Health Insurance Guide
Last Updated on Wednesday, 10 March 2010 16:57
What is and is not covered?
Remember, private medical insurance is designed to cover treatment for curable, short-term illness or injury. These are called 'acute conditions'.
Some illnesses and treatments are rarely covered. PMI isn't designed to cover the long-term treatment of chronic conditions for a number of reasons.
The private-hospital sector's main purpose is to treat conditions that can be cured, or mostly cured, quickly. A large part of the NHS's funding is to care for patients with long-term conditions. So, for example, patients with diabetes can go to clinics, be regularly monitored and have their insulin needs met. This will often happen locally, in a primary-care setting such as their GP surgery.
As well as the practical reasons mentioned before, insurers also have to balance how much cover they provide with what you are willing to pay for that cover. So, insurers don't cover the treatment of long-term (chronic) conditions. This is because their premiums would become too expensive for most people.
The following conditions or treatments are normally not included in your cover.
- Going to a general practitioner (GP)
- Going to Accident and Emergency
- Drug abuse
- HIV/AIDS
- Normal pregnancy
- Gender reassignment (sex change)
- Mobility aids, such as wheelchairs
- Organ transplant
- Injuries you get from dangerous hobbies (often called hazardous pursuits)
- Conditions you had before taking out the insurance (commonly known as pre-existing conditions)
- Dental services
- Outpatient drugs and dressings
- Deliberately self-inflicted injuries
- Infertility
- Cosmetic treatment
- Experimental or unproven treatment or drugs
- Kidney dialysis
- War risks
Your insurer will give you a summary of your policy, or Key Features Document, and a full policy document, either before or straight after your insurance contract starts.
The summary of your policy or Key Features Document will set out any important or unusual limits of the policy, as well as the main monetary limits.
Next: Will my premiums increase over time?
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Health Insurance Guide Index
- How do I buy private medical insurance?
- Will I need to give details about my health?
- How do I choose the right cover?
- What is and is not covered?
- Will my premiums increase over time?
- What if I want to change to a new insurer?
- Points to remember
