Anne is 56-years old and wants to buy an individual private medical insurance (PMI) plan. A non-smoker, Anne is in good health despite undergoing a hip replacement operation two years ago. She has not had any medical problems since and does not have any pre-existing medical conditions other than mild arthritis in her left wrist. She would like a fully comprehensive plan with no excess. What are her options?
Arnie Harmsworth, Preferred Medical
For a comprehensive plan with no excess, Health-on-Line's Choices would be ideal for Anne's requirements. For £80.22 per month, Anne would gain comprehensive inpatient and outpatient care, and for £85.57 per month, she would also gain valuable cover for therapy care.
This premium could be further reduced should Anne wish to submit her application online with her intermediary.
Full underwriting would exclude Anne's hip and wrist. However, she could opt for moratorium underwriting. This means that while her arthritis would still be excluded, if she did not show any symptoms or seek any advice or treatment for her hip replacement for two years after joining, she may gain cover for her hip at a later date.
Although Anne may have specific requirements, she would benefit from further discussion with an independent healthcare specialist about her healthcare needs. Flexible benefits, age-fixed pricing and excesses should not be discounted and as she is in fairly good health, she would benefit from a better understanding of the plans that are available. If Anne could be persuaded to consider her requirements in greater detail, she could save money on her premiums.
At 56, it is highly likely that Anne's PMI premiums will soon spiral to an unaffordable level. Therefore, age-fixed plans should be considered for the long-term. Premiums for Exeter Friendly Society's Comprehensive Shared Care plan starts from £69.77 per month.
Alan Keeble, SecureHealth
As Anne insists on having no excess, she would only be eligible for SecureHealth's Executive plan. This will provide her with fully comprehensive cover for £100.25 per month and includes home nursing and psychiatric cover. It also offers access to any top UK hospital. In many cases, treatment at a hospital not on our list is usually permitted providing it has been recommended by a specialist.
Under the plan, Anne's mild arthritis would be excluded because it constitutes as a chronic pre-existing condition. Complications from her hip replacement would however be covered under both SecureHealth's moratorium and fully underwritten options. This is provided complications or any problems or symptoms do not arise for two consecutive years after the start of the cover.
Although Anne does not want to take out a plan with an excess, in practice most people of Anne's age prefer to take a small excess because they have at least a modest level of savings. This will provide Anne with more options and would also help to lower the cost of her monthly premiums.
For example, if Anne was prepared to consider an excess of £100, she could enjoy comprehensive cover under SecureHealth's modular Options policy. This will provide Anne with the chance to tailor her own plan. By doing this, Anne can opt for a basic plan which simply provides cover for hospitalisation, or she can link a number of modules together to provide a more comprehensive plan covering a wide range of benefits including MRI, CT scans, physiotherapy and complementary therapies. By tailoring the cover available to suit her exact requirements, Anne could save up to 30% to 40% on her premiums.
Nye Jones, AXA PPP healthcare
Anne is looking for a comprehensive plan that offers a full refund for inpatient as well as outpatient treatment and rules out the option of taking out a voluntary excess. While this might appear to limit the choices available to her, it need not necessarily be so.As a starting point, AXA PPP healthcare's Premier policy would cost around £110 per month. This provides cover for hospital bills and surgery fees, MRI, CT and PET scans, radiotherapy and chemotherapy. It also features cover for other outpatient benefits such as diagnostic tests, consultations and physiotherapy.
While Anne would be eligible to benefit for treatment of illnesses that typically require expensive intervention, such as cancer or heart conditions, she would not be covered for treatment of her pre-existing medical conditions.
If Anne was willing to use the NHS for urgently needed treatment, she could reduce her premium by around 30% by opting for Premier 6. This is a six-week version of Premier, which includes the outpatient benefits described above as well as private inpatient or day patient treatment when the NHS can not provide it within six weeks.
Alternatively, Anne could lower her premium to £90 per month by choosing AXA PPP healthcare's Ideal plan if she felt that £800 would cover her for outpatient diagnostic tests, consultations and physiotherapy. Ideal does pay in full for outpatient scans, radiotherapy and chemotherapy, so these costs would not impact on Anne's outpatient limit. The Ideal 6 plan would cost Anne around £60 per month.
