Is there an excess?

Yes, you must pay the first £100 of the first claim in each policy year.

What underwriting options are available?

Moratorium

Unless otherwise specified in the policy certificate, you will not be covered for pre-existing conditions (or related medical conditions) that you have suffered from in the five-year period prior to your commencement date.

You will be covered for claims related to these pre-existing conditions and related medical conditions once you have been free of symptoms, treatment and advice for two continuous years from your commencement date.

Medical Underwriting

Your policy schedule will show exclusions for any conditions that are deemed to relate to pre-existing conditions based on the information that you have provided. Your policy schedule will also show whether we can remove the exclusion after a period of time.

Why are there limitations on chronic and pre-existing conditions?

To make our premiums competitive we have assumed our membership will be representative of the population as a whole.  If we were to accept pre-existing conditions at the time of joining, our membership profile would become skewed in favour of high-risk individuals, raising the incidence of claims and, subsequently, our premiums. We do, however, accept pre-existing conditions after two years provided no medical input has been required in this time.

Similarly, we limit benefits for chronic conditions as the cost of their long-term treatment can be very significant; this would also impact on your premium. This approach is adopted by most medical insurance companies.

What are pre-existing conditions?

A pre-existing condition is any condition for which a member has already received medical advice or treatment prior to their enrolment into the scheme or for which symptoms were present and a prudent person would have sought treatment. This definition also includes complications that may arise as a direct consequence of such a condition.

What is a chronic illness or condition?

 A chronic medical condition is defined as such if it meets any of the following criteria:

  • It needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests
  • It needs ongoing or long-term control for relief of symptoms
  • It requires your rehabilitation or for you to be specially trained to cope with it
  • It continues indefinitely
  • It has no known cure
  • It comes back or is likely to come back
  • Examples of some common conditions that fall into this category include: diabetes, asthma, ulcerative colitis, Crohn's disease, coeliac disease, rheumatoid arthritis, Barrett’s esophagitis, endometriosis, stroke, osteoarthritis, multiple sclerosis, ischemic heart disease, chronic airway disease, cardiac failure, connective tissue disorder

I AM YOUNG AND HEALTHY, WHY SHOULD I GET PRIVATE MEDICAL INSURANCE?

  • NHS statistics show that in 2016-17, individuals between 20 and 40 years of age made 6.64 million new hospital visits. This is the equivalent of 45% of this age group visiting the hospital at least once in that year. While this includes a whole range of conditions, some of which private medical insurance may not cover, it does show that all age groups may need hospital treatment. (HES outpatient activity data 2016-17)
  • Young people often have conditions that are not prioritised under the NHS, such as cancer or heart disease, and may, therefore, have to wait for treatment. (www.england.nhs.uk/rtt/)
  • Young people often struggle to cope with illness and delayed treatment because they have to juggle a busy lifestyle and family needs.
  • It is always best to safeguard against any risk to your health - regardless of your age; you never know when you may fall ill. Once an illness has been diagnosed it can become difficult to find insurance cover for it.

What is the County Medical network?

  • Our medical network is the group of doctors and hospitals we work closely with.
  • Our medical network is at the heart of our program and ensures quality and value for money and helps to keep our premiums low.
  • We set our medical coverage and costs in consultation with our medical network.
  • You are not obliged to use our network, but any funding you receive will be determined according to our network arrangements

How do I make a claim for AN outpatient consultation?

  • See your GP and get a referral letter to see a specialist
  • Contact us for an authorisation
  • We will check you are covered by the policy
  • We will give you the option of using our network or going outside it
  • If you use our network we will receive the invoices and will settle the bill up to the agreed amount on your policy
  • If you go outside the network we will give you a budget equivalent to our network costs. You may need to settle the bills and forward the invoice to us for reimbursement.
  • We will guide you through this process and will offer you the support of a senior doctor to help you
  • If you subsequently need a procedure or surgery you will need to make a new claim for further authorisation.

 How do I make a claim for surgery or a procedure

  • See your specialist and get a referral letter identifying the procedure you require.
  • Contact us for an authorisation
  • We will check you are covered by the policy
  • We will give you the option of using our network or going outside it
  • If you use our network we will receive the invoices and will settle the bill
  • If you go outside the network we will give you a budget equivalent to our network costs. You may need to settle the bills and forward the invoice to us for reimbursement.
  • We will guide you through this process and will offer you the support of a senior doctor to help you

How do I make a claim for the cancer benefit?

  • Contact us with evidence of your diagnosis and a letter from your specialist regarding the proposed treatment
  • We will check your entitlement under our policy and reimburse you directly to the agreed amount.

How do I choose my specialist for my outpatient diagnosis and investigations?

  • When you contact us for authorisation for an outpatient consultation we will give you a choice of whether you want to use our network or you would prefer to go outside it.
  • If you use our network we will give you a list of specialists from which to choose. These doctors will have admitting rights at our recognised hospitals.
  • You may choose to go outside our network, in which case you can decide upon your own specialist based on advice from your GP or other recommendations. Your specialist will have to be on the specialist register with a licence to practice in the area of specialism you are consulting them about. We will give you a budget in line with what we pay our network doctors and will reimburse against any invoice you receive up to the agreed amount.
  • Should you be unclear regarding your options, or who to choose, our specialist doctors can always help you.

How do I choose my specialist for a procedure?

  • If you are seeking our authorisation for a procedure, you will already have seen a specialist. If you saw this specialist privately we would advise you to stay with them for continuity of care.
  • If the specialist you saw was on our network then your procedure will be done in one of our recognised hospitals and they will bill us directly and we will settle the bill with them
  • If the specialist you saw was out of our network, then we will give you a budget for your procedure in line with what we would pay our network partners and we would refund you up to this amount against an invoice. If the cost of the procedure is more then you will have to fund the difference. If the specialist can perform the surgery in one of our recognised hospitals, despite not being in our network (Specialist often have admitting privileges in multiple hospitals) we would be able to refund the hospital but not the doctor directly. Please note the doctor who treats you has to be on the specialist register with a license to practice in the area of specialism you are consulting them about.
  • If you saw the specialist on the NHS and now want to claim on your policy for the procedure, we will again give you a choice of whether you want to use our network or go outside it. If you choose to go within our network, we will give you a choice of a specialist with practising privileges in our approved hospital. We will pay for your initial consultation with the specialist but we will not be able to pay for any further outpatient investigations unless you have cover for this. We will then pay the specialist and hospital directly.
  • If you choose to go out of network, we will let you choose a specialist and set you a budget for the procedure in line with what we would pay our network partners. We would not be able to pay for any outpatient investigations unless you have cover for this. You may have to make up any shortfall. Many hospitals offer package deals for procedures.
  • Should you be unclear regarding your options or who to choose. Our specialist doctors can always help you.

Why do you list the procedure your policy will cover?

We list the procedures we cover for the sake of transparency. This means that you will know exactly what is covered and what is not before you make a claim.  It also helps us keep your premiums competitive, as you will not pay for something you are unlikely to have done privately

In view of the fact that you list the procedures you insure, how does this coverage differ from those of other PMI providers?

Our coverage actually does not differ significantly from other PMI providers and we say this for the following reasons

  • The list of procedures we cover is based on recommendation from our medical panel taking into consideration what they feel safe doing in the private sector.
  • Our private hospital partners have informed us that our coverage in addition to commonly performed procedures includes many that are infrequently done in the private sector. (Feedback from network partners)
  • Our general exclusions are in line with those of other private medical insurance providers and when you take this into consideration and compare it with NHS data we cover the overwhelming majority of procedures that could be done in the private sector. (NHS- HES data- admitted care)
  • The exception to our coverage would be complex procedures such as major cancer, arterial, neurosurgical or cardiothoracic procedures, which can only be done in top end private hospitals, requiring expensive PMI policies. We believe complex procedures are often safer to do in the NHS. We do cover cancer as a separate benefit.
  • Finally, we have compared our coverage with the schedule of procedures listed by the private hospital information network (PHIN), a government body to advise the public about private healthcare facilities, and it reinforces our above views. (www.phin.org.uk)

What do I do if my procedure is not covered by your policy?

If we do not cover your procedure you will need to have this done via the NHS or if it is part of our exclusions, such as cosmetic surgery, and can be done in the private sector you will need to fund it yourself. Either way, we can advise you if you contact us.

If I choose to go outside your network, how much of my treatment will you fund?

If you chose to be treated outside our network, we will fund you to the same amount, as we would pay our network facilities. This amount is listed under the approved procedures on our website

I am over sixty and have pre-existing conditions why should I take get private medical insurance

  • The incidence of illness and the need to seek hospital treatment increase with age, as evidenced by NHS statistics. At the age of sixty, the rate of outpatient visits to the hospital is 230 per 100 population. That is to say that at the age of sixty on average each person will visit that hospital at least twice in the course of a year. (HES outpatient activity data 2016-17) Having private medical insurance may help you access some of this care quicker and at your convenience.
  • While you may not be covered for pre-existing conditions the scheme will cover you for unrelated conditions.
  • If you have been in the scheme for two years and have not had to seek medical help for your pre-existing condition we will be able to cover it
  • If you are worried as to the impact of your pre-existing conditions on your cover please ask for the full medical underwriting option when asking for cover and we will be able to advise you exactly what we will and what we won’t cover, then you can decide if you want to go ahead with the cove

What are the tax implications if I take out private medical insurance through a company?

  • HMRC considers private medical insurance as a benefit in kind. Which means that it is treated as if it is part of an employee’s salary. The company can claim it as a business expense, and saves on corporation tax, but has to pay the employer's national insurance contribution on the cost. The employee pays income tax on the extent of the benefit. (HMRC- expenses-and-benefits-medical-treatment)
  • The exact tax implication can vary depending on individual circumstances and it is best to get an advisors opinion if you are unclea

Why should a company take out private medical insurance with County Medical for its employees?

  • Private medical insurance ensures quick treatment for employees with medical conditions covered by the policy. Thus they havea shorter time off sick and the company has a healthier workforce.
  • It reassures the employees that their welfare is important to their employer.
  • We can support you in other ways including giving medical advice and arranging health assessments.
  • Our policies are designed to be affordable and relevant

Why should I get private medical insurance when I can pay for private treatment myself?

  • Self pay for treatment is indeed an option and some private hospital will afford you credit for this. You will save on paying a regular premium but if you need treatment this could be a significant expense.
  • The challenge is that you will have to arrange any treatment yourself and if things do not go according to plan you maybe liable for costs.
  • Furthermore, it is human nature to avoid spending money unless it is absolutely necessary which means you may delay treatment you need because of the cost. Having private medical insurance will encourage you to use it and seek prompt medical care
  • At County Medical we are able to support and guide you through out your treatment pathway and we will pick up the bill at the end.
  • Having private medical insurance gives you peace of mind.