The table provides a summary of health insurance coverage from a basic plan cover to what is typically included in a comprehensive policy and those that tend not to be included at all.
| Typically Included | Inpatient Treatment | Surgery as an inpatient or day patient | Hospital accomodation and nursing care | Cash payment for treatment received as an NHS patient |
| Included dependant on the level of cover | Outpatient tests | Outpatient consultations and treatment with a specialist | Overseas Cover | Physiotherapy and alternative medicines |
| Typically not included | GP services | Treatment of pre-existing conditions | Accident and Emergency admission | Treatment for a chronic illness |
When it comes to looking at health insurance coverage we must remember it is designed to cover treatment for acute conditions – curable, short term illness or injury. Chronic illness, long term llnesses and their treatment tend never to be covered which is common with most policies.
Health insurance providers often categorise their health insurance policies as either basic, mid-range or comprehensive.
Basic health insurance coverage
Health insurance is designed around inpatient treatment, starting with a basic plan which generally covers inpatient and day patient treatment in full. A basic plan will provide very little, if any amount outpatient treatment, in most cases consultation fees and diagnostic tests are not covered. Most health plans also provide a cash benefit when you receive treatment as an NHS patient which require an overnight stay.
Standard health insurance coverage
Standard policies build on what is covered in a basic plan. In addition to full cover of inpatient and day patient treatment a greater level of cover is provided for outpatient treatment, providing cover for outpatient scans and diagnostics tests although often limited to £1,000 per policy year.
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Comprehensive policies build on the standard policy by providing full outpatient cover. Comprehensive plans tend to cover scans, diagnostics tests and the likes of physiotherapy in full whilst often providing a host of other benefits which can include psychiatric treatment, alternative medicines, home nursing and overseas cover.
There is a vast array of health insurance providers and products on the market, when buying health insurance it is vital to compare a number of providers, both price and cover to find the most affordable health insurance plan that best fits your needs. However, it doesn’t matter how you cut it, generally the greater the level of coverage you require the more expensive the policy will be.
What is not covered?
When looking for a medical plan you must keep in mind that it is designed to cover treatment for curable, short-term illness or injury. The health insurance coverage is not designed to cover the long-term treatment of chronic illnesses, illnesses which require prolonged treatment and do not necessarily have a cure.
- The private health sector’s main purpose is treating conditions that can be cured, or mostly cured, quickly.
- A large proportion of the NHS’s funding is to treat and care for patients with long-term conditions. Take a patient with diabetes, the NHS enables them to go to clinics, be regularly monitored and have their insulin needs met.
Health insurers are just like any other business selling a product, they must balance how much coverage they provide with what you are willing to pay for that cover. Simply if the insurers included treatment for chronic conditions in their cover the premiums would become too expensive for most people.
When buying health insurance you will be provided with a policy summary also known as a Key Features Document as well as the full policy document. The summary Key Features Document will set out any important limits on the policy, as well as the main monetary limits for specific treatments.
Generally speaking the following conditions or treatments are normally not included in your health insurance coverage.
- Going to a general practitioner (GP)
- Accident and Emergency
- Drug abuse
- HIV/AIDS
- Normal pregnancy
- Gender reassignment
- Mobility aids, such as wheelchairs
- Organ transplant
- Injuries you get from dangerous hobbies (often referred to as hazardous pursuits)
- Conditions you had before taking out the insurance, commonly known as pre-existing conditions. See Health Insurance Underwriting
- Dental services
- Outpatient drugs and dressings
- Deliberately self-inflicted injuries
- Infertility
- Cosmetic treatment
- Experimental or unproven treatment or drugs
- Kidney dialysis
- War risks
Read the policy summary. When buying health insurance it is essential to read the policy summary also known as the Key Features Document in order to understand the health insurance coverage provided and any exclusions from the plan.
If you require some help finding the right plan, as independent insurance brokers dealing in insurance day in, day out, we can review the market with you and help you find the health insurance policy that best fits your needs.
For an independent guide to buying health insurance take a look at the Association of British Insurers guide to buying medical cover.
