Conservative Drugs Access

In the run up to the general elections all the main parties are letting us know what they intend to do about the National Health Service should they get elected. One issue which has been of concern for both medical insurance companies and the NHS is how much can feasibly be spent on cancer treatments.

The conservatives state that they intend to raise £200m for cancer drugs by increasing the threshold for employers national insurance contributions. The extra money would make more drugs available for cancer.

According to a recent report by an independent health think-tank, The Kings Fund, the UK has widespread differences in how cancer is treated across different health trusts. The conservatives plan to change this by implementing a policy which will not deny patients any drug which has been licensed since 2005. Currently the National Institute for Health and Clinical Excellence (NICE) decide which treatments are available depending on their cost effectiveness. Currently even if NICE have sanctioned a drug a health trust may deny its use if it considers the treatment too expensive.

The cost of drug treatments is a concern not just to governments but also to companies that supply health insurance for cancer. Some companies only cover drugs that are passed by NICE and compared to the rest of Europe the UK uses only 60% of drug treatments available for cancer.

NICE has its critics who say that many drugs that are used to prolong life may be expensive but that to deny patients treatment that may prolong their lives is inhumane. Despite its critics the Kings Fund report says that NICE is one the NHS success stories. NICE is there to assess cost effectiveness. Some of the more expensive drugs it has declined only prolonged life by a couple of months.

Mental Health Action Week

This week is Mental Health Action Week where The Mental Health Foundation is trying to raise awareness of what can be done to promote good mental health. Health insurance companies vary greatly in their offerings for mental health. Some offer no psychiatric cover at all whereas others offer limited amounts.

The problem for medical insurance companies is that mental health problems are more common that the general public realise. According to the statistics one third of patients visits GPs in relation to mental health concerns, in particular for mild depression and anxiety related complaints. What this means for us is that most companies cannot offer psychiatric cover because too many people would use it and this would force up the price of premiums accross the board.

Who Offers Psychiatric Cover?

• Pruhealth offers cover in both their midrange and comprehensive policies up to £7,000 and £20,000 respectively for inpatient psychiatry in any one year and £750 in inpatient care.
• Standard Life offers psychiatric cover in their comprehensive policy with an excess of £250
• CS Healthcare offer cover up to £1000 in any one year with an excess of 15% of treatment cost
• Aviva offer cover in their comprehensive policy of up to £1,000 a year for inpatient care and £500 for outpatient psychiatric care with the psychiatry element as an optional extra
• Bupa offer 28 days of outpatient care and up to £1,000 of outpatient care per anum
• The National Friendly Society offer up to 28 days of outpatient cover
• The Permanent Health Company offer up to 28 days of outpatient cover and up to £1,00o per year in outpatient cover.
  

Who Does not Offer Psychiatric Cover?
Budget policies hardly never include psychiatric cover however Health-on-line do offer a psychiatric add on option on their policies.

Self Help Steps
According to the Mental Health Foundation there are many steps that we can take to help us stay mentally well and reduce the likelihood that we will need medical intervention:

1. Talk about your feelings
2. Keep active
3. Eat well
4. Drink sensibly
5. Keep in touch
6. Ask for help
7. Take a break
8. Do something you are good at
9. Accept who you are
10. Care for others

Bowel Cancer Awareness Month

April is Bowel Cancer Awareness Month. Bowel Cancer UK is trying to increase awareness in an attempt to help people understand that bowel cancer is a serious condition that can in part be prevented by leading a healthier life. Its the same message that government bodies and health insurance companies are trying to promote.

According to the campaign someone is diagnosed with bowel cancer every 15 minutes in the UK. The symptoms of the disease are:

• A change in your normal bowel habit lasting four weeks or more
• Blood in your stools (poo) and/or bleeding from the bottom
• Unexplained unexplained weight loss and/or extreme tiredness
• A lump or pain in your abdomen (belly)

Reducing Risk
Living a healthier life helps to prevent many cancers and diseases. Like Bowel Cancer UK, most medical insurance companies are promoting healthy lifestyles in an attempt to improve the nation's health. Comprehensive insurance for cancer is expensive because treatments and drugs have improved so much over the last ten years. Some factors that can help you reduce the risk of bowel cancer are:

• Get to know your bowel pattern, so that you know what's normal for you
• Exercise regularly to help maintain a balanced weight
• Drink lots of water
• Eat a high fibre diet made up of at least five portions a day of fruit and vegetables
• Limit your consumption of red and processed meat to a maximum of one portion (approximately 80g) per day
• Do not drink more than the recommended alcohol limits of 14 units per week for women and 21 for men
• Increase unsaturated fats and avoid saturated fats
• Don't smoke
• Take part in the Bowel Cancer Screening Programmes when they roll out in your area and you are invited to do so
• Have a bowel screening if their is a history of bowel cancer in your family

Being Treated Privately

The latest figures from the NHS show that they have not quite hit their targets for single sex wards in hospitals. Being comfortable when you are in hospital is something which greatly helps aid recovery and the private single rooms given to health insurance patients are part of that whole package of care.

Like most things that are in the public arena at the moment in the UK this has been turned into a political argument. The Department of Health gave NHS trusts £100m in January in order to speed the final process along although it initially pledged in 2001 to abolish mixed sex wards by the end of 2002.

However, Shadow Health Secretary Andrew Lansley believes that the way forward is more single rooms. He said:

'Too many of their reforms are on piecemeal issues like curtains, screens and signs anyway. Patients needs to be given the dignity they deserve. That's why we've set out plans for a massive overhaul of hospital buildings so that every patient who wants one can be given a single room when they go into hospital for planned care.'

Single rooms that were usually the prerogative of private health hospitals are now on the increase in the NHS. Initially the conservatives promised an increase of 45,000 single NHS rooms but this does not appear in their manifesto. With the UK in financial debt it is unlikely that the NHS will see the increases in the level of spending that it has had over the last few years.

In the health insurance arena single rooms are still a priority, allowing for private consultations, treatment and recuperation. However occasionally some patients that are treated privately in NHS hospitals may have to stay in wards. If single rooms are a priority for you then check the details of which hospitals are covered by your medical insurance policy and what type of accommodation they offer.

New Exeter Friendly Plan

Exeter Friendly has launched a new health insurance product with a catchy and relaxed name: "Health and Stuff." Its clear and easily understood policy document is excellent and should enable prospective customers to easily understand what they are purchasing.

The new offerings are designed with an awareness of the cost conscious nature of the current economy. Richard Wyatt-Haines, sales and marketing director at Exeter Friendly, said:

'Our research shows that the needs and demands of customers can vary hugely according to their stage of life. With Heath & Stuff, we have built a plan which reflects this, allowing customers to buy their plan according to what is important to them and what they can afford. From there on it's simple. No hidden limits, no small print.'

"Health and Stuff" has several levels of cover: £2,500, £5,000, £10,000 or £20,000. Claimants have to pay the first 10% of any treatment. Cover includes: Cancer cover, in-patient and day-case hospital charges, CTI/MRI/PET scans; out-patient surgery specialists fees, specialist fees diagnostic tests, consultant fees, diagnostic tests, physiotherapy, osteopathy, chiropractic, podiatry, private ambulance, home nursing, parental accommodation, 24-hour GP helpline.

Unusually the cover provided enables parents to stay with their sick children up to the age of 18. Most policies only provide this cover when children are 12 or below.

They are currently offering two discounts:

• 10% discount if your body mass index between of 18 to 25
• 10% discount if you have not smoked for the last 12 months

The Exeter Friendly distinguishes itself by having a very clear policy document which warns prospective claimants that some of the more expensive treatments may not be covered by their annual limits. They detail the costs of common procedures so that consumers can see exactly what they can expect with each of the levels of cover. In fact the whole policy document is clear and leaves consumers fully aware of what is and isn't covered.

The Health and Stuff policy is likely to be a pioneer in clear and understandable policy documents which enable consumers to see exactly what they are and are not going to get when they sign on the dotted line. Well done Exeter Friendly Society!

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.'

Mental Health Cover

In the US private medical insurance is very necessary. Without it medical costs are extremely high. Despite their reliance on this system of health care the government has only just passed a law demands that health insurance providers give equal weight to mental health issues as well as physical ones.

Of course health insurance in the US is very different from what it is in the UK. They rely on it to keep their citizens healthy. Only 15% of US citizens do not have health insurance. Those that don't are not provided with very good alternatives.

Because there is no comprehensive, free health care like we have in the UK with the NHs, their insurance policies have to cover more. They cover substance abuse and addiction, for example, whereas UK policies do not. The new laws are designed to extend the level of mental health cover.

US Secretary of Labor Hilda L. Solis said about the new laws:

'Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services. The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society.'

In the UK health is not covered as standard on all policies. Psychiatric cover is provided only in the more expensive and top-of-the-range policies and even then with restrictions. Even then addiction issues, like drug and alcohol abuse, are never covered.

The problem is that mental health issues are quite prevalent in society. For example, at any one time it is thought that one in ten adults is suffering from depression. This means that it is an expensive thing for insurance companies to cover. It is also an area which is still surrounded by subjectivity, unlike physical health which has more known 'symptoms' used to diagnose it.

Of course if you take out a policy when you have already been diagnosed with a mental health condition then you will not be covered for this condition anyway. However if your policy covers mental health and you develop a condition you will be covered but each policy has its own limits of cover.

Bupa, for example, stipulate:

'Subject to your cover under your benefits, we may, at our discretion, pay for eligible treatment of a psychiatric condition ......'

The words 'at our discretion' suggest the arbritary nature of this kind of cover. This clause could mean that an insurance company has the ability to deny psychiatric cover to a client. 'Our discretion' is not a concrete term that can be contested.

Of course psychiatric treatment is available on the NHS but the resources are very stretched. Paying for treatment privately is expensive particularly when you consider the long term prognosis of many mental health conditions.

Cancer Lottery

National Health Primary Care Trusts (PCT) are responsible for healthcare in their area. They individually control funding and this is the reason why NHS healthcare across the UK is very uneven. This is a contributory factor to why some people like to take out health insurance: they have a high standard of care no matter where they live.

PCTs are responsible for spending around 80% of the national health service budget. They work within the overiding rules of the Department of Health and there are 152 care trusts in England.

Cancer sufferers seem to be particularly vulnerable to the 'postcode lottery' as the situation has been coined in the media. According to the National Colorectal Cancer Audit 60% of patients have a major resection (where parts of the bowel are removed) but there are variations across the country from 20% to 80%.

Survival rates vary too. In Kensington and Chelsea patients have a 43.7% survival rate for lung cancer and only a 15.4% rate in Herefordshire. Breast cancer patient one year survival rates are 89.3% in Tower Hamlets and a 99% in Torbay.

In the private health arena there is a more standardised level of care. Bupa the private health insurance provider, for example, include Avastin in their range of allowed drugs but some NHS trusts do not. Avastin is a chemotherapy treatment used for metastatic or secondary cancer and it costs around £60,000 a year per patient. The drug does not cure cancer but it prolongs life.

If you are considering private medical insurance you may be deterred when you hear that the NHS is improving. This is true, there have been improvements in the NHS over the last five years. However the improvements are not standardised across the country. It still depends on where you live and which hospital you go to.

Health insurance for cancer is available from many private medical insurance providers although there is currently a great deal of debate in the industry about the high costs of cancer treatment and what the industry plans to do about cover for this illness in the long term.

Insurance Fraud

Insurance fraud is not only a nuisance for the health insurance companies involved but also for consumers. The costs of fraud has to be paid for and its the average person who takes the brunt of it.

According to report from the National Fraud Authority (NFA) published last week insurance fraud costs the UK more than £30 billion a year with the insurance industry taking a £2bn loss.

Nick Starling, director of the Association of British Insurers, who regulate the health insurance industry said:

'Fraud costs every family in the UK. In these tough economic times, the last thing people need is to be paying for fraudulent activity. Dishonest insurance claims alone cost around £2 billion year, which adds on average an extra £44 a year to every household’s general insurance budget. The insurance industry’s zero tolerance policy towards fraud means we are making it harder than ever for cheats to succeed, and detecting more of the fraud that is committed.

'Today’s report shows that such a policy is needed by all agencies involved in tackling fraud, to protect potential victims better and reduce the financial cost to honest UK households.'

The UK Insurance Fraud Bureau (IFB) was set up in 2006 in order to combat UK fraud. John Beadle an NFB board member said:

'Insurance fraud is not a victimless crime and, in the case of ‘crash for cash’ scams, innocent lives can be put risk. The insurance industry is no longer an easy target and takes this criminal activity very seriously. Through working closely with law enforcement agencies, the IFB has been instrumental in over 300 arrests and this drive will continue.

Anyone with Fraud information can call confidentially and for free:

Cheatline on 0800 328 2550

You can also report online at: www.insurancefraudbueau.org/report.

Take Vitamin D says Bupa

According to Bupa, the health insurance company, people should be taking vitamin D supplements during the winter to reduce their chances of getting certain cancers.

According to Bupa research taking supplements of Vitamin D can reduce your risk of cancer by up to 25%. The recommended dosage is at least 1,500 - 2000 international units (IU) a day, which equates to 3-4 high strength capsules (12.5 micrograms/capsule).

Vitamin D can be obtained naturally from sunlight and foods but according to Bupa the British sun during winter is insufficient to provide us with what we need. Taking good doses of the vitamin is thought to reduce the onset of bowel, breast, colon and prostrate cancers.

Bupa’s assistant medical director, Dr Virginia Warren said:

'Natural ways to get enough vitamin D aren’t realistic because our skin cannot make vitamin D from winter sunlight in the UK as it is too weak. In the summer, people are rightly concerned about risks of skin cancer. And nobody wants to eat four tins of mackerel every day to get their vitamin D from oily fish.

'People have to act now to take preventative measures against cancer for their future long-term health. The old-fashioned view was to take a low daily dose of vitamin D for healthy bones. Cancer is today’s biggest killer and we need to protect our bodies from it as much as we can. Taking vitamin D supplements are an effective, inexpensive and easy way of doing that.'

Medical insurance for cancer in the UK is a subject of much debate at the moment. Bupa provides specific cancer cover in their Bupa Select Heart and Cancer policy but there is a great impetus at the moment on the prevention of the disease.

All the major private health insurance companies have been focusing on health prevention over the last few years. Obesity, lack of exercise, smoking and drinking as well as a poor diet are all linked with increased risk of cancer.

10 Disadvantages of Medical Insurance

1. Chronic conditions are not covered
Health insurance is designed to cover you for an acute illness and restore you to the health you enjoyed prior to the illness or injury. Should you be left with chronic symptoms after this they will not be covered by the insurance.

2. Your current health issues will not be covered
Any illness or even symptom of an illness that you had five years prior to taking out a policy will not be covered should you become ill from this. Even symptoms that do not seem related to any illness you have had can be included in this.

3. Health insurance can be complicated to purchase
There are many private health insurance providers and their policies can vary greatly from one another. Even within a company there can be several types of health insurance available with a variety of options to choose from. Because policy documents are legally binding agreements it is very important to read the small print so that you know what your rights are. Getting the help of a financial advisor is recommended when you are choosing a private health insurance policy.

4. Cancer is not well covered on all policies
Cancer cover is very varied. Some companies do not cover cancer at all and others provide fully comprehensive policies that cover palliative care should it be needed. As cancer is a one the main causes of death in the UK this is a factor which you need to consider carefully when looking into health insurance.

5. Comprehensive cover can be expensive
The most comprehensive policies are the most expensive. Most are also weighted depending on your age, sex and lifestyle. Its important to shop around and get the best deals.

6. There are many exclusions
Health insurance exclusions are great in number. Most are standard and are related to obvious risk factors for example alcoholism or drug use, dangerous occupations or hobbies, HIV. Others are less obvious - some policies will not cover mental health or pregnancy.

7. Mental Health is poorly covered
The statistics show that at any one time one out of ten UK citizens are suffering from a mental health condition at any one time. Some policies cover mental health others do not. Usually it is the top-of-the-range policies which include mental health cover.

8. Health insurance companies can be very stringent in following their rules
The health insurance industry has a reputation for repudiating claims on very minor details. Even though they have tried to remedy this reputation by providing guidelines which means that consumers are treated more fairly you still need to keep on your toes. If you have a claim that is rejected do not give up. Go back over the small print and see if there have been misunderstandings that can be rectified. You are within your legal rights to complain.

9. The NHS is improving
Some believe that the NHS has improved dramatically over last ten years and that therefore the private sector no longer has the pull it once had. The NHS has improved but it still lags far behind in the speed at which it can provide treatment compared to the private sector.

10. There are no official statistics for private health establishments
NHS statistics are published all the time. It enables the public to see what's going on. This does not apply to the private health insurance industry which is notoriously bad at transparency.

10 Advantages of Health Insurance

Taking out private medical insurance gives people peace of mind. Here are some of the benefits it offers.

1) A preliminary consultation is available quickly
Of course there are variations depending on where and by whom you want to be treated. As in all areas there will be consultants and hospitals that are more in demand than others. What is certain is that you won't have to wait anywhere near as long as you do with the NHS

2) A choice over which specialist or hospital treats you
Your GP will refer you to a consultant and hospital of your choice. However you do need to check the details of this with your provider. Different providers offer access to different hospital networks.

3) A single room with gives you greater privacy and confidentiality
Having said this,, some policies include treatment in an NHS facility under private health care terms. Its important to check the details.

4) Spreading your health care costs via the payment of a monthly premium
For people who always go for private health care, medical insurance is a way to budget monthly for unforseen illness or injury.

5) Being in an environment which pays a very great deal of attention to infection control
Bupa studies have found that better cleanliness and infection control is the main reason why people prefer to opt for private health insurance over the NHS.

6) Lower stress levels
High stress levels have been shown to increase recovery times. A patients' stress levels are lowered throughout. Quicker specialist referrals, quicker treatment times and a more private environment are all factors which lower stress and help with recovery.

7) You get back to work quicker
The longer you are out of work the more it affects your rights to sick pay. Being seen quickly enables you to retain your income levels. The financial impact of illhealth is an important factor.

8) Helps your employees get back to work quicker
Losing key employees to ill health affects productivity as well as morale in the workplace.

9) Short waiting time should you need an operation
This is not only a more pleasant result of medical insurance but can also improve your overall health over time. Leaving illness untreated can lead to complications and can worsen your condition which will then make it harder to treat.

10) With some companies you will get 24hr counselling helpline.
Different companies offer varying levels of 'extras' as part of their health insurance policy. This can include reduced rates and gyms as well as online and telephone help.

Health Spending Cuts

The UK Government has large debts which have to be paid for over the next few years. Public spending cuts are inevitable and the NHS is likely to suffer. But what kind of impact will this have on the private health insurance market?

According to the Windmill Report the NHS will have to plan for a 20-30% reduction in spending until 2011. Healthcare and the standards that the public expect are both advancing quickly that in real terms spending needs to rise. The Government aims to increase efficiency in order to make up the difference but according to the Windmill Report the funding gap could range between £21bn - £40bn by 2017.

One of the proposals in the drive towards greater efficiency is the move towards greater private involvement in the NHS. The report states:

'Both the culture of the NHS and input-focused procurement conspire to preclude effective engagement of the independent sector. There is still a great deal of wariness, if not reluctance, over using the expertise of independent sector providers - even when they may have proven solutions to the financial and demand pressures ahead - for example, in managed care, property and estate management, and in the expertise and technology to support care closer to home.'

If the government balance the needs of the NHS well the impact on the private sector could be great.

If the use of private companies increases in the NHS then the private sector will benefit. They will have larger volumes of work and less need to target the individual and business customers.

The economic climate has seen a decline in people taking out health insurance. This has been exacerbated by our perception that the NHS is improving.

This scenario is not so rosy for the health insurance market. As consumers we are less likely to take out medical insurance if we are satisfied with standards and waiting times in the NHS.

If the government cannot achieve their aims then the medical insurance market will benefit. In theory we will become dissatisfied with the NHS and move towards the security of health insurance cover.

Hellenic Project Update

Health Insurance News reported that the private health sector has agreed to more transparency by being part of the new Hellenic Project which aims to gather information about the sector from various sources.

It seemed like a very good idea that private and health insurance customers could have information about what the private health sector had to offer compared to the NHS. It would also have been a good way for individual hospitals to have been compared to each other.

Unfortunately for consumers there are currently no plans to publish the results of the project. This is a great shame. Transparency is something that seems particularly important when it comes to health care. Its not like other consumer products. If you buy something and its not good you won't buy it again and you will tell your friends that you didn't like it too. What have you lost? A few pounds and a little inconvenience.

There is a great deal of evidence that suggests that people regularly use customer review sites to make their minds up about purchases but purchasing health care is a different kettle of fish. If you become unwell and something goes wrong with your health care there is a lot more to loose. So, if the statistics are there why can't we see them?

The Hellenic project is a good start and it is possible that consumer group pressure will eventually encourage the industry to reveal all. This can only be beneficial to the consumer who has the right to vote with their pound once they have all the information at their disposal.

New Bupa Select

Bupa Select is a new health insurance offering for small to medium sized businesses. It became fully available from 1st December and aims to offer flexible cover in these difficult financial times.

Director of business markets for Bupa, Ann Greenwood, said:

'High broker demand told us we needed a policy that was much more flexible and modular rather than simply opting for a ‘one size fits all’ approach with lots of features you pay for but may never use. When we tested BUPA Select in the run-up to the launch, brokers were impressed, particularly with the web-enabled functionality and the flexibility available to build bespoke cover.'

This private medical insurance cover enables companies to build a bespoke cover for their employees by enabling them to add or remove various cover options. The policy is available for companies with between 50 and 250 employees.

According to Bupa they have made all their administrative procedures more efficient and streamlined in order to provide a better customer experience. They are also offering a 30% discount for companies that sign up to the scheme before 31st December 2009.

Some of the main features of the product are:

• £1000 towards out-patient consultations, treatment and diagnostic tests
• £250 towards complementary medicine
• full refund for in-patient and day-patient hospital charges and accommodation in a Bupa Partnership Network hospital.
• Full cancer cover
• up to 45 days of psychiatric treatment
• private ambulance
• £50 NHS cash benefit to cover each night in an NHS hospital
• 24-hour Bupa HealthLine
• Free use of Positive Health

Reduction in Costs:
• Policy excesses of £100, £150 and £200
• reducing out-patient benefit to £750, £500 or £250
• excluding psychiatric treatment

Extra Cover:
• Including cash cover to help with optical, dental and prescription costs.
• increasing benefits for out-patient treatment to £1500
• removing the limit for complementary medicine
• increasing the range of hospitals available

Swine Flu Information

The H1N1 virus is back and after a slow start the private medical insurance companies are now giving clearer information about their position on cover for swine flu.

All the medical insurance companies direct you to the government helpline and offer guidelines on how to treat and prevent the virus.

Aviva says that they have 'robust plans in place to help ensure that we can continue to support our customers in the event of a pandemic.' They state that swine flu is not treated on either their International Private Healthcare or UK Private Healthcare products.

CS Healthcare Say that their first priority is to offer their members up to date and accurate information and advise customers to call their GP or NHS Direct if they have any concerns.

Bupa state that they do provide cover for swine flu but that

'The details of the cover will depend on your scheme and is subject to the standard terms of your scheme.'

They also direct people to their Bupa health and information service which is manned by fully qualified nurses. The also make it clear that they do not cover preventative medicine which includes the tamiflu vaccination.

The Association of British Insureres (ABI) are very quiet on the topic of swine flu and health insurance and although they do offer a lot of information about travel insurance and the H1N1 virus.

Overall there has been very little information offered by the health insurance companies over their position on swine flu. This is quite dissappointing considering the natural concern shown by the British public.

Luckily, so far the intensity of the virus has not been as serious as some sources predicted. There is no data available for the number of complications of swine flu that health insurance companies have had to deal with.

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

Low Health Insurance Complaints

Health Insurance companies should have a very clear complaints procedure. If a customer is not satisfied with the response of their medical insurance company they have the right to appeal to the financial ombudsman who then arbitrates and gives a final decision by which the insurance company must abide by. Earlier on in the month the Financial Ombudsman Service (FOS) praised the health insurance industry for its low levels of complaints.

According to Melissa Collet from FOS, only 1% of insurance complaints were about private health insurance. On average 70% of complaints about insurance result in the insurance company having to back-track but for the health insurance industry only 31% of decisions result in a change of outcome. This is a remarkable difference and is testament to the fact that the health insurance industry is regulating itself well.

Last year, out of 127,471 new insurance complaint cases only 514 involved disputes over private medical insurance. However there were various areas however that Ms Collect felt needed attention because they featured high on complaints made to Financial Ombudsman Service (FOS):

• Jurisdiction
• pre-authorisation
• experimental treatment
• chronic and acute conditions
• pre-existing conditions

Collet said:

'Consumers get muddled about pre-authorisation. Particularly when they need treatment quickly. Sometimes a misleading impression can be given, over the phone, about what is and is not covered.'

FOS meet regularly with the health insurance industry in order to discuss how they make their decisions and give the industry feedback on the type of complaints that they receive and what they can do to alleviate the situation.

Help With Stress

Last week on the 4th November was Stress Awareness Day. Stress causes many problems of a psychological, physical and social nature and this is something that they health insurance companies are becoming more sensitive too.

Stress Awareness Day was sponsored by International Stress Management Association (ISMA) who want to draw attention to the harmful effects of stress. Ann McCracken, Chair of ISMA, said:

'Stress, depression and anxiety accounts for over 13.5 million workdays being lost each year, making it the single biggest cause of sickness absence in the UK. The aim, through the nationwide campaign, is to increase public awareness about the effects of stress, the treatments available and, most importantly, to help individuals suffering from stress to seek help using a team of stress experts.'

This years campaign focuses on work related stress.

The health industry as a whole is aware that stress causes mental and physical harm. What do private health insurance policies have to offer people when it comes to stress?

PruHealth consider fighting stress as an essential part of maintaining a healthy lifestyle. In their latest Vitality Index research they found that 16% of people consider stress to have the biggest impact on their health. In their Vitality scheme the health insurer discounts off monthly premiums if their customers engage in a range of health enhancing activities.

Counselling Services
Because of an awareness of the impact that stress can have some medical insurance companies offer a free telephone counselling service in an attempt to combat this:

Aviva offer a 24hr Stress Counselling Helpline
AXA PPP Healthcare Stress Counselling Helpline

Fact Sheets
Most of the private medical insurance companies offer information about stress, its effects and how to overcome it. Most of this information is available free online for everyone not just their own customers. Additionally. Bupa offer advice on stress free living as part of their online Wellness Programme.

Psychiatric Cover
As a last resort patients may need psychiatric care if they have been exposed to too much stress. It is important to note that not all health insurance policies cover psychiatric care. Those that do tend to offer it within their more 'premium' levels of cover.

NHS V Private Health Insurance

Last week the government announced that it would make it a legal requirement for patients to have to wait no longer than 18 weeks before they are treated on the NHS after which time they have to be treated at a private establishment.

This new development proves how linked the NHS and private sectors have become. However private medical insurance patients are not necessarily happy to see NHS patients treated for free within the private sector when they have been paying for their regular monthly premiums.

For private establishments the NHS desire to use them has been a godsend as their patient figures have been steadily declining. In 2007 53,000 NHS patients were seen in private hospitals. This figure had risen to 151,000 in 2008.

William Laing, chief executive of analysts Laing & Buisson said:

'The extra business, however, has been a mixed blessing for independent hospital operators since such work they take on at NHS tariff rates offers a lower profit margin than private work. If and when self-pay demand returns, and as medically insured activity grows in the future, existing independent hospitals will wish to return to their core private business.

'The big question for the future is whether the independent sector will have an appetite for investment in additional, lower cost capacity aimed specifically at servicing the NHS market. Experience with the independent sector treatment centre (ISTC) programme has dented providers' confidence in the government's long term intentions, but nevertheless the NHS is a massive market and the independent sector share of it is currently very small, at just 4%.'

For people who pay for their health insurance it might be upsetting to see NHS patients being treated in the same type of establishments as them. However, it is not just the proposed 18 week law that is causing cause for concern. Currently it is common for NHS patients to be given a list of private providers that can carry out their treatment at NHS cost.

Chris Meier, head of marketing at private health insurance (PMI) provider National Friendly said:

'It may be slightly jarring to realise that an NHS patient is being treated by the same type of consultant in the same environment, but they won’t necessarily have had the accelerated access and in all likelihood they will have spent a long time on a waiting list.'

18 Week Law

According to Health Secretary, Andy Burnham UK citizens should have a legal right to be treated within 18 weeks on the NHS. He proposes that if this is not possible then they should then have the legal right to be treated privately. This is good news for UK citizens but still a very poor effort in comparison to treatment times within private health insurance.

The reforms would come into force next April when they would become part of the NHS Constitution. A two week waiting time for cancer treatment would form part of the new laws.

Mr Burnham said: 'With this new power behind them, patients can be certain that they will receive the same high standards of care, regardless of who they are or where they live.'

Prime Minister Gordon Brown said: 'Every single person who has to go into hospital or go through the difficulty of cancer will have clear rights and real power guaranteeing them quick access to care, or the offer of going private or to another NHS provider if these standards are not met.'

The government are already hitting their 18 week waiting list targets on a regular basis so in many ways these new directives are a little meaningless. Now that these targets are being hit what is important is to set new, improved targets.

In medical insurance terms 18 weeks is a very long time. Even with the more inexpensive 'six week option' policies, as the name suggests you only have to wait six weeks. With more and more patients being treated in private establishments under the NHS one of the shining beacons for health insurance is the speed by which you can be seen. And, of course, speed is important for good mental and physical health.

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.'

Best of Both Worlds

Private health care is expensive but there are many reasons why people chose to be treated privately instead of going with the NHS. One of the reasons for taking out medical insurance is that it is a good way to budget for the unexpected.

Below is a list of typical procedures and the costs that they could incur if you paid upfront for your medical treatment:

Colonoscopy: £1,500 - £1,500
Cataract Removal: £1,500 - £2,950
Gall Bladder Removal: £3,500 - £5,800
Hip Replacement: £7,500 - £9,400
Inguinal Hernia: £1,500 - £2,450

Taking out medical health insurance means that if you become unexpectedly ill you will not have to find the money for expensive procedures and surgeries.

For some people paying upfront for medical insurance is not a problem and recent evidence suggests that individuals can get a much better deal from health providers than health insurance companies do. As an individual you can negotiate on the cost of treatment with some providers.

There is an alternative option which resides somewhere between the two options. Freedom Healthnet are a health insurance company that provide cover in the form of cash for outpatient procedures. This means that you have the best of both worlds: the security and budgeting benefits of traditional health insurance and the purchasing power of an individual patient in the independent sector. Freedom provide the added benefit that they also offer one of the cheapest health insurance options available.

Additionally, with Freedom you also have the option of having treatment abroad or staying with the NHS to have your procedure and keeping the money for other things.

Breast Cancer Screening

Leading health insurance company Bupa are trying to encourage women over the age of 40 to have breast cancer screening in order to detect the early signs of breast cancer.

Early detection of breast cancer is vital. It can save lives and also reduce the risk of the need for full mastectomies or reconstructive surgery. The NHS provides free breast screening every three years for women between the ages of 50 and 70 but the statistics show that more than 50% of breast cancers were found in women under 50. The government plan to extend the screening to 47 and 73 by 2012. Bupa have been offering breast cancer screening for the last 30 years.

Dr Janet Donaldson, lead physician at Bupa Wellness said:

'It is important for all women to be breast aware. We all lead incredibly busy lives and it is only too easy to ignore minor changes, when a simple check could make a difference. Breast screening from the age of 40 gives women the best opportunity to detect any abnormalities early and offers a much greater chance of successful treatment if any are detected.'

Screening takes the form of a mammogram which is an x-ray of the breast tissue. Mammographies can detect early abnormalities in the breast, before any changes can be felt manually. According to Cancer Research UK two pictures are taken during a mammogram and this increases the rate of detection by 25% - 40%.

The general advice is for women to regularly check their breasts for any changes. The Cancer Research Website suggest that you look out for the following:

• A lump or thickening the breast area
• A change in the shape or size of a breast
• Dimpling of the skin
• A change in the shape of the nipple
• A bloody discharge from the nipple
• A rash on the nipple or surrounding area
• A swelling or lump in the armpit

Prevention and early detection are the most important factors in dealing with cancer but comprehensive health insurance for cancer is offered by some health insurance companies including Bupa who offer cover under their Bupa Select Heart and Cancer Policy.

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.

Reconstructive Surgery for Breast Cancer

Some women who develop breast cancer have to go on to have a mastectomy. For many women this is not just a frightening medical matter but one which affects their self image and self esteem. Reconstructive surgery is an option for many women but recent evidence shows that this is not always offered on the NHS. Alternatively companies that offer health insurance for cancer will give you the peace of mind that you can have reconstructive surgery if you wish.

Statistics from the NHS Information Centre and Royal College of Surgeons indicate that in 2007-08 only 48% of women with breast cancer were offered reconstructive breast surgery.

Dr Chris Caddy, consultant plastic surgeon at the Sheffield Teaching Hospital NHS Foundation Trust said:

'There is a shortfall in access to breast reconstruction. We’re carrying out the audit to find out what the level of service is and where the shortfalls are.

It’s partly down to a lack of resources, the information given to women, and the options offered by the breast- care nurses who help create patient-care plans.'

The 2009 National Mastectomy and Breast Reconstruction Audit showed differences between NHS and private medical care. In the Independent sector, for example women having mastectomies were treated more quickly and immediate reconstruction (those that take place straight after a mastectomy) rates in the independent sector were high.

Research also shows that there are regional variations too. Those with comprehensive health insurance for cancer however can get reconstructive breast surgery as part of their health care policy. Normally plastic surgery is not included in medical health policies but if you have a policy which includes comprehensive cancer care then this is not the case. In the UK Bupa, The Exeter Friendly Society and PruHealth provide this.

Bupa, for example offer reconstructive breast surgery after cancer in their Select Heart and Cancer Policy. Each policy is different however and the details need to be checked. The Exeter Friendly Society policy wording is as follows:

'Post-traumatic or post-surgical reconstruction to restore function or appearance is included if performed within 12 months of the injury or primary surgery. Breast surgery where the treatment is to correct disfigurement is included if it was caused by an accident or specific disease of the breast'

The PruHealth wording is as follows:

'Post-traumatic or post-surgical reconstruction to restore function or appearance is included if performed within 12 months of the injury or primary surgery. Breast surgery where the treatment is to correct disfigurement is included if it was caused by an accident or specific disease of the breast. For a Policy start or renewal date on or after 1 July 2009: We will pay for the initial reconstructive surgery to restore functional appearance following major trauma or cancer. Any subsequent related treatment will be covered if the treatment is intended to cure an acute medical condition'

One problem which can occur is that women can be uncertain as to whether they want reconstructive surgery or not until some time after their mastectomies but under current private health insurance policies they only have 12 months to make up their minds.

Health Insurers use YouTube

Everyone is using YouTube and that includes health insurance providers. The growth in the appeal of video clips has been enormous over the last three years and health cover providers are making the most of this medium by publishing their advertising and information clips online. Below are a sample of what's available on YouTube:



The TV advert that was used to prepare British audiences for the change over from Norwich Union to Aviva is also available on YouTube:



AXA PPP Healthcare publish clips of their exercise videos on YouTube:



And this video is from their advertising campaign a couple of years ago:



Videos are great as they allow a company to communicate very directly with as. However, as with any other advertisement time should be taken to research the individual companies with a view to finding out both what they offer and what they do not offer. Remember in adverts companies are presenting their best side. As a consumer you need a more balanced view of what's on offer.

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

Bupa HM Forces Health Insurance

There are many specialist medical insurance products which are tailored to suit groups that have particular needs. Bupa, the UK's largest private health insurance provider, offer a specialist health insurance for HM Forces. The cover provided is offered at a 47% discount and includes the following:

• private medical treatment in eligible establishments
• the option to cover just your partner or your children
• access to private in-patient and day-patient treatment
extensive private cancer cover
• cover for injuries resulting from dangerous sports and military exercises
• complementary medicine
• psychiatric treatment after two years’ membership

The forces which are covered by this health insurance scheme are:

the Royal Navy, the Royal Air Force (RAF), the Royal Marines and the Army

It is important to note here that as members of the forces are often stationed abroad they will not always be able to be treated in a Bupa hospital or NHS hospital. In these circumstances Bupa will cover hospital stays up £200 only.

Another interesting aspect of this policy is that it appears to include cover for injuries arising from dangerous hobbies and self-inflicted injuries. It is very unusual for private medical insurance companies to offer these elements within their policies.

It is important to note that the Bupa HM Forces policy does not cover repatriation. Repatriation refers to the return of soldiers to their homeland. Also, the psychiatric treatment that they offer is discretionary and needs to be cleared by Bupa before the treatment goes ahead.

Bupa also offers dental insurance for HM Forces and MOD staff as well as health insurance for MOD staff at a 47% too.

Musculoskeletal Disorders Cause Absence

A recent study, Fit for Work Europe, shows that people who live in the EU are having to take a lot of time off work due to musculoskeletal disorders (MSD's). 49% of all absences and 60% of permanent work incapacity were accounted for by musculoskeletal disorders. Health insurance companies have been aware of working hours lost through these issues for quite some time.

Companies who provide their staff with health insurance are keenly aware that the sooner a problem is sorted out the quicker their staff members can return to work, not just healthy but also with more peace of mind.

The authors of the report say that the high levels of work absence is making Europe less competitive than America or China. They recommend that all bodies work together in order to reduce time lost at work but appreciate that this does not tend to happen:

'In many of the countries we studied - awareness, resources and political will are not yet at a stage where coordinated and effective early intervention is currently deliverable.

'The consequences of this lack of readiness may be far-reaching for workers with MSDs who want or need to retain contact with the labour market. Successful early interventions require clinicians, employers and the health care and social welfare systems to work together. This is rarely the case, even to achieve positive clinical outcomes. It is even less common to find that job retention or return to work is the goal.'

In the UK, earlier this year Aviva, a private medical health insurance company, launched a new product for its business clients: Back-Up. This product aims at dealing with back and neck complaints quickly in order to reduce time taken off by staff. It has been so successful that the product is now also open to individual private customers as well.

Back-Up customers are encouraged to call the Back-Up service where they will speak to a case manager who takes a full history of your problem and offers 'practical and clinical advice and support.' They can also work with the persons line manager to advise on how the person can be helped to proceed at work.

It is estimated that in the UK 9.5 million working days were lost in 2005-2006 due to musculoskeletal disorders. This presents a problem for the UK economy. Very often the NHS can do nothing for you. The problem is too widespread and they do not have enough resources. Private health insurance on the other hand can help to support a person much speedily and tailor-made schemes such as the Aviva one are even more useful as back conditions can often be chronic and are therefore sometimes not covered under normal medical 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.

Complaining About Health Insurance

If you have a complaint related to your health insurance then you do have redress, initially with the medical insurance company and if you are not satisfied, with the Financial Ombudsman Service (FOS).

1) Your first port of call is your health insurance provider. They will have a complaints procedure which you will have to follow. Ask to be sent a copy of the complaints procedure. This will give you a timescale by which they agree to deal with your complaint. Without following this you have no standing with the Financial Ombudsman.

2) Decide what you want to achieve from your complaint and make sure that you communicate this with the insurer.

3) Write to your insurance company explaining in as much detail as possible the nature of your complaint. Include all your details as well as copies of any documents that are relevant to the complaint. If you keep to written communication then you will have a copy of everything that has transpired. Its easy to forget what has been said in telephone conversations. IF you do have telephone contact take down the date, name of the person you spoke to and details of your conversation.

4) You should receive a reply within their agreed time scale. If not write again.

5) IF you are not pleased with a company's response then you can ask for a letter of deadlock. With this you can appeal to the Financial Ombudsman service which looks at each case impartially and decides whether applicants have a case. They can rule insurance companies to pay out up to £100,000 per case. Their website is: financial-ombudsman.org.uk

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.

Bupa Talks Swine Flu

After a decline in cases of swine flu over the summer months health professionals are preparing for a possible increase and severity of the virus over the autumn and winter months. Bupa UK Health Insurance assistant medical director Dr Rebecca Small spoke to Health Insurance and Protection Magazine about what Bupa are doing about about Swine Flu.

Dr Small said that they were taking measures to limit the spread of swine flu:

'We have introduced more rigorous office cleaning regimes, implemented hygiene measures including provision of alcohol gel for staff for hand-washing, published advice and helplines for staff on what to do if they suspect they have flu and issued specific protocols for managers.'

There have been many queries about what kind of cover can be expected from private health insurance companies when it comes to swine flu claims. Usually health insurance policies only cover people for non-emergency treatment of acute conditions.

Most cases of Swine flu are very mild and those that are affected are usually people who have underlying health conditions. This complicates matters as medical insurance companies will normally only cover conditions which are 'new'. If the complications of swine flu are brought about by underlying conditions this will surely muddy the waters when it comes to an medical insurance claim.

According to Bupa, swine flu is covered by them. Dr Small said:

'Those with Bupa health insurance can be reassured that they are covered for inpatient and outpatient treatment of swine flu by a consultant so long as they are referred by their GP.'

Individual or Company Health Insurance?

Many employers offer private health insurance as part of your remuneration package. Is it better to take up this offer or to have your own individual health insurance?

Most people in the UK who have health insurance have it through their employer and overall if you can get health cover through work it is usually the best option. There are three main differences between company and individual health insurance:

1) It will be cheaper. You will normally not have to pay anything towards the premium although it is a taxable benefit. Companies can normally negotiate much lower rates for their employees than can be obtained by individuals and this will keep down the taxable amount that you have to pay.

2) A company scheme will be less strict about exclusions. Because policies have to be underwritten en masse there are differences between the policies when it comes to pre-existing conditions. Company policies tend not to exclude these whereas individuals policies certainly do. Chronic conditions are normally excluded on company schemes however in the same way as they are on individual policies.

3) Company health insurance normally covers partners and children of the employee too which is not automatically the case with individual private medical insurance. You would normally have to pay a lot more to include a partner although with some companies children can be included for free.

Problems
Problems arise when people leave their jobs and want to keep some form of health insurance. Most people find that the premiums that they have to pay are much higher than they expected. If you are moving within the same insurance company it may be possible to negotiate better rates and its always worth asking as you never know what could be offered to you.

7) No Claims Discount

No claims discount enables people who do not make claims on their health insurance to pay smaller premiums. For each year that you do not make a claim you are rewarded by lower premiums.

It is a controversial area and many private health insurance companies are opposed to it on ethical grounds. The argument is that it may stop people claiming when they need to for fear of loosing their no claims discount.

Another argument against no claims discount policies is that the information provided about possible premium savings are misleading. Often no claims discount policies are more expensive at the zero rating than their counterparts policies that do not offer no claims discounts. It is important to check this out. Additionally if you do make a claim you may have to pay a surcharge and your monthly premium may shoot up and be higher than when you first took out the policy.

AXA PPP Healthcare and Standard Life Healthcare offer no claims discount policies.

All Standard Life Policies have a no claims discount and do not offer their policies without this option. AXA PPP Healthcare's policies give you the option of a no claims discount policy or not.

Standard Life
Standard Life claim that you can get up to a 50% reduction on all their policies with your no claims discount. If you do need to make a claim you do back two years per claim and can then build your no claims discount back up from there. They give you a starter discount of 35% when you take up one of their policies.

With Standard Life some things do not affect your no claims discount.

'such as if you receive cash for staying in an NHS hospital, claim on the travel or add-on element of a policy, make calls to the GP Advice Line, or use any other free service provided under Healthy Rewards.'

The discounts are as follows:

Level 0 - 0% discount
Level 1 - 10% discount
Level 2 - 20% discount
Level 3 - 25% discount
Level 4 -30% discount
Level 5 - 35% discount
Level 6 - 40% discount
Level 7 - 45% discount
Level 8 - 50% discount


AXA PPP Healthcare
AXA PPP offer no claims discount policies and their discounts vary slightly from Standard Life:

Level 0 - 0% discount
Level 1 - 10% discount
Level 2 - 20% discount
Level 3 - 27.5% discount
Level 4 -35% discount
Level 5 - 40% discount
Level 6 - 45% discount
Level 7 - 50% discount

If you make one or more claims with this company you go down by three discount levels and claims for the same medical condition are treated as one as long as they are within 180 days of each other.

In Standard Life's literature they say that it might be better for their customers to pay for small bills themselves rather than go through the insurance and loose the no claims bonus. They iterate:

'However, your first consideration should always be ensuring that you receive the treatment you need.'

They do offer no claims protection for a further fee to some customers however even with this your discount level will still drop by one level should you need to make a claim and the protection will be removed should you make claims in two consecutive years out of three.

Standard Life also allow you to reinburse them the money you have paid for a claim in order to preserve your no claims bonus as long as you do it within 30 days of the policy renewal date.

6) Excess

When you make a health insurance claim the 'excess' refers to the amount you have to pay upfront yourself before the insurance company will pay out. Paying more or less excess will affect the amount you pay for your monthly health insurance premium and paying extra is one way in which people can keep down the costs of their health cover. Each provider offers a different range of options when it comes to paying an excess. Some companies offer policies where you do not have to pay any excess at all.

Why do you have to pay an excess?
Firstly, excesses do help to keep your health insurance premium down. It means that you have to pay something if you need to make a claim but overall when you are not making a claim your premiums are reduced. The more excess you pay the cheaper your insurance will be.

Having an excess also stops people making claims small claims for things that could easily be cleared up by the NHS. This helps the insurance company to keep costs down. This is one reason why some people are against excesses as they feel that it might stop people seeking medical attention when they need it particularly as small health issues could be an indicator of something more serious.

How much excess will I have to pay?
Excesses normally start at £100 but the amounts vary from provider to provider. Most range from £100-£500. Some companies offer policies with no excess.

Some providers offer a one level excess. Freedom Healthnet for example, who offer one of the cheapest health insurance policies on the market, ask for a £100 excess on each claim.

Some companies offer very large excesses. Sometimes these medical insurance policies pay unlimited amounts for treatments costs and care should you become ill. The monthly premiums are then kept very low.

How much less will I have to pay for my premiums?
The discounts offered vary from company to company. Below is a selection of quotes from various health insurers for a 40 year old man who is in good health and has a healthy lifestyle.

Bupa's Select Heart and Cancer Care
This policy has several excess options available: £100, £150, £200, £250, £500, £1,000 or £2,000. Bupa do not give online quotes for their health insurance plans.

PruHealth: Comprehensive Plan
0 excess: £71.16
£100 excess: £68.47
£250 excess: £64.45
£500 excess: £60.43
£1000 excess: £53.38


AXA PPP: Comprehensive Cover
£100 excess: £48.06
£200 excess: £44.08
£500 excess: £40.52


XS Health
This provider offers large excess contributions which significantly lower your monthly premiums.

£1,500 excess: 19.08
£3,000 excess: £11.71
£5,000 excess: £7.21

With this company once your treatment costs have exceeded your limit WPA will cover the cost in full for all eligible treatment for a further 12 months. This kind of policy is usually only recommended to healthy individuals who are not expecting to make any claims.

The most important thing to consider is whether you would be able to pay for a large excess should you become ill. If not, then you are better off budgeting with higher monthly premiums. If you have savings that you can dip into the higher excess policies may be for you but if you will struggle to pay the excess then this is not the right type of policy for you.

MP's Attitudes to Private Health Insurance

The private health sector and the NHS have been sitting along side each other ever since the inception of the NHS in 1945. Some are not keen that people should be able to pay for private treatment if they can afford it but others are keen to move the NHS towards privatisation. Most people lie somewhere in the middle.

On the whole the British are proud of the NHS which gives free treatment to every UK citizen at the point of use. A new poll by health insurance provider BMI Healthcare reveals that conservative MP's are more supportive of the private health sector than other parties.

The BMI poll showed that two thirds of MP's backed tax relief on private medical insurance. In contrast only 1% of the labour MP's wanted this option.

The conservatives have been criticised for wanting to turn their back on the NHS despite Mr Cameron's insistence that they are 'the partly of the NHS.'

Allastair Darling, Chancellor of the Exchequer, said that the introduction of tax relief on private health insurance would harm the NHS:

'Tax breaks for private health care would take money away from the health service and undo the real progress we have made with the NHS over the last 12 years.'

'After a torrid two weeks, David Cameron can no longer hide the two faces of his party on the NHS – this poll shows where the heart of the Tory party lies.'

Adrian Fawcett, chief executive of General Healthcare Group (which owns BMI Healthcare), said:

'The results help progress what, in the run-up to an election, is an important debate about the future of health provision in the UK. I do not believe there are many in the private healthcare sector that would support a switch to the US model. The UK already has a growing partnership between the public and the private healthcare sectors and we are pleased that so many MPs take a pragmatic view about how such a partnership can be further developed and how it can be used to meet the health needs of an increasingly ageing population.

'The NHS delivers strong core health services but the patient experience, the clinical outcomes and the timeliness of treatment can undoubtedly be further improved, if the private sector is encouraged to work more closely with the NHS to deliver reduced waiting times and improved value for money.

'In my view, the private sector is not advocating a root and branch reconstruction of health provision in this country, rather measures to widen patient choice and improve patient services and outcomes as part of a closer public-private partnership.'

5) Moratorium & Full Medical Underwriting

Health insurance companies are like bookies. They have to work out the odds of people becoming unwell in order to charge them appropriate premiums. This is known as underwriting.

There are two ways that medical insurance companies assess you in order to provide you with health cover. Moratorium underwriting or full medical underwriting. Each has advantages and disadvantages.

Some companies offer both types of underwriting and others only offer one or the other.

Full Medical Underwriting
This involves companies taking a full medical history (Medical History Declaration) and lifestyle profile of you right from the start. In some cases your GP may be contacted to clarify issues that may be unclear. This is always done with your consent.

Advantages
-What you will and will not be covered for will be very clear. There will be no surprises should you become ill
-If you do become ill clearing your treatment will be speedy as all your information has already been collected by the insurer
-Companies that use full medical underwriting often have health reward schemes which enable you to reduce your premiums by performing certain health enhancing activities.

Disadvantages
-This type of policy tends to be more expensive
-You have to fill out long forms at the beginning and getting cover may be delayed whilst everything is checked out
-You are responsible for full disclosure when you take out this type of policy. If you have omitted anything you may not be covered. And it may be difficult to prove that the insurance company was at fault.

Moratorium Underwriting
This type of underwriting means that initially you only have to give out brief information about your health and lifestyle.

Under this type of policy you are not covered for any condition that you have, up to five years prior to taking out the policy until you have been on the policy for two consecutive years. After this time, if you have not had a recurrence of the condition or its symptoms you will be covered.

Advantages
-You can get health insurance very quickly with this type of health insurance. You won't have to fill out long medical forms and your application will be quick as the underwriting is not done until you actually make a claim.
-Premiums tend to be cheaper
-Once your period of moratorium is up you will be covered for everything as long as its in the policy document.

Disadvantages
-Treatment can be delayed if the insurance company needs to check out details of your medical history with the GP.
-Because this type of policy does not investigate your medical history thoroughly you could be surprised and disappointed to find that you are not covered when you go to make a claim.
-People could be put off seeking medical advice if they are trying to eek out their time until their two year, symptom free, window is up. This is potentially catastrophic.