Andrew, 35 and Fiona, 29, live in Yorkshire. They have twin girls, Victoria and Jessica, who are four years old. Andrew is a self-employed accountant and Fiona works as a private tutor. They have a combined income of £68,000 a year. Andrew's father died from heart disease, but he leads a healthy lifestyle. Fiona is an insulin-dependent diabetic, but is in very good health. Both the twins are healthy. What are their private medical insurance options?
Jan Lawson, The Private Health Partnership
For Andrew, Fiona and family, there are 57 products from 18 different insurers that are potentially suitable, with premiums ranging from £16.76 to £440.22 per month.
Fiona's diabetes would not prevent her from taking out private medical insurance (PMI), but we would be careful to explain that, as this is an ongoing pre-existing condition, insurers would not only exclude treatment for diabetes, but also for any medical condition directly resulting from it. This includes glaucoma and many circulatory disorders. Therefore, the scope of her cover would be more limited than for the rest of the family.
Identifying Andrew and Fiona's priorities is crucial in order to establish whether they are looking for comprehensive cover for both inpatient and outpatient care at a broad range of hospitals, or whether they are willing to accept a more restrictive choice of hospitals in return for significant premium savings.
The best value comprehensive plan is Premier Care from Universal Provident at £113.83 per month, which gives immediate access to a wide range of hospitals. It has a wide range of excess options and a good history of moderate premium increases.
Alternatively, if Andrew and Fiona are looking to keep costs as low as possible, the best value plan is In-care, also from Universal Provident. At £39.71 per month, this also includes a good range of excess options to reduce costs further if needed. Both plans are simple and straightforward, and are clearly laid out so Andrew and Fiona know exactly what they are getting.
Charlie MacEwan, WPA
Fiona's diabetes means that any investigation or treatment for the condition, the underlying cause, and all related illnesses will be excluded from her policy. Fiona should initially speak to her GP to understand all of these related conditions before she chooses a policy. She should then speak to an underwriter in order to understand exactly what will be covered.
WPA's Professional Health plan would be ideally suited to Andrew and Fiona as it is aimed at recognised members of professions including accountants, IFAs, lawyers and doctors. Assuming the benefits would include standard cover with a £1,000 shared responsibility option – combined for Andrew and the children – where they pay 25% of the claims until they reach £1,000, after which time, 100% of the claim will be paid by WPA, I would recommend one of two options.
The first is a Professional Health policy for the whole family, which works out at £33.41 per month. Medical underwriting will result in personal exclusions being applied on Fiona's policy for any illness associated with diabetes. The second option would be a Professional Health plan for Andrew and the children for £21.89 per month. Broken down, this works out to be £13.70 for the father and £4.10 for each of the children.
The family may consider that, rather than funding PMI for the mother, they could put the equivalent premium into a self-pay fund for possible private treatment on a needs basis.
Claire Ginnelly, Standard Life Healthcare
Both Primecare or Primecare Plus are ideally suited to Andrew and Fiona's needs as they have many features to support young families. As one of them is self-employed, rapid access to treatment and the privacy and comfort of private facilities will provide peace of mind by ensuring they do not lose too much time away from work. It is important to note however, that while the whole family will be covered – as will any future children at no extra cost – Fiona will not be able to claim benefits for diabetes or any related conditions, but she will be fully covered for everything else.
As well as fully refundable cover for most treatments and no overall limit on the combined cost of claims, Andrew or Fiona would also be covered to stay in hospital with either of the girls should they require treatment. They would have access to medically validated online health and wellbeing information and support, as well as a 24-hour GP helpline.
Andrew and Fiona can choose from several add-on plans such as major dental expenses or worldwide travel cover, which is included under the Primecare Plus package. Primecare and Primecare Plus both have the option of paying no excess, or paying the first £100 or £250 of claims. Assuming a £100 excess, Primecare would be £125.84 a month and Primecare Plus would be £152.51, both covering the whole family.
