What Do Health Insurance Policies Cover?

Whilst we may decide to take out home or car insurance without much of a second thought, how many of us apply the same logic to getting health insurance (though some may already have it as part of their employee benefits)? Find out everything you need to know about health insurance policies (also known as private medical insurance) such as what sort of cover they provide, and the types of treatments and conditions that they generally don’t.

Also important to note is that health insurance is different to other forms of cover such as critical illness insurance and life assurance arrangements and policies.

Should You Get Health Insurance Cover?

Whilst we are extremely fortunate in the UK to have the excellent National Health Service (NHS) that provides free medical treatment and support to all regardless of their level of income, there are unfortunately some disadvantages. Sometimes, if you have a particularly pressing medical concern this can become a problem. This is where having health insurance cover can become very handy by supplementing what’s already available on the NHS. Paying for health insurance means you can take advantage of:

  • A quicker diagnosis
  • Shorter waiting times than those on the NHS, with more prompt referrals to a consultant or an admission to a private hospital
  • Having access to better facilities
  • Choosing from a range of private facilities too
  • Being able to choose more convenient times for treatments and appointments

Most health insurance plans cover inpatient treatment, which is when you need a hospital bed. When it comes to outpatient treatment that require visiting external consultants this may be available through private medical insurance, but it tends to be an option available with more expensive plans that are on the market.

Depending on the exact details of your insurance policy you may also be able to receive access to specialist treatment or drugs otherwise unavailable on the NHS, due to where you live or due to being too expensive to provide to the general public. You may also be able covered for things such as surgical procedures, scans or radiotherapy and chemotherapy to treat cancer.

However, it is important to check the small print of any private medical insurance policy prior to taking one out to make sure that it meets your requirements, as there are many different providers with many options to choose from. So, be sure to opt for the right cover for your needs.

What Isn’t Covered by Health Insurance?

Whilst health insurance can cover many treatments, it can’t cover absolutely everything. In many health insurance policies this includes the following:

  • A&E visits
  • Treatments for ongoing, long-term or recurring conditions you suffer from
  • Drug abuse
  • Non-essential cosmetic treatments
  • Organ transplants
  • Normal pregnancy and childbirth costs
  • Injuries relating to dangerous sports or arising from war
  • Chronic illnesses, such as diabetes, epilepsy, hypertension or HIV/AIDs-related illnesses
  • A pre-existing condition prior to taking out an insurance policy
  • If you needed to make more than one claim, private medical care could end up saving you money

However, you may be able to opt for a policy to cover things like mental health, depression or sports injuries.

Different Types of Health Insurance

Generally speaking there tends to be two types of private medical insurance. These are moratorium underwriting, and full medical underwriting.

With moratorium underwriting. The insurer does not initially cover you for preexisting conditions, however after a period of time the insurer may then cover the medical condition subject to terms and conditions. With this type of cover, you only need to provide limited information to a health insurance provider.

Whilst with full medical underwriting, you will be expected to give your full medical history to the insurance provider as part of your assessment for the health insurance policy. This tends to be more expensive, but it does mean you are more likely to get wider coverage and receive this quicker too. Full medical underwriting is often the only type of health insurance provided to those over the age of 75 who take out a policy.

Full medical underwriting may also be a slightly longer process than a moratorium underwriting health insurance policy. Why? Well, in certain cases, your insurance provider may write to your GP (with your consent) in order to gain a better picture of your medical history.