Private medical insurers have until December 2007 to adopt standard case studies into their private medical insurance leaflets.
These case studies use real life examples.
Each case study explains what happened, and what the insurer paid for
Insurers will have to use the case studies, and comment on how their policy or policies would have responded to the claim.
Most of the case studies concentrate on chronic conditions such as angina and heart disease, asthma, cancer, diabetes, and hip pain.
The aim is to help consumers to compare products using almost real-life scenarios.
One case study on chronic conditions relates to angina and heart disease, and states: “Alan has been with INSURER X for many years. He develops chest pains and is referred by his GP to a specialist. He has a number of investigations and is diagnosed as suffering from angina. Alan is placed on medication to control his symptoms.”
Insurers must include this example in their leaflets, followed by their response explaining how they would insure the individual when faced with this scenario.
Insurers must also explain on chronic conditions:
What is a chronic condition?
What does this mean in practice? What if your condition gets worse?
Insurers must also use common definitions in their leaflets for acute condition, chronic condition, day-patient treatment, diagnostic tests, in-patient treatment, out-patient treatment, pre-existing condition, qualified nurse, and treatment.