FAQ - Private medical insurance

What is private medical insurance?

Private medical insurance covers the costs of private treatment for acute medical conditions. An acute medical condition is generally defined by insurers as a curable short-term condition that responds quickly to treatment. Such insurance offers the reassurance that speedy medical treatment is available if so required.

What is not covered by private medical insurance?

Private medical insurance will not usually cover pre-existing conditions or chronic conditions which cannot be cured. A pre-existing condition is any disease, illness or injury diagnosed, treated or which you have sought medical advice for before taking out insurance. A policies’ list of exclusions will also commonly include GP services, out-patient drugs, mobility aids and accident and emergency admissions.

What details of my health will I need to provide?

Medical history declarations and moratoriums are two main ways insurers use for accepting an application for cover. Medical history declarations are offered by all insurers and usually require the completion of a form requesting medical history details. A moratorium is only an option with some insurers and involves completing a form that doesn’t request medical history details. In this case however, pre-existing conditions arising in the last five years (depending on the insurer) will not be insured.

Could my premiums go up?

Premiums are rising and are likely to continue doing so. This is because of various factors such as the costs of advanced new treatments, insurees becoming older, and increasing numbers of private medical insurance claims. Your choice of cover however will affect what you pay.

Can I be covered if I am disabled?

Yes, but your insurer may not cover you for required treatment resulting directly from your disability. Details of your disability should be disclosed if you complete a medical history declaration.

What if I want to move to a new insurer?

It is possible to change insurers, but how a change may affect the terms and level of cover must be carefully considered.

How do I make a claim?

Once your GP has referred you to a specialist, contact your insurer to make sure you’re covered for the required private treatment. It is likely your GP or specialist will need to complete and sign a claim form on your behalf. Claim forms are usually sent to you with your insurance documents but if you don’t have one, simply request one from your insurer. Your insurer will then inform you how they go about paying the claim.

Is private medical insurance regulated?

Yes, the sale of private medical insurance is regulated by the Financial Conduct Authority (FCA). It is also covered by the General Insurance Standards Council (GISC) if the insurer or anyone selling or advising on private medical insurance is a member of GISC.