The NHS will meet most family's health needs. However, some people want additional peace of mind when it comes to the their own wellbeing and that of their family, and that is where private medical insurance can have a place. There are different types of insurance and different levels of cover. Here's a guide to what you may want to consider, along with information on how to claim on a policy you might already own.
Private medical insurance (PMI)
Also known as private health insurance, this allows you to pay for private medical care if you would rather not wait for treatment on the NHS. Some policies allow you to choose when, where and by which specialist you are treated. In addition, PMI typically pays for a well-furnished private room if your treatment requires a hospital stay.
The insurance lasts for a year at a time. Provided you keep up to date with the payments, most insurers will automatically renew the policy each year – although premiums may increase at renewal. The policy pays out if and when you need treatment, provided the illness is covered.
According to ActiveQuote.com, a 38-year-old single, non-smoking male could expect to pay anything from £10 a month for very basic cover (no inpatient cover but no-frills outpatient cover such as specialists fees and diagnostic tests), up to £102 for the most expensive comprehensive cover which includes cash benefits for NHS treatments and cover for all inpatient and outpatients treatments and services.
Similarly, a non-smoking couple in their mid- to late-thirties with an eight-year-old child could obtain the most basic level of cover for £23.50 a month or £229 for the most expensive, comprehensive cover.
PMI pays for the private treatment of "acute" conditions, which means illnesses that are short term and curable – provided they were unforeseen at the time you took out the policy. Although there may be a cap on the amount you can claim in each category, policies will usually pay out for: fees charged by private medical staff for both diagnosis and treatment; operating expenses including surgeons', anaesthetists' and operating theatre fees; accommodation and nursing charges; x-rays, dressings and medication while an inpatient; specialist treatment such as radiotherapy, chemotherapy and physiotherapy; as well as home nursing costs, outpatient and day care treatment if linked to treatment received as an inpatient.
PMI will not cover routine check-ups with your GP. Moreover, because private medical insurance covers the unforeseen, you will not be able to get cover for an illness you developed shortly before taking out the policy or for the recurrence of a recent illness, known as a "pre-existing medical condition". Pregnancy and childbirth do not tend to be covered, nor is A&E treatment, incurable or chronic conditions, long-term illnesses such as asthma, diabetes and multiple sclerosis or cosmetic surgery.
What you pay for PMI depends on your age, sex, health and where you live. The more comprehensive the cover offered, the higher the premiums. Because policies vary widely in the cover they offer, the best way to buy PMI is through an independent financial adviser – they can trawl through all the policies on the market to find one to meet both your circumstances and your budget.
How to claim: For a claim on a PMI policy to be valid it must begin with a referral by a GP to a specialist. At this point you should check with your insurer that your illness is covered by your policy, and if it is, you must get a claim form.
Both your GP and the specialist will need to fill in and sign the form, for which your GP may make a small charge. Your insurer will then be able to tell you how much of the cost of treatment, including tests and so on, the policy will meet. Your insurer should also tell you whether it will meet your medical bills directly or if you will be required to pay them and claim the money back later.
Cash plans
Health care cash plans are not strictly insurance policies, but they offer cash assistance in paying towards medical expenses such as dentist visits and optician's costs.
You take out a policy, which costs as little as £6 a month, and a cash plan pays out whenever you visit a dentist or other practitioner. You must pay the bill yourself but, depending on the level of cover, your cash plan will pay you a certain amount back – which may or may not cover the total cost of the treatment.
Most plans cover dentists and optician costs, but some include the likes of chiropody, acupuncture, podiatry, and physiotherapy. If you take out a plan, providers will usually extend it to cover your children free of charge –though given that many treatments such as dental work and opticians are free under the NHS for children the benefit is not as generous as it initially appears.
The more times you visit a certain practitioner, the more cash you receive from your plan, so it is often the people who make frequent trips who end up getting the best value. However, the amount you can claim for costs is usually capped, so it's worth analysing how many times you are likely to visit a practitioner in a single year and how much you are likely to get back.
Pricier higher levels of cover guarantee greater returns of cash. So while a £6 a month plan may guarantee 70% of a dentist's costs capped at £100 a year, a more expensive plan may have a cap of £500 a year.
Only by calculating how many of the benefits you are likely to take and offsetting this against the policy cost plus the cost for treatment, can you gain a understanding of whether a plan is right for you.
How to claim: You must pay for whatever treatment you need yourself and then, if that particular treatment is covered, submit a form to your provider, who will transfer the cash to you or send a cheque. There are usually deadlines on how long you have to claim, so check as soon as possible and be prepared to act swiftly when making your claim.
Dental insurance
Dental plans usually pay out for both standard and emergency dental treatment plus general check-ups, and are an alternative to NHS dental fees (where you pay as you go) and private dental costs. They routinely cover expensive treatments such as fillings, root canals and crowns, but cosmetic work is usually excluded.
Some plans pay out an unlimited amount towards treatment on the NHS, but private policies tend to cap annual payouts – unsurprising when private dentist fees are higher than NHS dentist costs. According to Which?, the average cost for a dental insurance policy for a 55-year-old man using an NHS-only dentist ranges from £105 to £176, with the cheaper policies capping annual payouts for treatment.
How to claim: You must pay your dentist first, then make a claim to your insurer via the usual methods.
Paying for private upgrades
It might make sense for some people to simply pay into a savings or investment plan of their choosing, and then use this capital to upgrade to a private room should they require it. Many NHS trusts allow you to do this, although few hospitals can guarantee that a room will be available at any given time.
Rooms can be costly - one hospital quotes £280 a night for a private room, and a private menu with cooked breakfast and three course meals at lunch and supper time.
Getting health insurance when you are already sick
If you buy PMI when you are already sick you will not be covered for the pre-existing condition, however you may still be able to take out a policy that covers non-related illnesses. This is complex, however, and it is worth speaking to an IFA or insurance broker before taking out a policy so you can be sure that you are definitely covered for other conditions and any subsequent claim will not be turned down.
Many employer private medical plans do not require you to disclose a pre-existing condition, so if you join a new company it is definitely worth checking out their health insurance provision – you just might find you are covered regardless of how long you have been living with your condition.
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