the Financial Ombudsman Service.
No Claims Discount (NCD)
Understand how claims impact premium rates and if NCD schemes are available.
Other Questions You Might Want to Consider
Inquire about policy limits, waiting periods, payment options, premium caps, and the scope for reducing premiums.