Key Facts to Know Before Buying

As with arranging any insurance policy, you must decide on the type of cover required and how much you are willing to pay it. It is also essential to be aware of the insurer's terms and conditions and claims procedure, in order to avoid difficulties or disappointments when making a claim.

Look out for the following terms in your Private Medical Insurance Policy:

Treatments Offered and Excluded

Most standard treatments for acute conditions will be covered, but psychiatric and dental treatments are often excluded.

Treatment Time

Some policies will specify that treatment must be completed in a given time, others will offer unlimited time.

Hospitals

Hospitals are generally broken down into three categories - London teaching hospitals, national hospitals and provincial hospitals. Check that you can use the hospitals of your choice.

Accommodation

Cover may range from a private room in a private hospital to a shared room in the private wing of an NHS hospital.

Claims

Check on how easy the claims procedure is, and how quickly your claims will be settled.

Premiums

As a general rule; the higher the premium you pay, the higher the range of cover you will receive. Additional cover may include hospice care, alternative medical treatments, transport to and from home or between hospitals, and home nursing.

Medical History Declaration

You will normally need to give full details of your medical history, and if necessary, the insurer may write to your doctor for more information. You must make sure that you give all the information you are asked for; otherwise your insurer may cancel your policy, or may refuse to pay any claim that you make in the future. If you are unsure whether or not to mention something, it is always best to do so. If you have a pre-existing medical condition that may come back, the insurer will issue a policy, but that condition (and any related to it) may not be covered; either indefinitely, or for a specific period of time (usually two years).

Moratorium

If you have a moratorium policy, you will not be asked to give details of your medical history. Instead, any medical condition which existed in the last (usually) five years will not be covered. These conditions may become eligible for cover if you do not have symptoms, or receive treatment, medication, tests and advice for that condition for a continuous period of (usually) two years after your policy has started.

Moving Plans

If you are currently in a group PMI Plan but want to change to another insurer, make sure that you sign up to the new plan on 'no worse terms'. This is known as a CPME (Continued Personal Medical Exclusions) plan, and simply means that the underwriting company of the new plan will accept offering the group cover on the same terms as the previous plan. This CPME transfer method allows for continuity of cover, particularly if you are presently undergoing treatment or have had treatment in the recent past and are concerned as to a re-occurrence of such a medical problem.