There are a handful of ways to help reduce the cost of your Private Medical Insurance policy.  When considering reduced cover options it is important to understand the advantages and disadvantages that each benefit brings. What happens if you pair certain options together, such as pairing out-patient limits with an excess?  Will the out-patient limit affect your excess and vice versa?

There are two ways that Health Insurers work when you have a policy with a reduced out-patient limit and an excess and the first claim you make during the policy year is for an out-patient service. These are best illustrated by examples which are shown below.

Out-patients limit applies, will this affect your excess: Example 1

Let’s imagine that a policyholder has a £500 reduced out-patient limit and a £150 excess. They haven’t had any previous claims this policy year and their GP refers them for an out-patient consultation totalling £250. The policyholder is liable for the first £150 due to their selected excess option, and the insurer will pay the remaining £100 for the consultation. However, before the policyholder’s insurer reduces their £500 out-patient limit by £100 to cover the outstanding cost of their consultation, the insurer firstly reduces their £500 out-patient limit by their selected excess amount (£150). This means that their £500 out-patient limit will automatically be reduced to £350 before the insurer then deducts the outstanding £100 for their consultation, leaving the policyholder with only £250 for further out-patient claims for the remainder of the policy year. In this instance the way the excess is handled, it will affect your out-patients limit.

Out-patients limit applies, will this affect your excess: Example 2

Again, the policyholder has a £500 reduced out-patient limit and a £150 excess. They haven’t had any previous claims this policy year and their GP refers them for an out-patient consultation totalling £250. The policyholder is liable for the first £150 due to their selected excess option, and the insurer will pay the remaining £100 for the consultation. However, unlike example 1, the policyholder’s insurer doesn’t deduct the excess from their reduced out-patient limit, instead they simply reduce the £500 out-patient limit by £100 to cover the cost for the outstanding amount for their consultation, leaving the policyholder with £400 for further out-patient claims for the remainder of the policy year. In this case, the way the excess is handled, it will not affect your out-patient limit.

How a specialist health insurance broker can help you work out which policy options you want.

Policies with a reduced out-patient limit and excess applied can save you money. As you can see however, the above two examples show what this could mean for you depending on the policy you buy. We want you to know exactly what your cover choices mean when you need to make a claim. Whether you are looking for an individual, family or company policy, let us help you find a great option for your healthcare.

Our expert team will talk through all reduced cover options with you to ensure we find the best policy for your specific requirements.

Please call us on 01245 929129 or email enquires@smphealthcare.com.