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How Does Private Health Insurance Work UK?

Are you considering purchasing a private health insurance policy in the UK but unsure how it works? This article outlines the definition of private health insurance, what it covers, how to make a claim, and how much it will cost.

An Overview of Private Health Insurance in the UK

Private health insurance, or private medical insurance, is a policy sold in the UK designed to cover the medical expenses of an individual, couple, or family. These can include private treatments, therapies, and consultations, high-quality and instant accessibility should the policyholder or beneficiary fall ill.

This article will provide insight into private medical insurance details, outline how policies work, and inform on the costs. We begin with a definition of private health insurance.

What is Private Medical Insurance?

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Private health insurance is for those looking to overcome the obstacles of public healthcare systems like the NHS. Purchasing a policy would give the holder access to private medical facilities and personnel with no waiting times and higher-quality services.

Private healthcare usually comes at a high cost. Private medical insurance can help cover the expenses to the extent defined on the policy. Many purchase a policy pairing with NHS services. They will seek personal care if treatments are unavailable or waiting times are too long.

Furthermore, private health insurance can offer policyholders control and choice regarding treatment or who treats them. Many plans also include coverage for specialist drugs should they find the need.

Private medical insurance usually only tailors acute illnesses or symptoms into the plans. That means you’ll have healthcare coverage for unexpected short-term ailments, not long-term pre-existing conditions.

We’ll elaborate more on what private health insurance covers further down the article. Let’s continue with the different common types of private health insurance.

The Different Types of Private Health Insurance

There are a few different categories of health insurance about the number of people in the policy or the applicant’s age. We outline the types below:

  • Individual
  • Couple
  • Family
  • Children
  • Company
  • Over 50

Each policy can vary in what they cover, depending on the category. However, there is a general outlook to what private health insurance in the UK covers.

What Does Private Health Insurance Cover?

Again, insurers and policies can vary in the extent of what they cover. Generally, private health insurance will cover acute conditions and inpatient and outpatient care. We’ll go into a bit more detail.

Acute Conditions

Acute conditions define as ones that feature short-term illness, disease, or injury with appropriate treatment and an expected outcome. The issue is severe enough to require medical treatment, but because the root cause is known, there is a high chance of swift recovery.

Private medical insurance will cover these conditions as they are finite, and your health will likely return to the state it was before suffering the acute illness.

An example of an acute condition would be a severely broken arm. You can split your arm suddenly and unexpectedly, requiring surgery to fix the bones and relieve discomfort. Depending on the agreed coverage, private medical insurance will cover the costs of surgery and treatments in a private hospital.

Inpatient Care

Inpatient care refers to treatments that require a hospital bed overnight. Most private health insurance policies include coverage for any stays, such as recovery from surgery.

Other examples of inpatient care include:

  • Pre-surgery examinations
  • Operation charges
  • Administered drugs during the operation
  • Surgeon, anesthesiologists, and nurses fees
  • Private hospital room charges, including catering

Outpatient Care

Outpatient care is medical consultation not requiring a hospital bed. Some outpatient care finds coverage from private medical insurance, including MRI, X-Rays, and CT tests.

However, not everything is covered unless the policyholder opts for a top-tier plan. The different tiers of outpatient coverage are below:

  • Capped coverage – There’s a limit placed on how much coverage you’ll get in outpatient care. You’ll have to pay for some outpatient consultations.
  • Capped coverage with full diagnostics – Diagnostics will have full coverage, though you may have to pay for other consultations.
  • Full coverage – All consultations and diagnostics are covered.

What Does Private Medical Insurance Not Cover?

There are conditions and ailments that private health insurance won’t cover. Find below what insurers will generally omit from the policies.

  • Emergency treatments
  • Chronic illnesses and pre-existing conditions
  • Treatments that aren’t urgent (elective treatments)
  • Medical care required abroad
  • Treatment relating to drug abuse
  • Medical care during pregnancies

So now we understand what private medical insurance covers, how does it work when making a claim?

What Happens When I Make a Claim?

Suppose you’re prospectively purchasing a private health insurance policy, or you already have one. In that case, you may wonder how it works if you need to make a claim. We can break the process down into three straightforward steps.

Check your eligibility.

Before processing a claim, you will need to make sure that you’re eligible for coverage. Details you’ll need to check include policy limits on treatments, if the condition is in the plan, and if the required medical care has complete coverage.

Process your claim.

We note that every insurer will have a different way to make claims, so it’s vital to check how policyholders should process conditions. However, most will follow a similar route in processing claims.

Before your claim, you will likely find that a GP will refer you to a specialist to consult on your condition. You will need that referral in writing to initiate your claim.

Once the insurer receives the claim, they will process it pairing up your information with the coverage. Delays only occur if there’s an investigation into your claim eligibility or some miscommunication.

Otherwise, if your condition matches the terms of your plan’s coverage, the claim will get approved.

Receive treatment.

Once the claim processes, you can choose treatment and care in one of the insurer’s approved facilities or specialists. The insurer will pay the provider directly, saving you the time and hassle of claiming money back.

What If My Condition is Urgent?

Urgent conditions usually refer to accidents and emergencies that are generally not covered by private medical insurance. However, there may be exceptions, including prolonged stays in the hospital or continued treatments by a specialist.

How Much Does Private Medical Insurance Cost?

There is no fixed cost for private medical insurance as it can vary on several factors. The monthly premiums will be higher or lower depending on this information. These include:

  • Age – premiums increase as you age
  • Medical History – if you’ve had past conditions such as cancer or diabetes, the cost will increase
  • Family History – if there’s any family history of conditions like heart disease or stroke
  • Lifestyle – if you smoke, drink heavily, or are overweight, these result in higher costs
  • The Extent of Coverage – how much coverage you want in your private health insurance plan

There are many private health insurance options in the UK, meaning there is quite a lot of competition. You will find that there are reasonably priced options because of that.

Remember, you want the private medical insurance that works for you. Cost shouldn’t be the primary driver in making your policy decision.

A Summary on How Private Health Insurance Works in the UK

Purchasing private health insurance helps you reduce waiting times for treatments on acute conditions and most inpatient and outpatient care. It also gives you access to higher-quality medical care. When deciding on your policy, ensure coverage with your specific needs and health concerns, making processing a claim straightforward.

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