Private Medical Insurance, PMI or some call it Health Insurance but it’s all the same thing, it provides cover for acute conditions at private hospitals.
The benefits of buying Private Health Insurance:
Avoid long waiting lists
Choice of consultant
Choice of hospital
Access to drugs to you may not get on the NHS (eg. Cancer drugs)
There are various ways of setting up Private Health Insurance policies based on what your need is for but overall all providers offer cover for inpatient treatment as standard; depending on how comprehensive your policy is, you may also have outpatient treatment covered.
What is the different between inpatient and outpatient?
The majority of Health Insurance policies cover inpatient treatment as standard.
This involves an overnight stay in hospital. Day patient cover, falls under the category of inpatient cover, generally involves minor operations where you have a hospital room but are discharged the same day.
Outpatient treatment is an additional benefit making your Health Insurance policy more comprehensive. There are various levels of outpatient treatment, it can be covered in full, up to a set limit, or excluded. Outpatient treatment makes up treatment that doesn’t not require a hospital bed, treatment in the outpatient facility of a hospital such as diagnostic tests, consultations with a medical consultant or sessions of physiotherapy.
There is often confusion that a health insurance policy will cover all events of illness; Health Insurance covers acute rather than chronic conditions.
The difference between chronic and acute conditions is that acute conditions can be cured with treatment, but chronic conditions are ongoing and need regular monitoring or maintenance.
Examples of Acute conditions:
Chronic conditions include:
High blood pressure (hypotension)
Acute illnesses may lead to chronic illnesses, in which case an insurer would pay up to the diagnosis and then once defined as a chronic condition a health insurance provider won’t pay for the ongoing care for that chronic condition.
Choosing the right benefits for your Health Insurance
If you are on a budget, then you may look at in inpatient-only Health Insurance plan, this would be priced competitively however in order to access inpatient treatment you would have to use the NHS for the initial investigations and this could delay your treatment and potentially your condition could worsen while you wait.
A Full Cover or Comprehensive Health Insurance policy tends to have inpatient cover and outpatient cover. You tend to see more claims in the outpatient area of Health Insurance; hence why adding outpatient cover can have such an impact on the premium.
There are varying levels of outpatient cover you can access from £500 per person, per year to full cover, the higher the benefit limit the more it will increase the premium.
Additional Health Insurance benefits
Health Insurance providers tend to have a ‘core cover’ and then a number of additional cover options, most provider will enable you to tailor the plan to your needs.
The additional cover options include:
Therapies cover doesn’t tend to be covered as standard therefore would be an additional cost.
The main four therapies covered by Medical Insurance providers are:
Mental Health Conditions
Some Health Insurance policies cover psychiatric treatment as standard, but for most it will be an optional add-on to the policy.
The amount of treatment will be in line with a benefit limit and often split into inpatient treatment and outpatient.
The limit can be a set cost limit or a day limit of how many days the insured can spend in an inpatient facility.
Some providers also have a focus on preventive mental illness, with the use of wellbeing tools.
Dental and Optical Care
Not something that is typically standard with Health Insurance, but there are options to include dental care will depend on your provider and the terms and conditions of the policy.
The majority of providers cover emergency dentistry, as the result of an accident or common dental cover is oral surgery, such as removal of wisdom teeth.
Routine Dental – which would cover you for everyday dentistry such as checkups, filings and crowns – is an optional added extra to PMI.
The same is true for optical care. While surgery to remove cataracts would be covered by most PMI policies, everyday eye care (checkups and glasses etc.) are not typically covered unless you choose an add-on.
Exclusions – what doesn’t Health Insurance cover
UK health insurance is not designed to provide all medical treatment. Some of the things PMI won’t cover include:
Ongoing management and treatment of chronic conditions
Treatment required as a result of war, terrorism, contamination with radioactivity etc.
Normal pregnancy and childbirth
Treatment for alcoholism/other substance abuse issues.
These are what you would call General Scheme Exclusions which will vary from provider to provider.
There is a lot to think about when looking at taking PMI cover which is why it’s worth getting an expert opinion. We work with you to understand your needs and then build a plan to suit them and your budget to ensure you get the most of out it.
For help and advice, get in touch today.