Want to save on health cover? Let your insurer choose your surgeon

JUMP the queues for an operation, speak to a GP whenever you want – even get access to eye-wateringly expensive life-extending cancer drugs that aren’t routinely prescribed on the NHS. It’s not difficult to see the appeal of health insurance, and demand has never been greater. Insurer Vitality has seen an astonishing 35 per cent spike in customers over the past year, twice what they saw the year before. Axa PPP saw a 20 per rise.

Put simply, medical cover pays out for private treatment should you fall ill. But with a bewildering array of policies out there, at a wide range of prices, how do you know which one is best and, crucially, whether you’re being sold things you don’t really need?

BEWARE PRICE COMPARISON SITES

EVEN a simple internet search for ‘private health insurance’ can throw up problems, warns Brian Walters, director of medical insurance brokers Regency Health.

‘Google search results can include price comparison websites run by companies which, once you fill in your details, will simply sell your data on to private healthcare companies which then bombard you with calls,’ he explains. ‘A rule of thumb – never put your details into a website that doesn’t have an easily visible phone number.’

You can go directly to insurers for a quote – the ‘big four’ are Axa PPP, Aviva, Bupa, and Vitality – or, far better, find an independent broker who can give expert advice and help secure a policy.

Which? Magazine produces a comprehensive private healthcare guide that recommends the broker route.

The British Insurance Brokers Association (biba.org. uk) and the Association of Medical Insurers and Intermediaries (amii.org.uk) websites both lists dozens to choose from. All of them have been vetted, and are regulated.

WHAT’S COVERED... AND WHAT’S NOT?

HEALTH insurance can be wideranging, covering surgery, but also outpatient treatment, virtual GP services, cancer care, and even things such as physiotherapy, acupuncture and mental health services, depending on the policy.

The one thing they all have in common, however, is they won’t pay out for pre-existing conditions.

Some insurers will ask to see your medical records – with your permission, they’ll get in touch with your NHS GP.

‘Others may ask you to detail any treatment you have received over the past five years and exclude these from a policy.

It’s vital to be aware of the small print, says Walters.

‘If you have diabetes, you’ll have regular check-ups and medication and none of that will be covered.

‘But there are many other problems that are related to diabetes – eye problems, poor healing wounds and heart issues to name a few. None of these things will be covered either because they’re related to the preexisting condition.’

When signing up for insurance, you can negotiate a moratorium, which means treatment related to a pre-existing problem can become covered over time, but only under very specific circumstances.

‘Moratoriums have stringent conditions,’ says Walters. ‘They require you to not have had any treatment for, or seen a doctor about a specific problem, for two years before they’ll cover it.

‘But that means no repeat prescriptions or a check-up. Many people don’t realise this.’

However having insurance can still pay off, adds Walters.

‘You might have exclusions for prostate problems or diabetesrelated issues, but then develop bowel cancer, which you could claim for,’ he says.

AGE AND EXTRAS THAT PUSH UP PREMIUMS

MOST insurers provide a basic policy that you can add or remove services from. The kind of care that’s covered, along with age and where you live, are what influences monthly premiums.

‘The cost of hospital care is highest in London and lowest in Scotland, so premiums reflect that,’ says Walters. ‘Premiums increase by roughly ten per cent every year, so they’re quite a lot more expensive as you get older and become more likely to claim on them.’

The other thing that can push a premium up sharply is making a claim. ‘If you claim on your insurance you can expect to see your premium rise by up to 50 per cent the next year, although some insurers, like WPA, do offer a policy that is not affected by claims,’ says Walters.

Basic policies rarely include outpatient appointments or diagnostic tests, but these can be covered – although it can add hundreds of pounds a year, or even double your premium. Insurers used to offer plans where customers agreed they’d seek NHS treatment in the first instance, and only claim if there was a treatment delay of more than six weeks.

When the pandemic hit and waiting times for NHS treatment began to soar, most companies axed these policies.

Instead, most now offer ‘guided’ or ‘directed’ policies – where the insurer tells you which consultants and hospitals you can use, from a selected list. These plans can reduce monthly premiums up by to a third, meaning a substantial saving.

Walters says: ‘The big worries clients have about these plans is that they’ll be made to travel miles from home for treatment, which doesn’t happen, and that they’ll just get given the cheapest doctor. This isn’t the case either.

‘Insurance companies tend to pick very good surgeons. They don’t want to have to pay out for repeat operations, so they want doctors who get it right first time.’

As for companies trying to wriggle out of claims, Walters says this is a misconception: ‘Medical insurance isn’t cheap, but companies have a good track record for paying claims.’

DON’T TURN DOWN CANCER COVER

INSURERS often offer to reduce monthly premiums by removing or limiting the amount that can be spent on cancer care. Walters advises against this.

‘Cancer care is where private medical insurance really comes into its own,’ he says. ‘Things like chemo and radiotherapy are costly enough, but newer therapies be extremely expensive – so much so they might not be available on the NHS.’

Several of Walters’ clients who have developed cancer have made claims at about £100,000. Two had claimed for treatment that cost £250,000 and there was one claim for £500,000. ‘Private insurance will cover most medicines as long as they’re licensed,’ Walters adds.