Medical Insurance Cost Cutting Plan Article Discussion Area

misfire22

Can anyone advise a decent policy for a 16 year old?

Most comparison sites will ony give quotes for over 18's.

He plays rugby at quite a high level however does not get paid. We need to be covered if he suffers an injury.

Any help greatly appreciated.

Errata

What advice does his club offer?

misfire22

They cant recommend a product! They just recommended he get some private health insurance!

Errata

A club giving its players a list of medical insurance companies that may be able to offer them insurance doesn't mean the club recommends them - it's information. What medical insuranbce arrangements have the other 16 year olds and/or their parents made ?

misfire22

I have not asked that question as I really dont know the other parents that well.

I will ask his coach if he can help although I would have preferred to sort it myself.

We took out a policy when he was selected last year. He disclocated his shoulder last Sunday and we found out or policy is worse than useless!

Although it really has not made a difference this time we are now aware that we dont have the correct cover and need to research this properly!

Rocking_Rooster

You really need to sit down with a independent (whole of market) health insurance specialist broker who will ask you all the appropriate questions. Then do a market review for you and make recommendations from there. Their advice is usually free, they do make a commission from any policies you decide to take out via them. They get the same commission the direct sales agents get. They can often get better deals through insurers than you can going direct due to the high volume of business they put through insurers. Because they are independent their advice is unbiased and they have to give best advice to stay compliant under the FSA. In saying that there are good and bad ones the same as in any other field or industry.

There are a lot of factors that need to be taken into account here. A few burning questions would be:

1. Who is he currently insured through and what is the name of the scheme/policy?
2. When is the renewal date on that policy?
3. Has he actually made a claim on that policy in the last 12 months?
4. I take it he went to hospital and had treatment on his shoulder?
5. What form of underwriting is he currently on i.e. moratorium or FMU (full medical underwriting)

Your choice of underwriting could be hugely important when it comes to getting existing conditions covered (i.e. his shoulder). CPME (continued personal medical exclusion) commonly known as switch underwriting is ideally the best form of underwriting for him. However most insurers in their cpme switch application forms ask if he has claimed or had hospital treatment in the last 12 months. The fact that he almost certainly has slams most doors shut on this unfortunately. So he may have to wait 12 months.

i.e. Bupa will cover 16 year olds as long as he isn't professional or semi professional. Premiums start at £10.88 monthly on their best value for money plan client choice (only available through reputable brokerages). However they ask in their cpme switch application form if anyone has had treatment in hospital or seen a consultant in the last months. If you cannot tick no to this then you are unable to join on cpme switch.

Obviously you can start him again with most insurers on a brand new policy on a standard rolling moratorium underwriting = Any medical condition you have had in the last 5 years may not be eligible to be claimed upon until you have gone 2 years advice (i.e. a consultation), treatment (i.e. physio, pills etc) and symptom free, from the start date of the policy. This means if his shoulder keeps playing up and he has advice, treatment
and or symptoms his shoulder (and related conditions) may never be covered until he manages to go two year advice treatment and symptom free.

Exeter Friendly offer a good fully comprehensive policy and are good for those with no current health insurance cover and Pre existing conditions as they offer a fixed moratorium underwriting = Any condition suffered 5 years prior to the join date of the policy may be excluded from cover for the first two years of the policy. After the first two years your medical history is effectively wiped clean and you can claim on old conditions just as you can on new ones.

All of these are of course subject to the insurers terms and conditions of the policies.

celticbhoy2010

Hi All,

I'm looking to take out health cover for my wife and I, both early 30s non-smokers no health issues.

There don't seem to be any sites that give reviews on the Medical insurers. We're looking for a good price, but obviously will pay more for great customer service as Insurers have a habit of trying to 'get out' of things

We want comrehensive cover for both

Any feedback from personal experience or website that give this info?

Many thanks

dizzie

Hi Celticbhoy,

Can't really give you any recommendations for PHI, but I can let you know some of the pitfalls which you may which to take into consideration. I'm not an insurance broker either, but have knowledge of the PHI industry from the health provider point of view and as a patient also, so perhaps mine is a view that you won't hear so often.

Let me begin by saying that PHI can be very useful if you can afford it. Compared to the NHS, it can cut down waiting times and it can also provide cover for treatments for which the NHS have a "postcode lottery" (i.e. some health authorities pay for treatments that other health authorities do not cover....although the whole concept of GP commissioning is about to come into play and it remains to see what the impact of that will be). For the average working person (particularly the self employed), not being able to work due to a medical condition and having to wait for investigations or referral, or being refused treatment can in severe cases threaten your livelihood so I am pleased that such products exist.

However, I think it is useful to discuss the concept of "comprehensive" cover. Remember that insurers are in this business to make money and they are going to set the premiums so that on average, they earn more than they have to pay out. Here is how they do this:

1. First of all, there is usually some form of excess. This may be the first £100 of any claim, per person, per policy year. This is to deter people from using their PHI for trivial things that could be perhaps easily sorted out on the NHS.

2. Secondly.they do not provide "comprehensive" cover. For example: If you go in for a private op, be prepared to meet some of the costs. For example, surgeons may put someone in a brace or aircast boot during leg/foot surgery, as opposed to say a Plaster of Paris. You won't usually be offered a choice about this. The surgeon will use whatever he/she feels will be more convenient for you and whichever will aid a faster recovery. On the NHS you wouldn't be charged for things like aircast boots, but when you go private, someone has to pay for these...and they are generally not covered by insurers. There can be a bill left for you to pay which is often in the region of £100-£200.

3. Heath insurers reduce costs by establishing "Preferred provider networks". This can limit patient choice as to where they can receive treatment. Cost is a major factor in insurance companies establishing these provider networks. They aim to get what amounts to a "discount for bulk". This can cause some frustration to patients - I've seen cases where a consultant who works say at two private hospitals may have a 4 week wait for procedures to be carried out at the first hospital (which happens to be on the insurer's provider network), but could do it at the hospital at the other side of town in less than a week (which the insurer will not pay for because it is not one on their "provide network")

4. Outpatient limits and surgical benefits

Things like consultations and therapies (e.g. physiotherapy) are often limited to a set annual limit which is often say £500 to £1000 per year. Once you have used up your outpatient limit, you have to fund these things yourself.

Allowable surgical procedures are paid for by the insurer. But again to contain costs here, the insurer has benefit maxima - i.e. a maximum amount that they will pay out per procedure. This does not mean that the consultant has to charge within these maxima. Indeed, some insurers have not changed these limits in over 15 years...imagine having a pay freeze for 15 years? So some docs will charge more, leaving the shortfall to be covered directly by the patient.

5. Chronic conditions. Most insurers will not cover chronic conditions, which used to be defined as a condition for which only symptom relief could be given, but there is no cure. However, we are noticing a slightly worrying trend that insurers are becoming keener to try to label conditions as being "chronic" thereby refusing to pay for any further treatment. Let me give you an example: I know of three patients who recently were declined further treatment for back pain. In all cases, following the onset of their back pain, they had tried some simple self-help measures before eventually seeing their GP who tried medication or recommended physio. After some 3-4 months if symptoms had not settled, they were referred on to specialists...and then in as little as one month more, if further investigations and treatment had not fully resolved symptoms, their insurers were labelling them as having "chronic conditions" and refusing to pay for any further input.

So there we are:

Health insurance can be fantastic but it is by no means perfect and I think it helps to understand this product, warts and all.

Incidentally, to state the obvious: Insurance premiums are calculated on risk, and age is clearly a risk factor. I see so many people who tell me that they paid health insurance premiums all of their working lives without ever making a claim, but then could not afford to continue paying premiums once they retired because the cost of insurance soared and their income dropped. Often this was the time of their lives...when bits of their body had worn out, when private health cover might have been very helpful. If anyone is interested in costs, we pay circa £3,000 per year in PHI for a family of 4 (adults aged 40 and 50 and two school-age children). Retired couples can be charged more than twice that just for two people. I have to say that since we have a decent savings pot, we are considering taking a gamble to cancel our PHI and put the equivalent monthly premiums into a savings account specifically to be used for healthcare. It is a risk, I realise that, but then we might have a chance of still being able to afford private healthcare in our old age. I guess it is down to each person's individual attitude.

wozearly

Celticbhoy - most health insurers can be expected to apply the policy t&c's to the letter, so if you happen to need/want to claim for something not covered, then an insurer's customer service record isn't going to help much.

With regard to dizzie's points, its possible to get policies with no excess, no restrictions on hospital choice, no out-patient limits or benefit maxima. However, as you might expect, they tend to be a little more expensive as a result and so they're not usually the first thing an insurer will try to sell you.

Chronic conditions and the aircast boots example are likely to be excluded across the board.

I don't feel I'm in a position to make recommendations, but its never a bad idea to talk to the big four (Bupa, AXA, Aviva, PruHealth) and, given what you're asking for, you might want to talk to some of the smaller insurers - for example, WPA has an exemplary low record of complaints being put to the Ombudsman.

Exeter Family Friendly also have a very low t&c comprehensive policy (the one Rocking Rooster was referring to a few posts ago) which is only available via health insurance brokers, but which might be worth exploring if you were considering talking to an intermediary in any event.

Wutang_2

Health_Insurance_PRO wrote: »

you can always look at direct-healthcare.co.uk who are offering 3 months for free on health insurance plans

Don't do it!! They have actually employed a former murderer - I learnt this the hard way.