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Are PMI's Really Worth Taking Out?

Being treated in a private hospital has been seen in an increasingly positive light and has raised the number of private medical insurance (PMI) policies, that are being taken out by patients, as the treatment, care and MRSA infection risks that are apparent throughout NHS hospitals worries a large number of people.

A survey conducted by Saga Private Medical Insurance also noted that more than two thirds of people noted that the cleanliness - or more correctly, the lack there of - in NHS hospitals was worrying and made them choose private medical services. Moreover BUPA, a health insurance provider noted that there was a 20 per cent increase in the sales level of PMI, in the first quarter of this year than in the same period in 2007.

However these PMI are found to cover only a certain amount of medical procedures and people, so the question of its necessity is in the minds of key industry figures. What is and is not covered depends on individual PMI policies; however they are generally designed to cover acute conditions such as disease, illness or injury that can be treated fully.

The benefits of PMI are that the policy holder can be treated quickly, the can also have a choice of specialists and hospitals, where they are to receive the treatment.

PMI policies
The biggest exclusion clause on PMI polices is for pre-existing medical conditions, in patients. On most occasions, medical conditions that have been suffered during the five years before a PMI policy is take out, will not be covered. Also non-disclosure of any previous conditions could also make the insurance policy invalid and invalidate any claims that the holder may wish to take out.

The Association of British Insurers (ABI) however, noted that treatments relating to HIV/Aids, gender reassignment and infertility were not covered by PMI policies. Also excluded from the standard policies, were dental treatment and organ transplants, however some insurance providers were found to provide cover for such treatments.

The ABI has released clarifications on non-disclosure rules that will make it harder for insurers to refuse claims. However policy holders have been warned that it is still easy for people to be caught out.

Medical history
Michael Vine, of Michael Vine & Co, the solicitors, says: "Insurers want to know your medical history, which you detail on a proposal form. Even if you complete this to the best of your knowledge, it is difficult to remember every reason for obtaining medical advice or treatment for the period requested. If you fail to disclose something - no matter how apparently irrelevant - for the period, they could refuse your claim."

Mr Vine suggests that you authorise your proposed insurer to examine your medical records at the time of application, adding: "This might help in the event of a claim dispute if the insurer subsequently alleges non-disclosure."

A spokesman for Tesco, which recently started selling medical insurance, says: "The last thing anybody wants is to be surprised with a nasty bill for an expensive procedure. If our customers are worried that their insurance might not provide cover for any treatment, we advise them to call a helpline for clarification."

Mike Izzard, chairman of the Association of Medical Insurance Intermediaries (AMII), also added that: "Choosing PMI is a minefield. It is a very complicated market and is too important to get wrong. It is not like buying car insurance. If you get your health cover wrong, you are messing with life and death."

Ruth has more articles covering health insurance



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