Private Health Insurance for Employees

How does private health insurance work?

Health insurance operates simply: you pay a monthly premium in exchange for quick access to private medical treatments, a great choice, especially when the National Health Service (NHS)has long waiting lists. Typically, health insurance covers acute conditions that arise after you obtain the policy, but it does not extend to pre-existing or chronic conditions.

When choosing health insurance, you have a few options, ranging from basic to comprehensive health insurance cover. Additionally, you can enhance your coverage by including additional benefits such as mental health, therapies, optical, dental, or travel insurance.

To make a claim, the process generally involves these steps: start by consulting your GP for a referral, then contact your insurance provider to obtain an authorisation code. You can either find a consultant yourself or rely on your provider to assist in this regard. Receive prompt diagnoses and treatment.

Health insurance provides a way to secure quicker access to medical care, giving you peace of mind in managing your health needs.

What does health insurance cover

Private health insurance typically covers services like private consultations, diagnostic tests, and non-emergency treatments in private hospitals. It does not replace the NHS but can offer quicker access and give you more options for where you get care.

Inpatient and day-patient care

Most providers include both private inpatient treatment and day-patient care as a standard part of their cover.

Inpatient Cover

This part of your insurance covers you when you have to stay overnight in a hospital for surgeries or treatments, whether it’s something simple like a cataract replacement or more serious like heart or brain surgery. It also includes your hospital room and board, surgery, anaesthesia, and the medicines and supplies you need during your hospital stay.

Day Patient Cover

This is for when you get medical treatment or surgery in a hospital but don’t need to spend the night. It includes surgeries done in a hospital’s day surgery unit or outpatient centre, along with anaesthesia, medicines, supplies, and care all on the same day.

Cancer cover

Cancer cover in health insurance in the UK typically includes a range of benefits, such as coverage for cancer diagnostics, treatments like surgery and chemotherapy, comprehensive aftercare, medications, specialist consultations with oncologists, access to additional therapies, palliative care, support for experimental treatments, and various support services, including psychological and emotional support. 

Some policies may also offer cover for aftercare, wigs, bone marrow transplants and treatments not readily available through the NHS. 

Digital GP

Most UK private health insurance now provides digital GP services, which became common during the pandemic. However, if you prefer to see a doctor in person, you can opt for a private GP for an extra cost. This allows you to have face-to-face appointments whenever you need them, which gives you more control and flexibility over your schedule.

Rehabilitation

Health insurance often covers rehabilitation services, providing you with essential support, when recovering from injuries or surgeries. This can include physical therapy, occupational therapy, and speech therapy, These will help you regain your mobility, independence and quality of life, contributing to a smoother and more effective recovery process.

NHS Cash Benefit

You might have the option to get an NHS cash benefit with your health insurance. It means they’ll give you some money if you use NHS services. For example, they might pay you for each night you stay in a hospital or for each outpatient visit. While you can’t use private healthcare, you can use this money for things like hospital parking or a private room. This can be helpful if you have a pre-existing condition and need treatment.

Private Medical Insurance Add-Ons

When you have private medical insurance, you can make it even better with add-ons. For a little extra money, you can upgrade your plan to cover things like dental care, mental health care or fancier hospitals. Let’s take a closer look at the choices you have to enhance your health insurance coverage.

Outpatient treatment

Outpatient treatment involves medical care that doesn’t involve staying overnight in a hospital. It covers services like consultations, diagnostic tests, and minor procedures, allowing patients to return home the same day. You can select from different outpatient cover options, ranging from none, standard and unlimited. 

Some insurers, such as Vitality and Exeter, allow you to reduce your outpatient limit to £500, £750 or £1000 while including unlimited diagnostics. Axa for example have an option to reduce your outpatient cover to up to three consultations with unlimited diagnostics.

Dental and optical cover

Dental and optical cash benefits, often offered as add-ons with health insurance, provide financial support for services like routine dental treatment, check-ups, hygiene, fillings, eyeglasses, and contact lenses. Some providers even include emergency extraction and crown replacement. However, it’s important to note that these benefits typically do not cover the cost of braces or implants.

Mental health treatment

Mental health treatment covered by health insurance typically includes therapy sessions, psychiatric consultations and in some cases, inpatient care. Mental health treatment coverage in health insurance varies: Bupa includes it as standard, while some insurers offer it as an optional add-on. Pre-existing conditions are typically not covered. However, with Exeter’s Healthwise app, you can access online consultations and support for mental health conditions.

Therapies

You can also include physiotherapy to your core cover to access physiotherapists and acupuncture quickly for your joint issues or nerve knots.  Some companies, like Bupa, include physiotherapy as part of their standard cover, without needing to add it separately. However, each insurance company might have different rules about how many sessions you can have and how much you pay.

Worldwide Travel Insurance

In the UK, health insurance with a worldwide travel insurance add-on is not widely available, but AXA and Vitality offer this feature. With this add-on, you can secure coverage for medical emergencies when travelling abroad. It also includes protection for lost baggage, flight cancellations etc, ensuring comprehensive support for your international journeys.

More Options For Private Health Insurance

When it comes to reducing your private health insurance cost, you have a few options to choose from. These include opting for reduced coverage, decreasing your excess, downgrading your hospital list, and taking advantage of annual payment discounts. These choices can significantly reduce the overall cost of your health insurance.

Six-Week Option

Some insurers offer reduced cover by implementing a waiting period for your treatments. For example, Aviva’s Healthier Solution provides the option for policyholders to choose NHS treatment if the waiting time is under 6 weeks. In cases where the NHS waiting time exceeds six weeks, private treatment under the Aviva policy ensures timely access to healthcare services.

Hospital List

When you’re picking your policy, you have the flexibility to choose a specific hospital list. If you don’t live in London, you can actually reduce your premium by selecting a local hospital list. This is because healthcare services in London tend to be more expensive, and your policy cost may increase as a result. It’s a way to make your cover align with your location and your budget.

No-Claim Discount

Insurers like The Exeter and Aviva offer a no-claim discount add-on for health insurance. This typically rewards policyholders who don’t make claims during a specific period. It offers a discount on premium rates for each claim-free year. The longer you go without making a claim, the higher the discount you can accumulate, helping to reduce your health insurance costs.

Annual Discount

Health insurance companies such as AXA and WPA often provide annual payment discounts of around 7-10% for health insurance premiums. Some insurers also offer family discounts, where you pay for only one child’s coverage even if you have multiple children, making healthcare more cost-effective for families.

At PremierPMI, we’re here to assist with your health insurance. Our knowledgeable advisors will guide you through all the available options, making sure you and your family fully grasp the choices. We’re dedicated to helping you make well-informed decisions about your policy.

What does private healthcare not cover? (Exclusions)

Private healthcare often comes with exclusions, meaning some medical conditions may not be covered. These exclusions can vary by insurance provider and plan, but they commonly include: 

Pre-existing and Chronic Conditions

Insurance providers often exclude coverage for medical conditions that you had before obtaining the insurance. It can change how much you pay and what the insurance covers. Chronic conditions that require ongoing care, such as diabetes, heart disease, or asthma, are typically not covered under many insurance plans. These conditions usually require specialised, long-term management and are often considered pre-existing conditions.

Accident and Emergency

This exclusion can be tricky. Some insurance plans may not fully cover emergency room visits if they determine that the situation doesn’t qualify as a true medical emergency. It’s essential to understand your policy’s definition of an emergency.

Kidney Dialysis

Coverage for kidney dialysis, which is required by individuals with end-stage renal disease, is often excluded or subject to specific limitations in many private insurance plans.

Pregnancy and Childbirth

Pregnancy and childbirth are typically not covered as part of the standard policy. However, complications that arise during pregnancy or childbirth may be covered. These complications are usually considered medical issues and are more likely to be included in your plan.

Infertility Treatments like IVF

Most private insurance plans do not cover infertility treatments, including in vitro fertilization (IVF), as these treatments are often viewed as elective rather than medically necessary.

Cosmetic Surgeries

Cosmetic procedures, which are undertaken for non-medical reasons, are almost universally excluded from standard health insurance coverage. There can be exceptions if the surgery is linked to reconstructive or medically necessary purposes.

Experimental Drugs and Treatments

Private insurance typically does not cover drugs or treatments still considered experimental or lacking approval from relevant medical authorities. Nonetheless, some experimental treatments may be accessible through clinical trials or special programs.

Alcohol and Drug Abuse

Help for problems with alcohol or drugs might not be included. Rehabilitation is primarily provided through the NHS and local authority services. These services are publicly funded and typically offered at no direct cost to patients.

How insurance providers deal with pre-existing conditions depends on the way you choose the underwriting option. There are a few underwriting options to choose from:

Moratorium

Under this method, certain pre-existing conditions are excluded for a specific waiting period, typically around two years. During this period, any issues related to these conditions won’t be covered. After the waiting period, coverage may be considered, if you get symptoms, medications and treatments free for that specific condition. 

Full Medical Underwriting

This approach involves a comprehensive evaluation of your medical history and ongoing treatments. Insurance providers assess your health in detail and make coverage decisions based on that assessment. It offers transparency but may lead to exclusions or higher premiums for certain conditions.

Medical History Disregarded

This approach disregards pre-existing conditions altogether. While it offers broad coverage, the premiums can be relatively high.

Selecting the right underwriting method is a critical decision as it directly impacts your access to private treatments and the cost of your policy.

While some common exclusions exist, the primary exclusions will be outlined in your policy documents, which can vary based on the chosen level of cover and the specific policy you’ve selected. It’s vital to thoroughly review these documents to gain a precise understanding of what is and isn’t covered under your private healthcare plan. Our PMI broker will guide you through the process and make the buying health insurance journey stress-free. 

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.

• LinkedIn