What to look for when buying private health insurance

When it comes to private health insurance, one size does not fit all. Choosing the right plan for you and your family is not always easy, especially with so many plans available.

There are many things to consider, from the excess and the cost to underwriting and what you are covered for. That is why we have put together seven things to look for when buying private medical insurance.

1. Choosing the right cover for you

When buying private medical insurance, you can usually choose from a range of benefits and levels of cover. For example, your options may include:

• the types of treatment covered, such as inpatient, day-patient and outpatient treatment, therapies, dental and optical cover and mental health cover
• the maximum amount you can claim for these treatments
• where you can be treated, such as your choice of hospital or clinic

The cover you choose affects your premium and what you can claim for later. Take time to understand the cover available, because you usually cannot change it until your policy renews.

Read more about private healthcare.

2. Understanding the excess

An excess is the amount you pay towards the cost of your treatment when you claim. You can usually decide how much you want your excess to be, although a compulsory excess may apply. Your excess may be between £0 and £1,000.

The higher your excess, the lower your premium, but the more you pay when you claim. Factor in the excess when comparing insurers, as it is another cost to plan for.

How does a health insurance excess work?

Depending on your insurer, you may pay your excess every time you claim, or just once in each policy year. The excess is usually paid by each person who claims on the policy.

When you claim, your insurer takes your excess off the amount it pays. It will tell you whether to pay the excess directly to the hospital or specialist, or whether it will be taken off any amount it pays back to you.

Read more about how excess works on health insurance.

3. What affects your premium

As well as your level of cover and excess, other factors affect the price of private health insurance. Every insurer has its own way of calculating premiums, but the most important factor is usually your age. Premiums rise with age, because the likelihood of needing medical care increases.

Some insurers also base the price on where you live, your medical history or your lifestyle, such as whether you smoke. It is worth getting quotes from several insurers. The cheapest option is not always the best for you, so consider your needs and the cover that matters most to you.

Read more about what affects the cost of health insurance.

4. Cancer cover

Most health insurance policies cover cancer, as long as it is not a pre-existing condition. Some policies let you choose more comprehensive cancer cover. Cancer cover can give access to private cancer treatment, including some drugs and treatments that may not be available on the NHS, depending on the policy.

Some policies pay an NHS cash benefit if you choose to have your treatment as an NHS patient rather than in a private hospital.

Cancer cover varies between insurers and policies, so always check it before you buy. Read about our cancer promise on Freedom Elite.

5. Underwriting

Underwriting is how an insurer uses your medical history to decide how pre-existing conditions are treated on your policy. The most common types are moratorium underwriting and full medical underwriting.

Moratorium underwriting

With moratorium underwriting, you are not asked about your medical history when you take out the policy. Instead, the insurer automatically excludes conditions you have had symptoms of, or received advice, treatment or medication for, in the previous five years.

A pre-existing condition may become eligible for cover if you go a full, unbroken two-year period without symptoms, advice or treatment for it. Read more about medical underwriting.

Full medical underwriting

With full medical underwriting, you give details of your medical history when you apply. The information must be complete and accurate, to the best of your knowledge and belief.

The insurer then decides whether to exclude any pre-existing conditions. These are shown on your certificate, and you cannot claim for them or any connected conditions. With this type of underwriting, you know what will and will not be covered from the start.

6. Exclusions

Every health insurance plan has conditions and treatments it does not cover, known as exclusions. These vary between insurers, policies and types of underwriting.

A full list of exclusions and other terms should be available when you buy. Some common exclusions are:

• pre-existing conditions
• chronic conditions
• emergency treatment
• cosmetic surgery
• drug and alcohol misuse
• normal pregnancy
• mobility aids, such as wheelchairs
• injuries from dangerous hobbies and sports
• drugs and dressings prescribed after you leave hospital
• self-inflicted injuries
• infertility treatment
• experimental or unproven treatment or drugs

Make sure you understand what will and will not be covered, so you are happy with your plan.

7. Your rights as a consumer

When you buy private health insurance in the UK, you have certain rights.

The cooling-off period

As with other goods and services bought at a distance, health insurance comes with a cooling-off period, when you can change your mind. The minimum is 14 days, and some insurers offer longer. If you cancel during this time, you are entitled to a full refund, as long as you have not made a claim.

Confidentiality

Your insurer collects personal information about you, including medical details. It must treat this information confidentially, and tell you what it will be used for, who it may be shared with and when. You can also ask to see the personal information an insurer holds about you.

Complaints

Health insurers in the UK are authorised and regulated by the Financial Conduct Authority. Every insurer should have a complaints procedure, and details of how to complain should be in your policy documents. If you are unhappy with your policy or the service you receive, you can complain to the insurer.

If you are not happy with the insurer's response, you may be able to refer your complaint to the Financial Ombudsman Service. Your insurer will usually give you this information.

Switching to another insurer

If you are thinking about switching your health insurance, it is usually better to wait until your current policy ends. This helps you avoid any early cancellation fees.

Compare the benefits, terms and limits of different policies before you choose. Always check whether conditions you are currently covered for will also be covered by your new insurer, as this is not always the case.

What questions should you ask a health insurer?

When shopping around, have a list of questions ready to ask each insurer. These might include:

• How much does the policy cost? Check the total cost, including any optional extras.
• What treatments are covered? This is especially important if your healthcare needs or medical history are not straightforward.
• What treatments are not covered? Most insurers have standard exclusions, but there are differences between them.
• Can I be treated at a hospital of my choice? Some policies do not cover every private hospital.
• How do I contact you to make a claim or ask a question? The insurer should explain its customer service process.

Looking for private health insurance?

Read more about our individual and family health insurance, or our group health insurance for businesses. If you have any questions, contact us.

Freedom Health Insurance cannot give advice on which cover is right for you. For independent advice, you can find a health insurance intermediary through the Association of Medical Insurance Intermediaries.