Getting covered

Taking out private medical insurance (PMI) should not be viewed as giving a ‘thumbs down’ to the NHS. For a start, it is not designed to replace such things as Accident and Emergency or GP services provided by the NHS.

What it does do is pay for some (or all) of the costs of treatment for conditions where you can reasonably be expected to return to good health. It also provides the reassurance that you will be treated quickly and will not be subject to delays, which can sometimes be

associated with treatment under the NHS.

You will usually have to be under 65 years of age to be able to take out PMI, and it is very much a case of getting what you pay for. Fully comprehensive policies are expensive but cover both inpatient and outpatient treatment and usually include a range of additional benefits such as dental costs, home nursing, chiropody, alternative medicines and special scans.

However, there are ways to keep the costs down. Two simple steps are either to pay the premium annually in advance or to accept an excess. This is the first part of any claim which you have to pay yourself before the insurance cover kicks in.

If you are willing to accept paying a contribution towards the cost of treatment then you can consider shared risk policies. Under these policies you agree to pay part of the cost of treatment up to a certain value and the policy then picks up the full cost above that.

A shared risk arrangement can be used to reduce the cost of any sort of cover, whether it is a fully comprehensive policy or one of the budget schemes which will help you to further reduce costs.

Budget schemes usually limit cover to inpatient treatments, which means you either pay for your own outpatient care or rely on the NHS for it. Because there are restrictions on the cover, it is vital you check the terms and conditions to ensure that you understand the limitations.

You can also buy lower cost medical insurance which only provides cover if treatment is unavailable in your area on the NHS within a given period – usually six weeks. This is ideal if all you want is the peace of mind to know that you will not have to be on a long waiting list for required treatment and operations.

Although they cost a little more, standard policies are popular. They cover inpatient and a range of outpatient treatments subject to monetary limits. Exactly what is – and not – covered varies between policies, so it is important to check the terms and conditions. However, within the cash limits, you will usually be covered for certain alternative therapies such as acupuncture and specialist consultations and diagnostic procedures.

Generally, standard policies do not include dental and maternity costs, but these are included in most hospital cash plans. These are an alternative to PMI and pay set amounts for different treatments no matter where they are carried out, even if it is under the NHS.

In addition to pre-packaged PMI, some insurers offer a menu approach. This means you get to choose exactly what cover you want and the level of payout in the event of a claim.

Although some policies will be fully underwritten – which means the insurance company will require full details of your medical history and may wish to verify any information it receives – it is often possible to get a policy on a Moratorium basis.

In such cases, you are being offered cover without disclosing your full medical history. That is fine as long as those covered under the policy are in good health and have no pre-existing conditions.

For insurance purposes, a pre-existing condition is something you have had in the recent past (anything up to five years) or something that is an ongoing problem. If in doubt, it is better to check with the insurer or a claim could be turned down.

PMI does not generally offer cover for long-term problems that cannot be cured. You are also unlikely to be covered for self-inflicted injuries or conditions. Examples of this might include drug abuse, HIV/AIDS, organ transplants, kidney dialysis, war risks and injuries resulting from dangerous hobbies where the cause is considered to be self-inflicted.

As most people in the medical profession will know, insurance companies have tended in the past to put UK hospitals into three bands: A, B or C with A being the most expensive.

Many policies will indicate what band of hospital can be used in respect of any inpatient treatment. It is

particularly important here to check out this aspect of cover if you live in the Home Counties, where costs tend to be higher and there may well turn out to be more limitations on which hospitals can be used.

It is also worth checking differences between providers, as a number of insurers now no longer enforce the banding system. On the other hand, some insurers have their own or preferred hospitals and, again, you need to be certain that these are conveniently located.

Wesleyan Medical Sickness provides specialist financial advice for dentists. For further information call 0808 100 1884 or visit the website at

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