Mark is a 50-year-old plumber who is looking to spend another 10 years in his profession before taking early retirement. He is married with one child and has yet to quit his 30-a-day smoking habit, which he started when he was in prison 20 years ago. He had a minor heart attack seven years ago but has now made a full recovery. There's a history of heart attacks in his family. What health cover is available to him? His wife and child are already covered on another policy and he is not restricted in terms of his budget.
Gerry Mould, Medibroker
In preparing solutions to Mark's needs, the key area to be taken into account is his pre-existing condition.
Mark had a heart attack seven years ago so consideration regarding the underwriting options available is important. An application for a private medical insurance (PMI) plan with full medical underwriting may result in an exclusion of any treatment for his heart attack or any related condition. Alternatively, an application for a plan with a moratorium could result in acceptance without any exclusion. However, if a claim was to be made related to his heart attack, it may be rejected under a standard moratorium if he received treatment or advice for his heart condition or suffered any symptoms in the five years before his application date.
Mark's future healthcare is the primary concern; bearing in mind his medical history, a comprehensive plan from PruHealth (£98.05 a month with nil excess) has a better moratorium than other insurers. His heart condition would be excluded for a period of two years, but will be covered after that time, irrespective of any treatment received.
Other alternatives would be comprehensive plans such as Axa PPP's Healthcover Deluxe (£66.66 a month with £100 excess), BupaCare from Bupa (£115.16 a month with nil excess and 20% discount) or Primecare from Standard Life Healthcare (£121.20 a month with nil excess). However, the underwriting options are not as beneficial as the PruHealth plan.Susie Colley, West Country Health Care
Mark's family having a history of heart disease is not deemed highly important with PMI. However, if he has a fully medically underwritten policy, his cardiovascular system may be excluded due to his heart attack. Regardless of his "full recovery", the underwriters' decision will no doubt be due to the inevitable scarring that he may have incurred on his myocardium. Alternatively, if he has a moratorium policy he will be subjected to moratorium rules. If he takes no medication and no longer has any check ups and receives no advice for a clear two-year period then there would be a possibility his cardiovascular system may be covered. It would clearly be beneficial to give up smoking.
Mark is eligible for an Axa Business Choice Gold or Silver (£80.68 to £95.53 a month) as a self-employed person, all other options would have to be on an individual basis. As budget is not an issue, Standard Life's Prime Care Gold plan (£285.37 a month) would be the policy of choice. This policy gives comprehensive cover for all inpatient/daypatient and outpatient treatments with additional benefits such as alternative medicine, private ambulance and a built-in worldwide travel plan. An additional benefit is £10,000 for critical illness. Prime Care Gold is underwritten on either moratorium or fully medically underwritten terms. If no claims are made on the policy, a no claims discount of 5% would be applied at the renewal each year to a maximum of 50% no claims discount.Ian McMillan, Standard Life Healthcare
Mark can take out an individual policy and it may be worth covering his wife and their child with the new plan. As Mark is a tradesman, he may well be self-employed, so Standard Life Business Healthcare is probably a good choice. This may be especially helpful if Mark's wife is a partner in their business or if Mark has employees or wants to add them in the future. Importantly, family history will not affect cover. It is only Mark's individual medical history - or that of anyone else on his policy - that is relevant, and even then only health issues that have produced symptoms or needed treatment in the past five years. In that case, cover will still be offered, though there may be a period when anything recent is excluded.
Mark may want to give up smoking or he may have other health issues he wants to change. As part of this policy, all adults covered have free access to an online health and wellbeing service with friendly, medically-validated tips and information.
Business Healthcare will enable him to mix and match the cover and benefits required. However, a suggested plan could include benefits like inpatient physiotherapy, radiotherapy, chemotherapy, oncologist fees and private ambulance. Mark would pay £120.84 a month for this, which would also give him travel and dental cover, and access to a GP by phone around the clock among other benefits. With modest adjustments he could reduce this to less than £70 a month if he needed to.
