Private Health Insurance GUIDE

All About Private Health Insurance (PMI)

Welcome to the Usay Compare Guide to Health Insurance. This section of the site is intended for those who have a basic knowledge about Private Medical Insurance (PMI), but want to go a little deeper.

We like to give our customers the best level of knowledge we can – knowledge is power, after all. This section is designed to aid in this task, in order to give you more detailed knowledge of PMI products and policies.

Please note - the terms "Health Insurance", "Medical Insurance", "Private Medical Insurance" and "Private Health Care" are interchangeable in the health insurance industry, and have an identical meaning. In this guide we refer to it as PMI (Private Medical Insurance).


Introduction To PMI

PMI is an insurance product designed to provide fast and effective medical treatment outside of the UK's NHS. When you decide to take out a policy, you and the insurer agree that should you fall ill or suffer an injury, the PMI policy will attempt to return you to the same level of health you had when you took out the policy.

PMI has a number of great benefits; perhaps the main practical one being that you get immediate treatment privately for covered conditions, rather than waiting weeks or months on the NHS.

PMI does not pay out a lump sum; instead it pays directly for diagnostics and treatment at a private hospital.

Over 4 million people in the UK today have opted for a PMI policy; many of those people have bought through us. Read through our Guide below; if you have any questions, please get in touch.


How To Get PMI

There are three main ways to buy health insurance:

  • Direct from an insurer
  • Through a broker or intermediary
  • Though a financial adviser (IFA)

All of these methods have their advantages and disadvantages. Being the leading PMI intermediary in the UK, we naturally think that our method is the best way to go…here’s why…

Buying from an intermediary means you are comparing a large part of the market and have access to different insurer policies and prices.

People sometimes get confused between a broker and an intermediary - the simplest way to explain this difference is to say that a broker will charge the client for their services, and an intermediary will be paid a commission directly by the insurer. By using an intermediary, your premiums will remain the same as when you go direct to an insurer as the intermediary provides their service completely free of charge.

With an intermediary like Usay Compare, you also have access to the UK's leading insurers like Aviva, Bupa, Axa, and Vitality so we can help you find the perfect policy tailored to your needs.

If you came to this PMI Guide looking for health insurance fee guidelines, or a guide to health insurance prices, then we would recommend you get in touch; we cannot answer these sort of queries in a guide like this. The reason for this is that the pricing of PMI policies is not always straightforward - each policy is completely tailored to your personal circumstances.

What Makes Up A PMI Policy?

A Private Medical Insurance (PMI) policy contains 2 main elements – the core cover that comes as standard provided by the insurer; and then add-ons - these are extras that cost more, but add features to your core policy and enhance your level of cover.


Tailoring Your Policy

Once you have established which insurer will provide your core cover, you can then choose to limit some benefits and reduce your policy’s premium. You may also consider adding on additional modules for additional cover at an increased premium. Health Insurance policies can be tailored to a large degree to suit your specific needs.


What Is Covered?

All PMI products contain In and Day-Patient Cover and the majority of products also include Out-Patient Cover. This makes up your basic policy/health plan.

Core Cover includes:

  • In-Patient cover - In-patient cover refers to when you are admitted to hospital and stay in a hospital bed overnight. Cover includes hospital accommodation charges, specialist fees such as consultants, surgeons and anaesthetists, diagnostic tests and scans such as CT, PET or MRI plus X-rays or physiological tests. Some insurers can also offer additional benefits, such as physiotherapy.
  • Day-Patient cover - Day-patient cover refers to when you are admitted to hospital and discharged the same day. Cover is identical to your In-Patient cover.
  • Out Patient cover - Out-Patient cover refers to when you are required to visit a hospital and return home the same day without being admitted, ie you are not given a hospital bed. You can choose to remove this cover, limit it, or choose a fully comprehensive option. If you choose to limit your outpatient cover, the options range from £500 to £1,500.
    Included in Out-patient cover; costs for consultations, diagnostic scans/tests and some minor surgical procedures. Some insurers will also include physiotherapy within this cover.

Core Cover Options

  • Hospital Lists - All insurers have their approved hospitals that you can choose to use. They split these up into lists and can either increase or reduce your premiums depending on what hospital(s) you want. Prestigious London hospitals tend to be included in the enhanced hospital lists, while others elsewhere in the country tend to be on the standard lists. If you have a preferred hospital, we can tell you what is available.
  • No Claims Discount (NCD) - the level of NCD will vary according to whether you currently have PMI or not. If you have, then your claims history will be taken into account, and you may get a different NCD than someone who is new to PMI. Once the policy has started, should a claim be made your NCD will reduce. This reduction is made according to each insurers own scale. If no claim is made in a policy year then your NCD will increase.
  • Six Week Option - Choosing the 6 week option means that should your treatment be available on the NHS within 6 weeks then you must use the NHS. However if not, the policy will give you immediate access to private hospital facilities. The 6 week option is a great way to reduce your premiums.
  • Excess - if you choose an excess level you will be responsible for the first part of the claim. These can range from £100-£5000. Most excess’ are offered per person per year however some insurers offer excess’ for each claim which again reduces the premiums to be paid.

Add-on Modules

Travel - this add-on will include the same features as a standalone travel policy; examples include missed or delayed flights, loss of travel money and passport, legal protection and some winter sports. More importantly the cover will include medical emergencies whilst abroad.

Dentist - this add-on will offer specific cover for general dental treatments - crowns, fillings, accidental damage and cover for dental emergencies. Alternatively you can opt for a more general level of cover which will offer some general dental costs.

Optical - this add-on will offer money towards the annual costs relating to eye tests and replacement glasses or contact lenses (usually provided there has been a change in prescription). Alternatively you can opt for a more general level of cover which will offer some general optical costs.

Psychiatric - this add-on will allow diagnosis and treatment for most mental health issues. This does vary from insurer to insurer however cover will usually include access to In, Day and Out-Patient Treatments.

Therapies - this add-on offers physiotherapy, osteopathy and chiropractic treatment and may include other holistic therapies.

Cancer Cover

When selecting what level of cancer cover you would like, each insurer has different options. These options are generally;


  • Included in core cover; here your diagnosis will be covered by your out-patient limits and treatment will be covered by your in and day-patient cover.
  • Full Cancer Cover Add-On – this will cover all diagnosis and treatments of cancer without limits.
  • Advanced Cancer Drugs – this will give you access to expensive drugs not normally available via the NHS and in some cases experimental trial drugs that have been shown effective in treatments. You will receive all diagnosis and other treatments via NHS.
  • Nil – if you don’t want any level of cancer cover.

Cancer Diagnosis

Provided you have cancer cover in core or as an add-on, you would be able to have CT, PET, MRI scans and any specialist consultations. Once you’ve received a diagnosis you can then begin to receive treatment under your policy.


Cancer Treatment

Your policy will cover all in and day-patient treatment, chemotherapy, radiotherapy and out-patient consultants in full. This means that whether you need an operation, or the latest drugs and radiotherapy treatment, your insurer will cover these costs. The good news is that even if you’ve opted to reduce your out-patient cover, when it comes to cancer treatments your insurer will generally remove your limitations and cover you in full.


For more information - please read our comprehensive guide to find out more about cancer health insurance.


Conditions No Insurer Will Cover - "Exclusions"

There are certain situations and conditions that no insurer will cover you as a matter of course; these are called exclusions. Some of these are:

  • War
  • Elective Cosmetic Surgery
  • HIV/Aids
  • Dangerous sports
  • Chronic conditions
  • Pre-existing conditions

Conditions No Insurer Will Cover - "Chronic Conditions"

No insurer will cover anything they class as a chronic condition. This is a condition which has no known cure, and causes recurring symptoms and potentially requires daily medication to control it. Diabetes is such an example of a Chronic Condition.

If you develop a chronic condition whilst insured, the insurer will cover the diagnosis and initial treatment until the condition is stabilised and you are able to receive regular medication from the NHS.


Underwriting

So that’s the basics - here’s the more complicated side of Private Health Insurance - Underwriting. There are two main types of underwriting - Moratorium (Mori) and Full Medical Underwriting (FMU).

Moratorium
Moratorium Underwriting does not require you to disclose your medical history, in short, anything you have had symptoms, treatment, medication, diagnostic tests or advice on in the 5 years prior to the policy start date is automatically excluded from cover for the first 2 years of the policy. If after a 2 year consecutive period you meet certain criteria (usually this includes remaining symptom, treatment, medication or advice free from that condition), then it will become eligible for cover.

This form of underwriting offers the potential for pre-existing conditions to eventually be covered and we can set up a moratorium policy over the telephone for immediate cover.

Full Medical Underwriting
Full Medical Underwriting requires a full application form with full medical history to be completed for everyone to be covered by the policy. These disclosures may mean that the insurer excludes certain conditions from cover for the lifetime of the policy.

Renewal/Switch
After 12 months, your policy will come up for Renewal. You can renew with the same Provider, or Switch to another insurer. This Switch process is something we specialise in; we compare our panel of leading insurers to find you the best deal, even if you did not take your original policy out with us.

If you have a policy in place currently it may be possible to continue ("Switch") your policy with a new provider. Each insurer has their own Switch eligibility criteria, but generally these include; not making a claim within the last 12 months, and have no ongoing symptoms, treatments or diagnostics, or anything planned or pending. There may be other criteria but don’t worry we can guide your through the process. Taking advantage of switch terms means that any conditions that are currently covered by your existing policy may also be covered by your new policy, ensuring continuous cover.

So that’s our quick Guide to Private Medical Insurance. We hope that the Guide has answered many of your questions about PMI, if you have any other questions please get in touch, we are more than happy to provide a free, no obligation quote for you.

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