Private Medical Insurance
Private Medical Insurance (PMI), is all about choice. It protects you and your family, allowing you to have a choice of hospitals and consultants, should you ever need medical treatment for a disease or illness in the future.
Private Medical Insurance (PMI), is all about choice. It protects you and your family, allowing you to have a choice of hospitals and consultants, should you ever need medical treatment for a disease or illness in the future.
UK Health Insurance
How Does Private Medical Insurance Work?
If you or a loved one found an unusual lump, you would want this checked out quickly. Normally, you would see a GP, but getting an appointment can sometimes be very difficult.
Using PMI you may be able to access a private GP or, using your own GP, you would be fast-tracked to a private hospital and specialist of your choosing. Avoiding NHS waiting lists, you would be referred for tests, scans and any urgent treatment.
Your PMI would cover your hospital visits, any overnight stays and your post-op recovery. All of your treatment and aftercare would be arranged at a time to suit you.
What Does it Cover?
Private Medical Insurance (PMI) covers you for private medical treatment should you fall ill. At Halo Consulting, we focus on you. It’s not about premiums or policies, we care about finding the right package for you and your family, should you ever need to use it. Depending on the policy, you will be able to benefit from the following:
- The avoidance of lengthy waiting lists at NHS hospitals.
- The choice of seeing a consultant privately at a time and place to suit you, usually within a matter of days not months.
- Access to private GP’s, either face-to-face or online via Skype, Facetime etc. (depends on policy).
- In-patient and out-patient treatment at a private hospital of your choice at a time to suit you and your family.
- Access to specialists to aid your recovery such as physiotherapists, chiropractors and osteopaths.
- Incentives to encourage healthy living, e.g. discounts on gym memberships, bikes and even running shoes (depends on policy).
We listen. We will spend time understanding your lifestyle and any health challenges you may be facing to make sure your Private Medical Insurance is the right option for you and your family. If you have a pre-existing condition, this may be excluded initially, but you may be able to receive cover after a qualification period – usually after 2 years.
What Do We Consider Before Advising?
We will look at…
- Your age
- Your height and weight
- Who you want to cover
- Where you live
- Whether you are a smoker
- The level of outpatient cover you require
- The level of excess you’re willing to pay
When it comes to your health, and the health of your family, we will give you all the advice you need to make the right decisions.
For more information and specific questions please see our Private Medical FAQs below.
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FAQS – Private Medical Insurance
With Private Medical Insurance being a fairly vast subject we receive many questions which are frequently asked which we have listed below.
However, for the best service, assistance and advice, please give our team a call on 0116 366 6866 or use the form above to request a call back.
What is Private Medical Insurance (PMI)?
This is a type of policy which is taken out to protect you if you need any medical treatment for a disease or illness in the future. If you have an ongoing illness when you sign-up, this will normally be excluded and classed as a pre-existing condition – this cannot be used as a ‘reactive’ insurance. Once insured, if you found you had a new medical condition – first, you would visit your GP. They would refer you to a specialist and your PMI policy will start to take effect. You would be covered for both the referral and the treatment – plus, if you needed rehabilitation or therapy as a result (this will depend on your chosen levels of cover).
Before I take out a PMI policy, is there anything I need to consider?
The following list below outlines important issues to consider:
- Do you know how much you would like to spend?
- Would you prefer a lower premium in return for part-payment of your treatment?
- Would you like your cover to include diagnostic tests (e.g. blood tests and X-rays) and the option to see a specialist as an outpatient?
- Would you like a choice of hospitals, or in a limited range of hospitals chosen by your insurer, or are happy to receive treatment in any location?
Please always check and be aware of any policy exclusions.
What is the cost of PMI?
This will depend on your smoking status, your age, and the level of cover you choose as PMI premiums will vary. Usually, policy premiums will rise on an annual basis due to your age and the increased risk of illness as well as staying in line with increasing medical costs. In some cases, discounts can be available if you agree to pay a higher excess or you pay the annual premium upfront. Plus, as a reward for staying in good health, a no-claims discount (NCD) is usually included on most individual policies. However, you should never delay in getting any suspected problems thoroughly checked out.
What is covered by Private Medical Insurance (PMI)?
Basic PMI will normally cover the costs of most in-patient treatments (tests and surgery), as well as day-care surgery. Most policies will extend to out-patient treatments (e.g. diagnostic, specialist consultant, and therapies), but may have monetary limits. They may also pay a small fixed amount for each night you spend in an NHS hospital should you choose to do so.
- Standard PMI – this would cover essential treatments such as consultations, surgery, hospital and nursing care.
- Comprehensive PMI – this would include all the standard benefits but may also cover additional benefits such as personal accident cover and complementary medicine or therapies. As with all insurance policies, the level of cover will depend on the policy you buy.
Would existing conditions or diseases be covered by PMI, such as a bad back, arthritis or cancer?
Usually, PMI policies would not cover any private treatment for pre-existing medical conditions e.g. conditions you have already been diagnosed with, or illnesses which are classed as chronic such as asthma, diabetes etc. Policies would normally exclude injuries relating to dangerous sports, diabetes, epilepsy, HIV or AIDs-related illnesses, organ transplants, pregnancy and childbirth costs, cosmetic surgery (treatments to improve your appearance), hypertension and related illnesses, or any problems caused by war/war-like hostilities.
Would I be able to cover my entire family including children and grandparents?
Usually, PMI would only provide cover for your immediate family. However, some specialist Private Medical Insurance policies do exist, which may cover more than two generations of families.
Is there a limit on how many children I could cover?
Your children’s age will be taken into account, but there are normally no limits to the number of children you can add to a policy. Some insurers cover children up to 21 years, and others provide cover up to and no more than 24 years of age. There could be a blanket rate for cover up to a certain number of children or policies may be priced individually.
What if I want to move my policy to another insurer?
If you try to move to another insurer, e.g. because you want a more competitive premium, you could lose cover for any health conditions you’ve developed since you began your policy if you begin a new moratorium. You may be able to switch your policy without losing cover for such medical conditions but this will be at the discretion of the new insurer. As each insurer has different rules surrounding switching policies, we would be happy to offer more individual advice.
What happens when a NCD is applied to a policy?
A No Claims Discount will depend on your situation and policy. The way it works is for every year you do not make a claim, you’ll go up a level on the scale. There are varying reductions depending on the insurer, and they may apply varying NCD reductions for every step on the scale. It is vital that you fully understand the potential impact of a claim on your premium. Dental cover and worldwide travel cover claims may not affect your NCD. However, should anyone on your plan make a valid medical claim, the No Claims Discount for the following year will be reduced. Often, insurers will allow you to protect your No Claims Discount.
What is the best process for choosing a suitable PMI insurer?
Because PMI policies can be very complicated, we strongly advise taking independent advice. By speaking to one of our advisers, we would be able to assess your needs and advise you on suitable cover, which is right for you and your budget.
I am looking to buy a low cost PMI policy, what’s the best process?
Generally, the more limits on benefits, and the higher the excess, the lower the premiums will cost. However, this will depend on whether you want a comprehensive level of cover, your claims history, your age and your health in general. A cheaper policy is more likely to have restrictions in place, e.g. you could face a 6-week waiting period before you are eligible for private treatment, you could be limited in terms of the hospitals where you can be treated or outpatient treatment and/or diagnostics may be excluded completely.
What if I am unsure that I am getting the best deal on my PMI policy?
It is important to use an independent specialist insurance broker such as ourselves, who will provide recommendations after conducting a whole of market search. This will ensure that you receive the most suitable PMI policy and related advice.
What is the benefit of using a broker for Private Medical Insurance?
If you opt to go directly to the insurer, you will only be able to access their range of products and services. As independent brokers such as ourselves are not tied to any insurer, we will work on your behalf to source the most suitable and affordable policy to reflect your situation.
How can I tell whether my insurance broker is independent?
The broker should inform you of this – generally, most brokers will state whether they are independent or tied to an insurer. By working on your behalf instead of the insurer, we have access to a greater range of products (whole of market) instead of limited options.
Private Medical Insurance brokers: are they all independent?
Some Private Medical Insurance brokers will be tied to certain insurers with their own arrangements in place. This means they can only offer products from the limited range of the relating insurer. We are fully independent and able to offer advice on the whole of the market.
Is it best to use a broker or go directly to the PMI insurer?
When you choose to go directly to a PMI insurer, the information and advice you will receive will relate only to the insurer, e.g. one premium and one provider. This means you could lose out on more suitable deals within the marketplace. Worst still, you could risk buying a policy that doesn’t reflect your own situation. By using ourselves, we will work on your behalf to source the most suitable and affordable policy, which does reflect your situation.
Are there any advantages of using an independent insurance broker?
A broker would talk through all of the available options to make sure you receive the right lever of cover – without any unforeseen limitations or restrictions. A broker would also contact the underwriters working for every insurer to discuss any pre-existing medical condition or exclusions that needed to be considered before switching insurers.
Should I expect my Private Medical Insurance premium to increase every year?
As you age, the chances of needing treatment increase, which means policy premiums need to reflect this fact. In addition, as methods advance to diagnose conditions (and may be used more frequently), doctors are more likely to identify certain conditions more quickly, which means patients are more likely to be treated earlier. Plus, PMI usually increases to be able to cover any new medical developments, such as new drugs, new technology for use in surgery, or cancer treatments, as and when these become available. Generally, policy premiums tend to rise above the rate of inflation.
How would I know what the rate of medical inflation is?
Currently, medical inflation tends to increase at a rate of about 9% to 10%; it
is higher than standard inflation, and increases year on year.
is higher than standard inflation, and increases year on year.
What is the best way to compare Private Medical Insurance policies?
By using a professional, independent broker/adviser, you will get a better level of comparison between policies. As well as advice and recommendations, they will aim to provide you with various options to choose from.
What if I want to move between Private Medical Insurance providers?
If you were to switch to a new health insurer on a CPME basis, they would agree to take the new policy on the same basis as your original insurer instead of having to restart the underwriting process. Alternately, it may be beneficial to begin a new policy with fresh underwriting. We would be happy to offer advice on both options.
If I do want to move between PMI providers, how would I do this?
You need to be aware of any pre-existing conditions as your new insurer will ask for health information before any new terms are offered to you. We strongly recommend seeking independent specialist advice from one of our advisers before you make any changes.
What is ‘switch underwriting’?
This term means having the ability to switch from one insurer to another, and the new provider would take on the previous insurer’s underwriting, i.e. switch underwriting.
Would my PMI policy cover me when I’m abroad?
If you are abroad for a considerable amount of time and would like to be covered, it is worth considering a specialist International Health Insurance policy, as the majority of PMI plans in the UK do not generally include overseas cover. Some may have limited cover overseas restricted to emergency treatment (usually, a set number of days per policy year); this will depend on the provider. For short trips, we would recommend general travel insurance.
Would maternity be covered under Private Medical Insurance?
Even under the most comprehensive of PMI plans, routine pregnancy is not covered. Some plans may provide a level of cover for complications relating to childbirth – although, usually, such plans will stipulate how long you need to have had the plan before you are eligible for a claim related to pregnancy. International Private Medical Insurance can provide options for routine pregnancy and any relating complications.
Would I be able to see a GP privately under Private Medical Insurance?
Recently, because of the difficulty in trying to see an NHS GP, some insurers have started to allow access to a private GP as a benefit – consultations are typically undertaken online. However, normally, a private GP would not be part of a Private Medical Insurance plan, but it may be a benefit in an International Health Insurance Plan.
For a Private Medical Insurance referral, would I need to see my own GP?
Usually, you would begin the process with a referral from your own GP so you’re your claim can be validated. Although, many insurers are now including their own GP services, which may include the GP referral process.
What is the cost of an MRI scan?
MRI scans usually cost between £400 – £600, and could be a sizeable proportion of the benefit, especially on older policies with a set combined limit for out-patients.
What is the process for making a claim under Private Medical Insurance?
If you need to make a claim for treatment under your policy the first point of contact should be with your insurer. This will avoid any unexpected charges should you proceed with treatment which is not eligible under the terms of the policy. You will usually be required to complete a claim form and there are sections on the claim form that will need to be completed by your GP. Usually, insurance providers will require a referral or letter from your own GP – insurers will either accept a GP’s referral to any consultant, or they may have a restricted list of preferred consultants.
What level of outpatient cover would I need?
The term ‘outpatient’ relates to healthcare at the diagnosis stage of treatment and where you do not need a hospital bed. Usually, basic plans will not have any cover for outpatient treatment – however, they would cover inpatient treatment in full (overnight stays in hospital for one day or more). As a comparison, a mid-range plan would usually have a limited amount of outpatient cover (around £500 – £1,500 per policy year). Lastly, a comprehensive plan would usually cover all outpatient treatment. We advise selecting a plan which is suitable for your needs and your budget.
Does an MRI scan take a long time?
An MRI could last between 10 minutes and over two hours – this will depend on the reason for the scan.
Would cancer be covered on my PMI policy?
Depending on the level of cover in your policy, cancer is normally covered. However, on certain lower cost and restricted policies, cancer may be excluded. Some insurers may offer higher levels of cover and varying amounts of cancer cover. As with all PMI plans, any symptoms or previous/recent medical treatment could be excluded. We strongly recommend speaking to one of our advisors before taking out cover.
Would any drugs unavailable on the NHS be covered in my PMI policy?
Yes – sometimes, drugs used to treat certain conditions, e.g. cancer, may not be available on the NHS – however, a PMI policy could still cover these. It is important to fully understand the details of your policy and any limits. Always check whether you are likely to have suitable cover in place for your situation.
Would I be able to have private treatment at my local NHS hospital?
Yes – most of the time this is possible, as long as there are private facilities at your local NHS hospital. In fact, certain PMI policies depend on the use of private facilities in NHS hospitals – this can help to reduce policy premiums. Check whether you are fully clear on the locations that you are eligible for treatment. Please contact our advisers if you’re unsure of this.
Would I be able to use any hospital?
Usually, an insurer will have 3 levels of hospital listings; categories include local and national lists, and a Central London upgrade list. Normally, nearly all PMI policies give you the choice, and you would select the level of hospital cover you want.
Is there a reason why a PMI provider might reject a claim?
Yes – if the condition is not covered, or details are incorrect on your claim form, a medical insurer may turn down a claim. If you failed to disclose relevant details in your medical history, or there is a pre-existing condition that is not covered, or the condition could be excluded under the terms of the moratorium, your claim may be turned down. There could be many other reasons too, so we strongly advise speaking to one of our advisers to make sure that you do not have any problems if you ever need to make a claim – they would liaise directly with the insurance provider on your behalf.
Do you have to pay an excess every time you claim?
Many insurers require the excess to be paid per claim, whereas other insurers require the excess to be paid on the first claim during any policy year, despite how many claims are made. If you are unsure, we strongly advise speaking to one of our advisers.
Is there a range of excess levels on a Private Medical Insurance policy?
The excess levels range from only £50 per policy year (per person), right up to over £5,000 per policy year (per person).
Are there ways of saving money on my Private Medical Insurance premiums?
This would depend on several factors – the more cover you choose, the more you’re likely to pay. A basic standard policy would cost less because you will have lower levels of benefit. Plus, as you get older, your premium will rise – just like any other type of insurance, especially if you make a claim. In determining the cost of a health insurance policy, the biggest factor is the level of outpatient cover, i.e. cover for consultations and initial tests. You could lower the level of outpatient cover if your policy is too expensive. Even without outpatient cover, all insurers would provide full cover for inpatient treatment. This would ensure the cost of major treatment, e.g. an operation, would still be covered.
However, there is another way to reduce your costs – many insurers will allow you to pay an excess on every claim, which would reduce the monthly payments. In addition, there is often the ability to add a 6 week waiting option to your plan. If the NHS waiting list is less than 6 weeks long, you would have your treatment on the NHS and would only be treated privately if the waiting time for treatment was over 6 weeks.
What if I want to cancel my Private Medical Insurance?
To receive a full refund, you could cancel your plan within the ‘cooling-off’ period. After the ‘cooling off’ period, you would need to speak to the insurer directly or your adviser can see what their position is on cancellations. Some insurers may charge you in full for the 12-month policy premium which was due. Many insurers will allow you to cancel with 1 months’ notice if you are paying your premiums by direct debit and your payment would stop without extra charges.
Would my policy premiums rise if I were to make a claim?
Yes – especially if your policy plan has a No Claims Discount (NCD) attached. Although, some insurers use community-rated products, which are less reactive to fluctuations on your premium that relate to your own claims. If you have an NCD with your plan, you can protect this – we recommend speaking to one of our advisers to establish the best option for you.
If I don’t make a claim, would my policy premiums reduce?
Many PMI policies include a No Claims Discount (NCD), which would reward you for staying in good health. However, policy premiums are likely to rise on an annual basis because the risk of illness is greater the older you get, plus costs need to align with rising medical costs. If you were to pay the entire annual premium upfront, you may be able to get a discount. Also, you may get a discount if you choose to pay a higher excess on any claims.
If I do claim, how much of my NCD would I lose?
This will vary – many insurers may move you back 1 – 3 levels on their NCD scale. We would advise checking this with your adviser.
Would I be able to have a PMI policy if I’m disabled?
It is against the law for insurers to discriminate against disabled people, although it is likely that any conditions related to your disability will be excluded, but unrelated conditions may still be covered. We would advise speaking to one of our advisers to find a suitable policy for your situation.
Is there an age limit for taking out Private Medical Insurance?
This would depend on the insurer and may vary between providers. At the start of a new policy, many insurers may place a maximum age limit, e.g. 65 years. However, some providers will allow new joiners up to 75 years. Plus, other insurers do not have age restrictions when starting a new plan.
What are the claim limits for a policy?
Every plan will have its own limitations and this will depend on the policy, so it is important to understand what these are. There are varying cover levels, limits and policy terms. Standard or basic policy plans have been designed to provide cover for more serious treatment, e.g. if a stay in hospital is needed. A mid-range policy plan could offer in-patient and out-patient cover – although, there might be a monitory cap (e.g. £1,000 per policy year) on out-patient treatments, e.g. consultations, scans and diagnostic tests. In general, comprehensive plans tend to offer full cover for both out-patient and in-patient treatment, along with other extra benefits.
What if I would like a second opinion?
Private Medical Insurance gives you the option to see a specialist of your choosing and at a suitable time for you. However, the insurer may place limits on payment for any treatment needed. In terms of complex or rare conditions, the options for treatment tend to be more varied (or experimental). In this instance, it would be helpful to seek a second opinion. In some cases, PMI policies may give you the choice to have your case reviewed and reassessed by a leading specialist (even if based overseas).
What is the process for getting a second opinion?
Contact your insurer – in consultation with you, they would help you seek a second opinion, advise on how to proceed, and they should agree to cover costs.
What health screenings are included in a PMI policy (if any)?
In some cases, health screenings can be provided – this will depend on the level of cover in your policy. Health screenings are important for early detection of possible health issues – threats can be identified and action can be taken at the earliest opportunity. To help you stay healthy, some policies offer certain discounts on health screenings. Speak to your adviser about health screenings – they will advise you on whether this is included in your policy.
What if I want to choose my own specialist?
To choose your own specialist, you would need to check with your insurer – however, go to your GP in the first instance, if you have symptoms or you’re unwell because insurers will normally need a doctor’s letter or referral. Some insurers have their own list of consultants and others will accept GP referrals to specialists. Usually, Private Medical Insurance providers have a list of hospitals and consultants, as well as the payment fees in relation to the limit of the policy benefit. Before you undergo any treatment, it is vital to check with the insurer as they may need to authorise this.
Would my policy cover prescription costs?
The level of cover in relation to prescriptions normally depends on the premium level (advice can be given on this). Private Medical Insurance policies will vary and will have defined limits for specific payments for different levels of cover.
Would Private Medical Insurance cover standard medication?
Standard or routine medication normally relates to the treatment of a chronic condition. As chronic conditions are usually excluded from a plan, routine medication would also be excluded.
Would Private Medical Insurance cover my dental treatment?
Many insurers provide an amount of dental cover within their policy plans – usually, this can be added as an additional premium. Plus, it is possible to buy a separate dental insurance policy. However, as the levels of benefit can vary greatly, it is always worthwhile seeking advice from one of our advisers.
Would Private Medical Insurance cover my costs for opticians, glasses or contact lenses?
Usually, insurers do not cover optical treatment within standard policy plans – this can be added as an add-on or to a personal medical insurance plan. This should not affect your main PMI plan because it is usually a separate health cash plan, e.g. providing cover for optical treatment at a set level (i.e. £300 per year). If you need to see an optician or you need an optical check-up, you would go ahead and pay for your necessary treatment, and then claim any costs back from your insurance provider. It is vital that you check to see if your optical benefit has a separate excess, which could differ from your main PMI policy. To use any optical benefit on your plan, check your policy schedule or confirm the process by calling one of our advisers.
Would Private Medical Insurance provide cover for any experimental treatments?
Firstly, any experimental treatment would need to be proven in terms of its ‘efficacy’, e.g. value or worth. However, Private Medical Insurance may still provide cover for a wide range of treatment unavailable on the NHS, e.g. where a treatment or drug has not been approved by the National Institute for Health and Care Excellence (NICE). Experimental treatments are usually assessed on a case by case basis.
What is the main reason for taking out a Private Medical Insurance policy?
A Private Medical Insurance policy is always a personal choice and may help you to not have to rely on the NHS. If you are self-employed, this type of insurance policy can be useful as it gives you more freedom for choosing and accessing treatment at a time to suit you.
How many people in the UK have Private Medical Insurance?
10.6% of the UK population has Private Medical Insurance cover, which is 3.96 million people. (Source: LaingBuisson analysts)
Would a Private Medical Insurance policy cover psychiatric services?
Many Private Medical Insurance policies do not cover psychiatric services; this is generally excluded and mainly in return for a lower premium cost. However, you may be able to add psychiatric cover as an additional benefit (any paid for treatment would be up to an agreed limit), which could be useful if you or a dependant covered by your policy need treatment due to the lengthy NHS waiting lists for psychiatric treatment. Private Medical Insurance does not cover drug or alcohol problems.