Private medical insurance What's covered?

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Okay, you're going to go the whole hog by buying full private medical insurance. What should you look for – what's covered and what's not?

What does private medical insurance cover?

With a full-service PMI policy, you can claim towards the cost of:

• Fees for outpatient treatment by consultants and specialists, plus any tests ordered;
• Diagnostic treatment (including CT and MRI scans);
• Daycare treatment (procedures and treatments which don't require an overnight stay);
• In-patient care (accommodation, nursing costs, drugs and dressings, post-operative care, payments to surgeons, anaesthetists, etc.);
• Radiotherapy and chemotherapy;
• Physiotherapy and other conventional treatments;
• Some home nursing;
• Private ambulances;
• Daily cash benefits during NHS stays; and
• Discounts towards annual health check-ups.

The benefits payable vary enormously and depend on the level of cover you've opted for (for example, “Gold”, “Silver” or “Bronze” cover), which, in turn, determines your annual premium.

What's not covered?

Not only do private medical insurance policies pay out limited benefits, they also don't cover every medical problem under the sun. These policies are designed to cover short-term, acute illnesses and injuries – problems which can be cured without lengthy medical or surgical intervention. Hence, most policies don't cover the following:

• Treatment from general practitioners;
• Long-term, chronic, incurable or lifelong conditions, such as asthma and diabetes, plus congenital or genetic problems (those you were born with);
• Intensive care (other than immediately after in-patient treatment);
• Long-term psychiatric illnesses (some policies exclude mental-health problems altogether);
• Accident and emergency treatment - when the NHS usually hits the mark;
• Treatment overseas (which should covered by your travel insurance policy);
• Complementary or alternative medicine (limited outpatient cover may be available);
• Nursing-home care (other than post-operative convalescence);
• Rehabilitation or treatment for addiction, alcohol and drug use;
• Normal pregnancy and childbirth;
• Treatment for HIV/AIDS;
• Non-emergency dental treatment (although oral cancer is usually covered); and
• Non-essential or elective treatment, including cosmetic surgery.

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