Catherine is 24 years old and has just relocated to Coventry to live with her boyfriend, Sam, 26. They are both non-smokers and go to the gym several times a week. While leading a healthy lifestyle Catherine was born with a heart defect, which meant her heart was originally the wrong way round. This means she has to go for regular check-ups. While this has not been a problem for her so far, in case her condition deteriorates, they are now looking to take out PMI. Sam has a history of cancer in his family as his mother had breast cancer. Money is not a massive issue but they would like to take out affordable cover. What advice would you give them?
Phil Taylor, Preferred MedicalCatherine and Sam are a young couple and, therefore, it is the perfect time for them to obtain private medical insurance (PMI). They sound as though they lead a healthy lifestyle, which stands them in good stead.
Catherine will need to take into account the parameters of coverage she requires for her heart defect. If she is happy to have treatment for this and other related conditions on the NHS, then they could look at any PMI provider and join on a standard moratorium basis.
The history of cancer in Sam's family will not be an underwriting factor unless he has experienced symptoms, treatment, medication or advice from a GP or medical practitioner relating to any potential cancers.
Catherine would be unable to find cover for her heart defect immediately, unless she joined a large corporate scheme on a medical history disregarded basis, which she may be able to explore with her employer. Her best option would be to look at a policy with PruHealth. PruHealth will not cover the condition in full, however, Catherine should join on a moratorium basis. PruHealth's unique moratorium means that she would be covered for acute flair ups of the condition after the policy has been in force for two years.
PruHealth also provides very good palliative care for cancer patients, which could potentially be beneficial for Sam.
Their healthy lifestyles will also help them to gain points for PruHealth's Vitality scheme which will enable them to save money on renewal premiums.
Stephen Walker, Medical Insurance ServicesCatherine appears to have a problem finding cover for any future treatment relating to her heart condition. Should she apply for a policy on a fully underwritten basis, she will almost certainly end up with exclusion on treatment for her heart condition and anything directly related to, or caused by it.
If she applied on a moratorium basis, the industry standard moratorium would not provide cover until she had completed a two-year period, after the commencement of the policy, free of consultations (including check-ups), treatment, medication and symptoms. However, a PruHealth policy would be ideal for Catherine as Pru operates a simple standing two-year moratorium, not a "rolling" moratorium as with other insurers.
Pre-existing non-chronic conditions will be covered after the policy has been in place for two years, irrespective of any treatment received during that period. Catherine can choose from three levels of cover on the national hospital scale. Good 'budget' cover is provided by Core at £24.56 a month, mid-range cover by Essential at £29.61 a month, and Comprehensive at £37.16. Future premiums can be kept to an affordable level by utilising Prudential's Vitality programme.
PruHealth's holistic approach to cancer treatment may be of interest to Sam, given his family history. PruHealth provides cover for all stages of the disease. Sam could take Core cover at £24.81 a month, Essential at £29.88 a month or Comprehensive at £37.46. Should affordability be an issue for Sam, a good low-cost comprehensive alternative would be BCWA's Personal Health policy, Options 1, 2, 3 and 4 at £27.90 a month.
Nicole Hockley, Norwich Union HealthcareNone of Norwich Union Healthcare's policies are lifestyle influenced, so going to the gym or being a non-smoker would not influence their underwriting or premiums. All its underwriting is based on the individual's medical history, so, if Sam has not had cancer, it would not look to exclude that condition just because he may have a history of it in his family.
The underwriting Norwich Union Healthcare would recommend is fully medically underwritten and the reasons for this are, firstly, because Catherine had symptoms of, medication or treatment for, or advice about such a disease, illness or injury within five years before her date of entry. Secondly, there has not been a clear two-year period after the date of entry during which she has been free of medication for, treatment for, and advice about such a disease illness or injury or related condition.
If Catherine went two years without check-ups or medication, then we would cover any acute phases. This cover would be designed to return her to her state of health prior to her suffering the acute phase. It is important to note that Norwich Union Healthcare would advise Catherine to take advice from her GP or specialist and continue with the regular check-ups unless they advise otherwise (and not stop having regular checkups just to satisfy the moratorium). This underwriting would provide cover for any new conditions or anything she has not suffered from five years prior to the commencement date of the policy.
The best quote available for cover for them is £81.47 a month from Health Solutions with no excess, core cover and standard hospital list.
