PRIVATE MEDICAL
INSURANCE
Convenient and rapid access to high-quality private medical facilities, medical treatments and procedures.
What is Private Medical Insurance
Private Medical Insurance gives individuals, families and employees convenient and rapid access to high-quality private medical facilities, medical treatments and procedures. It also helps fund the cost of early diagnosis and treatment of acute conditions.
For the most serious of conditions, you get the peace of mind knowing your treatment can begin quickly.
WHY PRIVATE MEDICAL INSURANCE?
For employers, the provision of Private Medical employee benefits is becoming more and more essential in order to both retain and attract the very best people. Often the health of your key employees can have a significant impact on your bottom line, making investment in healthcare and wellbeing services a smart choice.
For individuals and families, access to healthcare is becoming increasingly difficult, particularly primary care and onward referrals to specialist consultations.
For both Personal plans and Business plans, individuals and employees get the following;
Shorter Waiting Times
Private Medical Insurance removes the uncertainty of NHS waiting lists by providing you with fast access to the very best private medical treatment, at a time and place which suits you.
Access to a Wide Range of Hospitals
You choose where and when to be treated with easy access to a nationwide network of private hospitals or alternatively let the provider choose for you.
Online GP Consultations
It’s all too common now to have to wait days or even weeks until you can see your NHS GP. Private Medical Insurance often provides access to a private GP via an app on your phone for one-on-one video consultations, normally booked within 24 hours.
Comfort and Privacy
Eliminate concerns about shared wards with the comfort and privacy of your own room in a facility providing extremely high standards of patient care and hygiene.
Flexible Cover to Suit You
Cover, benefits, consultant and hospital choice can be tailored to fit both your needs and your budget.
Drugs and Treatment
Access to a wider range of drugs and treatments, including those which might not yet be approved for use or available within the NHS.
WHAT OTHER BENEFITS DOES PRIVATE
MEDICAL INSURANCE PROVIDE
Most of the main providers offer similar levels of cover and benefits with additional features varying from provider to provider. The following are the main benefits offered for full healthcare plans
Core Cover from most providers tends to include the following
Integrated Primary Care - Online private GP consultations within 48 hours, providing benefits such as written prescriptions, referral into physiotherapy, and other therapy services.
Out-Patient Surgical Procedures - treatment at private facilities without requirement of being admitted
Mental Health Support - limited support for mental health such as counselling
Full In-Patient and Day-Patient Treatment - these treatments are for patients who require admission into hospital for a day (day patient) or overnight stay (in patient)
Advanced Cancer Cover
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Chemotherapy and radiotherapy
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Biological therapy, targeted therapy, immunotherapy, hormone therapy and bisphosphonate therapy
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Surgery - including preventative and reconstructive surgery
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Follow-up consultations
Additional Benefits that can be added and tailored to suit your requirements
Out-patient Cover - your healthcare journey including specialist consultant's fees, scans and other diagnostic services when you don't require a hospital admission. This cover can be set at an annual amount or unlimited
Mental Health Cover - In addition to core cover, this can include private inpatient care
Therapies Cover - Physiotherapy, Chiropractic and Osteopathy treatments and more
Dental Cover - Limited cover for both routine preventative care and major treatment
Optical Cover - Options for preventative care and corrective prescription glasses
Employee Assistance Programme - Counselling and referral services for business healthcare
Worldwide Travel Cover- Comprehensive annual travel insurance available for both personal and business plans
Most providers include additional benefits as standard
NHS hospital cash benefit - when you elect to use the NHS
For example:
In-patient treatment: £250 per night
Day-patient treatment: £125 per day
Childbirth cash benefit
Home nursing
Private ambulance
Parent accommodation
Oral surgery
Pregnancy complications - cover for specified conditions
Rehabilitation – rehabilitation treatment following a stroke or serious brain injury.
Menopause Support
Weight loss and corrective surgery
The benefits listed here are provided by some but not all providers and are subject to the individual insurers terms and limits
Do I need to disclose medical information?
When setting up your private medical insurance, you face a decision regarding how pre-existing conditions are handled. You can usually opt for either 'moratorium underwriting' or 'full medical underwriting. It's important to understand the difference between the two so you can make an informed choice.
Pre-existing Conditions
Before delving into the underwriting types, let's define a 'pre-existing condition.' This refers to experiencing symptoms, receiving medication, advice, treatment, or diagnostic tests for any disease, illness, or injury before the policy start date, even if not officially diagnosed at the time.
Full Medical Underwriting
Opting for full medical underwriting entails completing a health questionnaire during the policy application process. You disclose any pre-existing conditions, and the provider may seek permission to obtain additional information from your GP. While pre-existing conditions are typically not covered, the provider, after assessing your questionnaire and doctor's input, outlines specific symptoms or conditions excluded from cover in your policy documents.
Accuracy in answering their questions is crucial. Providing a comprehensive health overview from the outset clarifies cover limits and expedites the claims process, given the provider's awareness of your medical history.
Moratorium Underwriting
This is the most popular underwriting type. Choosing moratorium underwriting means the provider doesn't require your medical history during the policy application. However, when you make a claim, they'll enquire about your medical history and may seek information from your GP. This ensures the provider understands whether the claim relates to a new or pre-existing condition, potentially extending the claims processing duration at the beginning.
Under moratorium underwriting, cover for pre-existing conditions depends on when symptoms or medical intervention occurred. Any pre existing condition within the five years preceding policy commencement can only be covered after two continuous years without medication, treatment, diagnostic tests, or advice for that condition.
Example:
Suppose you experienced right knee pain one year before starting the policy. Treatment for that condition isn't covered initially. You must wait two continuous years post-enrollment without any intervention for your right knee before cover kicks in. Any subsequent treatment within the initial two years restarts the waiting period.
Understanding these underwriting options allows you to make an informed decision tailored to your health history and preferences.
Medical History Disregarded
Only available for business healthcare and when the size of the scheme provides cover for a specific number of members. The provider will disregard all previous medical history but depending on the size of the scheme may impose some conditions for joiners with serious health conditions.
IMPORTANT
When setting up a group scheme it is normal to select Moratorium underwriting, simply due to the amount of time it could take to underwrite a business workforce.
Questions
What is the tax position on business healthcare?
Contributions towards company healthcare premiums are classed as a P11D benefit in kind. This means the person covered will pay tax on the value of the premiums being paid on their behalf.
The tax position for the business is that the cost is a tax deductible business expense.
What is covered by private medical insurance and what is not
Private medical insurance in the UK typically covers the costs of diagnosis and treatment for acute medical conditions, offering policyholders access to private hospitals and specialists for prompt care.
Acute conditions (conditions that can be fixed or treated successfully) characterised by sudden onset, are a primary focus of cover. However, chronic conditions, which are ongoing and often require long-term management, are generally not covered or may have limited cover.
Accident and Emergency treatment are not covered but ongoing treatment can be.
Pre-existing conditions may also be excluded. Additionally, elective treatments, cosmetic procedures, and experimental therapies are commonly not covered.
It's crucial for policyholders to thoroughly review policy terms and conditions, understanding the scope of coverage, waiting periods, and any applicable limits to ensure comprehensive healthcare protection. Our advisers at Optima Health and Life, will fully explain what exactly is covered on your policy.
It's worth noting that although illnesses such as cancer and heart disease can be classed as chronic, they are usually covered by private medical insurance, providing fast access to specialists, diagnostics and ultimate treatment. The speed of this healthcare can lead to much better patient outcomes as against languishing on a waiting list with a potentially worrying illness.
What is private health insurance and do you need it?
Private health insurance (also referred to as private medical insurance) gives you fast access to private healthcare and helps cover the cost of consultations, diagnostics, treatment and accommodation. everything from seeing a private doctor, to surgery and treatment.
Consider private health insurance if you want to: