Health Insurance

. What is Health Insurance?

Health insurance in the UK is designed to cover the costs of private treatment for what are commonly known as acute conditions. Most insurers in the UK define an acute condition as a disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

Most people buy this type of insurance to gain the reassurance of knowing that treatment is available promptly, if they become ill or are injured. As a private patient you can choose when treatment will take place, the specialist who treats you and the hospital. You will usually have the privacy of an en-suite room complete with TV and other home comforts. Some illnesses and treatments will not be covered and these are common to most policies. Examples of these are conditions you had before taking out the insurance (commonly known as pre-existing conditions), GP services, cover for long term illnesses that cannot be cured (chronic conditions) and accident and emergency admission. It is important to note that private health insurance is not designed to replace all the services of the NHS. Some such as accident and emergency, are beyond the scope of private hospitals.

The type of policies and level of cover you can receive normally come in 3 phases:


With this type of policy normally only inpatient treatment is covered, this means that diagnostic tests, Consultant’s fees and outpatient treatments are not covered. This type of policy best suits those who can afford to pay their own outpatient tests and consultants fees from savings leaving the policy to pay for the most expensive treatments such as operations. Some insurers will include diagnostic tests and consultants fees if this later results in an inpatient hospital stay. Inpatient radiotherapy and chemotherapy is covered by most insurers on budget polices. Inpatient treatment is covered in full.


This type of policy covers full inpatient treatment such as operations and a range of outpatient treatments. Specialist consultations and diagnostic procedures, including pathology, radiology computerised tomography, MRI Scans, radiotherapy and chemotherapy up to a limit of anything between �500 – �2000 depending on the insurer. Normally Therapies such as treatment by registered Osteopaths, Chiropractors, Physiotherapists, Homeopaths and Acupuncturists will also be covered again up to specified limits that vary between insurers.


Comprehensive policies are very much top-of-the-range healthcare solutions. They typically include full inpatient cover, unlimited outpatient cover as described above, MRI, and CT scans and other benefits such as psychiatric cover, travel cover, dental cover, home nursing costs, chiropody, recuperative care and incidental hospital expenses (telephone calls, newspapers etc). For complete peace of mind this is the type of policy you should choose.

However modular flexible type policies are increasingly becoming more popular as this allows the customer to tailor the cover to their exact needs and suit their budget.

2. How do I buy Health Insurance?

When you are considering purchasing Health Insurance there are a number of avenues you can go to get the right policy to suit you. The main three choices open to you are as follows:

1. Go direct to the Insurer 2. Seek the advise of an Independent Health Advisor or Broker online or offline 3. Insurance Agents ( Banks, Building Societies, Retail Outlets)

You can acquire quotes either over the phone, post, internet or face to face should you be happy to either visit or receive a visit from and a Health Insurance Specialist.

Once you have decided what the best policy is for you the Insurer on receiving your application will process it and then send out your certification of membership. From the moment you receive this you are into what is termed “a cooling off period”. From the moment you receive your documentation you will normally have 14 days in which to change your mind if you so wish. If you do, any premiums that would have been taken will be returned and your policy cancelled.

Some Insurers may arrange cover differently from above like over the phone. However cover will normally be provisional until they receive a completed application form.

3. How do I choose the right cover?

When looking at cover, it is useful to know that treatment is categorised in the following way.

In-patient treatment: Treatment which, for medical reasons, means you have to stay in hospital overnight or for longer.

Day-patient treatment: Treatment which, for medical reasons, means you have to go into a hospital or day-patient unit because you need a period of clinically-supervised recovery. However, you do not have to stay overnight.

Out-patient treatment: Treatment given at a hospital, consulting room or out-patient clinic where you do not go in for day-patient or in-patient treatment.

There is a large variety of schemes available-from low cost schemes offering limited cover, to those which offer wide-ranging cover and benefits. Most schemes offer cover for in-patient and day-patient treatment, but not always out-patient treatment.

You will need to decide what sort of cover you want. There are a number of things you will have to consider. Here are just two examples:

1. Do you want your cover to include seeing a specialist as an out-patient?

2. Do you want a choice of hospitals, or would you be satisfied to receive any treatment that you might need in a hospital available from a limited range chosen by the Insurance Company?

The answers you give to questions such as these could have a significant effect on the premium that you pay.

4. What am I covered for? What does my cover not include?

Health Insurance is designed to cover treatment for curable, short-term illness or injury ( commonly known as acute conditions). Some illnesses and treatments are never covered and these are common to most schemes.

1. Usually included: Cover for treatment of short-term (acute) medical conditions. In-patient tests. Surgery as an in-patient or day-patient. Hospital accommodation and nursing.

2. Sometimes included: Out-patient diagnostic tests. Out-patient consultations and treatment with a specialist. Overseas cover. Cash payments for treatment received as an NHS in-patient.

3. Usually not included: Conditions you had before taking out the health insurance policy (commonly known as pre-existing conditions). GP services. Cover for long-term illnesses which cannot be cured (usually referred to as chronic conditions). Accident and Emergency admission.

As well as those listed as “usually not included”, the following conditions or treatments are normally outside your cover.

Drug abuse, self-inflicted injuries, out-patient drugs and dressings, HIV/AIDS, infertility, normal pregnancy, cosmetic surgery, gender reassignment (sex change), preventative treatment, kidney dialysis, mobility aids, experimental drugs, organ transplant. War risks, injuries arising from dangerous hobbies.

Each health insurer will give you a policy summary or “key facts” document and a full policy document either before or immediately after you sign the contract of insurance. The policy summary or “key facts” document will set out any significant and unusual limits of your policy.

5. Will my premiums go up?

Whichever scheme you choose your premiums may rise above the rate of general inflation. This is because of factors which affect how healthcare is provided in all western countries. Each year people claim on their insurance cover for private medical treatment. The number, sophistication and cost of treatments to improve quality of life is increasing steadily. Most private health insurance policies aim to cover these treatments as they become established medical practice and available privately.

Likewise, the sophistication and complexity of tests used to diagnose illness and injury are also increasing. Such tests are becoming far more widely available in private hospitals.

Your choice of cover will affect what you pay:

Paying an excess: Paying the first part of a claim yourself.

Choosing to receive treatment at a specified hospital

Receiving treatment under the NHS when it is available within six to 12 weeks.

Paying for part of your treatment: For example out-patient consultation with a specialist

Choosing a different grade of hospital accommodation

It is unlikely you will find all these options in one product, but a combination will be available. There may also be other factors that affect your premium, for example, a no-claims discount or payment method.

6. Will my premiums increase with age?

As people get older they are more likely to need and receive medical treatment, which means that health insurance premiums will usually increase with age to reflect this.

7. Will I need to provide details of my health?

There are a number of medical conditions which you will not be able to get health insurance cover for. You won’t normally be covered for an illness from which you are suffering, or have already had. There are two main methods that health insurance companies can use to accept your application for cover. Full medical underwriting or moratorium. All health insurance companies will offer you the Full medical underwriting option. Some will offer both.

Full medical underwriting: You are asked to provide details of your medical history. If necessary, the insurer may write to your doctor for more information. It is essential that you give all the information you are asked for. If you do not you may find that your insurer may refuse to pay a claim that you make in the future or may cancel your policy. If you are unsure whether or not to mention something it is best to do so. If you have a condition which is likely to come back, the insurer will issue the policy but that condition and anything related to it may not be covered, either indefinitely or for a set period of time.

Moratorium: This is when you are asked to fill in a form, but you are not asked to give details of your medical history. Instead, the health insurer does not cover any medical condition which existed in the last (usually) five years. These conditions may automatically become eligible for cover, but only when you do not have symptoms, or receive treatment, medication, tests and advice ( from GP or consultant) for that condition for a continuous period of (usually) two years, after your policy has started.

There are some conditions, for example chronic conditions, that will probably never be eligible for this delayed cover because you will always need regular or occasional treatment, medication, tests or advice for them. You should not delay getting medical advice or treatment, simply to get cover. If your health insurer offers a “moratorium” they will give you printed information explaining how their particular moratorium works. You may also want to ask the insurer, or company who advised you on the policy to explain how it works.

8. What if I want to change to a new Insurer?

You may change Insurer. However, it is important to remember that your new insurer may not cover any previous, or existing conditions, which your current insurer may cover. You may also lose any premiums you have paid up front. It is best to check with your new insurer or whoever is selling or arranging a new policy for you, how the change may affect your cover.

9. Will my cover be affected if I am disabled?

Insurers will not refuse to cover you because you are disabled. As with other pre-existing conditions, your insurer may exclude cover for treatment arising directly from your disability. However, it must be reasonable and fair for them to do this. If you sign a medical declaration you must reveal all relevant information about your disability. If your policy does not cover pre-existing conditions, then an existing medical condition causing disability, or arising from it, will not be covered.

10. How do I make a claim?

Before you receive any treatment privately, you should call your insurance company to check that you are covered for the treatment that you will receive. In fact most health insurance companies insist that you do this. Your insurer will give you all the guidance you need.

Your GP and your specialist will probably need to fill in and sign your claim form. Your GP may charge a small fee which will probably not be covered by your health insurance company. Stay in contact with you health insurer who will confirm whether any treatment you plan to receive is within your cover.

Your specialist may recommend tests, admission to a hospital as an in-patient, or day-patient treatment. Your insurer will tell you how they pay claims. Remember, if you have chosen to pay an excess, you will have to make a payment.

Most hospital and some specialists have their bills paid directly by the insurer. Others will send the bills to you.

11. How is private health insurance regulated?

Financial Services Authority: As from January 14th, 2005, the Financial Services Authority (FSA) regulate the sales and administration of private health insurance. The FSA set out rules which regulate the sale and administration of general insurance which must be followed by those dealing with you. There is more information about the FSA at

Your application form or any declaration you make to your insurer forms the basis of your contract with the insurer. Answer questions accurately. By law all insurers have to treat personal information especially medical details with absolute confidentiality.

All insurers and anyone else advising on health insurance must have their own complaints procedure in place and be covered by the financial ombudsman. If you have a problem speak to your advisor or insurer first. If you are not satisfied with the way your complaint was handled, there is an independent dispute resolution procedure through the Insurance ombudsman service which your insurer or advisor must give you details of. The service is free.