Frequently Asked Questions

Private medical insurance also known as health insurance is designed to cover the costs of private medical treatment for short term illnesses or injuries, commonly known as acute conditions. Most people buy this insurance to gain the peace of mind of knowing that treatment is available promptly, should they become ill or injured. As a private patient you can usually choose where and when your treatment is to take place, the specialist who treats you and the hospital location. You will usually have a private room with en suite facilities, complete with tv, telephone and the freedom to entertain your visitors at all reasonable times.

Private Medical Insurance is designed to cover treatment for short-term illness or injuries. Some illnesses and treatments are not usually covered if they have been diagnosed, such as diabetes and asthma and these are common to most schemes. It is also important to remember that private medical insurance is not designed to replace all the services offered by the NHS. Some, such as accident and emergency treatment, are beyond the scope of most private hospitals. The level of cover provided depends on your choice of insurance company and the type of plan selected.

Listed Below are some very general guidelines. However it is important that you consult us to find out exactly what your policy does include;

Usually included treatment in the UK:

Hospital costs including: accommodation, nursing care, operating theatre, intensive care, specialists charges, drugs and dressings and all other costs relating to your operation whilst staying in the hospital either over night or as a day patient.

Included only in certain plans:

out-patient tests including blood tests, x-rays and scans, out-patient consultations with a specialist, cash payment for treatment received as an NHS in-patient, private nursing care at home, private ambulance service, therapies and alternative treatments including acupuncture, osteopathy, chiropractor and physiotherapy.

• Conditions you had before taking out the insurance (commonly known as pre-existing conditions)
• GP services
• Cover for long-term illnesses which cannot be cured (usually referred to as chronic conditions such as diabetes or asthma)
• Accident and emergency admissions
• Drug abuse, self-inflicted injuries, HIV/AIDS, infertility, normal pregnancy, cosmetic surgery, gender reassignment, preventive treatment, kidney dialysis, mobility aids, experimental treatment, experimental drugs, organ transplant, war risks, injuries arising from dangerous hobbies, and out-patient drugs and dressing. Optical, routine dental treatments and health screening are not covered as standard but these can be added on to selected schemes by request.

This could mean you are at a higher risk of developing these diseases than somebody who does not have this in their family, however, provided you have not yet been diagnosed with one of these conditions you can join a scheme and still have the peace of mind that they will be fully covered if they should arise in the future. Join now to ensure you are fully protected.

The prices vary hugely from company to company and the higher the premium does not necessarily reflect higher levels of cover. Here are some examples based on a 30 year old and a 60 year old; Budget Cover; 30 years = £16.49 per month 60 years = £31.27 per month, Standard Cover, 30 years = £34.74 per month, 60 years = £81.31 per month, Comprehensive Cover, 30 years = £41.34 per month, 60 years = £96.76 per month

Whichever plan you choose, it is likely that your premiums will rise above the rate of general inflation usually around 8-10% per annum. This is because of factors which affect how healthcare is provided in all western economies. 

Each year more people claim on their insurance cover for private medical treatment. A hip replacement will cost £9,450** (Source: Parkside Hospital-Wimbledon) and is a common procedure, particularly for older patients. We have included a more detailed list of the various prices for private treatment below.

The number and sophistication of treatments to improve quality of life is increasing steadily. Most private medical insurance policies aim to cover these treatments as they become established medical practice and available privately.

Likewise, the sophistication and complexity of tests used to diagnose illness and injury earlier is also increasing. Such tests are becoming far more widely available in private hospitals - for example, Magnetic Resonance Imaging (MRI) scans which cost on average £490** per body part (Source: Private Healthcare UK).

As people get older they are more likely to need and receive medical treatment, which means that health insurance premiums will increase with age to reflect this.

We will review your policy every year to ensure that you are getting the best possible levels of cover for your money. When new schemes come onto the market they are generally substantially cheaper to attract new business to the various insurers. We have the expertise to know as and when it is appropriate for you to take advantage of these special offers, we will always notify you of any new schemes.

**Prices are correct as at March 2014

This depends on the method of underwriting you choose when you join.
Moratorium underwriting - details of your medical history is not required.
Full Medical underwriting - full details of your medical history is required.

This is when you are asked to fill in a form, but you are not asked to give details of your medical history. Instead, the insurance company does not cover any medical condition which existed for a stated period of time, usually in the last five years. These conditions may automatically become eligible for cover, but only when you do not have symptoms, or receive treatment, medication, tests and advice (from your GP or a specialist) for that condition for the stated continuous period (usually two years), after your policy has started. If your insurance company offers a "moratorium" policy, they will give you printed information explaining how their particular moratorium works - you should always ask your Private Medical Insurance consultant to explain this for you. This is known as a ‘rolling’ moratorium; there also exists the less-common ‘fixed’ or ‘flat’ moratorium where pre-existing conditions are automatically covered after two years, even if they have required treatment. A fixed moratorium carries considerably more risk for the insurer, applicants deemed to be too high a risk—someone with a history of cancer, for example—are usually barred.

Full medical underwriting (FMU) is the traditional form of underwriting for a medical insurance policy. The applicant declares their medical history at the outset, which gives the insurer the option of excluding any pre-existing conditions. In practice, most pre-existing conditions are excluded and the exclusions are usually—but not always—permanent.

You can now transfer from one insurer to another on a continuous cover basis so your medical history continues to be covered whilst you make savings on your premiums. There are various qualifying conditions depending on the insurer but as a rule you need to have not seen a consultant in the last 12 months and you do not have any treatment planned or pending. Do discuss your own personal circumstances with us as the insurers are open to each individual case.

Yes you can join a scheme to cover any other non-related medical condition that could arise. If you join the moratorium underwriting option and you remain on the scheme for 2 continuous years without any symptoms, advice or treatment your condition may become eligible for cover.

Apart from emergency admissions to NHS hospitals all medical treatment will start with your GP. If your medical problem needs specialist advice, treatment or diagnosis your GP will refer you to a relevant expert, at this point, please tell your GP that you have private medical insurance. You then contact your insurance company to notify them of your planned treatment and they will give you an authorisation code to give to the hospital when you visit, that will enable your claim to be paid directly to the hospital by the insurance company.

Please speak with your insurance company when you contact them regarding your pending claim to discuss how they would prefer you to pay for your excess or your contribution towards the costs.

Yes but you will pay for these yourself. The prices for a specialist consultation are £140-£250 for the initial meeting and usually half the price for any follow up consultations. It is often cheaper if you pay these directly yourself.

From our experience over the last 20 years it is very rare that a claim gets turned down and in the odd case that this has happened we have followed it through with our clients to the Ombudsman and inevitably it has been sorted out and the insurance company has paid fully in the end. To avoid this situation happening it is imperative that if you have had any medical problems in the past, that we know about them before you complete your application form so that we can then determine the best way for you to join a scheme, 9 times out of 10 we will speak directly with the underwriters to determine if there will be any exclusions and if yes, can these be removed at a later date so you will know up front of any implications and you can then make an informed decision as to whether you still wish to proceed with the insurance (we do encourage our clients to contact their GP’s for a full list of any visits they have made as this will often jog peoples’ memories and ensure that everything is disclosed to the insurer)There are now several schemes that will cover an existing medical condition once you have been on the scheme for a qualifying period of time.

The disturbing facts (Source: Bupa) of life are that in the UK

• Each year over 130,000 people suffer a stroke and 80% of these survive at least one year or more
• One in three people will contract cancer sometime in their life
• One in four healthy men in the UK between 20 and 40 will have contracted a critical illness before age 65. For women, this is one in five and, of those who develop cancer, 40% will survive 5 years or longer
• One in six healthy men will suffer a heart attack before they reach 65 yrs
  of age 
  

The NHS offers an excellent service for emergencies however there are over a million people today on waiting lists for NHS treatment many of whom have been waiting 12 months or more (Source: Bupa).

You could wait for up to two years for a non-urgent operation under the NHS Scheme and may think of going "private". Some typical costs of treatment are outlined below, which could prove prohibitive if you do not carry insurance. Under private schemes, you can be operated on within hours or days and have nursing care at home whilst you recuperate. You will be treated in hygienic MRSA free hospitals. You usually will have your own private en-suite bedroom and visitors are not restricted to visiting hours. You can arrange your hospital appointments to suit you which is particularly useful if you run your own business or have children at school and your time for appointments is very restricted.

Adequate health insurance policies cover you for treatments that would otherwise be prohibitively expensive. Please replace everything that is bold and delete and replace when noted:

Average costs (Spire Alexandra Hospital) would typically be:

• Shoulder Arthroscopy £3893
• Hip Replacement £9461
• Knee Replacement £9661
• Back Surgery £6641
• Hysterectomy £5990
• Gall Bladder Removal £5998
• Cataract Removal £2271
• Hernia Operation £2609
• Gallbladder Removal £5998
• Prostrate Surgery(TURP) £5570

Cancer drugs are costing in excess of £20,000 per annum.

There are lots of options available to help you to keep your health insurance affordable;
An excess option; most companies offer a discount if you contribute towards the cost of a claim you can choose from £100, £250, £500, £1,000, £2,500 and £5,000. This can reduce your premium by up 65% discount.
Reduce your cover; Most insurers offer comprehensive, mid-range, low cost and budget options.
Healthy Lifestyle; Lower premiums if you actively improve your health, you can complete a regular lifestyle questionnaire to qualify for extra discounts on your scheme.
No Claims Discount; Get up to 72% discount off your premium as a reward for not making claims. Most companies now offer a 5% discount off your premium for every year you do not make a claim. If you have built up high no claims discounts please speak to us before you make a claim as losing your discount may cost you more than paying for a small claim yourself!!
Restricted Hospitals; Receive a discount for using non London hospitals. Some companies offer a discount for using selected designated hospitals.
6 Week Wait Option; Avoid lengthy waiting lists. Reduce your premium by opting to use the NHS if treatment is available within 6 weeks of diagnosis.