Ten tips to get best private health cover 

THE COST of private medical insurance is rising faster than inflation, pricing some people out of the market. How do you make sure you have the cover you need at a price you can afford? This guide tells you all you need to know. 

1. What sort of things does the insurance cover? 

Health insurance pays for treatment in a private hospital for acute, curable conditions, such as hernias, (Leistenbruch) hip replacements and cataracts (grauer Star). The policies do not cover emergency procedures or chronic illnesses that cannot be cured such as multiple sclerosis and diabetes. Normal pregnancy and childbirth are usually excluded. Insurance for private dental treatment is usually sold separately. 

2. I have a heart condition. Can I still get cover? 

Insurers exclude all pre-existing medical conditions. Although you can normally buy medical insurance if you already suffer from an illness, it will not pay for treatment related to that condition. Some insurers include existing conditions if they have not occurred in the five years before you take out a policy - but you are not normally covered for the first two years the policy is in force. Be careful. If you go for a check-up because you are worried that something is wrong it may be excluded from your policy - even if all tests are clear.

3. Does insurance cover outpatient care? 

Most schemes pay only for outpatient care linked to your treatment as an inpatient. 

4. Can I go to any private hospital of my choice? 

Insurers split hospitals into three or four cost bands. The premium you pay depends on the band you choose, but the most expensive hospital is not necessarily the best. Most advisers recommend that you select a band that includes a hospital near your home. 

Even a top-of-the-range policy may not include every hospital. BUPA and PPP are the biggest medical-insurance companies and both limit the number of hospitals in which policyholders can be treated. PPP has a network of approved hospitals based on a range of criteria, including quality and value. BUPA operates a slightly different system. If you use only its approved hospitals you pay a lower premium. But however much you pay, you are always subject to its limit on fees for consultants. If your consultant charges more than BUPA’s limit you are not covered and have to make up any shortfall. 

5. How much are the premiums? 

Premiums vary according to your age, medical history, where you live and the type of policy you select. You can pay anything from £100 a year to more than £2,000. Budget policies may pay out only if the waiting list for NHS treatment is more than six weeks. They also cover a limited range of illnesses and restrict the number of hospitals in which you can be treated. Standard policies also restrict your choice of hospitals. They also usually impose limits on the number of days' treatment and number of claims you can make in a year. If you do not want any restrictions, you can buy a deluxe policy, but you may have to pay a hefty price. 

Medical-insurance policies are renewed annually - and you may get a shock. The cost of insurance is soaring. You can expect a premium rise of about 12% this year, although some policyholders may face an increase of up to 50%. 
6. How can I cut the cost of medical insurance? 

If you can persuade your employer to provide insurance as a perk, you pay tax only on the premium paid by your company - much cheaper than buying an individual plan. If your employer will not oblige, the best way to keep the cost down is to restrict the cover. You can also check whether your insurer offers a discount if you do not make a claim, if you agree to pay towards the cost of any claim, or if you pay premiums by direct debit. 

7. Can I arrange cover for my family? 

You can often save money if you buy a joint policy. But if there is a big age difference between you and your spouse, you might be better off with separate cover - premiums are set according to the age of the eldest policyholder. Children are normally quite cheap to insure and new-born babies often get free cover for the first year. 

8. How do I go about making a claim? 

Always contact your insurer before you commit yourself to any private treatment. It may be a condition of your policy that you must obtain the insurer's written consent before any treatment. Even if your company does not make such a demand, it is always a good idea. 
Find out which bills the insurer pays directly and which you have to settle and claim back. If you get a claim form you can see exactly what you need to do and can ask your consultant to sign the paperwork on your first visit. Keep a record of all visits, letters and calls to your insurer and doctor and send your claim form in promptly. Some companies refuse to meet claims received six months after the date treatment started. 

9. Am I allowed to consult a private GP? 

Some companies, including Norwich Union, run private GP schemes. The Norwich Union scheme costs £10 a month and allows you four visits a year to a Medicentre GP. Alternatively, you can drop into one of the 12 Medicentre clinics in London's Victoria station and selected Boots and Safeway stores. Patients fill in a questionnaire and pay for treatment on the spot. A 15-minute consultation costs about £35. 

10. Is there an alternative to medical insurance? 

If you prefer, you can simply book into a private hospital and pay for your treatment by cash, cheque or credit card. Some hospitals even offer loans to cover the cost of medical care. Although costs vary, you can expect to pay between £5,000 and £7,000 for a hip operation and up to £2,500 for cataract removal. Or you can opt for a cash plan that pays out a tax-free cash sum for every day you are treated in hospital. You can also put the money towards dental, optical and chiropody treatment.

Source: Sunday Times