A Short Guide to Private Medical Insurance

But if you have ever faced a lengthy wait time for treatment or struggled to get a referral in the first place, you may be looking for a quicker and easier option.

Private healthcare could provide the additional flexibility you require, allowing you to access a high standard of treatment without the wait times.  

What is PMI?
PMI is simply a type of insurance policy paid by monthly or annual premium. Many employers provide it, and personal policies are widely available. A policy can cover one person, a couple or an entire family. If you have a business, PMI can be an extremely cost-effective benefit for your employees, particularly as it is likely to reduce absence due to illness.

The policy can then pay for a range of private medical treatments, usually on referral from your GP.

In most cases, you will need to pay an excess towards your treatment. The amount can vary, but the higher the excess, the cheaper the premiums.

What Does It Cover?
Policy terms and conditions will vary, and in general higher levels of coverage result in more expensive premiums. A typical policy covers:

• Diagnostic tests and consultations (before and after treatment)
• Hospital treatment
• Physiotherapy and rehabilitation
• Mental health support
• Dental and optical services
• Access to private GPs by telephone or video call

Some policies are designed to work alongside NHS services, for example an NHS diagnosis may be required before accessing private treatment. Other policies are more comprehensive, and therefore more expensive.

Some providers offer perks alongside the main policy benefits, for example health checks, travel insurance and discounts on fitness trackers or gym memberships. While these perks can be tempting, it is always worth shopping around as they will not necessarily save you money.

What Does It Not Cover?
PMI does not replace the requirement for the NHS, as there are certain issues that are not covered. For example:

• Emergency care
• Routine pregnancy and childbirth
• Pre-existing conditions
• Chronic illnesses or conditions
• Cosmetic surgery

What Are the Benefits?
The benefits of PMI are:

• Earlier access to appointments and treatment.
• Choice of hospital and doctor.
• Higher standards of accommodation in hospital, including private rooms.
• Access to treatments that may not be available on the NHS.
• Most policies offer additional support and perks to help you stay healthy.

A wider benefit of PMI is that in theory, demand on the NHS is reduced, freeing up access to services for those who cannot afford to privately insure.

In general, a healthier population who can access timely treatment for any health concerns, has to be better for society.

What Are the Disadvantages?
Any type of financial contract has disadvantages or risks. In the case of PMI, these are:

• Not all conditions are covered.
• This includes some of the conditions that are most common over a typical lifespan – acute injuries from accidents, pregnancy, ageing and chronic conditions such as diabetes.
• It can be expensive, particularly for comprehensive cover.
• The claim process is not always smooth, and relies on multiple healthcare providers and your insurer communicating effectively.
• It’s important to check that your treatment is fully covered. In some cases, while the initial treatment is included, complications and follow-ups may not be.
• Policy terms can be confusing, and it is not always clear what is covered and what isn’t. It’s worth speaking to your insurer if you are in any doubt.

It could also be argued that on a societal level, PMI creates a two-tier healthcare system, where the best treatment is only reserved for those who can afford it.

PMI provides a complementary service to the NHS, and can be extremely effective for diagnosing and treating acute conditions. Overall health can be improved through access to early treatment and preventative support, as well as generally living a healthy lifestyle.

It is not, however, a replacement for the NHS, which most of us will still need to access at some point in our lives.

Please do not hesitate to contact a member of the team if you would like to find out more about private healthcare.