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Health Insurance Guide

This Medical Health Insurance Guide, developed and published by the Association of British Insurers, is designed to help you understand more about what private medical insurance (PMI) in the UK is, why people buy it, and how it works, so that you will be able to make an informed choice before you buy a policy.

The Association of British Insurers publish this guide on behalf of all insurers who offer PMI, whether they are our members or not. The ABI is the recognised trade association that represents insurance companies working in the UK. Their members make up more than 90% of the UK's insurance business.

As well as this guide, the information you receive from PMI companies will tell you more about the products that you are considering buying. They
outline what is, and is not, covered.

Remember that products from different companies will vary. If you have any questions, your financial adviser or insurance company will be able to answer them.

What is private medical insurance?

Private medical insurance is designed to cover the costs of private medical treatment, for what are commonly known as 'acute conditions' that start after your policy begins.

Most insurers define an acute condition as a disease, illness or injury that is likely to respond quickly to treatment and aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery. Your
insurer can tell you about their cover for this and other conditions, such as cancer and chronic (long-term) conditions.

Why buy private medical insurance?

Most people buy this type of insurance to:

  • be reassured, knowing that treatment is available quickly if they become ill or are injured;
  • have a choice about when treatment will take place, the specialist who treats them and the hospital; and
  • have the privacy of an en-suite room with a TV and other home comforts.

How does private medical insurance work?

Although policies can be different, medical treatment usually has to start with a referral by your GP to an appropriate specialist.

Before you arrange any private treatment, you should call your insurance company to check that you are covered for the treatment. In fact, most insurers need you to do this.

Stay in touch with your insurer at each stage of your treatment. Your insurer will confirm if you are covered. Treatments for some illnesses, including pre-existing conditions (conditions from which you are already suffering, or have already had) will not be covered by a private medical insurance policy. It is also important to remember that private medical insurance is designed to work alongside, not to replace, all the services offered by the NHS. Some services, such as accident and emergency, are not available at most private hospitals.

Next: How do I buy private medical insurance?

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Health Insurance Guide Index

How do I buy private medical insurance?

Private medical insurance is provided only by insurers and may be bought:

  • direct from the insurer;
  • through an independent adviser; or
  • through an agent (bank, building society or retail outlet, such as a supermarket).

You can apply for insurance:

  • over the phone;
  • face-to-face;
  • using the internet; or
  • by post.

If you’re using the internet, try searching under ‘health insurance’ as well as ‘medical insurance’. An insurer, or an agent who sells policies on an insurer’s behalf, is only able to discuss that insurer’s own policies. An independent adviser offers policies from a range of insurers. Independent advisers give you recommendations after assessing your needs. They are responsible to you for the advice they give. If you buy direct from an insurer or an insurer’s agent they will also assess your needs. But, they can only give you advice on which of their own policies best suits you. Your adviser must explain whether they are:

  • independent;
  • advising on a range of insurers; or
  • a representative of one insurer.

If you buy direct from an insurer or insurer's agent without receiving advice, it is your responsibility to choose a policy that is right for you. You will be asked to fill in an application, and will probably be asked for information about your health. Your application, or any declaration you make to your insurer, is very important. In fact, it forms the basis of your contract with your insurer. You must answer any questions you are asked as fully and as accurately as you can, to the best of your knowledge and belief. If you don't, your insurer may refuse to pay your claim and could cancel your policy. Once your application has been
accepted you will be told when cover will start.

Cancellation period

Your insurer will send you policy documents when your policy has been set up. You have at least 14 days from the day you receive them to decide whether the product is suitable for you. If you want to cancel your policy, you must do so within the stated period and tell the insurer that you want to cancel your cover. If you have made any payments you will usually receive a full refund unless you have made a claim.

Next: Will I need to give details about my health?

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Health Insurance Guide Index

Will I need to give details about my health?

You won't normally be covered for any illnesses you are currently suffering from, or have already had. These are known as 'pre-existing conditions'. You must answer all questions as fully and as accurately as you can, to the best of your knowledge and belief. There are two main methods that PMI companies use to deal with your application for cover. These are:

  • full medical underwriting; or
  • moratorium underwriting.

All PMI companies will offer you the full medical underwriting option. Only some companies offer the moratorium option.

Full medical underwriting (medical history declaration)

You are asked to give details of your medical history. The insurer may write to your doctor for more information, but they do not do so in every case. You must give all the information you are asked for. If you don't, your insurer may refuse to pay any claim that you make in the future, or may cancel your policy.

If you are not sure whether to mention something, it is best to do so. If you have a medical condition that is likely to come back, the insurer will issue a policy, but that condition (and any related to it) might not be covered.

This condition may never be covered, or not covered for a set period of time.

Moratorium underwriting

You are not asked to give details of your medical history. Instead, the insurer does not cover treatment for any medical or related condition that you have received treatment for, taken medication for, asked advice on or had symptoms of.

In other words, you will not be covered for any condition that existed in the past few years. Five years is the usual time period.

These conditions may automatically become eligible for cover. But this will only happen when you do not have symptoms of, or receive treatment, medication, tests and advice (from your GP, a healthcare professional or a specialist) for that condition, usually for a continuous period of two years after your policy has started.

You do not need to tell the insurer about your medical history when you take out the policy. Your insurer might ask for medical notes that are needed to decide if your claim can be covered.

There are some conditions, for example chronic conditions, that will probably never be covered. This is because you will always need treatment, medication, tests or advice for them. You should not delay getting medical advice or treatment, simply to get cover. Your insurer will give you information explaining how their moratorium works. You may also want to ask the insurer or adviser, to explain this.

Next: How do I choose the right cover?

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How do I choose the right cover?

You should check to see if you already have PMI cover. Some employers include PMI as part of their benefits package. Even a club or professional organisation might have arrangements to offer you (and your family members) cover at better rates.

If this is not the case and you want to take out cover yourself, you need to think about what benefits are most important to you. When looking at cover, it is  seful to know how much medical treatment costs, so you know how much cover to buy.

There are lots of different sorts of policies, from low cost, offering limited cover, to those that offer wide-ranging cover and benefits. Most policies offer cover for inpatient and day-patient treatment, but not always outpatient treatment and diagnostic tests.

You will need to decide what sort of cover you want. There are a number of things you will have to consider.

  • How much do you want to spend?
  • Do you want to pay for part of your treatment?
  • Do you want your cover to includes seeing a specialist and having diagnostic tests (for example, X-rays and blood tests) as an outpatient?
  • Do you want a choice of hospitals, or would you be happy to have any treatment that you might need, in a hospital available from a limited range chosen by your insurance company?
  • What am I not covered for?

The answers you give to questions such as these, could have a significant effect on how much you pay.

The more your cover includes, the higher your premiums are likely to be.

Next: What is and is not covered?

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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

Will my premiums increase over time?

Even with the wide range of PMI policies available, it is likely that whatever policy you choose your premiums will rise above the rate
of general inflation.

Advances in modern medicine mean that doctors are able to identify some conditions earlier than ever before. For example, a patient who had a heart attack 20 years ago might have been treated with a heart bypass operation. Today they might be offered a pacemaker before a bypass is considered. The cost of healthcare will increase when:

  • new drugs, such as Herceptin and Avastin for the treatment of cancer, become available;
  • the methods used to diagnose conditions become more advanced, which means patients can be treated more quickly, and are used more; and the technology used in surgery becomes more advanced.

PMI tries to keep up with new medical developments, as they become established medical practice. As you get older you are more likely to need treatment.

Premiums usually increase with your age to reflect this. You can always ask your insurer to give you advice about their current rates at different ages.

Can I reduce my premiums?

You may be able to reduce your premiums by choosing from:

  • a reduced level of benefits, such as limited outpatient cover; a specific range of hospitals;
  • an excess on your policy, where you pay the first part, say £100, £200 or £500 of any treatment, either each policy year or each claim;
  • a policy with ‘co-insurance’ where you agree to pay a set percentage of any claim and the insurer pays the balance until you have paid an agreed yearly amount (after this the insurer pays 100%);
  • a policy that offers a no-claims discount or a discount that depends on your commitment to health, including exercising regularly and
    not smoking;
  • having treatment on the NHS, if this is available within 6 to 12 weeks of being diagnosed, rather than in a private hospital; and
  • receiving a discount by changing how you pay.
Next: What if I want to change to a new insurer?

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Health Insurance Guide Index

What if I want to change to a new insurer?

You can change your PMI company. If you want to switch, there are four main things you need to consider.

Existing conditions

Some insurers may match your exclusions (what is not included in your cover) and add these to your new cover. They will not add any new ones. However, some insurers might not cover illnesses or injuries you have had in the past or any condition that you suffer from now, even if these are covered by your current insurer.

Comparing your cover

Even if your personal medical exclusions stay the same with your new insurer, the overall cover is likely to be different. You should:

  • compare the benefits of each insurer;
  • compare any cover limits or monetary amounts; and
  • ask questions about how the cover works.

Paperwork

Paperwork varies from one company to another, but there’s likely to be an application form to sign and you might need to provide a copy of the policy certificate from your current insurer as proof of your current cover.

When you choose to switch

Usually, private medical insurance is offered through an annual contract. If you are thinking of switching to another insurer, it’s best to consider doing this at your renewal date. At any other time, check if you will lose any payments.

Next: Points to remember

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Health Insurance Guide Index

Points to remember

You must give full and accurate information to your insurer or adviser. This will avoid your claim being refused or your policy being cancelled.

You should read all the policy documents and terms carefully, now and in the future. Keep all documents safe.

You need to keep your payments up to date. If you don’t your cover will stop and only eligible treatment costs from before the cancellation date will
be included.

If your policy is a yearly contract, you will be sent details of changes to benefits, rules or premiums before your renewal date. Your insurer cannot cancel your policy just because you have claimed or your health has got worse.

Before you change insurers you should check the benefits, policy terms and underwriting position carefully to understand the consequences. The cover offered may not be the same.

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Health Insurance Guide Index

 

Health Assessments

BUPA’S Specialist Health MOTs for the Over 40s

Over the age of 40? You can now have a more accurate picture of your health with Bupa’s health checks.

Using your age, gender and lifestyle as a barometer, a health check can help to determine the risk of developing health problems in later life.  Doctors at the leading healthcare company have developed a range of health assessments which focus on issues that matter most for men and women at a later stage in life.

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By the time people reach their 40s, risk factors for diseases such as heart disease and cancer becomes more of a concern.  Bupa has develop a range of specific health checks that focus on common health concerns – for example, looking at risk factors for strokes, aneurysms, bowel cancer, heart and liver disease to name just a few.

The more in-depth Bupa Health Assessments include a list of comprehensive tests – for instance,, a diabetes risk predictor that enables customers to take steps to help avoid developing the disease.

As the leading UK experts in preventive health care, mammography tests are available to women from the age of 40 as a stand alone check or as part of Female Health Assessment. Bupa believes this provides a greater chance for the early detection of abnormalities as early treatment of breast cancer allows a greater chance of successful treatment. More than half of breast cancers detected through Bupa Heath Assessments last year were in women under 50 and would not have been detected through routine NHS screenings (offered to women over age of 50).

Dr Peter Mace, assistant medical director at Bupa Wellness, said: “Any doctor will tell you that the earlier a health problem is identified the more likely it is to be successfully treated, or even avoided. Our customers are interested in understanding  their own health and health risks allowing them to take positive steps to reduce their risk of illness.

“We aim to look at your individual risk and give you a programme to decrease that risk rather than a one-size fits all approach to assessing your heath. For example, we now have a mature health assessment, for those aged over 65, which includes tests for conditions such as thyroid disease and pernicious anaemia that are much more likely in that age group.”

Customers can expect same day results for many tests and up to an hour’s consultation time with a doctor to discuss results and any other health concerns.

“97 percent of people say they feel reassured about their health after their health assessment. Importantly, as a result of health assessments two in every three people tell us that they are prompted to make positive lifestyle changes to improve their health,” said Dr Mace.

Bupa pioneered health screening and provides more than 100,000 health assessments each year to individual and business customers concerned about their health and wellbeing.

These innovative tests are available at over 40 Bupa Wellness centres across the UK.  

Get up to £100 off selected Health Assessments here.

Summary of health assessments and diagnostic tests:

  • Bupa Female Health Check - more
  • Bupa Complete Health Check - more
  • Bupa Mature Health Check - more
  • Bupa Advanced Health Check - more
  • Bupa Breast Health Check - more
  • Bupa Liver Health Check - more
  • Bupa Sexual Health Check - more
  • Bupa Colon Health Check - more
  • Bupa Coronary Health Check - more

About Bupa

Bupa is a leading international healthcare company. Established in 1947, it has over ten million customers in more than 190 countries and employs over 52,000 people around the world.

Its main interests are health insurance, care homes for young disabled and older people, workplace health services, health assessments and chronic disease management services, including health coaching and healthcare services in the home.

While Bupa’s largest and original business is in the UK, it has significant operations around the world including Sanitas in Spain, MBF, HBA, Mutual Community in Australia, IHI in Denmark and Health Dialog in the US. Bupa also has businesses in Hong Kong, Thailand, Saudi Arabia, India, China and Latin America. In addition, Bupa Care Services owns care homes in Spain, Australia and New Zealand.

Bupa has no shareholders. We reinvest our money to provide better healthcare for our customers, helping them to live longer, happier, healthier lives.

 

Bupa Female Health Check

This health assessment empowers you to take charge of your female health. If you have any worries about your family history or have noticed any changes in your body, you can discuss your concerns with an expert – and get yourself thoroughly checked.

It includes a cervical smear, blood analysis, a thorough breast examination, mammography (for women aged 40 or over)

For more information about a female health check click here

 

Bupa Complete Health Check

A Complete Health assessment will provide you with an in-depth profile of your health and wellbeing and includes up to 45 minutes with a Bupa doctor. So, whatever your concerns, there's no rush as you'll get plenty of time to discuss them with the doctor.

The physiological tests include assessing your heart, lungs, abdomen and central nervous system. We'll look at your blood pressure, cholesterol, heart trace (ECG), and assess your risk of heart disease.

We carry out detailed blood analysis to test for conditions such as diabetes, gout, anaemia and liver and kidney problems. Your hearing and vision will be checked, and we’ll provide a detailed body composition profile, including your body fat percentage. We'll also talk you through diet and lifestyle.

For men, we'll provide a testicular examination; for women, a cervical smear and breast examination. We'll inform you about your potential health risks and instruct you on how to perform self-examinations and be 'body aware'.

This health assessment empowers you to take charge of your female health. If you have any worries about your family history or have noticed any changes in your body, you can discuss your concerns with an expert – and get yourself thoroughly checked.

For more information about a complete health check click here

 

Bupa Mature Health Check

Helps to give you peace of mind with this extensive health assessment – tailor made for people over the age of 65. Whatever your concerns, you won’t be rushed as you'll get plenty of time to discuss them with the doctor. We’re here to help you and offer the appropriate advice.

Through an extensive range of tests, including additional ones for age-related conditions, we aim to give you a thorough health check.

The physiological tests include assessing your heart, lungs, abdomen and central nervous system. We'll look at your blood pressure, cholesterol blood tests and heart trace (ECG), and assess your risk of heart disease.

We carry out detailed blood analysis to test for conditions such as diabetes, gout, anaemia and liver and kidney problems. Your hearing and vision will be checked, and we’ll provide a detailed body composition profile,. We'll also talk you through diet and lifestyle.

For men, we'll provide a testicular examination, for women, a cervical smear and breast examination. We'll inform you about your potential health risks and instruct you on how to perform self-examinations and be 'body aware'. Women can have a mammogram for an extra fee.

For more information about a mature health check click here

 

Bupa Advanced Health Check

An advanced health and fitness assessment providing an in-depth profile of your fitness, health and wellbeing. It includes 43 tests covering a wide range of medical issues, up to 60 minutes with a Bupa doctor and up to 60 minutes with a trained health adviser

Unique to this health check is a cardio-vascular exercise test, which measures the efficiency of your heart and lungs at getting oxygen to your muscles to create energy. This test will give you an accurate measure of your aerobic fitness.

Your aerobic fitness can indicate your risk of developing a number of conditions, including heart disease and cancer. We can advise you on what sort of exercise might suit you best and how hard you need to work to maximise the benefits.The health assessment also includes a new 'lung age' test as well as a metabolic rate test which indicates the minimal number of calories you need in a resting state.

For more information about a advanced health check click here

 

Bupa Breast Health Check

A breast check is a physical and visual examination of the breasts. Additionally we recommend women aged 40 to 50 have mammograms on an annual basis, and those over 50 have mammograms every other year. A mammogram involves having both breasts X-rayed.

Mammography is the most effective means of detecting and investigating breast disease. It can detect a change in breast tissue before you can feel anything unusual yourself. NHS screening programmes offer mammography to all women over 50. There is clinically evidence that mammograms from the age of 40 are valuable in detecting early breast cancer. Bupa Wellness offer mammography to all women over 40 (there may be an additional charge).

For more information about a breast health check click here

 

Bupa Liver Health Check

Liver problems are linked to alcohol consumption and obesity. In the early stages they can be very hard to detect, but if caught early enough, they can often be treated.We use a scan to obtain an accurate picture of your liver’s health. Capable of spotting abnormalities before blood tests can, it checks for signs of fibrosis and cirrhosis which can result from lifestyle issues, metabolic syndrome and excessive alcohol intake.

The Bupa Liver Health check includes the following tests: blood biochemistry profile; blood haematology profile and FibroScanTM of the liver

For more information about a liver health check click here

 

Bupa Sexual Health Check

Some sexually transmitted infections (STIs) can lead to long-term complications and can affect anyone any age that is sexually active so it’s best to find out as early as possible whether you are suffering from one. With Bupa, your results are processed and sent to you as quickly as possible. Even better, you have plenty of time to talk to through any concerns with a Bupa doctor who will be able to give you advice about potential treatments and staying healthy.

Test includes swabs, blood tests, and urine tests for all common sexually transmitted infections.

For more information about a sexual health check click here

 

Bupa Colon Health Check

This assessment uses a virtual colonoscopy, a new technique that enables doctors to look for polyps (which may become cancerous) and early cancers in the bowel using a CT scanner. Suitable for everyone over the age of 45.

This will need to be performed at a scanning centre. The results are sent to the Bupa centre nearest to you for review with a Bupa doctor. It takes approximately one week to process the results from your scan so the two appointments are scheduled a week apart.Bupa Colon Health is available on its own or as an add-on to Bupa Advanced, Complete and Mature Health.

For more information about a colon health check click here

 

Bupa Coronary Health Check

This is a highly advanced risk assessment of heart disease that gives you the opportunity to reduce your risk through positive lifestyle changes.

A heart scan gives us information about the state of your heart arteries and can indicate more precisely your risk of a heart attack.

The CT scan looks for calcium in your coronary arteries. If no calcium is detected your risk of having a heart attack is low. If calcium is present then you may have coronary artery disease, in which case we can recommend ways to minimise your personal risk.

A scan is fast, safe, accurate, painless and non-invasive, taking just 15 minutes to perform. You simply lie on a padded table under the arch of the scanner. Your head is not enclosed at any time so there is no feeling of claustrophobia. You will simply be asked to hold your breath a few times while a series of pictures is taken.

For more information about a colon health check click here

 

Hair loss is thought to affect 10m men and 8m women in the UK, 50% of all men over 50 are affected by male pattern baldness. When considering hair restoration it’s essential to educate yourself about the available treatment options, what you can expect and what is likely to work best for you.

Laser Eye Surgery

With recent medical advances, laser eye surgery is becoming a popular alternative to wearing glasses or contacts to correct vision problems.  The more recent LASIK eye surgery has dramatically reduced the discomfort and recovery time associated with laser vision correction, making it possible for many people to get back to work within a few days.