Private Medical Insurance (PMI) insures you against the costs of private medical treatment for acute conditions (curable medical conditions). Who needs PMI? Anyone who wants prompt treatment, without NHS waiting lists. Remember a diagnosis in time can save a life…
- Speed of Treatment
- Choice of specialists and surgeons
- Treatment in a private hospital of your choice (within the policy hospital list)
- Treatment in private wings of NHS hospitals if preferred
- Accommodation in a comfortable room with privacy – no wards
- Peace of mind
You can also choose the level of cover you would like to be insured for. You can choose from in-patient, limited out-patient, full out-patient, extra hospital lists, psychiatric cover, therapies and more….
Private Medical Insurance generally does not cover ‘chronic’ conditions (conditions which are incurable, for example asthma, HIV and/or AIDS). Pre-existing conditions are not covered under individual policies or new (previously uninsured) company schemes.
However, pre-existing conditions within the last, usually, five years may be covered if you have been advice-free, symptom-free, treatment-free and medication free for (usually) two consecutive years after the commencement date of your policy under the ‘moratorium’ underwriting. Conditions that are considered cured by your GP or specialist over (usually) five years before the commencment date of the policy may immediately be covered if they re-occur.
Pre-existing conditions are any disease, illness or injury for which you have received medication, advice or treatment; or you have experienced symptoms; whether the condition has been diagnosed or not (usually) in the 5 years before the start of your cover.
There are two main methods that insurers can use to accept your application for cover – medical history declaration or moratorium. Here is a description of the two types:
Medical History Declaration (otherwise known as full medical underwriting) You are normally asked to fill in a form, giving 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 don’t, you may find that your insurer may refuse to pay any claim that you make in the future, or may cancel your policy. If you are not sure whether or not to mention something, it is best to do so. If you have a medical condition, which is likely to come back, the insurer will issue a policy, but that condition (and any related to it) may not be covered, either indefinitely, or for a set period of time (usually two years).
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 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 your GP or a specialist) for that condition for a continuous period of (usually) two years, after your policy has started.
Here are two examples: Some time after your cover has started, you go to your doctor for a routine visit and, for example, a heart condition is diagnosed. It has obviously developed during the period before the start of your plan. Would you be covered? Yes you would as the clause only applies to any medical condition or related condition (or both) which you were aware existed in the 5 years before the start of our policy. If:
- The heart condition was first diagnosed after you joined the policy; and
- You had no previous treatment for any obviously related condition, such as high blood pressure or chest pains; and
- You were not aware of any symptoms; benefit would be available even if it was proved that the condition existed before your policy began.
What if you suspect that you are suffering from a condition, for example, you have a lump, but have not seen a doctor for the condition or received any firm diagnosis? Would you be covered if a visit to your doctor after the start of the plan revealed that surgery for that condition was necessary?
Because you were aware of the condition during the 5-year period before the start of the plan, even though you weren’t quite sure what it was, you would be excluded from cover for at least the first 2 years of the plan.
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 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 us, to explain further how it works.
There are four main methods that insurers can use to accept your company application for cover – medical history declaration, moratorium, switch or medical history disregarded. Members who have not been insured before can be insured on either a Full Medical Underwriting basis or a New Moratorium basis. See the description above for more details. Currently insured members can be accepted on Switch (also known as Continued Personal Medical Exclusions (CPME) or Protected Underwriting Terms (PUT)) if they have been previously underwritten. You will need to provide current insurance certificates with your application form to be accepted under these terms. Medical History Disregarded terms may be offered to those members who form part of a group of (usually) 20 or more members and who are currently insured on this basis. You will need to provide current insurance certificates and three years claims experience with your application form to be accepted under these terms. If you are applying for a Switch or Medical History Disregarded (MHD) scheme, cover is usually offered on the basis that the Group Secretary is not aware of any employee or dependant who has previous, pending or on-going treatment for any of the following conditions:
- Heart/stroke conditions; any forms of cancer; organ failure or transplants; psychiatric, mental or nervous conditions;
- Any condition where there has been a claim for an amount in excess of £10,000
- Any medical condition likely to result in an in-patient stay.
Yes, if companies are currently insured and would like to switch to another insurer to reduce their premiums or improve their level of cover, their pre-existing conditions may also be covered under the new insurer.