1) Not shopping around
If you have never purchased health insurance for you or your family it can appear to be confusing. There are lots of companies out there all vying for your business and there are lots of policies and options to choose from. This choice in health insurance is fantastic but it can be disarming. It is well worth getting immersed in the subject to make sure you get a cover that suits you.

2) Not reading the small print
Medical insurance companies are obliged to provide clear information about what their policies do and do not include. Then there is the small print. This goes into more detail about the health insurance cover you are considering. Many people buy policies without really being aware of exactly what they will be covered for. This can create problems and disappointments when they come to make a claim.

3) Not telling the whole truth
The cover you are given by health insurance companies relies on you disclosing everything about your medical history and lifestyle. Problems arise when people either forget or deliberately mislead an insurer about their health. Even though private health insurance companies have to treat customers fairly over matters of non-disclosure it can cause problems and invalidate your claim if something comes to light that you did not let them know about in the first place.

4) Not having enough health  cover
In order to make monthly savings many people take reduced cover health insurance. This is a great strategy that allows you to have some cover whilst still keeping your costs down. However you should have an awareness of the costs of private medical treatment in order to know the kind of treatments that would be covered by the insurance policy that you want to take out. If you opt for a very low level of cover you may find it disruptive to find that in the middle of your treatment you have to stop and continue with your care in the NHS.

5) Not following the rules
Health insurance companies have strict procedures when it comes to making a claim. These rules need to be followed in order for claims to be processed properly. For example, if you inadvertently go ahead and have a treatment that is not covered by your private medical insurance policy and then find you are denied payment for this treatment you will then have to foot the bill yourself.

GP’s are the pivotal point in all health care. They are the first port of call for private and NHS patients alike. Health insurance companies need a GP referral before they can process a health insurance claim and NHS patients cannot be seen by a consultant without GP referral.

The Government have published a draft legislation which is designed to allow GP’s to be in charge of commissioning services for their patients by the year 2013. The theory behind the changes is that not only will costs be reduced but that it will allow for a more direct and meaningful decisions to be made by the people who have the most contact with patients.

The controversial bill is the most revolutionary change in the NHS for sixty years. It is estimated that it will cost up to £1.5bn to make the necessary changes but that up to £8.8bn could be saved by the reduction of the costs of commissioning in the NHS.

The British Medical Association were quick to jump in in response to the bill. BMA chair Dr Hamish Meldrum said:

‘The benefits that clinician-led commissioning can bring are threatened by other parts of the bill. In particular, the legislation will allow competition to be forced on commissioners, even when they believe the best and most appropriate services can be provided by local hospitals.’

‘Forcing commissioners of care to tender contracts to any willing provider, including NHS providers, voluntary sector organisations and commercial companies, could destabilise local health economies and fragment care for patients.’

GP’s should have fabulous relationships with their patients. They are the front line of medical care for all patients. Getting them to commission drugs and services takes their role to another level. How will patients feel about this. Will GP’s be compromised to make decisions that may not be popular with patients because they have to look after the ‘bottom line.’

If GP’s have a bigger budget with more decisions to make how will patients feel that they are making financial decisions that directly affect their health care. It was easier before for GP’s to explain unpopular decisions away by explaining that ‘the trust won’t provide for that.’  There is almost a sense of solidarity between patient and GP – making the most of what’s available.

A Patients Association spokesperson said that is was ‘very concerned’ that the trust between the public and doctors could be affected. Chief executive, Katherine Murphy said:

‘Patients may wonder whether they will be referred to the best services, and not the hospital which the GP may see as making money for him.

‘Could the healthcare needs of some patients be compromised because GPs are now holding the purse strings and are more concerned with the consortium’s bottom line than the patient’s needs?’

Freedom is already known for its cheap cashplan health insurance which offers value for money with a twist. With this type of insurance your inpatient costs are paid to you directly. You can then use this money to either go privately for treatment, or pay for your care abroad. Alternatively you can opt to use the NHS and keep the cash.

What’s really good about the new Freedom offering, Elite, is that it gives you many, many options that traditional health insurance does not provide. The following choices for example are not offered in the average medical insurance policies:

GP, Dental and Optical Cover
Cover for routine and accidental dental care, Private GP, Optical consultations and prescriptions

Supplementary Benefits
Cover for Home nursing, Rehabilitation, Pregnancy complications and infertility diagnostics. There is also a Cash Benefit available for NHS Day-Patient and InPatient stays.

Executive Option
This option is only available for people who have chosen every one of the cover options that Freedom has to offer.
External Prosthesis, Chronic Conditions, Wellbeing Assessment, Maternity, Second Specialist Opinion, NHS Prescriptions and London Premier Hospitals.

With Elite you can choose to opt in or out of any options although the basic core In-Patient Cover is not optional as it is the starting block for the whole policy. In addition to the options above you also have: Out-Patient Cover, Psychiatirc Cover and Alternative Therapies Cover

As a company Freedom offer policies for individuals, families and businesses. As an additional service to businesses they offer another unusual benefit. They run this part of the business on a non-profit basis and offer a range of health and lifestyle cover benefits which have been designed to cover stress and health initiatives but also provide fun things like outings for employees and their families.

1) Read the small print
The first step is pre-emptive. The most important things you can do before you agree to sign a health insurance contract is to make yourself aware of what is and is not included under the terms of your cover. As with any insurance product, you don’t want any surprises when you do fall ill and are expecting to be treated under the terms of your policy.

2) 14 day ‘cool off’ period
As with all financial products you have a 14 day cool off period within which you can cancel your health insurance premium and not incur any penalties. If you are unhappy with any contract that you have signed it is your right to withdraw you business.

3) Familiarise yourself with your health insurance contract
What is included in your policy, what is not? What do you have to do should you become ill? Under most policies, for example, you cannot just go ahead and have treatment and expect it to be paid for. You have to have authorisation from your health insurer. They can refuse to pay for treatment that they have not authorised. Reading the small print ensures that you keep within the parameters of your contract. If you do this you have much better grounds for complaint should there be a serious problem.

4) Communicate
If you are not happy with something, tell your private health insurance company. Sometimes problems arise from misunderstandings which can easily be corrected by good communication.

5) Official complaint
If you are not happy with how your problem is resolved then you can go through an official complaints procedure with the health insurance company. Every company will have one because they are legally obliged to do so. Tell your insurer that you want to make an official complaint and they should start proceedings in order to help you do that. They are legally obliged to acknowledge your complaint within five days and they have to respond in full within 28 days.

6) Keep notes
If you have a complaint, keep track of who you spoke to about it, what they said and when any conversations took place. This will help you to keep things clear in your mind but will also help if you are not happy and need to take the matter further.

7) The Financial Ombusdsman
If you are not happy with the way the company have dealt with your complaint and you feel that all avenues have been covered you have the right to take your complaint further. The Financial Ombudsman Service is a free and neutral organisation which helps to resolve complaints. They will look at all the evidence and make decisions based upon its findings. However you will need to show that you have followed the official complaints procedure with the company in question.

Finding the right balance of cover and affordability is crucial. There is no point having a policy that you cannot afford but have committed to. On the other hand there is no point finding that you are not covered for all your needs should you become ill even though you could have afforded a more expensive level of cover.

Work out your costs. Find out what can you afford and then get the best cover for that amount. There are different cost reducing options available if you are looking for great cover at reduced cost. These include:

• Six week plans
• Co-payment options
• Increasing your excess
• Paying for a year of cover upfront
• Picking some ‘options’ instead of others
• Using a health insurance provider, Freedom Healthnet, for example, that allows you to arrange your inpatient treatment in exchange for a cash payment

2) What are your expectations of medical insurance?
This is a very important question. When people are first looking for health insurance they are often surprised not by what is included in the policies out there but what is not included. These are known as exclusions.  Read all small print carefully before committing to any policy. Many things are not covered by any insurance company, including:

• Pregnancy and complications of pregnancy
• HIV/Aids
• Chronic illness
• Conditions you have recently suffered from
• Alcoholism
• Drug abuse
• Cosmetic surgery
• injuries from professional sports
• injury from dangerous sports

Try and match your expectations to what is available. Here are some of the things that are not covered in every policy but are covered in some:

• Psychiatric treatment
• Alternative treatments
• Full cancer cover
• Pregnant women

3) How much choice do you want?
One of the great things about health insurance is that it gives you a greater element of choice. However not all health insurers are equal in this respect and some offer you a greater degree of freedom than others. Some insurance companies for example reduce the cost of their policies by including a six week option. If you are happy to go with the NHS for treatment then this is a great policy for you. You wait for six weeks to see whether you can be treated with the NHS and if you cannot then you can go privately. Axa PPP Healthcare, for example offer a six week option policy.

Choosing your own consultant and hospital is another element of choice that can be restricted with some health insurance companies. Some insurers have lists of hospitals that you can use and others are more restricted that others.

The following health insurance providers were honoured this month:

Best Occupational Health Provider
WINNER: Aviva UK Health
Highly Commended: Bupa Health & Wellbeing UK
Highly Commended: AXA PPP healthcare

Best Customer Service by a Provider
WINNER: Groupama Healthcare
Highly Commended: Standard Life Healthcare (now part of PruHealth)
Highly Commended: Aviva UK Health

Health Insurance Company of the Year
WINNER: Aviva UK Health
Highly Commended: Bupa Health & Wellbeing UK

This year the event was held on at the Grosvenor House in London’s West End. Comedian Patrick Kielty entertained the crowd. Kielty, David Sawer, Health Insurance’s Editor and the event sponsors handed out the awards.

The health providers were voted for by the medical insurance interemediaries and individuals who read Health Insurance Magazine.

According to the British medical journal patients could seek treatment in the European Union if waiting lists get too long in the UK. Fears hinge around the new rules that will put GPs in charge of commissioning local health services.

Even though most patients stay in the UK for treatment, since 1971 they have had the right to get treatment in another EU country. There have been several court cases which have upheld people’s rights to treatment abroad where there are facilities available that are not being used fully.

Currently there are no protocols in place that would make this transition an easy one but the authors of the research point out that if GPs are put in charge of commissioning health services this is something that they will need to address.

Of course private health insurance or paying up front for private medical care is available for people who are not happy to wait or to travel abroad for free treatment.

Some people choose to be treated abroad anyway. Many countries provide good quality healthcare at cheaper prices than the UK. With Freedom Healthnet medical insurance people can have the best of both worlds. They offer different levels of cover and give you cash when you have made a successful claim. You then have the choice to stay with the NHS, or to pay for private treatment.

One of the options that Freedom customers can take is to travel abroad for their inpatient treatment. This can save them money as private health care abroad is often cheaper than it is here. The customers then get to keep the difference between what they claim from Freedom and the costs of treatment abroad.

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.

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.’

NICE
The Kings Fund praised National Institute of for Health and Clinical Excellence (NICE) for being a ‘big step forward in delivering evidence-based and consistent guidance to the NHS.’

Infections
The report also described as ‘successful’ the reduction in hospital-acquired infections such as MRSA and C.Difficile whose incidences were down by 34% and 35% respectively since 2007/08.

Waiting times
The reduction of NHS waiting times was also praised. Most people have to wait less than 18 weeks now from when they are given a GP referral.

Improvements
The report cited that the quality of surgery had improved and referred in particular to cardiac surgery.

Cancer
There have been improvements in the access to cost effective cancer drugs.

Criticism
The report said that there was a wide ranging disparity of provision and care across the country and also in comparison to other European countries. They made particular reference to cancer care where there was a big difference in the kinds of treatments given.

They also criticised the mental health services which they felt had failed to improve the quality of life of those with mental illness.