Private Health Insurance worth it? Employer pays..

judywoody

So I have been asked at work if I wanted to join the private health insurance scheme. It´s a taxable benefit but everything else is paid for. So some people might think it´s a no-brainer but I have suffered from depression, stress and anxiety and am overweight (non-smoker). I might as well save the tax if everything I get in the future will conveniently get linked to past conditions (oh, so you have cancer..that must be due to the stress you suffered in 300 AD!!!). I could add my hubby but he also has ulcerative colitis (which hasn´t flared up for over 5 years and he isn´t on medication).

Has anyone got any experience with that? I asked HR if they do a Health Cash Plan which they are looking into at the moment. That would be more useful I think, but my concern with this kind of plan is pretty similar. Will they find ANY reason not to pay out?

InsideInsurance

It depends on the terms of the policy.

The last time I was an employee the company PMI covered all pre-existing conditions as standard and all employees paid the same for it (well the taxable rate was the same for everyone, how much you actually paid was dependent on your tax band etc)

The first PMI policy I had via a different employer was much more restrictive and didnt cover pre-existing plus the NHS waiting list had to be longer than 60 days or such before you could claim.

From dim and distant memory the benefit value was £900 of the decent PMI and so as a 40% tax payer the charge to me was £360 per year. As I had cover under that policy I was able to keep the cover of our pre-existing conditions on a personal policy (after some arguing) but my charges initially went up to £1,800 and I can assure you have only gone one way since.

judywoody

Just checked and here are examples of what isn´t covered. Not sure whether it´s worth it. Although most of this will prbably never apply to me I feel especially sleep problems, pain in back etc.. are things that most people have problems with at one point.

What isn’t covered?

Some examples of what is NOT covered by the Policy are:
Pre-existing conditions (see reference above)

■■ Long term or chronic conditions
■■ Treatment undertaken by a specialist without GP referral
■■ Seeing a GP privately
■■ Prescription charges
■■ Charges by a GP, medical practitioner or specialist for completion
of a claim form
■■ Take home drugs and dressings
■■ HIV/Aids and related conditions
■■ Treatment received in a health hydro or similar establishment
■■ Cosmetic treatment (except following an accident, or surgery for
cancer)
■■ Routine medical examinations including eye tests, health screens
etc
■■ Professional sports injuries
■■ Convalescence
■■ Experimental treatment (limited benefit may be available - please
contact us)
■■ Incidental hospital expenses such as newspapers and telephone
calls
■■ Varicose veins of the leg, unless they meet the criteria specified in
the policy wording
■■ Surgical and medical appliances such as neurostimulators (for
example cochlear implants) and crutches
■■ Kidney dialysis
■■ Self-inflicted injury
■■ Sleep disorders and sleep problems
■■ Warts and verrucas
■■ Weight-loss surgery
■■ Treatment for pain in your back, neck, muscles or joints –
musculoskeletal conditions that has not been pre-authorised by
us.
■■ All dental treatment including oral surgical procedures
■■ All pregnancy and childbirth including complications
■■ Psychiatric and mental illness
■■ Alcoholism, alcohol abuse, solvent abuse, drug abuse and other
addictive conditions
■■ Overseas treatment
■■ Treatment required as a result of war, terrorism, or contamination
by radioactivity or chemicals


These things are covered:


A. In-patient or day-patient treatment of
acute conditions at any hospital on the
Key Hospital List that we recognise for
your condition and treatment
■■ Hospital accommodation charges
■■ Prescribed medicines, drugs and dressings
■■ Operating theatre fees
■■ Nursing care including intensive/high dependency care
■■ Specialists’ fees including surgeons’, anaesthetists’ and
physicians’ fees (subject to Aviva’s fee guidelines for
specialists)
■■ Charges for diagnostic tests, for example X-rays, CT, MRI
and PET scans, blood tests and ECGs
■■ Radiotherapy and chemotherapy
■■ Treatment for pain in your back, neck, muscles or joints –
musculoskeletal conditions (see member guide for details)

B. Out-patient treatment of Acute
Conditions
■■ Radiology/chemotherapy
■■ CT, MRI and PET scans at a diagnostic centre recognised by us
■■ Treatment for cancer
■■ Physiotherapy for pain in your back, neck, muscles or joints
(musculoskeletal pain) - see member guide
■■ The following benefits are subject to an overall maximum of
£1,500
■■ Specialists’ fees for consultations (any procedures included are
subject to Aviva’s fee guidelines for specialists)
■■ Charges for diagnostic tests, for example X-rays, blood tests
and ECGs
■■ Treatment (other than physiotherapy) for pain in your back,
neck, muscles or joints (see member guide for details).
Osteopathy and chiropractics (if agreed) is limited to 10
sessions per condition per person per policy year.
■■ Physiotherapy, osteopathy, chiropractics and acupuncture for
conditions other than pain in your back, neck, muscles or
joints (if directly referred by your GP, limited to 10 sessions in
combined total per condition per policy year).



Additional Benefits

■■ Targeted drug therapies for cancer (for example
Herceptin or Avastin) are covered for 12 months per
condition. The time limit starts from when you first started
receiving the targeted therapy.
■■ Nursing at home following eligible in-patient or daypatient
treatment
■■ Private ambulance where medically necessary for
transportation to the nearest available hospital for the
purpose of eligible treatment
■■ Parent accommodation costs when staying with a child
under 12 receiving eligible treatment, one parent only
■■ Minor surgery by a GP up to £70 per procedure (payable
to the GP)
■■ Hospice donation of £70 per day up to 10 days’ care
maximum; donation to the hospice
■■ Baby bonus of £100
■■ Cash benefit of £100 per night where eligible NHS inpatient
treatment takes place as an NHS patient without
charge. Benefit is limited to 35 nights. Cash benefit is not
payable for the first three nights following an accident or
emergency admission
■■ GP helpline
■■ Stress counselling helpline


So whether pain in back and neck is covered or not doesn´t seem to be quite clear. I still find that a Health Cash plan might make more sense. I am a 20% tax payer so I don´t have to pay that much.

InsideInsurance

Overall looks a reasonable policy other than the exclusion of Psych and a not massive limit on outpatient cover

On back/ joint pain they just say they want to pre-authorise them rather than it being a blanket no.

For Chronic conditions you normally dont get cover for ongoing maintenance but do sometimes/ often (PMI isnt a major specialty of mine) get cover for Acute incidents of it. I can certainly see the exclusion but doesnt seem immediately obvious that you get the benefit of cover for acute on them.

As to if its worth it? Thats down to you. Personally I do think its worth it, for my family in our circumstances which is why I continue to pay for it privately now I am effectively self employed. That isnt to say I havent had good treatment from the NHS when I've not had PMI.

The Mrs and I both had treatment 2 years ago. Hers under PMI mine on the NHS as its was really cosmetic but the GP was willing to fudge it as medical. We both saw the GP the same day and the copy referral letters we got were dated the same day.

She got a phone call the same day from the PMI provider authorising the claim and a phone call that night apologising that the consultant couldnt see her "tomorrow" but could the day after. I on the other hand had to wait 5 months to even be told what my appointment date was, though the appointment was only 3 weeks after that - obviously some target they are manipulating by delaying when the appointment is set.

Aretnap

I've used my BUPA cover with work for a knee operations and my wife has used it for some complications after pregnancy, as well as things like physiotherapy for more minor conditions. No problem at all getting treatment authorised (paying claims is what insurers do for a living - contrary to popular belief they're not looking for any excuse whatsoever to refuse to help their customers - if your policy says that something's covered then it's covered). And in both cases it was a godsend because we had the sort of problems which are not life threatening so would have taken months to be treated on the NHS - but were still having quite an impact on our quality of life. (Yes I understand why the NHS prioritises cancer treatment over people like me who are limping a bit, but limping around for months is still not a lot of fun, especially if you have quite an active outdoorsy lifestyle.)

If you have a lot of pre-existing conditions or are in generally poor health then an employers policy where everyone is charged the same and pre-existing conditions aren't excluded is likely to be good value - as to get a policy of your own you'd either have to pay an increased premium to reflect your medical history, or you'd have to exclude the pre-existing conditions. (Though if your previous conditions are mainly psychiatric, the exclusion of psychiatric conditions perhaps diminishes that argument a bit). That's before you even consider that you're only paying the tax on the premium, rather than paying the premium itself.

missbiggles1

I'm one of those who thinks it's a no brainer.

martinsurrey

Also in the no brainer camp.

I had a health scare related to a potential hereditary heart condition, I had every test under the sun and was in-front of one of the leading UK specialists within 48 hours.

My brother had to wait 2 months to get an appointment on the NHS. we both got the care we needed, but I got it a lot faster

All good in the end, but I didn't have the 2 months of worry, which is worth a lifetime of tax on the benefit.

judywoody

Thanks all for your input. Yeah I think my biggest worry was, that they would just try to avoid paying so it's good to hear first hand reports. I will check how much I will have to pay as soon as I pass the probationary period and. Hope it'll be worth it.

charliewocka

I have private cover and use it a lot. I'm lucky that mine covers me for private GP visits so I never wait more than a day to get seen. I had knee surgery last year. From seeing the physio to getting referred for an MRI to getting the operation took six days. I've had mine long enough now that all pre-existing conditions are covered and my excesses are low. If you can afford it then it definitely gives peace of mind. I'm having minor surgery on my eye on Monday - arranged at a time and date to suit me.

poppy_f1

im another that says its a no brainer, i have bupa thru my work and the only time ive needed to use it - it was excellent, was seen within about a week

for the amount of tax you would pay on it will be very little compared to buying your own policy

my company one has a helpline so if you were unsure something was covered you could call them before asking a GP etc for a referral then getting it autorised by the company

hcb42

i also think no brainer,

I have a policy, which does cover pre existing medical (not that I have anything to worry about there) and I figure it costs me per month about the same as a couple of prescriptions..