What is Outpatient Cover?

Suppose you’re interested in a private health insurance plan.

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Suppose you’re interested in a private health insurance plan. In that case, one of the most common terms that will arise is the outpatient cover. Many insurers will ask if you want this coverage included in your private medical
insurance policy.

If you’re unsure what outpatient cover is, let this guide help you understand the term and whether you need it in your prospective health insurance policy.

Defining Outpatient Cover

The outpatient cover is when your private health insurance plan will pay for any treatments, consultations, and diagnostics that don’t require a hospital bed for the night. In other words, they are medical facility
visits that will have you in and out within the day.

Examples of outpatient cover include private hospital visits for x-rays, CT scans, blood tests, and other diagnostic procedures. Others may consist of minor surgeries like colonoscopies, wart or mole removals, and any acute treatments
that don’t need overnight stays.

Outpatient cover won’t find automatic inclusion in your private health insurance plan. It leaves the prospective policyholder wondering what they need to know should they consider outpatient treatments in their plan.

What Do I Need to Know About Outpatient Cover?

Suppose you consider adding outpatient cover to your current or future health insurance policy. In that case, you’ll need to understand that there are different levels of coverage. Find below information relating
to the standard tiers of outpatient cover:

Capped Outpatient Cover

Capped outpatient cover means that there will be a limit to the amount an insurer will cover your outpatient treatments. Most caps will put a bar of £500 to £1500, where the policyholder may need to pay for some tests and procedures

The insurer usually covers outpatient treatment like MRIs, CT-Scans, and X-Rays. If you want outpatient cover in your plan but are on a budget, capped outpatient cover will have lower monthly premiums.

Capped Outpatient Cover with Full Diagnostics

Capped outpatient cover with full diagnostics includes the same cap on outpatient treatment and consultations. However, all diagnostic tests get covered in this plan (blood tests, PET scans, et al.).

Many health insurance plans will offer this outpatient coverage at reasonable rates, not differing from capped outpatient cover.

Full Outpatient Cover

Since most people aren’t sure what outpatient treatments they’ll need in the future, they’ll opt for full outpatient cover. There are no limits on the number of tests, treatments, and consultations with this option. Your insurer will
cover all outpatient requirements.

Some health insurance providers may differ in how they cover outpatient care. When picking your plan, be sure to speak with your broker or insurer about your needs.

So with an understanding of outpatient treatment, how does it differ from inpatient treatment?

What are the Differences Between Outpatient and Inpatient Cover?

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The fundamental difference between outpatient and inpatient treatment is that the former doesn’t require an overnight stay in a hospital bed, whereas the latter does. We can break that down into bullets to highlight the differences
between the two.

Inpatient Cover

Inpatient treatments require an overnight stay in the hospital, ranging from one night to several. The insurer will generally cover the following:

  • Pre-surgery tests such as bloodwork and scans like MRI, CT, and PET

  • Consultancy fees for surgeons, physicians, and anesthesiologists

  • Payments for treatments and surgeries

  • Costs of post-surgery medications

  • Charges for staying in the private medical facility

  • Private cancer treatment

Outpatient Cover

As mentioned earlier in this article, outpatient cover does not require hospital stays. However, these treatments will still need you to visit a private medical facility. The insurer usually covers the following
outpatient care:

  • Minor diagnostic tests like X-Rays and ultrasounds

  • Outpatient conditions that require treatments like physiotherapy

Outpatient diagnostics could see you referred to a hospital or clinic for further treatment, in which case, you’ll become an inpatient.

The range of coverage for both inpatients and outpatients can change depending on the insurer. Ensure you understand the full extent of cover with your provider before agreeing on a private health insurance policy.

Considering that outpatient care in health insurance plans can significantly raise your premiums, one would question whether it’s necessary. Outpatient cover may not feel needed when your inpatient visits are already rare.

Is Outpatient Cover Necessary in Private Health Insurance?

It’s a vital question when choosing to include outpatient cover on your private health insurance plan. Often, monthly premiums play a significant role in deciding whether to have it or not.

Outpatient cover will raise your premiums by a fair cost. However, price should not decide your health insurance plan – your needs and concerns should take precedence.

Here are some of the considerations if you choose to omit outpatient cover from your private medical insurance:

  • Diagnostics – You will need to get diagnosed by the NHS to access inpatient care, which could mean lengthy delays before you’ll get coverage for private treatment.

  • Cost – You will have to pay for any outpatient care received after inpatient treatments, which could amount to quite a lot of money.

  • Seamlessness – You never know when you need outpatient cover. Not having it in your plan may slow down the claims process figuring out what’s covered and not.

Outpatient cover is not necessary for private health insurance plans, not automatically included for that reason. However, if you want assurance that any treatments needed have coverage, explore limited outpatient cover options. There
are outpatient extras that won’t hike your premiums too much.

A Summary of Outpatient Cover

Let’s recap on all the information behind outpatient cover to grasp the term in private health insurance.

  • Outpatient cover is insurers paying for private treatments that don’t require hospital stays

  • Three general types of outpatient cover range from limited to complete

  • Including outpatient cover will raise your premiums on a health insurance plan

  • Inpatient cover, in comparison, is coverage for treatments requiring hospital stays

  • Outpatient cover isn’t necessary for private health insurance policies but can cause issues if not included

Remember, brokers or insurers can always help you decide whether to include outpatient cover in your health insurance plan. Speak to them should you have any questions, queries, or concerns.