International Health Insurance Costs

The rising costs of international medical insurance may lead to a service which is completely unaffordable according to the medical director of Bupa International, Dr Sneh Khemka.

International medical insurance covers expatriates or people who holiday or travel extensively abroad but according to Dr Khemka rising costs are proving problematic:

'This is something the entire healthcare community needs to address, but we are in a prime position to facilitate a strategy. We have to contain costs. Otherwise, private care will become uninsurable. The golden goose gets shot.'

There are several ways in which the issue can be addressed:

• Encouraging good health. This is something that private medical insurance companies are all doing in an attempt to help keep health cover down.
• Looking at corruption. Over time there have been many cases of medical insurance companies being charged more than they should have by unscrupulous health providers.
• Getting doctors to look at the treatments they are prescribing which in some cases can be replaces adequately by alternative, cheaper treatments. According to Dr Khemka, who spoke to The Telegraph: 'There are lots of treatments and doctors will continue to try them because they like to do something, and they make money out of it.'
• Choosing the best hospitals and sending more patients there, thereby driving down costs by the scale of economy.
• Keeping policyholders informed. Dr Khemka said: 'This is where we are trying to win customers over. Rather than using treatments willy-nilly, we are trying to get the right treatment, which will help the patient, and save cost.'

New AA Health Insurance

Many more consumers will exposed to the benefits of health insurance as AXA PPP healthcare have teamed with the AA to offer their customers three levels of medical cover. The Automobile Association will also be offering the products to non-members.

Simon Douglas, director of AA Insurance, said:

'This is a logical expansion of our health and life related products which include life insurance and critical illness cover.

'The AA has built a trusted reputation amongst its 15 million members for helping to ensure the health of their cars.

'Looking after the health of our members and their families is an obvious step and we've launched into private medical insurance with one of the leading providers in this market.

'Private health care, once the province of the well off, is now available to anyone and we think that this cover will be widely welcomed. We expect to expand the range of services later this year with, for example, health screening cover. We already offer Accident Healthcare which provides medical treatment in the event of a car accident.'

Currently new customers are being offered one month free private medical insurance and customers who have had AA membership for a year or more are being offered two free months of health cover.

University Health Insurance Fraud Course

As consumers we want affordable medical insurance that covers us when we are in need. For health insurance companies it has become an uphill struggle to provide this. Health care is becoming more expensive and consumers are not prepared to spend as they once were. One way in which they can save money is to route out fraud.

Fraud has been on the increase in the health cover market and ultimately consumers bare the brunt of the deficit. This year the Health Insurance Counter Fraud Group (HICFG) will be launching the first university-accredited qualification in healthcare fraud investigation. The qualification will cover the standard fraud investigation modules but will also include additional elements that are relevant to health.

The development of this course is as a result of the HICFG opening its doors to cash plan providers. HICFG chairman Dr Simon Peck says:

'I am delighted to announce this development. We believe there is significant cross-over between the problems experienced by cash plan providers and those we see in private medical insurance and this is a great opportunity to pool our resources in a way which will benefit all of us.'

Saving on Company PMI

Just as the country is coming out of recession many companies are struggling with cash flow problems. This in turn can lead to reviews cuts in pay and perks. One way to keep health insurance for your staff is to review the provisions you have in place.

According to Hewitt Associates, an HR consulting company, reviewing health cover should be an annual thing as it can help to reduce costs. Colin Bullen, head of health and risk benefits from Hewitt said:

'Companies are losing out by not reassessing their current contracts. Shrinking budgets, coupled with the effects of the recession, have presented an opportunity to review and reset priorities. In many instances, benefit providers have become extremely competitive on price and are willing to adjust their rates to attract and retain business - a situation that is unlikely to last indefinitely. Savings are realistically achievable if companies act now.

'By seizing this opportunity, more advantageous terms for the next two to three years may be on the table; meaning that companies can lock in significant savings without damaging employee morale.'

In other words, private health insurance companies need your corporate business and they might be willing to negotiate on your current terms. That's great news for business and great news for your employees who won't have to miss out on medical insurance cover. Bullen warned against reducing cover. He said:

'Blanket benefit cuts do not lead to enduring business advantages. We are urging companies to start 2010 by acting with an eye to the longer term. A well-structured benefits policy that is valued by employees typically results in more engaged employees and is proven to boost workforce motivation. Rather than just taking an axe to current benefit structures to control costs, employers should reshape their benefits to meet member needs and demand the best value for money from their providers.'

How to Buy Health Insurance

Sometimes people ask How do I Buy Health Insurance? It can be a complicated process as there are many different medical insurance companies that sell various policies in a different number of ways. This is a brief guide on the different options available.

Who sells health insurance?

Health insurance companies
Health insurance companies can sell policies directly to consumers and businesses. Operative should have a very thorough knowledge of the policies that they sell and should therefore be able to give you good advise. Be aware that their job is to sell you a policy.

Independent Advisors
Independent Advisors earn their money by selling insurance policies to businesses and the general public and taking a commission on what they sell. They should be impartial and be able to sell you the best policy for you, your family or your business. They are regulated by the Financial Services Authority. Some health insurance policies are only sold via brokers.

Insurance Agents
Insurance Agents sell policies from standard medical insurance companies on to their clients. Examples of this include supermarkets, banks and building societies.


How can I buy health insurance?
Health cover can be purchased in a variety of ways:

Face to Face
This is the traditional method of buying medical cover. The advantage of it is the personal touch. It also enables a broker to get to know their client and ask important questions, that could help reduce non-disclosure, based on their customers facial expressions and body language. This method of buying insurance is becoming less common.

Over the Phone
Taking health insurance details over the phone is another option. Operators usually follow a paper or online questionnaire which will help them to fill in a customers application.

By Post
This is the least common way of buying health insurance although sometimes people use this method after they have been to see an advisor. If they feel they have been bombarded with lots of information they may take forms home with them and make a decision when they have a clearer head.

The Internet
This method is becoming more common. Access to health insurance via the internet is available either directly through a health insurers website or via price comparison sites such as www.comparethemarket.com or www.moneysupermarket.com

9) Specific Policies: Childrens Private Medical Insurance

One way of reducing private medical insurance costs is taking out a very specific policy. The health insurance market is coming up with more and more ways to reduce costs but still enable people to get the kind of care that they want.

Children's Medical Insurance
There are specific policies available now that only cover your children.

AXA PPP offers First Healthcare. This is a health cover plan for children which works under their six week option. This means that if a child cannot be treated within six weeks for their day or outpatient treatment then they will be covered by the insurance.

Ben Faulkner, speaking for AXA PPP, says:

'Regardless of waiting times, the policy covers immediate access to private outpatient tests and costly MRI and CT scans. It also pays – again irrespective of NHS waits – for the child to see an experienced consultant privately at a convenient time for both child and parent, helping to relieve the worry of not knowing what’s wrong.'

Medical cover from First Healthcare costs £9.99 per month for the first child and then £8.99 for each additional child.

Child Health Solutions from Child Health Cover was launched in September and provides paediatric health insurance for children from birth to 18 years old. This policy costs £13.50 for a first child with discounts for additional children. It includes dental cover and speech therapy. It also provides access to specialist paediatric hospitals and a 24hr GP helpline.

Rebecca Freebody, head of propositions management and market development at Aviva UK Health, says that the research they carried out showed that people who maybe could not afford full health insurance cover were keen to still have protection for their children:

'When we first conceived the product there wasn’t a child-only product available in the market. Our product has core cover similar to adult PMI, but it also covers physiotherapy, chiropody, dental and speech therapy which often have long NHS waits. Our policy is comprehensive in that as soon as the child needs treatment they can access it straightaway.'

FOS Health Insurance Complaints

The Financial Ombudsman Service (FOS) published its public complaints figures this month. But are they valuable and what do they tell us about complaints made about medical health insurance?

If people are unhappy with their health insurance company they have to follow the company's official complaints procedure and if they are still not satisfied they can appeal to the independent FOS who will make a final decision in each case.

The statistics collected for insurance include different types of insurance including private medical insurance as well as critical illness insurance and income protection therefore there is not an easy comparison. However out of all the insurance complaints they received 70% were upheld. This is a large percentage and means that 7 out of every 10 complainants had not received fair treatment from their insurance company.

Individual companies were named although again it is hard to compare as different types of products were being scrutinised.

Complaints Upheld
Bupa - 25%
Aviva Health UK - 36%
AXA PPP Healthcare - 44%

Maggie Craig, director of consumer strategy at the Association of British Insurers (ABI), said:

'It’s absolutely right that consumers should know about the performance of firms who look after their insurance and investment needs, and complaints handling is an important part of that. But any such data must be presented in a way that helps consumers make informed choices.

'Unfortunately, the way that the FOS has chosen to present the data doesn’t achieve this aim, and may in fact mislead consumers about the performance of individual firms. For example, consumers can’t compare performance by sector or by product.'

Even though comparisons between figures may be misleading it must provide an extra incentive for the private medical insurance industry and individual health cover providers to look at their complaints statistics and procedures and see where they are going wrong.

More transparency is what some quarters are looking for. Critical illness insurance providers, for example, have to declare their claim rejection figures every year. Transparency enables solutions to come quicker even though it may be painful for a company to expose its results to the general public.

The complaints figures for this year were almost the same as last year which is a good sign. Since 2005/6 complaints have come down from 2,291 to 1,874. The ABI's work on improving non-disclosure is one of the reasons for this reduction.

According to FOS one area where they still receive complaints is in health insurance cases where consumers received reveiwed premiums which they feel are unfairly steep. Their website states:

'We continue to receive complaints from consumers who have entered into so-called "reviewable" insurance policies, where the insurer has the right to review the premium at intervals of five or ten years. These disputes generally involve reviews that have been carried out after many years – and have resulted in a significant increase in the premium.'

Unfortunately FOS does not publish the results from companies who have had less that 30 complaints. F0r a small company this may represent a large number of complaints and it would be good for the public to have this kind of information available to them.

Yearly Health Insurance Premium

Lots of people are trying to cut down on the cost of their health insurance premiums. Most people pay for their health cover with a monthly premium that is calculated for you when you take out a policy. However some medical health insurance providers allow you to pay for the whole year upfront and for this they usually give you a discount.

AXA PPP Healthcare for example give a 5% discount if you pay yearly.

This is only one way that can help to cut your health insurance premium costs. Other ways include:

* The six week option
* Co-payment
* Restricted hospital lists
* Reducing your level of cover
* Using the cheapest health insurance

Making a Health Insurance Claim

Different health insurance companies have slightly different ways in which they deal with claims so it is important to find out ahead of time how your company deals with claims.

A lot will depend on the type of health cover policy that you have: whether its a moratorium or fully underwritten policy. The most important advice is unless you are prepared to be out of pocket do not agree to any treatment or consultation that has not been agreed by your insurance company.

1. Visit your GP
This should alsways be your first port of call. If your GP agrees that you need to be refered for treatment or further investigation then you need to inform them that you are making an insurance claim and give them the details of the company that you are with.

In order to make a claim you will need details of your condition and probable diagnosis and the treatment that has been suggested. You will need the details of the consultant/hospital that you would like to have treatment with.

2. Contact your medical insurance company
Some companies provide an online claims method as well as a telephone number for you to ring.

You will be asked about the details of your condition and in some cases you will be informed that the insuerer will need to contact your GP to get more details about your health status. When you sign a private health insurance policy you must make sure that you have answered everything truthfully - any differences in what you have said and what the GP reveals about your records may invalidate your claim at this stage.

3 Confirmation of claim
You health insurance company will confirm whether you are covered for treatment/consultation under your policy. Companies vary in the length of time that they take to do this. Pruhealth issue an authorisation code which you need in order to have your bills paid efficiently.

4 Make an appointment
Once your medical insurance company have agreed to pay for a claim you can book an appointment to begin treatment. You will need to take your insurance details with you when you go.

5 Paying the Bill
Companies vary in how bills are settled. In most cases bills are sent directly to health insurance companies who then settle up with the health care providers. In some cases you pay the bill and your insurance company pays you back. With some policies, for example with Freedom Healthnet Ltd, the rules are very different. Freedom pay you the cash and then you pay the health provider directly.

The Advantages of Health Insurance

The statistics show that the NHS is improving its targets all the time so what are the advantages of having medical health insurance?

Get seen quickly
Hospital waiting lists are down to 18 weeks but this is still too long. If you have private health insurance you can be seen very quickly. This is reassuring and means you are tackling your health problems quickly abd therefore improving your chances of good health. It also cuts down on the stress of having to wait for important diagnosis and treatments.

Choice
With private health insurance you have much greater choice about which consultant you see and which hospital you go to. Different medical insurance companies offer a range of different hospital networks.

Cleanliness
Survey's conducted this year cited the poor NHS standards of cleanliness as the main reason that people would consider taking out private health insurance. Concerns over superbugs such as c.difficile and MRSA are particularly important and the private health sector is perceived as having much higher standards of cleanliness.

Comfortable Surroundings
Many private hospitals offer very pleasant and comfortable surroundings. Usually patients have a room to themselves with a television and they are provided with good quality meals.

Staying with Children
Most medical insurance policies cover a parent staying overnight in hospital with their children of 12 or under. For many people with children this gives great peace of mind.

Budgeting
Paying monthly premiums for health insurance enables people to budget their money better. For people who want private health care, medical insurance helps to spread the cost and mainly avoids large, unexpected medical bills.

What are Exclusions?

Exclusions to your health care insurance are things that are not part of the terms of your policy. Things that you will not be covered for. When choosing health cover it is just as important to find out about exclusions as it is to know what you will be covered for. Additionally all policies vary in what they do and do not cover so it is important to read the small print.

Typical exclusions
Pre-existing conditions: this is very important. Sometimes even previous symptoms of an undiagnosed condition will be treated as an exclusion.

Chronic conditions: private medical insurance is only designed to treat short term illness or infection.

Emergency treatment: private hospitals are not geared to look after emergency cases.

Routine pregnancy care: this is hardly ever covered with any policy although some companies, for example, Norwich Union Healthcare, offer you a cash lump sum with each child you have. An exception to this is Standard Life who do cover normal pregnancy as long as you have been on their Primecare Gold policy for at least two years. Complications of pregancy are covered by several companies however.

Cosmetic surgery
Infertility
Addictive conditions
HIV/AIDS related conditions
Drugs or Alcohol related conditions
Illness or treatment resulting from terrorism, criminal activity or war
Out-patient drugs and dressings
Professional sports related injury
Self-inflicted injury
Gender Reassignment
Dangerous Sports
Radioactive accidents

Sometimes Covered
Psychiatric care: Mental illness is not part of all standard policies but can usually be added as part of an extended policy.

Alternative therapies: Some policies cover alternative and complimentary therapies and others do not. Usually the more expensive policies include it.

Experimental Treatments: Normally experimental treatments are not included within your medical cover. However, as part of their comprehensive cancer treatment PruHealth will in some cases allow their customers to have experimental treatments 'provided it is within the context of a properly controlled trial.'

Ambulance cover: Very few medical insurance companies cover private ambulances to take you from your home to your treatment destination. Tesco health insurance, which is underwritten by AXA PPP, does however.

Organ transplants: Most companies do not cover organ transplants.
Bupa's Select Heart and Cancer Policy however does provide cover for transplant of either of these organs.

Swine Flu & Health Insurance

Swine flu is now spreading in the UK at a fast rate. We have moved from 'prevention' status to 'treatment' status and yesterday the first person to have no underlying health conditions died from complications of swine flu. Your local GP and NHS Direct will be able to advise you about the best course of action should you contract the virus but if you have health insurance how will you be treated if you contract swine flu?

For most people swine flu will be treatable at home with the usual cold and flu remedies and plenty of rest. Most people across the world who have become seriously ill with swine flu have had underlying health problems. Vulnerable groups include those with respiratory complaints, heart, liver and kidney conditions. If you have a chronic, already existing health problem, the most likely situation is that you will not be covered for this condition anyway by your medical insurance and if this becomes exacerbated by swine flu you will not be able to receive private medical care unless you pay for it.

Additionally if you are taken ill and need to have emergency treatment then you will have to go to an NHS emergency department as emergency treatment is not covered under any health insurance policy. In fact private hospitals are not set up for emergency medical care at all. They tend to only cater for pre-planned hospital and out-patient consultations and treatments.

However, if you have been generally in good health and become seriously ill as a result of swine flu and are then stabilised in an NHS emergency department it is possible that you could then be transferred to a private hospital under your health cover.

New cases of swine flu are expected to rise to 100,000 a day in August. This will no doubt put a strain on the NHS which will overspill into the private sector. We will be monitoring the situation and reporting on any new developments and their effect on the private health care sector.