Health insurance does not cover all medical eventualities. Making sure that you are aware of the exclusions on your private health insurance is vital, so you know what is and what is not covered.
1. Chronic conditions. These are categorised as a disease, illness or injury which has at least one of the following characteristics:
• It continues indefinitely and has no know cure
• It comes back or is likely to come back
• It is permanent
• You need to be rehabilitated or specially trained to cope with it
• It needs long term monitoring, consultations, check-ups, examinations or tests
2. Pregnancy. Pregnancy services are not covered by many health insurance companies, although pregnant women who present with other medical conditions can claim if they have been with a medical insurer for a designated period of time. This length of time varies from insurer to insurer.
3. Emergency medicine. Private hospitals are not equipped to deal with emergencies. This is one of the strengths of the NHS. Patients can be referred under the terms of their health insurance once they have been stabilised.
4. Pre-existing medical conditions. Pre-existing medical conditions are not covered by health insurance policies. Medical insurance is designed to cover you for unexpected acute medical conditions only. If you are diagnosed with a new chronic condition then an insurance company may cover you for the diagnostic tests that led up to the diagnosis.
5. GP consultations. Most people use NHS GP’s who can then refer them to private health hospitals and consultants. However health insurance companies do not pay for private GP consultations, unless you have that specifically as an option on your policy. Additionally, NHS GP’s sometimes charge for private referral and these fees are not covered either under health insurance policies.
6. Cosmetic surgery. Elective cosmetic surgery that is not part of a medical problem is not covered under health insurance policies.
7. Dental treatment. There are many cash plan insurers that cover dental treatment but this is not covered by normal health insurance companies. This may be an optional extra on your policy.
8. Other things not covered: Drug, solvent and alcohol abuse; HIV/AIDS
It is important to refer to policy documents to find out exactly what your policy exclusions are.
