What is usually covered/not covered by Private Medical Insurance?
While all policies are different in their specifics, there are certain illnesses, conditions and treatments that are covered by the vast majority of Private Medical Insurance policies. Similarly, there are certain conditions that are not covered by most policies.
For the most part, all acute (curable) conditions are covered by insurance policies. Your policy will cover all fees and charges associated with treatment for curable conditions. All fees charged by the medical professionals involved in your diagnosis and treatment will be taken care of by your insurance company. This also includes diagnostic expenses such as x-rays and testing. If your treatment requires an operation, then all operating expenses such as surgeon’s fees, anaesthetist’s fees and anaesthetic will be paid for. You will also avoid charges for any equipment used or drugs administered during the course of the operation and recuperation.
During the course of your treatment, your insurance will cover all charges associated with your accommodation and nursing. Any medication or dressings you need while you’re in hospital will also not incur a charge.
In most situations, you can also expect your medical insurance to cover oncology treatments such as radiotherapy or chemotherapy, as long as your cancer has not reached a terminal stage. Specialist treatments such as physiotherapy are also covered in many situations.
If you require further care at home before or after your treatment, the nursing costs will also be covered. If you require outpatient treatment, the costs will be taken care of provided it is part of a course of treatment that also included a hospital stay.
Certain additional treatments tend to be only covered by the more expensive Private Medical Insurance policies. These include any outpatient diagnostic tests or treatments that are not linked to an inpatient hospital visit, and also any emergency medical treatment that is required while travelling abroad. As an additional benefit, some policies give you a cash incentive to opt out of private treatment for your condition, and choosing to rely on NHS care.
Of course, there are also treatments that aren’t generally covered by private health insurance. Routine check ups and initial consultations from a GP won’t be covered. In fact, even when you’re insured privately, you’ll still have to rely on the NHS for initial consultations. However, your NHS GP can quickly refer you to a private consultant.
Accident and emergency treatment is beyond the scope of most private hospitals, so this won’t be covered either.
As a general rule, incurable, chronic and terminal conditions aren’t covered by private health insurance. This includes the terminal stages of cancer, and long-term incurable illnesses such as asthma, diabetes and multiple sclerosis. Illnesses that have developed shortly after taking out the policy may also be exempt from cover.
Normal pregnancy and childbirth will not be covered, but if you need any additional treatment as a result of complications arising from pregnancy or childbirth you will normally be able to claim for private treatment.
Cosmetic surgery is not covered, and preventative medicine is also something you will have to pay for yourself.
If you require medical treatment as a result of inflicting harm on yourself, or engaging in risky behaviour, then you will not be covered. This includes drug and alcohol abuse, and dangerous sports and activities such as mountain climbing or skydiving.
