Firms must provide details of how they deal with claims arising as a result of cancer, detailing:
What is covered
Limits on time periods and cycles of treatment
Maximum payments
Circumstances in which cover is not provided
This is important as cancer can start as an acute condition but - if treatment is unsuccessful - become chronic. It is not uncommon for insurers to receive high value claims. Due to the high cost of claims and improvements in cancer care provided by the NHS, some insurers now limit the amount they will pay for cancer or exclude it completely. Most policies will also not pay all types of cancer care, for example, experimental treatments or drugs nor licensed in Europe or by the Government’s National Institute of Health and Care Excellence (NICE).
It is therefore important that the terms and conditions of the policy are clearly understood along with any restrictions and limits on benefits. To help provide customers with support, many insurers now provide specialist cancer nurses or claims staff to help and guide those claiming as a result of being diagnosed with cancer.
Benefits are paid either directly to the medical services provider or to the insured to refund the costs where these have been paid upfront, and generally will cover the costs of:
Accommodation, including meals
Nursing
Theatre fees
Drugs
Dressings
Doctors’ fees
Consultants’ fees
Anesthetists’ fees
Outpatient treatment
Diagnostic tests and investigations
Home nursing during recovery
Costs of parents staying in hospital with a young child
Minor surgery carried out by a GP
Chemotherapy, radiotherapy, etc.
Private ambulance
An ‘open referral’ system may be used; the patient’s GP refers them to a specialist but does not specify which specialist or hospital, rather, these are appointed by the insurer, often with the patient’s agreement.
Treatment is usually restricted to UK residents and does not include treatment outside of the UK. Treatment outside the UK may be covered under the terms of travel insurance.
PMI plans come in a variety of formats offering varying degrees of cover.
Exclusions
It is a feature of PMI that chronic conditions are excluded from cover or that cover is limited to acute conditions. While insurers use different definitions of “acute” and “chronic” the general intention is much the same. An example policy wording would be:
An acute condition - “This term is used to describe a condition of rapid onset, severe symptoms ...
Shortened demo course. See details at foot of page.
... are free of tax and tax relief in respect of premium payments is only allowed where an employer pays premiums to a group scheme
As all PMI plans are annually renewable, claims may result in an increase in premiums or the application may be declined at renewal
PMI sales and marketing
The cost of private medical treatment has risen well in excess of inflation, as a consequence, premiums for PMI have also increased and to such an extent that cover may be unaffordable to many.
Providers have looked at different ways to manage premiums, for example, by applying larger excesses which have the impact of requiring the insured to pay for straightforward treatments. This approach is likely to be suited to the needs of those who are in good health.
If available, a group scheme will provide access to PMI at lower cost.
There is a wide range of choice available in the PMI market and with increasing costs and the short-term nature of PMI insurance, clients can be tempted to review the market place to look for a better deal.
Where changes are to be made it is vitally important to take the following into account:
A new policy is likely to exclude all pre-existing conditions, even where treatment would have been provided under the previous policy
Existing conditions may be subject to a moratorium
Although there may be a saving on the premium, the cover is likely to be reduced
There is also a trend for new policies to make premium rates look attractive by offering larger excesses where the insured pays the first £1,000 to £5,000 of a claim.
PMI abroad
Unless specifically sold as international PMI policies, a policy arranged in the UK is unlikely to provide cover for treatment outside of the UK. If medical treatment is required whilst on a short trip abroad, cover will normally be provided under travel insurance, as will the costs of transfer to a nearby country if the standards of treatment in a particular country are considered to be sub-standard
For longer trips, of over a month, an alternative arrangement is required. For UK citizens arranging travel within the European Economic Area (EEA) cover can be partially provided through the Global Health Insurance Card (GHIC). The GHIC provides for treatment necessary whilst outside of the UK, in circumstances where the treatment cannot be delayed until return to the UK. However, care for treatment is at the level provided to home nationals and not necessarily at UK NHS levels.
What types of benefits are offered by a hospital cash plan?
Answer : Purchase course for answer
