Advice on Healthcare Insurance
Legal stuff
This is just an introduction to healthcare insurance and is not intended to be representative of the covers or restrictions offered by any particular insurance or that all insurance provides the protection described. You can get a recommendation for a particular insurance to suit your own personal circumstances by talking to the skilled staff at any Coversure Insurance Services branch.
Why buy healthcare insurance?
Purchase healthcare insurance if you want to protect yourself or your family against the cost of being treated privately if you suffer an illness or need to consult a specialist for diagnosis and do not want to be treated within the National Health Service. The advantages of being treated privately are:
- You can often be treated more quickly
- You may get access to more senior consultants and specialists
- If you need a hospital stay, you can stay in a private hospital where the food may be better and the staffing ratios higher
How do I choose the right cover?
When looking at cover, it is useful to know that treatment is categorised in the following way:
- In-patient treatment – Treatment which, for medical reasons, means you have to stay in hospital overnight or for longer
- Day-patient treatment – Treatment which, for medical reasons, means you have to go into a hospital or day-patient unit because you need a period of clinically-supervised recovery. However, you do not have to stay overnight.
- Out-patient treatment – Treatment given at a hospital consulting room or out-patient clinic where you do not go in for day-patient or in-patient treatment.
A large variety of schemes are available – from low cost schemes, offering limited cover, to those which offer wide-ranging cover and benefits. Most schemes will offer cover for the first two categories listed about but not always out-patient treatment.
You will need to settle on what sort of cover you want; there are a number of factors you will need to consider. Below are just two examples:
- Do you want your cover to include seeing a specialist as an out-patient?
- Do you want a choice of hospitals, or would you be happy to receive any treatment that you might need in a hospital available from a limited range selected by your insurance company?
What is covered and what is not covered?
It is important to remember, healthcare insurance is designed to cover treatment for curable, short-term illness or injury (acute conditions). Therefore, some illnesses and treatments are never covered and these are common to most schemes.
Usually Included:
- Cover for treatment of short-term (acute) medical conditions
- In-patient tests
- Surgery as an in-patient or day-patient
- Hospital accommodation and nursing
Sometimes Included:
- Out-patient diagnostic tests
- Out-patient consultations and treatment with a specialist
- Overseas cover
- Cash payment for treatment received as an NHS patient
Usually not included:
- Conditions you had before taking out the healthcare insurance (know as pre-existing conditions)
- GP services
- Cover for long-term illnesses which cannot be cured (know as chronic conditions)
- Accident and emergency admission
In addition to those listed above as ‘usually not included’, the following conditions or treatments are normally outside the scope of your cover:
- Drug abuse
- Self-inflicted injuries
- Out-patient drugs and dressings
- HIV/AIDS
- Infertility
- Normal pregnancy
- Cosmetic surgery
- Gender reassignment (sex change)
- Preventive treatment
- Kidney dialysis
- Mobility aids
- Experimental treatment
- Experimental drugs
- Organ transplant
- War risks
- Injuries arising from dangerous hobbies (hazardous pursuits)
Each healthcare insurance provide will give you a policy summary or ‘key facts’ document and a full policy document either before or immediately after you sign the contract. The policy summary or ‘key facts’ document will set out any significant and unusual limits of the policy.
How much does healthcare insurance cost?
This is a difficult question to answer; there are so many factors that will influence the premium you pay for your healthcare insurance policy. Our advice would be to speak to one of our skilled staff at your local Coversure Insurance Services branch and discuss your requirements fully in order to get the most accurate premium and best possible cover for you.
Healthcare insurance gets more expensive as you get older. In addition to this factor, healthcare insurance premiums rise above the rate of general inflation. This is due to the factors that affect how healthcare is provided in all western economies. Year on year, more people claim on their healthcare insurance policies for private medical treatment. The number, sophistication and cost of treatments to improve quality of life is increasing steadily. Most healthcare insurance polices aim to cover these treatments as they become standard medical practice and available privately. By the same token, the sophistication and complexity of tests used to diagnose illness and injury are also increasing. Such tests are becoming more widely available, especially in private hospitals. As with standard insurance polices, no claims bonus/discount and payment methods can also affect the cost of your policy. In addition to these factors, the combination of what you choose to have covered and what you choose not to have covered will affect the premium you pay for your healthcare insurance policy.
How do I make a claim?
Except in the case of an emergency admission to NHS hospitals, all medical treatment must start with a referral by your GP to an appropriate specialist or consultant. Before receiving any treatment privately, you should ensure you call your insurance provider to check that you have the correct cover in place. Nearly all insurance providers insist you do this. Your GP and your specialist or consultant will usually need to complete and sign your claim form. Your GP may make a charge, by way of a fee; this is unlikely to be covered by your healthcare insurance policy. Most hospitals and some specialists have their bills paid directly by the insurer, others will send the bills to you.
Your insurer will give you all the guidance you need, confirm what your cover includes and, if necessary, send you a claim form. Stay in touch with your insurer who will confirm whether any treatment you plan to receive is covered. Your insurer will tell you how they pay claims. Remember, if you have chosen to pay an excess, you will have to make a payment.
What to watch out for?
As with any type of insurance policy, there are very good polices that offer wide levels of cover and there are inferior policies that offer very limited cover. If you do intend to buy a healthcare insurance policy, ensure that you check the limits on each section of the policy and make sure they match your requirements. There are policies available that will only provide limited cover, for example only covering the cost of treatment for cancer.
Many companies offer healthcare insurance as an employee benefit. Check whether or not the company you work for has such a scheme in place. Employer schemes can provide wide levels of cover at very reasonable premiums. However, if your employer provides the cover as a benefit, free of charge to yourself, you will be liable to pay tax on the cost of cover paid by your employer.