Summary

Health Insurance is not there to cover your health in any eventuality, although you could be forgiven for thinking so! This article explains what is andisnt covered, and tells you what pitfalls to look out for.

Health Insurance - not as straightforward as it would seem

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Most of the seven million people covered by health insurance in the UK have a policy provided by their company. As such it is a useful benefit, but many of us assume that it will cover any kind of health issue and this is definitely not the case. Theinsurers exclude a wide variety of possible claims, and this article will explain those in detail.

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Health insurance has a very specific purpose - to get people suffering from short-term, curable health problems straight through to a consultant and to receive top quality private care in top speed time. Essentially, its about jumping the lengthy NHS queues. However, there are many health problems that dont fit into this narrow band, and as such are not covered by a health insurance policy.

Be aware however that every policy is different, and only be reading your own policy documents will you be able to find out exactly what you arecovered for. This article will give you the knowledge you need to understand your policy better.

Defining Chronic

Illnesses and conditions etc fall into two main categories: acute and chronic. Short-term illnesses that can be fixed and cured are called acute, forexample if you fell and broke your arm, this would be classed as acute. If, however, your problem is either incurable or deemed to be a long-term issue, then it will be classed as chronic and subsequently you will not be able to make a claim.

What counts as acute and what counts as chronic is a hotly disputed issue between insurance companies and their customers. Diabetes and asthma are acknowledged as chronic, long-term conditions that cannot be cured. (car insurance )

The issues become more difficult with certain types of cancer. It often happens that the cancer is considered to be treatable at first, and then the diagnosis is changed at a later time to incurable (car insurance cover). In this case, you would only be covered as long as the cancer was diagnosed curable. If the prognosis changes you will lose your cover. Insurance companies are allowed to reclassify an illness from acute to chronic at any time.

What about the long-term
If you need long-term treatment then youre out of luck. However insurers have different ideas on what constitutes long-term, you may be covered for 10 months or up to a year, but it probably wont be for any longer than that. Check your policy for details. (secured loans)

Does preventative medicine count?
Health insurance cannot be used to pay for preventative treatment, although that is another matter of contention. For example, a drug called Herceptin can be used to help women who have HER2, a virulent form of breast cancer. The drug has helped reduce the risk of the cancer returning by an average of 50%. Many would call this an essential treatment, but some insurers call it preventative. Legal and General and Axa PPP will not pay for this treatment, however BUPA, Standard Life Healthcare, Norwich Union and WPA will.

Drugs not yet available on the NHS
You might think that it doesnt matter if the drug is available on the NHS, but it relates to the system of drug approval in England and Wales. Before a drug can be used in the NHS, it must be approved by The Institute for Health and Clinical Excellence. The problem is, if its not approved, the insurance company wont allow you to be treated with it. Huge delays affect the introduction of new drugs into the NHS because The Institute for Health and Clinical Excellence must first ascertain if the benefits of the drug justify the financial costs of adding it to the NHS treatments. As a result, the drug you need may not be approved, and if so, it wont be covered.

Aware of this problem. the Financial Ombudsman issued a compromise which stipulates if the insurer wont cover experimental treatments, then it should cover the cost of the approved conventional treatment. The policyholder is then free to undergo the experimental treatment and pay the surplus if its more expensive. (best loans)