Health Insurance for Individuals
Anyone born in England is eligible to receive publicly funded healthcare through the National Health Service (NHS). The NHS also covers all citizens and legal residents of other countries and territories within the United Kingdom who happen to be within the borders of England. The NHS is funded through general tax revenue just as other public services and institutions like schools, fire and police departments.
Ever since the NHS started providing healthcare services to citizens and legal residents of the UK in 1948, individuals have taken advantage of the “free” medical service to provide the vast majority of their healthcare needs. Today, approximately 92% of the population uses the NHS for treatment of minor ailments to major surgeries.
Another 8% of the population has decided to obtain a private medical insurance policy which entitles them to some additional benefits and, in the minds of many, a higher level of service and quality care.
The main reasons why people choose to pay additional premiums to have a personal medical insurance policy may or may not be completely logical. People choose private medical insurance in the UK because:
• They have a fear of getting an infection, catching pneumonia or some superbug such as the MRSA virus because they believe that public hospitals are not as clean, sterile and germ-free as private hospitals
• They do not want to have to endure the long waiting list for specific procedures
• They feel that they get better doctors and better outcomes through private medical providers and medical facilities
Private Medical Insurance or PMI provides coverage for a variety of urgent conditions including surgery and treatments for a variety of different medical conditions. It does not cover pre-existing conditions or treatment for such things as drug addiction or alcoholism.
There are two forms of PMI. The first is a fully underwritten plan where the patient must reveal his or her complete medical history. If you are a smoker and fail to mention that fact when you sign up for the insurance, any condition you might develop that could be attributed to smoking, would not be covered by the policy. Moratorium policies require the applicant to disclose any conditions or health history that was known to exist during a specific period of time – the moratorium. Moratoriums might go back 5 or 10 years and will exclude any pre-existing conditions from coverage if they were present during the specified time period.
Most people who choose to purchase a Private Medical Insurance policy do so with the knowledge that these policies do not cover every possible contingency. They do not cover accidents or emergency treatments. If you are injured in an automobile crash, you will, at least initially, be treated at an NHS hospital. PMI is intended to cover short-term illnesses and medical problems where you are likely to recover in a matter of days or weeks. It is usually not intended for chronic medical conditions like kidney failure where a patient may have to be on dialysis for the rest of their lives. It also does not normally cover pre-natal or pregnancy care, substance abuse or any type of elective surgery such as a face lift or breast enhancement.
While people with Private Medical Insurance may often get premium hospital rooms in private hospitals, they may also be treated in NHS hospital facilities. The waiting time for treatment can be shorter than through public healthcare, but sometimes the patient will still have to wait just as long to see a doctor that accepts private health insurance.
Private insurance varies in cost and coverage depending upon the type of policy you purchase and also from which provider you choose to purchase the insurance. Some doctors or medical consultants are part of the insurance plan and agree to accept the insurance policies pre-determined fee schedule as full payment for their services. In other cases, the patient may be responsible for paying a small percentage of the overall charge that is not covered by insurance.
Most of the UK private healthcare insurance policy holders do not purchase their policy with their own money. Instead, their employer provides them with coverage as part of the benefit package of their employment. These perks are not totally free to the policy holder as the value (premium) of the policy is considered income and is a taxable event for the employee.
Rates charged for personal healthcare insurance are based on risk just as any other type of insurance product. Older individuals tend to file more claims as do overweight people who may develop complications such as diabetes or heart disease due to their excessive weight.
Policies vary in what services and treatments they cover. The more expensive and more comprehensive private insurance policies cover both in-patient and out-patient services including diagnostic tests, chemotherapy and physiotherapy. Coverage may be for greater amounts and be offered for longer periods of time. A low priced or budget policy will still provide a decent level of coverage, but may exclude some services and treatments that are not considered essential for the health and well-being of the patient.
Other services such as ambulance rides, psychiatric care, medications, doctor visits, follow-up care and preventative care may only be offered on a limited basis. You may have to pay a portion of the fee if you want services that are not normally covered under your PMI.
A private medical insurance policy should be used to supplement the NHS treatment that you already have. It may be more convenient and you may like the private facilities better than the public hospitals, but, care is good in both the private and public sector. If you can afford the extra coverage, it is a nice luxury to have. If you can not afford private healthcare insurance, you will still be protected by the government’s national healthcare program.