Health Insurance explained
What is it and what’s covered?
Health Insurance, also referred to as PMI (Private Medical Insurance) is an insurance policy which allows the policyholder to access speedy diagnosis and treatment for medical conditions at private hospitals (e.g. Nuffield, Spire, Ramsay, HCA and other hospital groups) and scanning centres. It aims to facilitate quick diagnosis and treatment of conditions which can either be completely cured, or significantly bettered, through planned treatment(s).
What isn't covered?
Health Insurance doesn’t cover everything, so it’s good to be clear about that early on to avoid any confusion or disappointment when you need to use it.
Typically, it won’t cover treatments which you simply choose to have done (i.e. not medically necessary), nor does it cover cosmetic surgeries by choice, childbirth (although many providers will cover pregnancy complications), or accidents and emergencies… there are no A&E facilities at private hospitals. It’s also uncommon for it to cover conditions which are likely to be with you for life, such as diabetes, as these conditions require ongoing medication and/or regular monitoring to manage – which is usually covered by the NHS. That said, some providers do now offer some cover options for certain lifelong conditions.
What can I claim for?
Your insurance claims depend on two key factors: your selected coverage and the depth of the insurance company's initial risk assessment (underwriting). How thoroughly they review your situation upfront determines what you can claim later.
What you chose to have cover for (in other words your benefit selection) will determine what types of treatments are included in your plan. For example, Mental Health – covering diagnosis and treatment for a wide range of mental health conditions, including stress, anxiety, depression and many more.
Now, whether you’re actually allowed to claim for the treatment you have cover for will generally depend on a few simple things; whether you’re brand new to Health Insurance, or already have a policy in place. And; whether the condition you want to claim for is new to you, or it already exists (including existing symptoms even if it hasn’t yet been diagnosed).