Health Insurance FAQs, Questions and Information

Below are a few health insurance frequently asked questions and their answers which may assist:

Q. What is the National Health Service (NHS)?

A. The National Health Service Act 1946 came into effect on 5 July 1948 to provide services for physical and mental health, providing free or low cost health care to all UK residents regardless of their age or medical condition. Most services are free at the point of use although there are charges associated with eye tests, dental care, prescriptions, and aspects of personal care. The NHS provides the majority of health care in the UK including:

• Primary care - GPs, Pharmacists and Community Nurses
• In-patient care - Hospitals, Physicians, Surgeons etc
• Long-term health care - At home, in the community, in assisted living or in nursing homes for people of any age, although most commonly senior citizens.
• Ophthalmology - Eye specialists
• Dentistry - All aspects of dental medicine

Q. Which medical conditions are not covered by private medical insurance?

A. There are treatments and medical conditions, such as long term incurable (chronic) illnesses and day to day GP and accident and emergency services which the private sector does not provide cover for, these are called exclusions. Pre-existing conditions and normal pregnancy are usually not covered either (although some insurers do). In addition to the above, some typical exclusions for private insurers include:

• Ageing, menopause and puberty
• AIDS/HIV
• Allergies or allergic disorders
• Birth control, conception, sexual problems and sex changes
• Chronic conditions
• Complications from excluded or restricted conditions/ treatment
• Convalescence, rehabilitation and general nursing care
• Cosmetic, reconstructive or weight loss treatment
• Dangerous hobbies/sports/work
• Deafness
• Dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc)
• Dialysis/organ transplant
• Drug/alcohol abuse or self inflicted injuries
• Drugs and dressings for out-patient or home use
• Experimental drugs and treatment
• Eyesight
• HRT and bone densitometry
• Learning difficulties, behavioural and developmental problems
• Overseas treatment and repatriation
• Physical aids and devices
• Screening and preventive treatment
• Sleep problems and disorders
• Speech disorders
• Temporary relief of symptoms
• War risks

Different insurers offer different levels of cover and have differing exclusions so always check with your insurer what their specific exclusions are and what you are covered for.

Q. What is meant by Chronic and Pre-existing conditions?

A. The Association of British Insurers (ABI) provides the following common definitions which private health insurers must use: A Chronic condition is a disease, illness or injury which meets one or more of the following criteria:

• ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests
• ongoing or long-term control or relief of symptoms
• rehabilitation or special training to cope with it
• continues indefinitely
• no known cure
• comes back or is likely to come back

A Pre-existing condition is any disease, illness or injury, whether diagnosed or not, for which you have:

• received medication, advice or treatment
• or experienced symptoms

Q. What is predictive genetic testing and how does it affect my private health insurance?

A. Predictive genetic testing is used to see if you have an inherited family gene that might cause you to suffer a specific condition or illness in the future. While you do have to disclose any family medical history when applying for health insurance, under the terms of the 2001 moratorium (voluntary ban) agreed with the Government and the Association of British Insurers, members of the ABI are not allowed to access applicants' predictive genetic test results. Also ABI members will not ask you to take a predictive genetic test in order to obtain insurance. For more detailed information refer to the ABI's Genetic Tests and Insurance Guide

Q. What is Long term care insurance?

A. The ABI's definition of long term care insurance is an insurance that provides a planned way of paying for some or all of the cost of any long-term care you may need now or in the future. Through a lump sum payment in advance, or regular premiums, you can buy insurance to cover the cost of care in your own home (domiciliary care) or in a residential or nursing home. The expression "long-term care" does not apply to care needed to recover from short illnesses, or convalescence following such illness. It refers to care that is needed for the foreseeable future, perhaps as a result of permanent conditions such as arthritis, stroke or dementia. Care needs caused by these long-term conditions are not always met by the NHS and are not supported indefinitely by private medical insurance policies.

Q. What is a 'Health Cash Plan'?

A. A health cash plan is another type of health insurance which can be used as an alternative to, or as an add on to, private medical insurance. It enables you to claim between 50% and 100% (or up to a specified amount) of the cost of routine daily medical expenses, like trips to the optician, dentist or physiotherapist or can pay you a fixed amount per day if you need to go into hospital to receive treatment, for example for a pre-existing condition. Health cash plans can also include a form of personal accident cover. The amount you can claim back as cash depends on the premiums you pay.

Download the Health Insurance PDF Guide here - see our other free PDF guides here

Guide Contents

What is health insurance?
Why you might need private health insurance
What are the different types of health insurance plans?
Shopping around for your health insurance cover
Health Care Insurance, How to Apply
Health Insurance FAQs - Questions and Information
UK Health Insurance, where can I go to get more help?

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