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Private Medical Insurance : Types of cover

Channel Isles

The need

If you are lucky enough to live on one of the Channel Islands you have the same needs for medical treatment as those living on the UK mainland. Many standard Private Medical Insurance products will offer you much of what you need. But there are two extra factors for those living in Guernsey, Jersey and Sark:

  • for some medical treatment you will need to travel to or be taken to, the UK mainland, by air or sea
  • the Channel Islands each have their own unique laws and taxation systems

The solution

A few insurance providers have designed special policies for those living in the Channel Islands. They are adaptations of UK policies, to take into account the extra travelling and taxation systems. There are separate policies for Guernsey, Jersey and Sark.

Children

The need

Should your child fall ill you need the reassurance they will receive the best treatment available as soon as possible.

Although the NHS tries very hard to treat children as a priority, local resources are not always adequate.

The solution

Most private medical insurances either automatically or as an option, cover children.

But, some providers define children as 16 or under, some as 18 or under, some as 21 or under, and some under 25. All must live at home There is also usually a rule that they must be still in full time education.

A few private health schemes will offer cover only for children.

Private Medical Insurance for Schools

An increasing number of schools offer schemes where parents can buy cover for their children at the school. This is often at a lower price than individual policies could be bought.

Historically, school private health schemes were only offered by “public schools”. With an increasing number of independent schools of various types being created which have more autonomy than in the past, such insurances can be offered to these schools also.

If your child goes to such a school it may be worth enquiring if a scheme is in place.

If a school private health scheme is not in place, as both the school and parents could benefit financially, why not make the school aware of availability.

First Healthcare

No matter how carefully you look after the health of your children, you never know when an unexpected illness or injury may occur.

Private medical insurance allows you to take more control over where and when your child will be treated. However, many private health insurance plans only provide cover for your children if you have a policy yourself. That is why AXA PPP healthcare has developed First Healthcare, a private medical insurance policy specifically designed to provide cover just for your children.

How much will it cost?

Premiums for First Healthcare are £9.99 a month for the first child and £7.99 a month for each additional child.

How does First Healthcare work?

Eligible diagnostic tests that the specialist may need to carry out on an out-patient basis are covered and can also be carried out privately without delay.

The specialist may advise that your child requires further treatment such as an operation or tests in hospital as an in-patient or day-patient. If that treatment is not available on the NHS within six weeks of the date it should take place; your child will be able to receive that treatment privately. If your child then requires a related follow up consultation or treatment as an out-patient with the specialist or a clinical practitioner such as a physiotherapist, these are covered provided they are received within three months of eligible in-patient or day-patient treatment.

Choice of cover

Who needs a "choice of cover" plan?

We all have different wants and needs. What suits one person may be unsuitable for another. A single man may feel that pregnancy and maternity cover is irrelevant. A family may want to include the costs of parent accommodation if a child is ill. The number of variables is infinite. In looking for cheap medical insurance, each person or family has different budgetary needs for which a package can be designed.

What is a "choice of cover" plan?

Technology now allows individual medical insurance providers to offer more choice. There is usually, but not always, a core cover which everyone must have. Typically this will be most costs of in-patient and day-patient treatment. Helplines will usually be automatic too.

Each insurer and each product has its own range of choices, and there are many different ways of describing the main areas covered. Among those available are:

  • medical costs, as in-patient, out-patient and day-patient
  • hospital charges including accommodation costs
  • consultants and specialists fees
  • radiotherapy and chemotherapy
  • physiotherapy
  • psychiatric treatment
  • diagnostic tests
  • scans

Other benefits include:

  • nursing at home
  • private ambulance
  • recuperative care
  • complementary therapies
  • alternative medicines
  • chiropody
  • parent accommodation
  • dental surgery
  • pregnancy consultations and tests
  • overseas evacuation/repatriation
  • GP minor surgery
  • GP fees
  • health information and other helplines
  • GP advice line
  • permanent disablement
  • health screening
  • no claims discount
  • discounts at health clubs

Other insurances are:

  • health cash
  • dental cash
  • dental
  • critical illness
  • personal accident
  • travel

Some individual medical insurance policies offer full cover with no limits. As we look for cheap medical insurance, others will put limits on amounts paid per policy year, amounts paid per claim, limits on fees and procedures expressed in £s in total, per day or per week, or in number of days or weeks for which cover applies. There may be limitations on which hospitals can be used.

Cover for older people

Most leading PMI insurers have no done away with upper age limits.

Recent research shows that older people are getting healthier and more of us will live to 100.

With the ending of the default retirement age and economic restrictions, the idea of sudden total retirement for all at 65 or 60 has passed into history.

Many people in their sixties and seventies are as fit, if not fitter, than those thirty years younger. More want to work, full-time or part-time, for many years.

Inevitably, as we grow older, the body does not always do what it once did. Medical problems such as arthritis, heart condition, hernia and varicose veins, are more common.

For older people, many NHS charges are waived, and other health benefits such as fertility treatment or pregnancy are no longer relevant. But with the sea change in the NHS and the increase in personal responsibility, older people can no longer expect so much for free.

On health insurance, some insurers do not charge more for older people, but most do.

As well as the normal private health insurance market and limited cover schemes; it is worth older people looking at those insurers that have a specialist offering.

Hospital treatment plans

Where do hospital treatment plans fit in?

If you pay for your own healthcare without insurance, you benefit financially from arranging cheaper treatment in the UK or overseas. If you buy insurance, the insurer benefits from any costs savings. Costs savings are often related to which hospital or consultant is used, and insurers may not allow the customer to choose this. If you find the NHS can give as good or better treatment than privately, the only beneficiary of this is the insurer.

The approach

An insurance which pays out for almost any treatment needed. The customer decides when and where treatment is carried out, and whether it is private or NHS. The customer gets a fixed sum.

Limited cover

Who is a limited cover scheme for?

Some people cannot afford a full cover private medical insurance, but want the basic costs of private health care covered. Others feel that the NHS will offer adequate treatment for anything major that goes wrong, so only want to protect themselves for certain long term diseases. Another group is those who do not see why they should pay for a policy with screening, health cash, helplines and lots of extras that they are unlikely to use.

What kinds of limited cover scheme are there?

Various limited cover private medical insurances, often called "budget" policies can meet the needs of those who, for whatever reason, do not want a full cover.

There is no standard policy, so each insurer differs on what they cover, what extras they include/exclude, and whether or not the limited cover also has high excesses (the amount the customer pays for any treatment) as well.

Membership plans

Membership plans are not private medical insurance as such.

There are different versions around. Some are where people club together to buy access to hospitals and other services, so you get some treatment for your membership fee.

Others are commercial organisations which help you arrange private treatment but which do not include any treatment or health service within the fee.

Package products

The need for package products

Providing a pre-set package of benefits and limits keeps costs down for insurers and makes it easier for customers to buy a product. Insurers use their knowledge to decide what is best for the average person or family. A particular package may or may not be the best solution for you.

The approach

A packaged policy means that you have no choice on what covers or benefits you can include or exclude. There may be limited choices such as how high the excess is (the amount you pay). Some insurers offer a range of packages to suit different budgets.

What's in a package

There is no such thing as a standard package. Each provider has their own ideas, and often has a range to choose from. As well as private medical costs, policies often include automatically, or offer as an option, related health and other insurances.

The main items likely to be covered include:

  • medical costs as in-patient, out-patient and day-patient
  • hospital charges including accommodation costs
  • consultants and specialists fees
  • radiotherapy and chemotherapy
  • physiotherapy
  • psychiatric treatment
  • diagnostic tests
  • scans

Other benefits include:

  • nursing at home
  • private ambulance
  • recuperative care
  • complementary therapies
  • alternative medicines
  • chiropody
  • parent accommodation
  • dental surgery
  • pregnancy consultations and tests
  • overseas evacuation/repatriation
  • GP minor surgery
  • GP fees
  • health information and other helplines
  • GP advice line
  • health screening
  • no claims discount
  • discounts at health clubs

Other insurances are:

  • health cash
  • dental cash
  • dental
  • critical illness
  • personal accident
  • travel

Some policies offer full cover with no limits. Others will put limits on amounts paid per policy year, amounts paid per claim, limits on fees and procedures expressed in £s in total, per day or per week, or in number of days or weeks for which cover applies. There may be limitations on which hospitals can be used.

Private treatment overseas

The need

On a conventional Private Medical Insurance you can only get treated in the UK and even then you may be limited to a number of hospitals chosen by the insurer.

In the last decade, medical inflation and claims costs has meant that the traditional full-cover package has become unaffordable for many families.

The alternative of choice of cover policies does mean that you have to second-guess what type of medical problem you may get in the future.

The problem

Thousands of Brits go overseas for dental and medical treatment as even after travel and other costs are included, it is cheaper than private treatment in the UK.

But insurers have been very wary of and antagonistic to allowing people to go abroad. For the handful of insurers who allow it, all arrangements have to be made by the customer and payment recouped afterwards.

A problem with self-selection is that few people know which is a ‘good’ hospital that treats overseas patients well, and which is a ‘bad’ hospital that does not speak or understand English well, and where customer service for overseas visitors is invisible. And then there is the problem of arranging travel and accommodation for the patient, often with a companion. Other problems relate to aftercare and pre-treatment care.

The solution

Private treatment overseas packages only cover treatment in selected overseas hospitals.

They combine private diagnosis in the UK with private medical treatment overseas, along with all travel, accommodation and support-the latter arranged by specialist concierge services.

The beauty of this new cover is that it allows everybody to do what they do best; overseas hospitals (private care at affordable prices) concierge services (arranging travel, accommodation and support) and diagnosis in the UK (specialist organisations).

Self pay

An increasing number of people want to pay for their own private healthcare without having any insurance, funding it from savings or loans.

Many hospitals now offer self pay packages so you know in advance what you will be charged.

But deciding where to go and if you are getting a good deal is far from easy.

The solution

There are companies, including health insurers, who can use their expertise to guide you.

Shared risk

Many people feel they neither need nor can afford a private medical insurance covering virtually everything. They are wary of choosing a limited risk, wanting to protect some treatments that a limited cover policy does not, or not cover treatments which a limited risk cover does. It is all about personal choice.

The approach

Most private medical insurance policies have an excess, the amount of the claim that you pay yourself. The first solution is to see if your insurer will reduce the costs if the excess is increased. The amounts on offer vary, but can be up to £1,000.

An alternative is to select a High Excess policy which only offers a high excess. Typically the excesses on offer are £1,000, £2,500, £3,000, and £5,000. Some policies limit the total amount you could be asked to pay in one year.

Another alternative is a Shared Responsibility cover. You pay a percentage of the treatment costs yourself. Typically this can be between 25% and 75% of costs. The more you pay, the lower the premium. Usually there is a £ limit on how much you can be expected to pay in one year.

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