Private Health Insurance 101: Is It Worth It?
The last thing the internet needs is another lengthy tome full of insurance mumbo jumbo with long complicated explanations. So, below is all the info you need when considering private medical insurance, put simply.
What is private health insurance?
Private Healthcare, Private Medical Insurance, Private Health Insurance, PMI – different names for the same product. PMI is an insurance policy which covers the cost of private healthcare. It works in a similar way to any other insurance – you pay monthly or annual premiums, and your provider pays out for some or all of the cost of the private medical treatment you receive.
PMI gives you quick access to treatments and private facilities. It helps pay for any high, unexpected private medical bills you may need covered. This could be anything from physiotherapy sessions, to major heart surgery. PMI also plays an important role in funding the early diagnosis of critical conditions.
We are blessed in the UK with the incredible NHS, but it is a critically overused resource buckling under the pressure, with ever-increasing wait times. Especially now due to COVID-19, the delays are even worse with the average wait for a treatment by a hospital consultant hitting 19.6 weeks in July 2020.
PMI members can still use all services offered by the NHS. The role PMI can play is complementary and supportive to the NHS. Helping reduce the pressure and demand as well as getting people back to health quicker.
What does health insurance cover?
The cover typically pays for any medical and surgical costs, including prescription drugs, incurred by the insured. PMI reimburses the insured for expenses incurred from illness or injury or pays the care provider directly.
PMI is designed to cover the cost of private medical treatment for acute conditions. An acute condition is a disease, illness or injury that is likely to respond quickly to treatment and return someone to the state of health they were in before, or lead to a full recovery.
It doesn’t usually cover treatment of long-term (chronic) conditions, where the main aim is to keep the symptoms under control.
How does private medical insurance work?
For the majority of claims, medical treatment begins with a GP referral for specialist treatment. This can either be your NHS GP or a private GP.
Lots of insurers now offer video GP appointments, allowing you to see a doctor online at your convenience. The Vitality GP app was designed to make it quicker and easier for you to speak to a doctor about your physical or mental health. You can book a video consultation within 48 hours, they can issue prescriptions and are the start point for any further appointments, treatments or claims.
It’s a fantastic, modern approach to healthcare that not only reduces the waiting times in surgeries but also helps streamline the process of getting you a diagnosis / prescription or consultation.
PMI in action – a true, recent story
Craig has PMI for himself and his family. On the Monday his daughter’s nursery noticed a delay in her speech and suspected she may need grommets. That afternoon Craig called the Vitality GP and by Wednesday they had an appointment with a consultant. Within 10 days she had her surgery at the hospital of their choice. PMI gave his family this quick access to treatment.
What is an insurance premium?
This is what you pay either monthly or annually via direct debit in order to be covered by a plan. Your PMI premium is reviewed once a year and changes depending on your age, your current health, if you’ve made a claim and medical inflation.
How Much Is Private Health Insurance?
The exact cost of your premium will depend on several factors. As mentioned above, your age, postcode and current state of your health, as well as the level of cover you wish to purchase. Just like with house and car insurance, the postcode lottery applies here, this is because prices are directly influenced by the cost of treatment in that particular location (i.e. private hospitals in London tend to more expensive than in other places).
The level of cover you wish to take out is a personal choice. Insurers will commonly offer a base level cover which you can then add extras to, depending on your needs. Premium prices will also vary due to what level of excess you choose – see below for more info on this.
What is an excess in health insurance?
Excess in health insurance is a contribution you agree to make towards any claims. The larger the excess you agree to, the lower your premiums will be. You can choose to pay the excess on each claim you make, or only on the first claim you make in each plan year. The choice you make with excess is again purely personal. If you have access to lump sums you may prefer to pay less per month and pay out on a claim, or you may opt for a higher monthly payment that results in less or nothing to pay when claiming.
If you choose a yearly excess, you pay that once and you can claim as many times as you want after that, but if you think you will be claiming a lot, then it may be more beneficial to choose a higher monthly premium and no excess. Swings and roundabouts eh!
What should I look out for when buying PMI?
- • Waiting Lists – Private Medical Insurance takes away the uncertainty of NHS waiting lists, by giving you access to the very best medical care, at a time and place that suits you.
- • Fast Diagnostic Tests – With waiting times being a major cause of anxiety in many health events, Private Medical Insurance offers the reassurance of a quick and full diagnosis.
- • Choice of Hospital – PMI offers easy access to hundreds of private hospitals in the UK, as well as the freedom for you to choose where and when you’re treated.
- • Choice Of Consultant – PMI gives you the freedom to choose a consultant for a specific claim.
- • Privacy – Private healthcare offers you the comfort and privacy of your own room in a nationwide network of private hospitals, with no worries about shared wards.
- • Drugs & Treatment – PMI provides access to a wider range of drugs and treatment, including those which might not yet be approved for use or paid for by the NHS.
Do I need health insurance?
Although PMI is considered a luxury, the old adage puts it into perspective ‘health is wealth’. The best investment you will ever make is in your health. However, that looks, be it nourishing foods, a commitment to being active, getting enough sleep or opting for private medical insurance.
It’s worth noting that PMI can only be applied for while you’re in good health. Private medical insurance will not cover any pre-existing conditions that you may have when taking out a plan.
What isn’t covered with private health insurance?
Although most insurers terms vary, most will not cover the below, alongside the aforementioned chronic and pre-existing conditions.
- • Any regular monitoring or treatment of long- term (chronic) conditions, like diabetes or allergies
- • Any treatment you receive outside the UK
- • Emergency treatment or visits to your NHS GP
- • Pregnancy, childbirth and most related conditions
- • Cosmetic treatment
- • Organ transplants
- • Any treatments or practices that are experimental, unproven or unregistered
- • Any treatment for learning difficulties, delayed speech disorders and other developmental problems
Coronavirus – what it means for health insurance?
Covid-19 has seen an increase in the demand for PMI. This has meant that premiums have increased by around 20% due to people using the service more.
As it has become more difficult to see GPs, having quick access to efficient appointments via private healthcare is paramount. Healthcare providers are now relying heavily on online GP services to help get people the treatment they need safely.
Private Health Insurers are assisting the NHS during this time by allocating beds and tests. Insurers are offering discounted COVID-19 tests to members alongside cashback offers. Most private health insurers have raised the amount of money given back to policyholders if they must stay in an NHS hospital. Some have increased this ‘NHS cash benefit’ by £100 or more per night. Vitality currently offer;
Day 1 – 8: £250 per day
Day 9 onwards: £500 per day.
If you have an existing policy but are struggling to maintain payments, some insurers will allow you to take payment holidays or reduced premiums.
Why WillU Life choose VitalityHealth?
VitalityHealth offers award-winning insurance policies alongside an honest desire to help get people active and in optimum health; something we are also very passionate about. Of course, the rewards, discounts and benefits they offer members are a very lovely icing on the cake, but ultimately the level of care they deliver is what does the talking.