Individual Private Medical Insurance

Having health insurance means that some – or all – of the cost of private healthcare treatment will be covered if you’re ill or injured. Without medical insurance, private healthcare can be costly. Individual private medical insurance can cover you, you and your partner or you can choose a family cover. It is paid for by the individual usually by monthly instalments, but discounts are sometimes available if you pay the full annual premium in one lump sum.

Health insurance gives you access to fast-track appointments at a private hospital at a time convenient to you. It covers the cost of your GP referred consultations, diagnosis and treatment for acute conditions (conditions that are treatable). 

Chronic Conditions

Your insurer will typically not cover the long-term treatment of ‘chronic conditions’. These are diseases, illnesses or injuries that have one or more of the following characteristics:

  • It needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests.

  • It needs ongoing or long-term control or relief of symptoms

  • It continues indefinitely

  • It comes back or is likely to come back

  • You need to be rehabilitated or specifically trained to cope with it

  • It has no known cure

A chronic example would be something like Asthma. The day-to-day management of asthma or other chronic conditions like osteoporosis, will not be covered under your PMI policy.

So, while the costs of routine long-term treatment and monitoring of illnesses such as asthma will not be claimable, it’s important to note that acute flare-ups of chronic conditions may be covered. This will depend on the terms of your policy and underwriting.

Emergency Treatment

Private hospitals do not treat emergencies and so if you were to need immediate treatment you would need to go to the nearest A & E department. Once you have sought immediate treatment you can then access your insurance cover, if it is appropriate for you to be moved to a private hospital some insurances will cover a private ambulance. Cover will not include cover for pregnancy or childbirth, however, complications due to pregnancy or childbirth can sometimes be covered.

Direct Payment


The cost of treatment and hospital stay is paid directly by the insurer to the private hospital. Outpatient cover can be covered in full or limited to a set amount.

Hospital Lists


There are multiple- insurers in the marketplace that provide Individual Private Medical insurance with varying levels of cover and different hospital lists to choose from. Independent private hospitals work with all health insurance providers but are not owned by insurance companies. Hospital lists become important when you have members that are likely to need to access London hospitals as the fees charged by London hospitals are significantly higher.

Excess

You can apply an excess to your private medical insurance, this typically is a one-off excess and is applied per policy year, not per claim. It is worth checking this. By applying an excess to your policy the insurer will view this as less of a risk and so offer a discounted premium.

Underwriting

Underwriting is what sits behind the policy and dictates what can and can’t be claimed on the policy. For new policies moratorium underwriting is very popular as no medical questionnaire is needed. It typically applies a blanket rule that means that every member on the policy will not be covered for pre-existing conditions they have had in the last 5 years before the cover start date. Once you have been free of symptoms and have not had treatment or check-ups associated with that condition and been on the policy with no break in cover for 2 years - you may then be covered. *subject to the terms and conditions of the policy.

It is important that if you are thinking of changing providers you do so on the basis that the underwriting is continued over onto the new insurance policy as changing provider should not negatively impact the members.

What Are The Benefits Of Individual Private Medical Insurance

You'll typically have a wider choice of treatment options. Fast track appointments mean that you will be able to bypass potentially long waiting times. Also, for your comfort you'll get access to better hospital accommodation- a private room and ensuite facilities.  More choice at mealtimes and also flexibility in visiting hours.

How To Get Individual Private Medical Insurance

Individual private medical insurance can be purchased directly with an insurer. You can potentially get several quotes online or over the phone from several different individual insurers. You could also choose to use an intermediary (broker) to do the work for you.

A health insurance specialist will, following a consultation establish the requirements and needs of the individual. They will then take the time to request the appropriate product cover, receiving multiple quotes from various providers to provide you with a market report. They will be able to use the market feedback to negotiate the premiums.

Pegasus Benefits will explain in simple terms the differences between the different products and will provide you with their recommendation. It is also very important that the broker explains in detail what your underwriting options are.