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PMI Overview
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PMI plans are normally offered with three options of cover
| Basic |
Standard |
Comprehensive |
Basic
This is normally the most cost effective option. With a basic plan, only limited cover is provided and it usually excludes out-patient cover. Generally therefore, consultant's fees, diagnostic tests and therapies and out-patient treatments are not covered - unless this results in a later in-patient stay.
As well as being suitable for clients on a basic, these plans also suit people who are able to cover the costs of areas such as out-patient consultations themselves.
Standard
Standard plans normally provide full inpatient and a number of outpatient treatments including consultations and diagnostic procedures. Complementary medicines may also be covered up to certain limits. These schemes are attractive to a broad range of people looking for PMI but the number of hospitals available may be limited.
Comprehensive
Comprehensive schemes will pay for in-patient treatment, outpatient specialist consultations, diagnostic tests and scans. Physiotherapy and complementary therapies are usually covered too. These are top of the range plans suitable for clients wanting complete peace of mind.
The costs of all of the above schemes can be reduced by taking out voluntary excess or by paying premiums annually.
Click here for a copy of the ABI Guide to Private Medical Insurance
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If your client is suffering from or has had an illness (known as a pre-existing medical condition), this may not automatically be covered should they take out a PMI policy.
Insurers use two methods of underwriting to establish what conditions may be excluded:
Fully Underwritten (Medical History Declaration)
Full medical history details are disclosed on the application form. Any on-going medical condition or one that is likely to recur may be excluded permanently or for a period of time.
Moratorium (deferred cover for a pre-existing condition)
Your clients do not need to complete a medical questionnaire with moratorium underwriting.
The insurer will automatically exclude any pre-existing conditions that you have received treatment and/or medication for, or had symptoms of, or asked advice on, or were aware of, during the five years immediately before your policy started.
If they do not have any treatment, medication or advice for those pre-existing conditions, and any directly related conditions, for two continuous years after the policy starts, then the conditions may become eligible for treatment and their exclusion removed from the policy.
It is best to advise your clients to contact the insurer before making a claim so that eligibility can be confirmed and to ensure that they get the most appropriate treatment.
Whats covered
When looking at cover, it is useful to know that treatment is categorised in the following way.
| In-patient treatment |
Day-patient treatment |
Out-patient treatment |
Treatment that for medical reasons, means you have to stay in hospital overnight or for longer.
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Treatment that, for medical reasons, means you have to go into a hospital or day-patient unit because you need a period of clinically-supervised recovery. However, you do not have to stay overnight. |
Treatment given at a hospital, consulting room or out-patient clinic where you do not go in for day-patient or in-patient treatment.
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There is a large variety of schemes available - from low cost schemes, offering limited cover, to those which offer wide-ranging cover and benefits. Most schemes offer cover for in-patient and day-patient treatment, but not always out-patient treatment.
You will need to decide what sort of cover you want. There are a number of things your clients will have to consider. Here are just two examples.
- Do you want your cover to include seeing a specialist as an out-patient?
- Do you want a choice of hospitals, or would you be satisfied to receive any treatment that you might need in a hospital available from a limited range chosen by your insurance company?
Remember, PMI is designed to cover treatment for curable, short-term illness or injury (commonly known as acute conditions). Some illnesses and treatments are never covered and these are common to most schemes.
| Usually included |
Sometimes included |
Usually not included |
Cover for treatment of short term (acute) medical conditions.
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Out-patient diagnostic tests.
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Conditions you had before taking out the insurance (commonly know as pre-existing conditions - read section 7) |
In-patient tests
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Out-patient consultations and treatment with a specialist. |
GP services
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Surgery as an in-patient or day-patient.
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Overseas cover
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Cover for long term illnesses which cannot be cured (usually referred to as chronic conditions) |
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Hospital accommodation and nursing.
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Cash payment for treatment received as an NHS in-patient. |
Accident and emergency admission.
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As well as those listed above as 'usually not included', the following conditions or treatments are normally outside PMI cover.
Drug abuse, self inflicted injuries, out-patient drugs and dressings, HIV/AIDS, infertility, normal pregnancy, cosmetic surgery, gender reassignment (also known as sex change), preventive treatment, kidney dialysis, mobility aids, experimental treatment, experimental drugs, organ transplant, war risks, injuries arising from dangerous hobbies (often called 'hazardous pursuits').
Source: ABI 2004.
Demonstration
If you would like to find out more about our PMI proposition please contact us on 0121 767 1020 or email: dasupport at dasupport@personaltouchfs.com
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