It is important to understand that private medical insurance is designed to be complementary to the NHS and not a replacement for it. It principally covers the costs of private consultations and diagnostic tests to identify the medical condition needing treatment, and the costs of then treating that condition in a private hospital. It is not intended to cover emergency treatment, which the NHS remains best able to provide. Also, it does not normally cover treatment of long-term illnesses. A long-term medical condition is one which cannot be cured and for which treatment will normally only relieve symptoms.
Although our plans offer different levels of benefit, there are some exclusions which are common to them all. For example, we do not pay for treatment of wilful self-inflicted injuries, HIV or AIDS, cosmetic surgery, regular renal dialysis, charges for routine medical examinations and visits to the GP or dentist.
Pre-existing conditions
We provide private medical insurance for medical conditions arising after the start date of the policy, and not for conditions that are already existing. In common with most insurers pre-existing conditions are not normally eligible for benefit.
On our personal plans, we offer a choice of two methods by which we underwrite any pre-existing conditions. You do not need a medical.
Moratorium Clause
We apply a straightforward exclusion for treatment of any medical condition or related condition which members:
in the five years before the start of the plan. These are all pre-existing conditions.
Pre-existing medical conditions may later become eligible for benefit providing the insured member has not:
Individual Assessment
We offer the option of individual assessment based on completion of a detailed health questionnaire. Our underwriters will assess each application, obtaining any additional information from the applicant's general practitioner where necessary. A personalised certificate is then produced detailing any medical conditions specifically excluded under the plan.
Full details of these and other exclusions can be found in our policy documents for each of our products which are available on request from our Intermediary Sales Support team on 0845 602 3461.
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