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Can I use any hospital?
Each scheme has its own defined hospital list which lists the hospitals that are available on the particular scheme you have chosen. This might also then be sub-divided into different scales – sometimes using a, b or c or other methods. So all hospitals are available to be used however consideration needs to be given at the point of purchase to ensure that any hospital you would particularly like is available on the list for the scheme you have chosen. If a scheme is chosen that has a network of hospitals there would be an allowance for treatment to be received at the most appropriate hospital should the hospitals on the network not have the medical capability to treat any particular condition.
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Will I need a medical?
Most of the schemes are joined without the need for a medical. However, there are some schemes where a medical may be necessary. This almost always done at the expense of the insurer and should be seen as a positive benefit.
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Does the company contact my GP for medical records?
Medical insurance is not designed to pay for conditions that are already present when you take out a policy. To do this insurers use one of the forms of underwriting described in our fact sheet. Like all insurances there needs to be checks built into the system and with medical insurance the check will come from the GP records of the insured person. In most cases there is no need for the GP to be contacted nor for the medical records to be disclosed when taking out a policy. The contact with the GP is usually done with any checks that may be required at the point of claim for which a claim for is used.
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Do any of the companies operate at the specialist fee schedule system?
Most of the insurance companies offer a table of specialist fees that are payable in the event of a claim. The only company that is currently able to publish this is BUPA due to an office of fair trading ruling which prevents other companies that use these schedules to publish these. In fairness most companies fee schedules are broadly the same and as altering is pre-authorised you do have the opportunity to know if there will be any shortfall on your selected specialist, prior to any treatment taking place. There are also schemes where there is no fee schedule and full cover means full cover and the insurer will pay an eligible claim irrespective of the fees that the consultant may charge. If a consultant is extremely expensive on a persistent basis this may lead to an insurer removing them from their approved panel which means you would not be able to use them at all. This however is extremely rare. Most consultants will charge what is a reasonable and customary amount for the procedure performed. Further advice would need to be given on a scheme’s specific basis.
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If they cannot treat me in my hospital of choice can I claim compensation?
The objective of medical insurance is to cover the costs of treatment of acute medical condition within the terms and conditions of the policy. This enables you to have treatment at any of the hospitals on the schemes hospital list (see “can I use any hospital?”) and the insurer will indemnify the costs. Therefore the issue of compensation would not arise as the only reason for not being treated in the hospital of your choice and on your scheme’s hospital list would be if that hospital was unable to treat you either in the time frame that you require or indeed for the condition that you have.
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If I have to make lots of claims will the premium increase drastically?
Almost all of the schemes are community rated within the appropriate age banding. This means that premiums are set using the claims experience across the community (i.e. all people of your age) of insured individuals. This is the original principal of insurance and even if you have extremely high claims your premium would still be at the community rated premium. There are some schemes that use a no claims discount to reward those people that don’t claim by reducing the community rated premium. Just like car insurance any no claims discount that you have will reduce should you make claims. Therefore if you are on a scheme with a no claims discount although the base rates are worked out on a community basis because of the no claims discount you can see your premium rise as a direct result of claims that you make.
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