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Private Health

For emergency medical treatment the NHS remains - in the vast majority of cases - the best option. If you have a serious injury or illness, unless you are unlucky, you will be attended to swiftly by some of the most highly qualified people in their field. For less acute conditions, however, the picture may not be quite so rosy. If you need a hip replacement you may wait for months and months for an operation on the NHS and you may be in quite considerable pain for all this time. If you have private medical insurance , however, you are likely to be able to book an appointment for an operation at a time that suits you and in a place that is convenient. Once you get to the hospital you will also find that your level of comfort is far greater as a private patient than it would have been in the NHS. And, of course, there is nothing to stop you transferring into a private room in the hospital having had an operation on the NHS. The downside, of course, is that private medical insurance is expensive. Basically it is a rich man or woman's perk. 

What exactly is private medical insurance?
 
A private medical insurance policy covers the policy holder against the costs of private medical treatment but only generally where the condition in question is "acute". The word "acute" has no fixed definition but generally an "acute" condition is one which is serious but curable or treatable within a reasonable period of time (see 'exclusions' below for more on what types of condition are and are not covered). In other words you would not normally be covered under a private medical insurance policy for a condition that is likely to lead to your death. 
 
Private medical insurance policies vary. However most will cover you for the cost of your stay in hospital (including as a day patient) and, specifically, for:

 - the cost of all medical treatment (ie anything done to you by a doctor including a surgeon)
 - all nursing costs
 - the costs of being in a private room in the hospital
 - the costs of all medicines 
 
What is excluded from private medical insurance cover?
 
As with all other types of insurance, private medical insurance policies typically contain a long list of 'exclusions' (ie conditions or circumstances which relieve the insurance company of the obligation to pay out under the policy). It is very important that you understand these exclusions before signing up for private health cover. There is almost nothing more irritating and unsettling than becoming ill then discovering that your particular complaint is not covered by your insurance policy.
 
The following are usually excluded conditions:

 - HIV/AIDS
 - Pregnancy
 - Infertility
 - Sex changes
 - Organ transplants (including kidney dialysis)
 - Cosmetic surgery (other than where associated with another insured condition - eg following a car crash)
 - Self inflicted harm (including from what the insurance industry calls 'hazardous pursuits')
 
In addition to which the insurance company will not normally be obliged to cover the costs of private treatment where:
 
 - you had the condition prior to taking out the policy
 - you are dealt with as an accident and emergency patient (as referred to above, accidents and emergencies still tend to be administered by the NHS)
 - you have a condition that the insurance company deems to be incurable  

However, there are also a number of items which may or may not be covered depending on the type of insurance you have. Examples would include out patient consultations, out patient tests, compensation for having certain aspects of the condition treated as an NHS patient and oversees cover. You should check the wording of your policy carefully to see whether these items are included or not 
 
What types of private health cover are there?
 
There are lots of different types of private health insurance policy. For most people it is cost that determines which type of policy they go for.
 
The insurance companies who provide private medical cover tend to differentiate between:

 - in patient treatment (ie treatment which requires you to stay in hospital for one or more nights)
 - day patient treatment (ie treatment which requires a period of medically supervised recuperation but does not involve an overnight stay in hospital)
 - out patient treatment (ie other forms of treatment)
 
Obviously the first category is the most expensive and the last the least expensive. However, another key component of cost is the type of hospital you are entitled to receive treatment in. Hospitals are basically like hotels in this respect. A '5 star' hospital  - as it were - is obviously more expensive than a '3 star'.     

Where to obtain private medical insurance
 
There are two main ways of obtaining private medical insurance: either directly from an insurance provider or through an agent. A lot of people tend to go direct to the 'household' names in this segment of the market (eg BUPA, AXA) but, as always there is merit in shopping around before taking any final decisions. The internet is, of course, an ideal way to do this. Brokers or specialist agents can be useful, particularly if there is anything about your health that is in any way unusual or complicated. But of course they charge a commission for their service.  
 
The cost of private medical insurance
 
The  cost of private medical insurance has sky rocketed in recent years, in part because claims have been rising and in part because the cost of providing healthcare has risen much faster than inflation. You will also find that the cost of insuring yourself for private medical care increases with age. If you are 60 it will cost you approximately twice as much to insure yourself as if you are 35 - it being (obviously) the case that your are far more likely to claim under a policy when you are 60 than when you are 35.
 
There are various ways in which you can reduce the cost of your private medical insurance:
 
increase the excess: as with most insurance products, private medical insurance policies invariably contain a provision under which you (the policy holder) are obliged to pay a certain amount before the insurance company will contribute towards the claim. This is known as the excess or voluntary excess. One way of reducing your annual premiums is to increase the amount of the excess. Make sure you can afford to pay the amount of the excess before going down this route however  
 
use the NHS: an apparently absurd suggestion but not actually as daft as it sounds. If you make any claim under your private medical insurance policy you will probably find the premium increases significantly the following year. For a very minor operation or form of treatment you may well find it better to use the NHS than run the risk of your premiums going up far more than usual

contribute yourself: as an alternative, but using the same logic, you may choose to use the private sector for a minor complaint but pay for it yourself
 
downgrade the type of hospital you are entitled to use: some hospitals are considerably more 'expensive' than others. What this means is that if you limit those in which you are entitled to receive treatment you should also be able to lower the cost of your insurance
 
How to obtain private medical insurance
 
Once you have selected the company through which you wish to purchase your private medical insurance you will typically have to fill in an application form containing information on you and your medical history. The insurance company may also write to your doctor and you may have to attend a medical before the cover is valid. In filling out an application form it is vital that you disclose all relevant information since failure to do so may invalidate the policy. If in doubt about whether to disclose something err on the side of caution. Some policies will not cover any medical condition that existed within a period of (say) 5 years prior to the cover being given. This is known as a 'moratorium.

How to make a claim
 
Your policy documents will provide information on how to make a claim. It is important that you follow the procedures carefully. In virtually all cases (except emergencies) you would need to consult your GP before seeing a private consultant. But as a general rule it is advisable to discuss with the insurance company all aspects of a potential claim before taking any final decisions on how to proceed.