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 Health insurance guide
Health insurance is designed to cover the cost of private medical treatment for illnesses and injuries that are curable and short term.To help you decide if it's right for you, our health insurance guide explains how it works in more detail.

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Health insurance explained

To help you decide if health insurance is right for you, we've compiled a short guide that explains what it is and how it works.

What is health insurance?
Health insurance is designed to cover the cost of private medical treatment for illnesses or injuries that are curable and short term (also known as ‘acute conditions’). Although a health insurance policy won't make such events any less stressful or upsetting, it can provide valuable peace of mind that specialist treatment will be available promptly, often at a hospital of your choice.

Remember! Health insurance is not designed to replace all NHS services as some services are outside the scope of private hospitals e.g. Accident and Emergency and GP services.

What’s the difference between ‘health insurance’ and ‘private medical insurance’?
There’s no difference other than in the name. Private medical insurance is also commonly referred to by its abbreviated form – PMI.

What does health insurance cover?
There are a wide variety of health insurance policies available, ranging from budget policies offering a limited range of benefits to higher priced policies offering much more extensive cover. Depending on the individual policy cover may be available for:

Out-patient treatments

Diagnosis, investigations, consultations or treatments that do not require the patient to be hospitalised overnight. Out-patient treatment usually includes consultation with specialist, diagnostic tests, radiotherapy / chemotherapy, physiotherapy and psychiatry.

Day-patient treatments

Day-patient treatments often require the patient to attend a hospital or clinic on a regular basis or for a period that lasts at least half a day without requiring them to be hospitalised.

In-patient treatments

In-patient treatment requires the patient to be hospitalised for one or more nights. In-patient treatment usually includes hospital charges, specialist / consultant fees, diagnostic tests, psychiatry and physiotherapy.

As a private patient you will usually have the privacy of an en-suite room along with other comforts, such as a television and telephone.

Remember! Some insurers do not make a distinction between out-patient and day-patient treatment, instead preferring to split the type of treatment into in-patient and out-patient treatments only. Cover can vary significantly between providers, so it's important to check exactly what level of cover you are getting from a policy before you buy.

What isn’t covered by a health insurance policy?
Health insurance usually does not provide cover for:

Chronic conditions i.e. those that cannot be cured
GP services
Accident and emergency admissions.
Pre-existing conditions i.e. a health condition or medical problem that was diagnosed or treated before the insurance policy was taken out.
What are exclusions?
An exclusion is a circumstance of event – such as a particular condition or treatment – that can prevent or invalidate a claim e.g. drug abuse, self-inflicted injuries, infertility, cosmetic surgery, preventative treatment, mobility aids, etc.

Remember! Always check the policy documents for a full list of policy exclusions.

What is an excess?
An excess is the contribution you agree to pay towards any claim. The excess is split into two different types, compulsory excess and voluntary excess.

Compulsory excess

This is the amount your insurance company requires that you pay towards any claim made on your policy. Normally it is deducted from the settlement made to you.

Voluntary excess

This is the amount you agree to pay towards the claim in addition to the compulsory excess. You agree this at the start of the policy; the higher the excess the lower your premium will be.

Depending on the insurance company, you may be able to opt for a no-excess policy. This means that you will not be required to contribute towards a claim, although the cost of the policy will increase as a result.

In the next part of our guide we look at arranging health insurance in more detail.
Arranging health insurance

Arranging health insurance can provide peace of mind in the event that you fall ill or are injured, so knowing what to look for when you compare policies is the key to getting the right cover for your needs.

What should I look for when I buy a policy?
When comparing policies you’ll need to consider:

Whether you want the policy to include access to a specialist as an out-patient – budget policies normally only provide cover for in-patient treatments.
Whether you’d like a choice of hospitals rather than access to a limited selection chosen by your insurance company.
Who you’d like to cover i.e. yourself only; yourself and your spouse or partner; or yourself and your family.
Whether you want cover for alternative therapies, for example acupuncture.
Whether you’d like access to additional benefits, such as nursing at home, a private ambulance, etc.
Whether you’d be willing to receive NHS treatment where it is available within 6-12 weeks.
What grade of hospital accommodation you’d prefer.
The cost of the policy will depend on the choices you make.

What other factors affect the cost of a health insurance policy?
Insurers will ask you whether you are a smoker – if you are then you will normally pay more for the policy than a non-smoker as tobacco use has proven links to conditions such as lung and throat cancer.

Insurers will also look at your age when calculating the cost of your policy. This is because people are more likely to need medical treatment as they get older.

Some insurers will allow you to choose from a range of excess amounts when you take out the policy (the excess is your contribution towards the claim); the higher you set the excess, the cheaper your premiums are likely to be. However, remember to always set the excess at an amount you can comfortably afford should you need to make a claim.

Will my premiums stay the same for the duration of the policy?
Whichever policy you choose, it is likely that your premiums will increase on an annual basis. This is because more people are claiming on their health insurance policies each year with some treatments now becoming routine e.g. hip replacements in older people (Source: Association of British Insurers). Similarly, as you get older your insurer will normally increase your premiums to reflect the fact that you are more likely to require medical treatment.

In addition, the advances in medicine mean that the complexity of tests and treatments is increasing, with more hospitals having access to sophisticated equipment and specialist staff – both of which come at a cost. To support these developments, insurers need to review the cost of the policies they offer.

Remember! If you stop paying your premiums your cover will stop.

Will I need to provide details of my medical history?
When you make a health insurance application the insurance company may accept it based on either a medical history declaration or ‘moratorium’.

Medical history declaration

If the insurer requests that you complete a medical history declaration then you will need to fill in a form giving full details of your medical history; this may result in the insurer requesting a medical report or Doctor’s letter.


Instead of asking you to provide details of your medical history the insurer will simply exclude cover for any pre-existing conditions, usually those that occurred within the past five years. Depending on the insurer, these conditions may become eligible for cover in the future providing that you have not had any symptoms or received treatment or advice for a continuous period. Some conditions will be classed as ‘chronic conditions’ and as a result they will never be covered.

What if I am disabled?
If you are disabled then you will still be eligible for cover, however in line with their stance on pre- existing medical conditions the insurer is within its rights to exclude cover for treatments that directly result from your disability.

Remember! Always declare all relevant information about your disability, that way the insurer can make an informed decision when underwriting the policy. Failure to do so could invalidate your right to make a claim.

For more information on insurance for disabled people, call the Association of British Insurers on 020 7600 3333 and ask for their information sheet ‘Insurance for disabled people’.

Where can I buy a health insurance policy?
You can buy a health insurance policy through a financial advisor, bank, building society or insurance company.

By using an online comparison site you can compare quotes from a number of different insurance companies with one search. This enables you to compare prices and see what is included in each policy before you buy, enabling you to find the right level of cover at a price that’s right for you.

Remember! The cheapest policy may not provide the right level of cover for your needs. By paying a little extra for your insurance it is usually possible to secure better cover and therefore get better value for money.

What if I change my mind?
If you do not receive full details of the policy terms when you buy the policy you will be entitled to a ‘cooling-off period’, which normally lasts 14-28 days. If you decide not to go ahead you will usually be entitled to a full refund of any premiums you’ve paid – providing you’ve not made a claim.

If you want to cancel your policy after the cooling off period then your insurance company does not have to refund the payments you’ve made.

Can I change insurance companies?
Although you can change insurance companies it’s important to remember that the new company may not cover any previous or existing medical conditions that your current company may cover.

Before changing insurance companies always check how the change may affect the cover you receive.

If your insurance company plans on making changes to your policy you will be provided with the details of the changes before you renew.
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