Does Health Insurance Protect You Instantly?

Does Health Insurance Protect You Instantly?

In the busy world today, looking after your health is super important and having good health insurance is a big part of that. It helps you with medical bills when there’s a health emergency and makes sure you get good private treatment care on time. People often ask, “Does health insurance start right away?” This guide will give you some information on the cover provided by private medical insurance and what types of medical expenses you can claim.

How Does Health Insurance Work?

Private medical Insurance is there to support you and your family when you need it most, taking care of the costs for private medical treatments in case of acute health problems. However, it won’t cover existing or long-term conditions. The details of what’s covered depend on your underwriting options.

It grants access to private healthcare through your selected provider. You have options ranging from basic to comprehensive health plans. Typically, plans with higher premiums offer more control and choices. In case you need treatment, your initial step is reaching out to your policy provider. If you encounter any challenges, don’t hesitate to contact your broker, who will assist you throughout the process.

What is Covered Under Your Health Plan?

Insurance providers generally don’t cover pre-existing and chronic conditions. Cover is usually limited to acute conditions that arise after the policy start date. Now, let’s examine these conditions more closely.

Acute Conditions

Private health insurance policies provide cover for treating acute conditions. These are illnesses or injuries that can be cured with a single course of treatment. Even if your treatment for cardiovascular or cancer problems spans a long period, it is still considered an acute condition.

If you break a leg or your GP suggests treatments or therapies, your health policy should cover private treatment, as long as the symptoms or injuries occurred after your policy start date. In simpler terms, if something goes wrong with you once you are signed up with any health plan and you need help, your insurance provider is there for you.

Basic Cover

When it comes to health insurance, you can choose between two main types: core cover and comprehensive comprehensive. The basic plans are designed to cover you for inpatient treatments and surgeries. This means you have financial support specifically for hospital stays and necessary medical procedures, ensuring your policy meets your essential healthcare needs.

Comprehensive Cover

The comprehensive plan goes beyond the basic cover, including outpatient treatments, in and day-patient treatments, diagnostic tests and MRI, PET and CT scans to support your overall well-being.

Cancer Cover

Your health plan usually covers cancer treatments as standard unless you downgrade it for NHS treatments to reduce your monthly premium. Your cover includes inpatient treatments, scans and tests Outpatient consultations, diagnoses and tests may be covered based on your chosen outpatient plan. Cancer cover provides access to treatments and medications not offered by the NHS.

Virtual GP

Since the COVID-19 Pandemic, most plans now include virtual GP as a standard. You can use their apps to see a doctor right away. It’s handy, especially if you’re too busy to go to a doctor in person or if you don’t want to wait on the phone for long. This way, you can quickly get medical help using your insurance, making things easier for you.

Optional Add-Ons

You can add extras to your core cover and build the cover that’s right for your medical treatment. There is an additional cost for most add-ons to get further treatments. According to National Institute for Health and Care, mental health is important for your well-being. However, some of the options such as the 6-week option or reducing your outpatient cover will reduce your premium.

• Dental & Optical– You can include dental, optical and audiology in your health insurance policy and claim some expenses back.
• Therapies– To tackle problems with back, joint and bone add therapy cover to your policy to get back on the move as quickly as possible.
• Mental Health– Get Mental Health added to your policy to cover mental health conditions provide support and cover the cost of recovery.
• Worldwide Travel– You can include Worldwide Travel Cover in your policy to cover you for medical emergency expenses while you are abroad.
• Protected NCD– You can protect your and your whole family’s no-claim discounts for an extra cost.
• Six-Week Option– You can reduce your premium by adding a six-week option to your plan. You will be treated privately if the waiting time with NHS for inpatient treatment exceeds 6 weeks.

What is Not Covered Under your Health Plan?

Private medical insurance is there to assist you when you face a sudden health problem or injury, helping you bounce back completely. However, it doesn’t cover everything. Insurance companies have a list of things they won’t pay for, known as exclusions. They only pay for treating new conditions that appear after you get the insurance. Exclusions work this way to ensure the insurance is for unexpected health issues, not things you already had or were aware of. So, if you had a health problem before getting insurance, it might not be covered.

Acute Pre-Existing Conditions

An acute pre-existing condition is a medical issue that someone already had before seeking treatment. It’s a health problem that comes on suddenly or lasts for a short time. If you have such a condition, it could influence your medical care and insurance coverage.

Examples are:

• Acute urinary tract infection.
• Sudden kidney stones.
• Acute gastroenteritis.
• Acute migraine attacks.
• Acute sinusitis.
• Sudden appendicitis.
• Acute pneumonia.
• Short-term injuries.

Chronic Conditions

A chronic condition is a medical condition that lasts for a prolonged period, usually three months or more. It may persist throughout a person’s life or require ongoing management and medical attention. Unlike acute conditions that come on suddenly and last for a short time, chronic conditions often require long-term treatment and lifestyle adjustments to improve the patient’s quality of life and prevent complications.

Chronic conditions examples are:

• Asthma.
• Type 2 diabetes.
• Hypertension (high blood pressure).
• Chronic asthma.
• Rheumatoid arthritis.
• Chronic obstructive pulmonary disease (COPD).
• Chronic migraines.
• Crohn’s disease.
• Chronic kidney disease.
• Multiple sclerosis (MS).
• Chronic heart failure.

Management of chronic conditions is commonly addressed through regular appointments and care within the public healthcare system, such as through the National Health Service (NHS). rewrite with readable words

General Exclusions

There are other general exclusions with your policy, these can be:

• Allergies.
• Deafness.
• Dialysis.
• Genetic tests.
• Vaccinations.
• Health screenings.
• Health screenings.
• Learning difficulties.
• Developmental problems.
• Menopause and ageing.
• Self-inflicted injury or suicide.
• Sleep problems and disorders.
• Treatment to correct eyesight.
• Weight loss treatments.
• Pregnancy and childbirth.
• Drug abuse

We strongly advise you to check with your health insurance provider or speak to one of our insurance advisors to get more information on what is included in your plan and which conditions are excluded.

Scenarios Where Immediate Coverage May Not Apply

There are certain scenarios where immediate coverage might not be applicable. For instance, most health insurance policies do not cover pre-existing conditions immediately. If the condition was present before the policy’s inception, there might be a waiting period before it gets covered. Additionally, treatments for chronic conditions or specific exclusions outlined in the policy might not be immediately covered.

Understanding Policy Underwriting

When considering cover, you have the choice between two underwriting options

Moratorium

The most common underwriting option is the moratorium, where any pre-existing conditions in the past five years will be excluded for the next two years, provided you remain symptoms, treatments and medications free for those conditions during this period.

Full Medical Underwriting (FMU)

With FMU, you are required to declare your entire medical history from the beginning. The advantage of this underwriting option is that, from the policy start date, you will have a clear understanding of what is included and excluded from your policy.

Options if you require immediate treatment?

When you urgently need treatment, your choices become a bit limited. In these pressing situations, you may not have many options, so it’s important to act quickly to deal with the immediate medical issue. Let’s explore the available choices in such cases:

A&E

In an emergency, whether you have health insurance or not, the first step is to dial 999 and go to A&E. After your condition is stabilised, you can contact your provider to arrange a transfer to private care. Alternatively, if you are self-funding your treatments, you can request to be transferred to a specific hospital of your choice.

Health Insurance

Your health insurance policy isn’t meant to cover pre-existing conditions. For instance, if you had a heart condition before your policy started, this condition and any related treatments will likely be excluded. You can only claim from your policy for acute conditions that arise after your policy begins.

Self-Funded Treatments

If your health insurance won’t cover your pre-existing condition, don’t worry—you can self-fund it. Many healthcare providers offer financing options. Start by getting a referral letter from your GP and finding a consultant, which could be your NHS consultant seeing you privately. Once you’ve identified an affordable treatment plan, explore financing choices, like lump-sum payments or medical loans. However, self-funding cancer treatment can be a financial burden due to its length and expense. In such cases, choosing NHS for treatment could be a viable option.

Treatment with NHS

If you need urgent treatment, especially for cancer, the NHS is the best choice. However, for non-urgent treatments, the current waiting lists are longer than expected. Waiting times can extend up to 65 weeks for certain treatments. The advantage of using the NHS is that it’s entirely free and you still have access to the same healthcare professionals as in private clinics, as many professionals work for both the NHS and private institutions.

How does the claiming process work?

Upon obtaining health insurance, you can expect to receive a welcome pack within 14 days. This pack will outline the inclusions and exclusions of your plan, along with a document explaining the claiming process. While many insurance providers allow claims through their app, some individuals may still prefer to make claims over the phone.

How to claim

The claiming process involves three simple steps:

➡️ First, obtain a referral from your GP

➡️  Next, contact your insurance provider and obtain authorisation

➡️  Get private Treatment!

If you just signed up for health insurance, additional information may be required from your GP to check for pre-existing conditions before your policy start date.

For instance, if you received a referral for knee pain, but had similar symptoms a year ago, the claim may be rejected as a pre-existing condition.

However, if your GP provides information about a different knee issue from the past, unrelated to the current symptoms, the claim may be successful.

Why my claim is rejected?

If your claim is denied, don’t be disheartened; it can occur for various reasons.

• Commonly, it might be rejected as it’s considered a pre-existing or chronic condition.
• Sometimes, denial happens due to exceeding your outpatient limit.
• Additional information from your GP might lead to rejection if the claimed condition is related to a pre-existing one.
• Opting out of additional therapy options, for instance, while claiming for sports injury therapies, can also result in rejection. Understanding these reasons can help navigate the claims process more effectively.

The Issue of Fraud in Health Insurance Claims

Fraudulent claims in health insurance are a serious offence with significant consequences. These can range from the rejection of the fraudulent claim to legal action. Insurance fraud increases costs for insurers, which can lead to higher premiums for all policyholders.

Why Being Honest in Insurance Matters?

Being truthful is crucial in health insurance matters. When you apply for a policy or make a claim, it’s important to give accurate and full information. If you don’t, it can be seen as dishonest and may result in cancelling your policy or rejecting your claim. Always be upfront and open to ensure a smooth insurance process.

Is it considered fraud to claim for a pre-existing condition?

Claiming for a pre-existing condition is not inherently considered fraud. However, it depends on the circumstances and the information provided during the insurance application process. If you fail to disclose a pre-existing condition intentionally or provide misleading information to obtain coverage, it could be deemed fraudulent. Honesty and transparency in disclosing your medical history during the application process are essential to avoid potential issues and ensure a fair insurance arrangement.

Final Thoughts

In summary, we’ve explored important aspects of health insurance, breaking down how it works and the details of coverage.

Understanding the ins and outs of health insurance cover and exclusions is crucial. It ensures you have adequate coverage during medical needs and helps you make informed decisions, potentially saving money and avoiding future issues. Additionally, we’ve discussed underwriting options, conditions permanently excluded and temporarily excluded conditions and delved into the process of self-funding private treatment.

Keep in mind that navigating the world of health insurance is a significant move to protect both your health and financial well-being.

Discover Personalised Health Insurance Solutions with Premier PMI

Understanding health insurance can be tough, but you’re not alone. At Premier PMI, we’re here to provide personalised advice on medical cover that fits your needs. Our expertise is in comparing and recommending the best policy options for you. We know how important it is to match these options with your specific health needs and budget.

Contact us at Premier PMI for expert guidance and to receive a quote that’s specifically tailored for you. We believe your health deserves the best protection and we’re here to ensure you get exactly that.

Stuart Hendy, Senior PMI Advisor &Editor

Stuart Hendy is a highly experienced health insurance broker with extensive knowledge of private medical insurance and private treatment. His expertise is frequently sought by industry professionals and his insights have been featured in leading financial publications. Stuart is committed to providing his clients with the best possible healthcare solutions and empowering them to make informed decisions.

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