Understanding Private Health Insurance And How It Works In The UK

If you have experienced delays in receiving treatment for a medical condition from the National Health Service (NHS), you may wish to consider taking out a private health insurance policy, which can also be known as medical insurance.

Private health insurance is just what the doctor ordered if you want to beat waiting lists for planned medical treatments.

A private health insurance policy works by enabling you, and possibly your immediate family as well, to use a private healthcare provider if the NHS is not able to treat your condition within a timescale that suits your needs.

Depending on the type of policy you buy, your health insurance will cover the costs of your private treatment. 'Going private' using health insurance often not only results in swifter treatment, but also removes the stress of having to pay high private medical bills.

The cover – sometimes called private medical insurance or PMI – fast tracks patients away from National Health waiting list for speedy consultations and treatment with top Doctors.

So what are the benefit of paying for private health cover in a country which is the envy of the world and a model for providing free treatment?

Why Choose Private Health Insurance?

The NHS delivers world class and urgent treatment for many life-threatening medical conditions. However, the NHS often lacks the resources to promptly treat many commonplace conditions that, although not critical, may still cause you considerable distress and discomfort.

Health insurance will allow you to seek treatment in the private sector much sooner than may be possible in the public sector. You may also find some drugs are available privately that are not available on the NHS, because they have been deemed too expensive to provide.

You may also prefer to be treated at a time and location that suits your needs, which may not be possible at your nearest NHS hospital or clinic. A private health insurance policy makes this both possible and affordable.

Should the treatment for your medical condition require an overnight stay, you will find that, unlike the NHS, you may have a private room. The quality of non-medical services during your stay can often help you to recover faster.

What Does Private Health Insurance Cover?

This varies between providers, so you should always read the terms and conditions of your policy to make sure any specific condition you want treated are actually included.

In general, private health insurance covers ‘acute' rather than ‘chronic' conditions.

Chronic conditions are long-term, like osteoporosis, while acute conditions are sudden, like broken bones and can usually be 'corrected' with a planned medical intervention.

Private Medical Insurance does not replace the need for the NHS emergency services.

Cover can include consultations with Doctors, tests and scans, hospital treatment, nursing and out-patient visits.

Types Of Private Medical Cover Underwriting

Private medical cover underwriting comes in two types:

Moratorium – No need for an upfront medical or other investigation – but existing conditions will certainly be excluded for a period of time and will require you to be incident free, usually for at least two years, before the Insurer will pay for treatment for any existing condition.

Fully underwritten – This policy involves disclosing your medical history to opt for the conditions you want to cover. Pre-existing conditions are normally excluded.

Watch out for limits on treating mental conditions like depression, eating disorders or sleep problems, especially if treatment involves counselling.

Some comprehensive policies will include extras like alternative therapies.

What's Excluded From Private Health Care?

The important issue is pre-existing conditions. You should discuss this with your provider to make sure you understand what's covered.

Otherwise, expect to go to a NHS hospital for accidents and emergencies. Once your condition is stabilised, the doctor can refer you on for private treatment.

Other key exclusions include non-curable illnesses, some mental health issues and addictions.

How Does Private Health Insurance Work: The Costs

The cost of your private healthcare insurance will vary according to your age, lifestyle and whether you have any pre-existing medical conditions. Costs are also influenced by whether your policy also covers your spouse or partner and children.

To apply for a private healthcare insurance policy, you typically complete a detailed application that asks about your age, lifestyle and health. Depending on what you include in your application, you may also be asked to undergo tests and a medical examination by a doctor.

Your application, and any test and medical results, are assessed by a specialist medical insurance expert – a medical underwriter. They will decide on what your healthcare insurance will cover and the premiums, or the amount you would pay, usually monthly, for the insurance.

What Medical Costs Private Health Insurance Covers, And What Costs It Doesn't

Your private health insurance will work by paying the private healthcare provider directly for the treatment of a wide range of illnesses or conditions. There are also commonplace exclusions, such as pregnancy and long-term, chronic conditions such as asthma and diabetes.

If you have a pre-existing medical condition, or are in what is considered to be a high-risk group such as a smoker, you may find your premiums are higher as a result, or that related conditions are not covered by the policy at all.

You may be able to choose to reduce your premiums by excluding pre-existing conditions. If you later choose private treatment for an excluded condition, you would have to pay the costs yourself, as they would not be paid for by your insurer.

Because of the variation in cover, when applying for private health insurance make sure you check exactly how it works with each service provider, so that you know you have the right cover for you and your family.