What is health insurance, and why do I need it?

Millions of people across the UK have a private health insurance policy, but what exactly is it, and why would you need it?
17 July 2017

What is health insurance?

Health insurance, or private medical insurance, was created to make sure that if you develop any kind of medical condition, you can receive treatment, check-ups or specialist facilities that wouldn’t usually be available. You also won’t need to pay for your treatment or deal with any NHS waiting lists.

Your health insurance provider will ensure you are quickly diagnosed by a specialist, and treatment will be arranged at a conveniently located private hospital, at a time of your choosing.

What is included in my cover?

Full Medical Underwriting

Generally there are two main types of cover. The first is with full medical underwriting. This means you are required to disclose your full medical history when you apply for a policy. Your doctor may be contacted in order to verify this. Most insurers will only offer full medical underwriting to customers who are over the age of 75.

Moratorium Underwriting

The second kind of cover is with moratorium underwriting. This means that you are not initially covered for any pre-existing medical conditions over a period of time that your insurer will specify – usually 2 – 5 years.

After a set period of time, you may then be covered for these conditions as part of the terms of your policy. If you have any pre-existing conditions, make sure you ask any insurers at what point you will be covered for these issues.

Inpatient Treatment

The vast majority of health insurance policies cover inpatient treatment, which means once your cover has been arranged you will be able to stay overnight in a hospital for one night or more.

You will be able to choose a private hospital room, from a pre-approved list of hospitals which your insurer can provide. All fees, tests, treatments and the cost of your stay will be covered by your policy.

Outpatient Treatment

Some policies cover outpatient treatment, which is where you may need to see a consultant or specialist that doesn’t require an overnight stay in a hospital. This often means smaller procedures or treatments such as acupuncture or physiotherapy where you aren’t required to stay overnight in a hospital. This also includes specialist consultants, radiotherapy, chemotherapy and other tests and scans that may be required to complete a diagnostic.

Outpatient treatment is not often automatically covered on many health insurance policies so if you want to be covered for this ensure you ask your provider when setting up your policy.

How to make a claim

If you are unwell and have been advised to see a specialist by your GP, the first thing you should do is contact your health insurance provider. Once you have gotten in touch, you should confirm with your provider whether your specialist appointment is covered by your private medical insurance policy.

If you subsequently require any additional procedures or tests, contact your provider to update them on the status of your treatment, and check that you are covered.

You shouldn’t be sent any bills from specialist checks and treatments, the costs will normally be settled by your health insurance provider directly.

If there is an excess on your policy you will normally be required to pay this directly to the hospital.

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