Universal Provident has revealed a breakdown of its declined private medical insurance (PMI) claims statistics for 2014, with two reasons each accounting for 16% of rejections.
Not exceeding the excess on a policy accounted for 16% of declined claims.
Not having the relevant module of the policy, such as claiming for an outpatient treatment/consultation on a policy covering only in-patient and day treatments also accounted for 16% of declined claims.
Hazardous pursuits and dentistry also both accounted for the same proportion with 11% of declined claims being due to each of them.
The most common reason for claims being part paid was for chronic conditions, followed by palliative rather than curative treatment.
Other reasons for part payments were for outpatient parts of claims on in-patient only policies, conditions subject to a moratorium clause and personal medical exclusions.
The remaining reasons for declined claims and their proprotions of the total of declined claims were:
• Chronic conditions (not an acute flare up thereof) 8%
• Cosmetic treatment 8%
• No benefit under policy for treatment claimed 8%
• Routine examinations 8%
• Fertility/infertility 5%
• Pre-existing condition/within moratorium 5%
• Psychiatric illness 3%
• Personal Medical Exclusion 3%
Dale Tranter, assistant group underwriting manager, said: "This latest release again reinforces our ongoing commitment to a culture of openness with our broker partners."
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