"Finding the Right Medical Assurance ~ can be a Job in Itself"
Good Health is one of the most important things we undervalue when we are well. We all forget what problems can arise if we became ill. We want the best treatment & in the fastest possible time. This unfortunately may not always be possible on the NHS, even though it is a valuable lifeline.
Medical Assurance (PMI) allows you to skip the waiting lists, arrange treatment at a time you choose and maybe provide medication that the NHS cannot afford to cover.
You need to choose Medical Assurance carefully, as policies vary greatly in what they offer and how much they cost; It's important to be aware all of the limitations. Getting a broker to help source your ideal Medical Assurance policy could save you both time and money.
Also known as Private Medical Assurance, Medical Assurance Cover, Medical Insurance or PMI Insurance.
FOR PRIVATE MEDICAL INSURANCE PRODUCTS WE MAY ALSO INTRODUCE TO PMI PACKAGING DESK
Things to consider for Medical PMI Assurance
Medical Assurance doesn't replace all NHS services - for example, accident and emergency treatments aren't covered. It covers the cost of being treated privately, either at a private hospital or in a private NHS bed. It is designed to cover short-term, curable medical problems. Anything that isn't short-term or curable is likely to be excluded - however each policy is different, so check carefully what is and isn't included before you buy. PMI doesn't always cover every medical eventuality.
With very serious illnesses, you will not necessarily receive treatment more quickly with Medical Assurance than you would under the NHS. You won't always get treatment in a private hospital. You may be put in a private patient unit within an NHS hospital. You could also end up on an NHS ward rather than in a private room.
A typical Bupa customer survey found that the main reasons for going private were:-
Desire to avoid long or any waiting lists via NHS
Issues re Covid 19 Coronavirus
Receive fast-track consultations
A more personal service for treatment for short-term, curable medical problems
NHS Hospital cleanliness issues as often highlighted in the media
The fear of superbugs such as MRSA
Home nursing facility as do not wish to goto or stay in hospital
Concern that NHS may not be able to cover expensive drugs if needed
Want to be treated in the plusher surroundings of a private hospital
Parental or additional accommodation if in hospital
2 main types of Medical Assurance policy: Full Medical Underwriting or Moratorium.
The difference between them is how your existing medical history is handled. With full underwriting, you know what will be covered straight away. With moratorium, you don't know what's covered until you claim.
Full medical underwriting - you'll have to give full details of your medical history when you sign up to the policy. Pre-existing medical conditions aren't usually covered, either indefinitely or for a set period. Insurers provide a registration certificate which lists all the exclusions so customers know what they're not covered for upfront with full underwriting terms.
Moratorium policy - you won't have to give full medical details until you make a claim. But you won't get cover for any condition that you have previously had, usually in the past 5 years. If you remain free of that condition for a period of time, usually 2 years, that condition may be covered from then onwards.
Questions to ask before you take out a Medical Assurance Plan
What does the medical assurance policy cover?
Does this policy build up a no-claims discount?
What is included or excluded?
What level of cover is right considering my circumstances?
Is there a compulsory or voluntary excess?
A Moratorium policy or a fully-underwritten policy?
Typical Medical Assurance Plan Exclusions
Your policy won't usually pay for longer-term treatment such as dialysis, or illnesses such as asthma. Other common exclusions include alcohol abuse, standard pregnancy or non-essential cosmetic treatments.
Private medical assurance companies typically offer a variety of policies with different levels of cover. Most offer at least one top-level comprehensive policy, a medium-level standard policy & then a lower-level budget policy.
Some insurers also have specialist policies. For example, some policies cover you only when you have to wait longer than 6 weeks for treatment on the NHS. Other policies are designed specifically for the over-55s, or have a special focus on one disease, such as cancer.
Menu style policies are becoming increasingly common. These cover you for in-patient treatments but also allow you to add cover for different things so that you tailor-make your insurance package.
Read the Key Features that come with any Medical Assurance Policy
This sets out, amongst other things, the main features and benefits of the policy as well as any significant or unusual exclusions and how long the cover lasts.
In-patient vs out-patient treatment
Most policies cover all the costs of in-patient treatment (tests and surgery) and daycare surgery. Cover for out-patient treatment (diagnostic tests, scans, physiotherapy, consultations and chemotherapy and radiotherapy) varies. Comprehensive policies usually cover all out-patient treatments, although annual limits may apply.
Standard policies cover most out-patient treatments but may limit the cost of treatment covered. Budget policies cover fewer types of out-patient treatment and have lower financial limits on the amount of treatment covered. With budget policies, out-patient treatment may also be covered if it directly relates to in-patient treatment eg; follow-up physio needed after a stroke.
Extra benefits cover
Cover for psychiatric treatment varies between insurers. This is a difficult area for insurers to categorise as it blurs the line between curable illness (which is covered by medical assurance) or long-term care (which isn't covered). Comprehensive policies are more likely to include psychiatric treatment, but not all do, so you have to check.
Some policies also offer extra cover, for example, for complementary therapies, a private ambulance, home nursing, a 24-hour advice line and parental accommodation if your child is in hospital. Again, the higher grade the policy is, the more likely it is to cover these areas.
Switching Medical Insurers - Issues
Health problems can tie you to your own insurer. Switching health insurer to take advantage of more competitive premiums can mean that you lose cover for any conditions you've developed since you started your policy !
However, some insurers may allow you to switch policy without losing cover for pre-existing conditions. Others will agree to cover you for these conditions after a set period if you remain free of the conditions in that time. Check this carefully with the insurer before you buy the policy.
If you're moving from a policy you've had as a perk through your employer, check whether it allows you to switch to its individual policy without losing any cover.
How much does Medical Assurance cost?
Premiums vary, depending on the level of cover you buy, your age, state of health and whether or not you smoke.
Your premiums will tend to go up annually to keep pace with medical costs and because the risk of illness increases with age.
How could I keep Medical Assurance costs down ?
Discounts are sometimes available if you're able to pay the whole annual premium upfront
If you agree to pay an excess fee on any claims.
No-claims discounts but could put people off seeking vital treatment when needed just to preserve their discount.
Earn higher discounts by adopting a healthy lifestyle.
Excesses - which work in a similar way to excesses on car or house insurance. If you need private treatment, you pay your chosen excess and the insurer foots the rest of the bill. Broadly speaking, the higher the excess (typically £1,000 or less), the lower your premium will be.
Delayed treatment - Another option for cutting costs is to use your private insurance only if the NHS can't treat you quickly. Some insurers may offer plans with a 6-week, 4 week or 90 day options respectively. This means that if you are told you have to wait for more than, say, 6 weeks for NHS treatment after your specialist says that you need it, your insurer will pay for you to be seen more quickly privately.
Shared responsibility schemes where premiums can be kept down if you agree to pay a percentage of the cost of any treatments you have. The theory is that doing so gives you an incentive to keep costs down.
So how can I find the best deal? It is important to shop around, as policies vary greatly. Insurers also have their own or preferred hospitals, so you should consider where you'd like to be treated. It is also worth asking how swiftly claims will get processed. Some employers offer PMI as a benefit, which may be worth considering. This means the premiums are paid for you, but you have to pay tax on this perk.