Private Health Insurance - share treatment cost

LarryR

Hi

My work has provided me with health insurance, which is great. And it's pretty comprehensive, not excluding any preexisting conditions, Etc.

I had my own private health insurance policy before taking this, which I've had for many years with Bupa.

My worry was that if I cancel my own policy and take the one offered by work and then leave their employment, I would have to start again with my own policy and then pre-existing conditions would inevitably be excluded.

So, I took the work policy but have kept my own - but made it a basic policy (although kept cancer care in) and set a high £2000 excess, as I don't plan to use it, unless I leave my company, in which case, at renewal I would reduce my excess to a manageable amount.

Trouble is the policy I have with work has a condition in their terms that say if I have my own insurance policy, they expect to "share" the cost of any consultation/treatment.

Now, if I need a consultation and they ask if I have another policy and I say no, can they find out? If they can, why ask and if they can't why have this as condition in their policy?

If I say yes, then it will be me who pays because of my high excess, surely? 

Anybody else come across this?

Brie

As I understand it this is a standard thing with any insurance policy not just for health care. 

So if, like me, you find you need a knee replacement then the cost of that will be split between the 2 companies.  So 5 years back my knee op cost my employer's health scheme £15k.  I had a deductible of £300 per year so the cost to me was minimal. 

What you have is the possibility of 2 companies each paying £7500 for a knee job and you will have to pay the deductible for both.  And one company may not cover things in the same was as the other so that might further complicate the whole thing.  One might cover everything to do with the knee op from initial consultation to physio for 6 months.  The other might cover just the op but not the MRI or the physio or have that as a separate charge with a deductible paid each time.  

And if you lie to them and they find out that would like invalidate everything and you'll have to pay the lot as neither company will cover you.  

You need to read the T&Cs carefully.  

LarryR

Thanks. That's what I was afraid of.

The thing is, I may have had a couple of consultations and a CT scan.

So, now I know the situation I don't really want to perpetuate it. So I think I have 2 options...

1. I could call my work provider and come clean and say I'm so sorry I didn't realise I had two policies. They'll either say don't worry and you owe us half of what we've outlayed so far (maybe £1k?) and thanks for letting us know. Or they'll say we don't believe you didn't realise, you were obviously trying to deceive us and you're out, so you have to pay everything you've ever claimed, plus we'll let your other provider know and they will also throw you out too. 

2. I could cancel my personal policy now, so any future claims are honest and clear, and hold my breath that work provider don't look retrospectively and say hold on a second, what have we got here... then see option 1.

Feels like I'm in a no win situation now?!?

Any other options or have I completely screwed myself?
Thanks 

DullGreyGuy

Committing fraud is never a good start with an insurance claim. Won't just be medical insurance that will become difficult when you have to admit to your Motor insurers etc that you've been caught committing claims fraud. 

What does your Bupa policy state about sharing costs/ if other insurance exists? The two policies have to be read side by side to work out if one or both would respond. 

LarryR

I realise that now. It started off with me just wanting to cover myself, if/when I leave my job so I don't have to start again or worse have no health cover. It wasn't really there to be used while I had the work policy (hence the high excess), but now it's all gone horribly wrong and backfired 🤦

I will check my personal policy Ts&C's, but don't think it had a 'shared' element to it - but now I'm not sure.

LarryR

My personal policy specifies:

Other insurance cover
You cannot claim more than once for the same private medical expenses. This means that if you have two policies that provide private medical cover, the costs of your treatment may be split between Bupa and the other insurance company. You will be asked to provide us with full details of any other relevant insurance policy at the time of claim.

So, I don't think I've done anything wrong, technically, with them, as I've not made any claims with them. I'm really just trying to figure out how to get myself out of this mess I've stupidly created for myself. Ideally, without losing all insurance cover on everything. Any suggestions? Or should I just cancel all policies and give up?

DullGreyGuy

They are both split costs policies so irrespective which you made the initial claim on your should have advised them of the existence of the other and they'd have liaised and agreed the cost sharing, if any as it also depends on if both policies cover the particular claim. 

It's ultimately your choice if you decide to proactively become honest and just work out how you rationalise the false declaration or you sit tight and hope your fraud isn't detected. Ultimately cancelling anything doesn't undo the false declaration and whilst it becomes less likely that they'll continue investigations they can in principle still void the policy were they to become aware even after you've cancelled it.

XRS200

Have you actually made any false declarations?

Does the company policy say anything about other cover?

LarryR

Thanks for replying. I have claimed a couple of consultations and and mri, not a big op or anything. But assume it doesn't matter about the size of claim - it's the principle. I'm really not sure which way to go on this. 

sheramber

Can you refuse the work policy and just use your BUPA as before.

LarryR

I was thinking about cancelling Bupa and hoping that my work provider can't see/won't check that there was a period of overlap? Then if I make a future claims I will only have one policy in place. If I leave my company, I will have to start again with a new provider or negotiate a personal policy with my work provider?