There are quite a few companies providing health insurance (PMI).  Their policies can look very similar – but they are not always so!  Don’t forget there is the option of paying the bills yourself

There can be some fundamental and striking differences between policies from different companies and the most important thing for you to do is to spend time looking at the details before you decide. Here are some points made to PPF which are worth thinking about when you are choosing your insurer:

·         78% of private patients have a private medical insurance (PMI) policy. 

·         2 main insurers cover 65% and have a major influence on PMI.

·         Commercially driven insurers’ decisions may be obscured under a cloak of “quality”.

·         There is conflict between patients’ clinical needs for high quality care and insurers’ wishes to control costs.

·         The Office of Fair Trading has identified a lack of accessible, transparent, and comparable information to patients.  This may affect the informed purchase of PMI policies.

·         Restricted access (in that, an insured member can only see “approved” consultants, often within an insurer’s contracted network) disrupts traditional GP to consultant referral pathways. It also restricts patient choice

·         “Open referral” in which the GP is not allowed to refer directly, but depends on the insurer to choose a clinician, is in fact a restriction of access.

·         Consultants have an overriding duty of care to their patients, which insurers do not.

·         Doctors have undergone rigorous medical qualification and specialisation, are subject to continued appraisal and revalidation, and are regulated by the General Medical Council and are liable for negligent actions.

·         On the other hand, insurers are financial institutions regulated by the Financial Services Authority (FSA) and (as the OFT has recognised) do not own quality data on which to base clinical decisions.

·         Patients are disempowered and disadvantaged, and consultants’ standards and delivery of care may be compromised.

Some polices, for example, cover complications arising as a result of pregnancy but many do not and some exclude cover after the onset of the menopause.  Equally, costs of complementary practitioners such as osteopaths or chiropractors may be covered.  In some policies this cover as an option according to the premium you pay. Other policies will not cover complementary medicine fees at all.

Existing illnesses are very seldom covered by a ‘new’ insurer so take care when moving from one PMI to another.

Always remember that insurance companies do not promote what they do not cover and therefore it is vital to check out the fine detail before you buy. You might look at article on the BMA website which may concern you.

Companies who buy private medical insurance for their staff often hire experts to draw up a shortlist of providers and negotiate prices.  That is much more difficult for the individual choosing a new insurer.

If you are buying as a private individual, we recommend that you start by deciding what level of cover you need to suit you or your family, taking into consideration your particular lifestyle and income etc.

Drawing up a chart will make it easier for you to compare policies and make an initial choice. Once you have done this it is absolutely key to investigate exclusions in the fine print of each policy.

The Association of British Insurers has a statement of best practice (Adobe PDF) which may also provide some guidance on what questions to ask. Also check out their guide to buying PMI

Having chosen your ideal policy and having received the policy documents from your new insurer, you should take the time to check the small print again and in particular to look at the claims process. You should expect to make to claim at some stage. It really is best to understand the procedure whilst you are in good health so that difficulties are avoided if and when you become ill and you are anxious about what lies ahead. (See ‘How to make a claim’)


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