Employee medical Insurance declined by Pruhealth - now what?

northcoombes

Hi all
My husband has mild hypertrophic cardiomyopathy (genetic so he's had it all his life but was only diagnosed four years ago at the age of 56). No-one in his family has died from heart problems and both parents lived until 84. Our problem is that he recently started a new job and the company offers health insurance with Pruhealth as an employee benefit. They have now written to say they are declining his health cover on any underwriting basis. He was with Axa PPP with his previous employers and we can show that he hardly ever made a claim during his 12 years with them. We are not sure why he has been declined as we weren't expecting his heart condition to be covered anyway as it is a pre-existing condition. Should we ask Pruhealth to reconsider or is that a futile idea? He is more than happy to go with the NHS for most things but we would like to be covered in case he ever needs cover for something like cancer drugs. Should we just insure independently with moratorium underwriting? Does anyone have any suggestions?

Many thanks

InsideInsurance

You can try and appeal the decision and to be honest it is the best option initially as (a) company policies are often better values and (b) if you are successful you dont have to answer yes to the ever been declined insurance type questions (only relevant to other health/ life type insurances)

Was the cover continuous between Axa PPP and the PruHealth? Presumably as diagnosis was 4 years ago and you say you have 12 years with low claims the condition was identified whilst under cover with Axa?

I to have a pre-existing condition but thankfully had an employer that gave a non-underwriten policy and therefore it was covered by them (never needed to claim for it and most likely never will). When I moved on to pastures new I found new PMI insurers were willing to provide cover, including for my pre-existing condition, as I had previous cover for over 3 years that included this condition.

Wutang_2

northcoombes wrote: »

Hi all
My husband has mild hypertrophic cardiomyopathy (genetic so he's had it all his life but was only diagnosed four years ago at the age of 56). No-one in his family has died from heart problems and both parents lived until 84. Our problem is that he recently started a new job and the company offers health insurance with Pruhealth as an employee benefit. They have now written to say they are declining his health cover on any underwriting basis. He was with Axa PPP with his previous employers and we can show that he hardly ever made a claim during his 12 years with them. We are not sure why he has been declined as we weren't expecting his heart condition to be covered anyway as it is a pre-existing condition. Should we ask Pruhealth to reconsider or is that a futile idea? He is more than happy to go with the NHS for most things but we would like to be covered in case he ever needs cover for something like cancer drugs. Should we just insure independently with moratorium underwriting? Does anyone have any suggestions?

Many thanks

Sounds like the insurance on offer is not the same as the cover offered to InsideInsurance. For Medical-History-Disregard, there is no form to complete so sounds like a normal underwritten policy which is available with any other policy (or moratorium as you suggest) available with any other health insurer.

If the AXA policy was ceased within the last month, there may be other insurers who will switch the policy. This would be your only real option.

Contesting their decision will be futile and also being declined is largely irrelevant with pmi too.

InsideInsurance

Wutang wrote: »

For Medical-History-Disregard, there is no form to complete

<snip>

Contesting their decision will be futile and also being declined is largely irrelevant with pmi too.

I did actually have a form to complete for my former non-underwritten employers policy - though Bupa couldnt really explain why, they said they just required other information from the form and ignored the pre-existing box

Once I left the work scheme I was declined, did contest it and was then offered like for like terms but on an underwritten basis

northcoombes

Thank you Wutang and Inside Insurance.

My husband's employer's broker has advised him to get a letter from his heart specialist stating that the condition is mild although I still don't know why as we don't expect any heart conditions to be covered anyway.

There was four month period between jobs where he had no cover. Axa PPP did offer to continue the cover at a cost of about £300 a month but at that stage we didn't know whether my husband would get another job in the UK or move overseas.

His new employer offers the whole bells and whistles premium package from Pruhealth so it's a good benefit that is part of his remuneration package.

He was given a standard form to fill in but there were about five boxes asking if he had ever had certain things like heart problems, diabetes etc. When he ticked the heart one they then advised they needed to get more info from our GP and after that they declined to cover him. Our GP says they just see the words hypertrophic cardiomyopathy and that's it - even if it is a mild case. My husband's parents and his aunts and uncles who presumable also carry the gene have all lived into their 80s and 90s.

We have written now to the heart specialist and will try and appeal. Otherwise we will try and get cover elsewhere. We don't really care about most of the cover having a very good NHS hospital nearby. Our only real need is for cancer cover - not that anyone in his family has ever had that but we're willing to pay just to have the peace of mind.

InsideInsurance

GPs can be a pain in the !!!! with these kinds of things.

Was recently trying to sort out my life and PHI insurance and was declined across the board after they saw the GPs report - dont know what was in the report as the GP wanted to charge me £75 to see their report (after charging the insurer £100 or so for writing it). The GP also denied ever having received any of the decline letters even though one insurer promised they'd sent 3 copies.

I got my specialist to write advising that actually my medical condition most likely will increase life expectancy and quality of life. Eventually got all the insurers to reverse their decisions and one for each class of insurance were willing to offer cover with no loading or special terms for my pre-existing condition.

northcoombes

Thank you - that's good to know! Worth the extra effort in case we get the same result as you did. Our GP is quite good and helpful although he doesn't have the knowledge that the heart specialist who sees my husband does. He just forwarded the annual letter he gets from the specialist to Pruhealth but that just says what the condition is not how severe or mild it is.

I am amazed your GP wanted to charge you £75! We weren't asked for any money. Surely these records should just be provided to patients by the surgery admin staff? I would have been extremely annoyed about that :mad:

InsideInsurance

northcoombes wrote: »

I am amazed your GP wanted to charge you £75! We weren't asked for any money. Surely these records should just be provided to patients by the surgery admin staff? I would have been extremely annoyed about that :mad:

See according to our surgery the admin staff cant give you a copy but you have to book a private consultation with the GP so he can discuss/ explain it to you.

Of cause could have done a SARs request but that'd still have been £50

Our GP is good in that they give me what I want when I want and rarely kick up a fuss about having to wait for the letter from the consultant but know nothing about either my condition or meds as it is rare and all predates them plus the consultant only ever sends them a one line letter saying no change, continue prescribing.

In my case I suspect they were asked things outside of their comfort zone and so guessed/ gave textbook answers/ said unknown to questions.

Thankfully my consultant is a more reasonable person and thinks that GPs are profiteering too much and didnt charge either for writing the letter to the insurers nor for signing passport application.

Quentin

Sharron_Penney wrote: »

Hello northcoombes

You say your husband was with AXA PPP until recently. Why don't you call AXA PPP and explain that he was on a company scheme and is interested in joining on an individual basis and they might be able to offer him terms - but I think it has to be within 3 months of leaving his old company scheme. It's worth a try.

Good Luck!

Sharron

As you work as a manager at axa ppp healthcare, how come you don't "know" their rules rather than just "think" them??

Cynical spam or what??

I know we may look daft on here, but we aren't that daft!

So axa are prepared to stoop this low (and isn't what you are doing illegal anyway??)

InsideInsurance

Quentin wrote: »

So axa are prepared to stoop this low (and isn't what you are doing illegal anyway??)

Do you really think that Axa have asked/ encouraged them to post rather than someone just recommending their employer off of their own back?

Which law do you think they have broken? Have you called the police about it? Or do you just mean you think they have broken forum rules over advertising?

Quentin

InsideInsurance wrote: »

Do you really think that Axa have asked/ encouraged them to post rather than someone just recommending their employer off of their own back?....

As her job is "eMarketing Manager at AXA PPP healthcare", probably she is paid to post this sort of shill spam.