Illnesses Not Covered by Health Insurance
The primary purpose of private health insurance is to cover acute illnesses, or new conditions that may be treated quickly. Pre-existing conditions, incurable illnesses and chronic conditions may not be covered, or may be covered with certain limitations. Before you purchase health insurance, it is important to review your policy's covered benefits and exclusions carefully, so that you are aware of the illnesses that are not included as well as the conditions that may be treated under your insurance plan.
Pre-Existing Conditions
Health insurance companies address pre-existing conditions in different ways. In some cases, pre-existing illnesses may be excluded altogether. Other insurers may agree to pay out for treatment after the member has paid for coverage for a certain period of time. The underwriting process that an insurer uses can make a difference in the cover you receive for pre-existing conditions.
With moratorium underwriting, the insurance company does not request any details about your medical history when you apply for a policy. However, any conditions that you have been treated for within a certain period of time, often the past 5 years, will not be covered. With full medical underwriting, you must provide details about any illnesses you have had in the past. The insurance provider may then decide to include or exclude certain conditions in your coverage, or to pay for treatment after a certain period of time.
After one or two years, you may receive coverage for pre-existing conditions if you have not received treatment for these conditions and have had no signs or symptoms of recurrence. A chronic condition, such as diabetes, may never be included on certain private health insurance policies. However, you may continue to receive treatment for chronic conditions on National Health Service, which receives funding for the treatment of long term illnesses.
Excluded Illnesses and Services
Certain illnesses or conditions are excluded from many health insurance policies; however, the list of exclusions varies from one provider to the next. Many policies exclude treatment for HIV/AIDS, infertility, drug abuse, self inflicted injuries that were caused deliberately, injuries incurred in war and injuries incurred during dangerous sports. Normal pregnancy care is not included on most health insurance policies, but treatment for complications of pregnancy may be covered.
Elective services, such as cosmetic surgery, bariatric procedures, infertility treatment and gender reassignment, are excluded from most private medical cover. Experimental drugs or therapies, immunizations, dental services, kidney dialysis, wheelchairs and other mobility devices, wound dressings and outpatient prescription drugs may be excluded. Routine medical care is typically not included in private health insurance benefits, nor is emergency medical treatment. Many of these treatments or services are covered on NHS.
When you apply for health insurance, you may or may not be asked to provide information about past medical conditions, dependent on the insurer's underwriting policies. If you are asked specific questions about prior illnesses, you must give complete details. If you are uncertain about whether you should include a particular illness, condition, treatment or diagnosis, the safest bet is to include the information. Leaving out any details about prior illnesses may result in claims being denied, and the insurer may invalidate your policy.
Private health insurance may be used to extend your treatment options and provide a more comprehensive approach to your medical care. As you consider which insurance provider to choose, review the illnesses not covered by health insurance in each policy. Planning your health care requires a consideration of which services you will continue to receive on NHS and which treatments you may pay for with benefits from your private health insurance plan.
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