- When it comes to buying an individual health insurance plan, where do you start?
- What is motivating you to buy a health insurance plan in the first place?
- Do you have a budget in mind for your health insurance plan?
- What is the priority treatment that you want to have access to?
Let’s start at the beginning – where do you start?
Think about the information that the insurance companies will need in order to provide you with a quote. When it comes to individual (consumer) health insurance plans they will need to know the following:
Who is going to be covered on the policy?
This could be just you as a single person, a couple, a single parent, family or a child only policy. The insurer will want to know the names and dates of birth for everyone to be covered.
Your home address.
You and your family members should all be living at the same address. If you want to cover your children who live with your ex-spouse, allowances can be made. Older children at university can also be covered under your policy.
Your medical history.
This applies whichever underwriting type you opt to have (explained further later in this article). If you have pre-existing medical conditions, they may be excluded from cover on your individual health insurance plan.
When you want the policy to start?
The start date of your policy is important. There are often incentives available for consumers buying health insurance for the first time. You don’t want to miss out on a great deal for the sake of a day.
The renewal date of your current policy.
If you already have a health insurance plan in place, you can review your options at the renewal date. Health insurance is an annual contract and therefore mid-term switch options are unusual.
Once you have the above information, think about why you want to buy your policy?
With the arrival of the coronavirus pandemic in 2020, health really is a hot topic. You cannot watch TV or listen to the radio without hearing something health related. The fear that the NHS will become overwhelmed, the reports of ever increasing NHS waiting lists, the lack of access to primary care by NHS GP’s may all have some influence over your thought process.
It is worth remembering however that for diagnosis and treatment of COVID 19 you still need to follow the current government guidelines for treatment. This applies whether or not you have a health insurance plan in place.
Perhaps your decision to look at individual health insurance is due to the medical history of a family member or recent medical experiences of close friends. Whatever has made you decide to consider private health insurance, it is essential that you find the right policy from the start. You need to have realistic expectations of what you can use the policy for and how it works if you need to make a claim.
The cost of individual health insurance plans.
You might be pleasantly surprised at the cost of individual health insurance plans in the UK. Historically it was deemed to be a real luxury and only affordable by the wealthy, this really is no longer the truth.
Most insurers in the UK now offer modular health insurance plans. This means that you can almost certainly find a plan that will fit your budget.
The cost of your insurance is affected by your age, where you live, possibly by your medical history and the benefits that you select.
The premiums will increase as you get older as the risk to the insurer is greater. The premium for a 65 year old living in Central London would be more expensive than a 65 year old living in Cornwall.
One of the easiest ways to find out whether an individual health insurance plan is something you can afford is to speak to a specialist broker.
AMII – The Association of Medical Insurers and Intermediaries has a member search option so you can easily find a specialist that you want to work with.
What do you want your health insurance to cover you for?
As a quick guideline an individual health insurance plan can be broken down into the following basic categories:
- In-patient and day-patient cover
- Out-patient cover (consultations, out-patient diagnostics such as X-rays and blood tests)
- Therapies (such as physiotherapy and osteopathy)
- Mental Health
- Dental and Optical cover
- Travel cover
- Other benefits and add-on extra’s
Most basic health insurance plans will cover you for in-patient and day-patient cover. You then need to work out which of the additional benefits you want to include.
Benefits such as out-patient cover can be varied. You could choose full cover for out-patients or limit it to perhaps £1000. The premium is higher for the full refund option.
Do you want access to the Central London hospitals?
Although some insurers only offer one full hospital list including the higher charging London hospitals, others offer different hospital lists. The premium for cover excluding the high charging London Hospitals is quite often far lower.
If you are living in Glasgow, it is unlikely you are going to want to travel to London for hospital treatment. Most people like to have treatment in a private hospital close to their home and therefore analysing the hospital list options is a great way to contain the cost of your health insurance.
Can you afford to pay an excess?
Adding an excess to your individual health insurance plan can make a substantial difference to the premium. Most insurers offer a range of excess options payable per person per policy year. If you know you can afford to pay an excess of £500, your premium will significantly reduce. Remember, you only pay the excess if you make a claim. If no claims have been made then you really have seen the benefit of adding an excess to your policy.
Be aware that you may be offered an excess per claim instead of per year although this is not common. The premium would be cheaper on this basis. If you make more than one claim in a policy year, the excess would be paid for each claim and therefore it could be a false economy.
What type of underwriting is best for you?
Individual health insurance plans can be underwritten in one of 3 ways:
- FMU (Full medical underwriting)
- MORI (Moratorium underwriting)
- CPME/ CMORI (Continued personal medical exclusions/ continued moratorium)
Full Medical Underwriting
Each member to be covered will be required to complete an application form with a series of medical questions which must be answered truthfully. The Insurer will assess the answers provided. They may choose to permanently exclude pre-existing medical conditions. This would include illness/injury or disease that has not been diagnosed prior to the date of application if there have been symptoms, treatment, medication or even advice sought for the condition.
If you have an exclusion applied to your policy your insurer may agree to review the exclusion at a later date. There is no guarantee that an exclusion will be removed upon review.
You are not asked to give details of your medical history when setting up the policy. Instead the insurer does not cover treatment for any medical condition that you have received treatment for, taken medication for, asked advice on or had symptoms of for a specific time period (often 5 years). These conditions may become eligible for cover but this would only happen when you do not have symptoms of, receive treatment for, medication, tests and advice (from your GP, a healthcare professional or a specialist) for that condition, or a related condition for a continuous period of two years after your policy has started. If you make a claim, the insurer might ask for medical notes that are needed to decide if your claim is covered.
There are some conditions, for example chronic conditions, that will probably never be covered. This is because you would always need treatment, medication, tests or advice for them. You should not delay getting medical advice simply to obtain cover under the moratorium terms.
When you switch your policy to a new provider, they may agree to accept you on continuous personal medical exclusions or continued moratorium basis. The new provider would apply the same underwriting terms as your previous insurer or the same moratorium start date in the case of CMORI. You will also be required to answer a set of questions and your answers may result in the new insurer applying additional exclusions to your cover. If your previous insurer has applied a specific exclusion to your cover, this would also be excluded by the new provider.
Chronic conditions once diagnosed would still be excluded from cover by the expiring or new provider whether shown on your certificate or not. Please remember that no two providers offer exactly the same policy or transfer criteria.
What is not covered on an individual health insurance plan?
Health insurance in the UK is designed to cover the diagnosis and treatment of acute medical conditions. It will not cover the routine monitoring and medication for a chronic condition.
As an example:
You took your policy out in 1972 and were fully medically underwritten. There were no exclusions on your policy.
In 1985, you began to feel poorly. Your NHS GP referred you to a consultant.
Your insurance company authorised the consultation and diagnostic tests required. On the follow up consultation your specialist diagnosed you with Type 2 Diabetes which is a chronic condition.
In this instance your insurer will cover the original consultation, diagnostic tests and follow up consultation. Now that the you have been diagnosed with a chronic condition you would use the NHS for the routine treatment of this condition.
Your insurer will however cover you for any acute flare ups of the chronic condition.
General exclusions that are likely to apply.
Health insurance like any insurance policy has a number of general exclusions that apply. Each insurer has their own general exclusions but you can expect to see some or all of the following:
- Accident and Emergency treatment
- Alcohol and substance abuse
- Cosmetic Surgery
- Gender re-assignment
- Preventative treatment and screening
- Learning disorders
- Natural ageing
- Routine pregnancy and childbirth
- Self-inflicted injury
- Sleep disorders
The above list is not exhaustive and may differ depending on the insurance provider you choose. If you have been fully medically underwritten then you may also have exclusions on your policy relating to your pre-existing medical conditions.
Where can you buy an individual health insurance plan in the UK?
There are a number of options available to you when it comes to buying your health insurance.
Direct from the insurer
If you purchase a policy directly from an insurer they are able to explain the benefits and costs of their products only. They would be unable to tell you whether their policy is better or worse value than a competitor.
Cost comparison websites
There are a number of well-known cost comparison websites which allow you to in-put your details, the cover you want and it will provide you with a number of options available to you. Essentially you then make your own choice about the policy you buy.
Independent Financial adviser (IFA)
If you use a financial adviser they may offer health insurance as part of their suite of financial planning options. They may be limited to a small number of providers or have access to the whole UK market.
Specialist health insurance broker
Working with an independent specialist health insurance broker offers you a whole host of benefits. They will discuss with you what you want, the budget you have and your medical history.
Using this information, your broker will provide you with a market review and make a recommendation based on your own unique requirements. A specialist broker can help you make a truly informed decision about your individual health insurance plan.
What can SMP Healthcare offer you as a client?
SMP Healthcare Ltd is an independent, specialist health insurance broker based in Chelmsford. We offer our clients a high level of service whether as an individual, small business or corporate business.
Our team of advisers are all CERT CII qualified and have many years experienced within the health insurance sector. We have no affiliation to any insurance provider and therefore our recommendations are totally unbiased and based on the best interest of our clients.
We are paid by the insurance company on the inception or renewal of your policy and therefore you are never charged additional fees.
Individual health insurance plans in the UK are available for the following:
Single members’ ∙ Couples ∙ Single Parents’ ∙Families ∙ Child only
Our service includes:
- A full market review at the start and each renewal of your policy.
- Negotiation with the insurer to obtain the best possible premiums.
- Advice on switching provider if this is the best option for you at renewal.
- All administration as required at inception, renewal and throughout the policy year.
- Assistance with any claims issues should they arise.
- If you need to speak to someone in the evening or at the weekend, we can arrange this for you by prior appointment.
If you would like to work with SMP Healthcare in 2020 and for the future, please contact us via
Telephone: 0800 047 0127 or 01245 929129
We look forward to helping you find a great health insurance plan soon.