10 UK Private Medical Insurance Facts you Need to Know

When you buy a Private Medical Insurance policy you should read the Terms and Conditions provided. Knowing some of the basic Private Medical Insurance Facts before you agree to purchase can avoid issues in the future. Not every insurer offers the exact same cover, however, the principles tend to be the same.

Common Private Medical Insurance Facts.

  1. Private Medical Insurance does not provide cover for Accidents and Emergencies, these are still covered by the NHS.
  1. Policies cover the treatment of ACUTE medical conditions.

         Acute conditions are those that are likely to respond quickly to treatment.

  1. Chronic conditions are not generally covered. There are exceptions where policy “add-ons” offer a small contribution to the treatment of a chronic condition.

         Chronic conditions can be described as:

  • Those with no known cure.
  • Conditions that are re-occurring.
  • They need long term monitoring.
  • Conditions that require on-going symptom relief.
  1. If you opt to have your In-patient treatment on the NHS even though it is eligible for cover under your Private Medical Insurance you could be entitled to CASH BACK from your Insurance provider.
  1. To be eligible for cover on a UK policy you must be a resident in the UK for the time period specified by your provider.

         Vitality Health advise 180 days per policy year as their guideline.

  1. Make sure you contact your provider to pre-authorise any treatment. Make sure it is eligible for cover under your policy, that the consultant is recognised and that the hospital is on their approved list. This will avoid any claim shortfalls or declinature of claims. You cannot self-refer to a consultant and a GP referral is normally required. Access to private GP services remotely are available via private medical insurance.
  1. If you are a member of a Company scheme you must be employed by the company to be eligible. Your insurer can request proof of employment at any time throughout the policy year.
  1. Treatment for alcohol/drug/substance abuse and the treatment of any related medical conditions relating to these are normally excluded from cover. Bupa are an exception.
  1. If you have a baby or adopt a child you could be eligible for a “Baby bonus” cash amount from your insurer. This would be payable once per child and could be up to £150. There could be a qualifying period before you are eligible to claim.
  1. Many providers offer a discounted premium if you opt to pay for your policy by annual direct debit.

If you would like help in renewing an existing or selecting a new Private Healthcare policy then our experienced team will be more than happy to help you.

You can contact us on enquiries@smphealthcare.com or by telephone on 01245 929129.

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