Health Insurance Guide
The plethora of health insurance plans, and what is on offer within each individual product, can be very confusing. This guide to private health insurance is designed to help you understand more about what health insurance is, how it works, why people buy it, how to reduce your costs and how to ensure you are getting the right cover. We'll also look at some questions to ask so that you can make an informed choice before you buy a policy.
Health Insurance Guide Index
What is private health insurance?
Private health insurance is designed to cover the costs of private medical treatment for acute conditions that start after your policy begins. Most health insurers define an acute condition as a health problem or injury that is likely to respond quickly to treatment and aims to return you to the state of health you were in immediately prior to becoming ill or injured.
Insurance will cover the cost of medical treatment at a private clinic or hospital, eliminating the need to go onto an NHS waiting list. The NHS lacks funding and faces a great level of demand for treatment for acute illnesses and injuries. In comparison, private health insurance would enable you to access treatment promptly.
As a private patient you can often choose when treatment will take place, the specialist who treats you and the hospital itself.
However, private medical treatment can be expensive, so choosing to have private health insurance should be seen as a real investment in your future health.
Why buy private health insurance?
Most people buy health insurance because they want to:
- have reassurance that treatment will be available quickly if they become ill or are injured
- have a choice about when and where treatment will take place, and which specialist will provide their care
- have a more comfortable hospital stay, with a private room, TV and other comforts unavailable at NHS hospitals.
How does private health insurance work?
Policies differ depending on the company that provides them and the options you pay for, but typically you will need to get a referral from your GP to see a specialist. Once you get a referral, you then contact your insurer to check your coverage, and which hospitals and specialists you can use under your policy.
Treatments for some illnesses, including pre-existing conditions (conditions from which you are already suffering, or have had in the past) will not be covered by a private medical insurance policy. Private health insurance is designed to work alongside the services offered by the NHS like visits to your GP or accident and emergency care.
What is and is not covered?
Private health insurance is designed to cover treatment for acute medical conditions, which are curable, short-term illnesses or injuries. PHI isn't designed to cover the long-term treatment of chronic conditions.
Examples of services usually covered by PHI include:
- Cover for treatment for acute medical conditions
- In-patient tests
- Surgery, hospital accommodation, theatre time and nursing
- Medical consultations
- Out-patient testing and consultations
- Overseas cover
- Cash payment for treatment received as an NHS in-patient
A large part of the NHS funding is used to care for patients with long-term conditions like diabetes. Private medical insurers have to create a balance between the insurance coverage they provide and the amount that they charge for cover. Covering longterm conditions would make PMI very expensive.
The following conditions or treatments are normally not covered by PMI:
- Pre-existing conditions
- Going to a general practitioner (GP) or to Accident and Emergency
- Outpatient drugs and dressings
- Drug abuse
- HIV/AIDS
- Normal pregnancy
- Gender reassignment (sex change)
- Mobility aids like walkers and wheelchairs
- Organ transplant
- Injuries received during dangerous hobbies
- Dental care
- Self-inflicted injuries
- Infertility
- Cosmetic treatment
- Experimental or unproven treatment or drugs
- Kidney dialysis
- War risks
When you purchase insurance, you'll receive a Key Features Document and a full policy document describing policy limits and rules.
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