Insurance World

Most of the seven million people covered by health insurance in the UK have a policy provided by their company. As such it is a useful benefit, but many of us assume that it will cover any kind of health issue and this is definitely not the case. The insurers exclude a wide variety of possible claims, and this article will explain those in detail.

Health insurance has a very specific purpose – to get people suffering from short-term, curable health problems straight through to a consultant and to receive top quality private care in top speed time. Essentially, it’s about jumping the lengthy NHS queues. However, there are many health problems that don’t fit into this narrow band, and as such are not covered by a health insurance policy.

Be aware however that every policy is different, and only be reading your own policy documents will you be able to find out exactly what you are covered for. This article will give you the knowledge you need to understand your policy better.

Defining ‘ Chronic’

Illnesses and conditions etc fall into two main categories: ‘acute’ and ‘chronic’. Short-term illnesses that can be fixed and cured are called ‘acute’, for example if you fell and broke your arm, this would be classed as acute. If, however, your problem is either incurable or deemed to be a long-term issue, then it will be classed as ‘chronic’ and subsequently you will not be able to make a claim.

What counts as ‘acute’ and what counts as ‘chronic’ is a hotly disputed issue between insurance companies and their customers. Diabetes and asthma are acknowledged as chronic, long-term conditions that cannot be cured.

The issues become more difficult with certain types of cancer. It often happens that the cancer is considered to be treatable at first, and then the diagnosis is changed at a later time to incurable. In this case, you would only be covered as long as the cancer was diagnosed curable. If the prognosis changes you will lose your cover. Insurance companies are allowed to reclassify an illness from acute to chronic at any time.

What about the long-term
If you need long-term treatment then you’re out of luck. However insurers have different ideas on what constitutes long-term, you may be covered for 10 months or up to a year, but it probably won’t be for any longer than that. Check your policy for details.

Does preventative medicine count?
Health insurance cannot be used to pay for preventative treatment, although that is another matter of contention. For example, a drug called ‘Herceptin’ can be used to help women who have ‘HER2′, a virulent form of breast cancer. The drug has helped reduce the risk of the cancer returning by an average of 50%. Many would call this an essential treatment, but some insurers call it preventative. Legal and General and Axa PPP will not pay for this treatment, however BUPA, Standard Life Healthcare, Norwich Union and WPA will.

Drugs not yet available on the NHS
You might think that it doesn’t matter if the drug is available on the NHS, but it relates to the system of drug approval in England and Wales. Before a drug can be used in the NHS, it must be approved by The Institute for Health and Clinical Excellence. The problem is, if it’s not approved, the insurance company won’t allow you to be treated with it. Huge delays affect the introduction of new drugs into the NHS because The Institute for Health and Clinical Excellence must first ascertain if the benefits of the drug justify the financial costs of adding it to the NHS treatments. As a result, the drug you need may not be approved, and if so, it won’t be covered.

Aware of this problem. the Financial Ombudsman issued a compromise which stipulates if the insurer won’t cover ‘experimental treatments’, then it should cover the cost of the approved conventional treatment. The policyholder is then free to undergo the experimental treatment and pay the surplus if it’s more expensive.

Pre-existing conditions

A ‘pre-existing condition’ describes a condition or illness that you suffered from before starting your health insurance policy. You will have to provide details of all these when you fill out your application form. That way the insurer is aware of what they can exclude from your policy. Be sure to be truthful in the application form as the insurer can easily contact your doctor to see your medical history, and they often do – having requested your approval first. They will also sometimes ask people to undergo a medical examination.

What counts as a pre-existing condition is also a potentially sore subject. If you fell off your horse years ago and fractured an ankle, you may find in later life that it starts playing up again and you need an operation to fix the problem. The insurance company may reject a claim, saying that it’s a condition that occurred before the policy began. If that happens, you either pay yourself, or go with the NHS.

Some insurance companies write a moratorium provision into their policies, which allows some respite from a potential long list of pre-existing conditions. For example, you may be covered as long as you have not suffered from the condition for two years, with the condition first taking place in the last five years. These time frames are individual to insurance companies, read the small print first to see if your policy includes a moratorium provision.

The condition or illness is excluded

Health insurance is renewable on a yearly basis and at renewal time, you may find that your policy, and your premiums, have changed – often not for the better.

If you are undergoing treatment at time of renewal, it’s possible that your condition or illness will have become ‘excluded’ in the renewed policy, and that you will have to cover the cost of the rest of the treatment.

Because medical research is advancing so quickly, and the number of conditions considered treatable is increasing, the goalposts are always shifting as to what is chronic and what is acute.

The insurance companies are usually trying to cover their own backs. More conditions are being classified as acute, so they have to pay out more in claims. At the same time, newly introduced treatments and drugs are often expensive, so that’s more expense to the insurer. To cover their losses, the insurers increase the premiums, and introduce some more exclusions. You have to watch out for this as you may renew your policy without realising that some very important details have changed.

So if have Health Insurance, or you are considering signing up to a policy, take this article into account and read the small print so you know exactly what is and isn’t covered. And the golden rule: before getting treatment, always double check with your insurer first that it is covered.

The nature of a car insurance company is such that you might not discover their true stripes until you need to call on them in a crisis, but car insurance company ratings are an extremely useful way to find an insurance carrier that won’t let you down when worst comes to worst. We might hope that we never need to call upon the insurance we’ve taken out, but it’s still not a service we can do with out, and finding reliable and unbiased car insurance company ratings can be our first step in locating an insurance provider that will be everything we need it to be if that dreaded accident ever occurs.

There’s little doubt that it can be difficult to find insurance company ratings that are fair and balanced. Of course the company themselves are unlikely to show you their less than positive side – they will point you in the direction of glowing testimonials, but are a little more behind the door in admitting their shortcomings. And there are a lot of factors to take into consideration when choosing a car insurance company. Price is important, of course, but so are customer service, and the ease with which you can make a claim in the event of an accident. Finding an insurance company that offers all of these can be a daunting affair – that’s why it’s so great that someone has registered our needs and come up with automobile insurance ratings that we can trust.

One of car insurance company ratings is offered in a company’s reputation, and carriers such as Allstate, Nationwide, and State Farm, well-known companies that have managed to hold onto some clients for years, are a fairly reliable bet. That’s not to say, however that smaller, less well-known companies don’t offer a great service, so for an inside look on how the big companies are really rated, and to find details of those you might not have heard of, check out J.D. Power and Associates.

J.D. Power and Associates rates insurance companies in terms of the variety of coverage they offer, rates, claims processes, and customer service, helping you compare insurance companies in all these important categories. Other services that have grown up in recent years are Amica and Erie, who have posted the best rankings with J.D. Power. These companies have secured rave reviews for finding ways to cover claims. Another extremely useful source for car insurance companies ratings is A.M. Best and Standard and Poor’s who offer insights into an insurer’s financial strength by displaying ratings that determine an insurance company’s ability to pay claims.

Thankfully there are great resources available to help us find the car insurance companies ratings we need to help us make the best decision for ourselves and our families. Before you sign on the dotted line, you want to know which insurance provider is the best for you, so be sure to check these resources out before you put pen to paper.