How does private health insurance work?

Health insurance policies explained

The first thing to know about private health insurance policies is that they’re unique to you. It’s often built around your medical history, treatment preferences, required hospital access, the policy provider and the premium you’re able to afford.

Here are a few of the things you can expect to vary between health insurance policies:

1. Hospitals that you can be treated at
2. The treatments excluded in your policy
3. The medical specialists available to treat you
4. The excess you’ll pay in the event of a claim
5. Your monthly or annual premium (the cost of an insurance policy itself)
6. Access to non-standard treatment (dental, complementary therapies etc.)
7. Access to additional benefits, such as reduced gym membership costs, private GP cashback, food discounts etc.
8. The provider your treatment is with
9. Underwriting (depending on your health insurance policy history)
10. Group, or single person policy

What treatments does health insurance cover?

Health insurance policies are not inclusive of every medical condition known, and there are types of illnesses that are extremely unlikely to ever appear on a health insurance policy, regardless of the provider.

Most insurers will have a list of treatments that they won’t cover you for as standard, known as medical exclusions. Again, this is unique to the provider themselves, but here are some examples of common health insurance exclusions:

1. Routine pregnancy
2. Cosmetic surgery
3. Chronic conditions
4. Treatment required due to a patient’s criminal behaviour
5. Behavioural/ learning problems
6. Home care
7. Dentistry
8. Vision care (eye tests, glasses etc.)
9. Treatments relating to substance abuse
10. Contraception

Acute medical conditions VS chronic medical conditions

Health insurance policies focus on relieving acute medical conditions and the treatments associated with them. Chronic conditions, on the other hand, are long-term conditions that sometimes cannot be treated fully and may last throughout a patient's life. For this reason, insurers may choose to exclude some medical conditions completely.

However, there may be instances where a health insurance policy does cover you for treatment relating to a chronic condition. This depends on your provider, and the medical underwriting of your policy. If you're weighing up whether you'd benefit, read our post on is health insurance worth it where we cover everything you should consider.

Health insurance underwriting (medical underwriting)

Health insurance underwriting is the term providers use when they evaluate your medical and health information before offering you a policy. Every policy will come with underwriting, and it’s important that you understand what this means for your new and future health insurance policies.

Medical underwriting is concerned with the medical history of an individual and uses this information to define exclusions in policies, as well as dictating what treatments are available. Medical underwriting is split into two categories; Moratorium and Full Medical Underwriting.

Moratorium underwriting

Moratorium underwriting is very common in health insurance, and excludes most pre-existing conditions that you’ve suffered from over a set period of time, with the option to include them in the future.

Rolling moratorium

Rolling moratoriums, a type of moratorium underwriting, will usually exclude medical conditions that took place in the past 5 years prior to your join date. But, if you’re able to go 2 years without any treatment, advice, symptoms or medications while you have a policy in place, then the insurer may cover you.

Full medical underwriting

A policy with full medical underwriting requires you to disclose your entire medical history by completing a medical assessment questionnaire. Usually, all previous major conditions will be excluded, regardless of when you last received treatment. Your insurer will advise you on what conditions and treatments they can cover you for, however, there is scope to negotiate the terms, particularly for medical treatments that happened a long time ago.

You may be able to transfer your current underwriting terms to a new provider - we can find out for you

Continued personal medical exclusions (CPME)

CPME is another option for existing policyholders who are looking to switch provider. A CPME will allow you to transfer your current underwriting and exclusion list to a new provider, without additional exclusions being added. CPME is an excellent option for anyone with an existing policy that is looking to switch provider, without it affecting their access to medical treatment.

Which health insurance underwriting is right for you?

If you’ve suffered from a serious medical condition in the past 5 years, but you’re in recovery, moratorium underwriting may be the best option for you as treatments that were previously unavailable might be included in future policies.

If you’re medical history consists of minor conditions, full medical underwriting means that you may be able to negotiate their inclusion in your policy. But, bear in mind that any serious conditions are likely to be excluded indefinitely.

We’re experts in underwriting, and it’s an important part of every policy to get right; in short, it’ll determine the treatments you can access both at the start of your policy and for any future policies. Speak to us, and we’ll be able to advise you on the best option for you depending on your personal circumstances.

How much can you expect to pay for health insurance?

Because health insurance policies are so dependent on the applicant and the insurance provider, there’s no definitive cost you can expect to pay. There are, however, factors for you to bear in mind that will have an impact on the monthly or annual premium. If you’re interested in the factors influencing the cost of your health insurance policy, check out our ‘What is health insurance’ blog where we cover the topic.

Health insurance claims process

Knowing what to do in the event of a claim is just as important as the policy itself, and understanding the process specific to a provider is vital before making any purchase. The general steps to making a claim are similar across providers, but there may be additional options, such as a private GP, for you to consider.

Step 1: Your first step is more often than not to visit your NHS General Practitioner (GP) and discuss the medical issue. If the medical condition requires further treatment, you can request a referral from your GP. Some companies also give the option to see a private or virtual GP. This may be at an additional cost, but is sometimes included within the provider’s core cover.

Step 2: Contact your insurance provider and inform them of the medical referral as well as your intention to seek private medical treatment. You can discuss which hospitals are available to you, and the treatments covered in your policy. You’ll need to supply your provider with your GP referral and your unique policy number.

Step 3: Your provider will determine whether your claim adheres to the terms and conditions of your policy, and may recommend a specialist or treatment centre. Once agreed, you can book the treatment.

Step 4: Your provider may provide you with a ‘letter of code’ to take along to your medical appointment, which informs the hospital that the patient’s medical care is being paid for by the insurer.

Step 5: Once you’ve undergone your treatment, the payment bill will be handled by your insurance company. It is at this stage that you may pay the excess fee outlined in your policy.

At any point during the claims process, your insurance provider will be on hand to answer questions if you’re unsure whether you’re eligible for treatment with your current policy.

Finding the best private health insurance policy for you

It’s important that you understand the basics of health insurance policies before you make a purchase, and the best time to ask any questions is when you’re on the phone to an expert. By reading up on what to expect, you’ll be able to work with a provider to tailor a policy around you. Our what is private healthcare blog is a great place to start.

We specialise in working with people to build a policy unique to them, and going through all of the details extensively to ensure they’re getting exactly what they need. So, if you do have any questions about purchasing a health insurance policy, get in touch with a member of our team, and we’d be more than happy to help you out.

Consider this when you renew health insurance

At the end of your health insurance policy, you’ll usually have the option to renew with the same provider. You can expect your premiums, inclusions and exclusions to change based on your new health circumstances. Variables such as your age which will naturally demand a higher premium. Your renewal policy is usually calculated one month prior to the end date, so it’s a good idea to start shopping around at this time too. Even if you’re considering continuing your policy with the same provider, we recommend that you go through the comparison process as there may be more competitive policies available to you.

Equity Health is on hand to negotiate a better health insurance policy for you, and you’re under no obligation to purchase through us. Due to the extensive network that Equity Health works with, we’re often able to offer highly competitive health insurance policies, new and renewals alike. For more information you can visit our page on health insurance renewals.

Switching health insurance provider

Come renewal, we recommend that you compare health insurance across providers. This may be a policy with more inclusions for the same price, or a policy with the same underwriting and cover as the previous policy, but at a more competitive cost. We understand that this can be a daunting process to go through at the end of your policy, so get in contact and we’ll advise you if there’s something better out there for you. It’s a free service, and you can ask us any health insurance related questions while you’ve got us on the phone!