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Because private medical insurance is designed to cover the unforeseen, you
cannot take out a policy to get treatment for a medical
condition that has already developed recently.
Exclusions to cover
Health Insurance will almost certainly not cover all
your health and medical needs. The following are more
than likely to be excluded under the policy terms and
conditions:
• Emergency treatment – you will almost
certainly be treated by the NHS
• Existing or previous health problems
• Incurable or chronic conditions (including the
terminal stages of cancer)
• Long-term illness (e.g. diabetes, asthma, multiple
sclerosis) – although initial treatment and relief
of acute phases might be covered
• AIDS-related illnesses – although you
may be covered for the initial diagnosis and a limited
stay in hospital
• Treatment on a kidney machine (renal dialysis)
• Routine check-ups from GPs, dentists or opticians
• Preventative medicine such as vaccination or
cancer screening
• ‘Palliative’ treatment designed
to relieve rather than cure
• long-term hospital or nursing care
• complementary medicine – although some
policies pay for osteopaths and chiropractors if your
GP refers you
• normal pregnancy and childbirth
• abortion
• vasectomy and sterilisation
• some out-patient costs (e.g. glasses, hearing
aids and prescriptions)
• the services of your GP (e.g. the fee for filling
in your claim form)
• self-inflicted injuries or suicide attempts
• treatment related to drug or alcohol abuse
• cosmetic surgery
• psychiatric treatment
• dental problems
Pre-existing conditions
Private medical insurance policies always have some
sort of clause covering claims for pre-existing conditions.
Some will pay out for the treatment of existing (or
foreseeable) conditions only if the health insurer agrees
to cover them when you take out the policy.
In this case the health insurer assesses the risk of
paying out on the basis of a medical questionnaire and
possible medical examination by an approved doctor.
You may find that cover is adjusted or premiums loaded
accordingly and sometimes that you are refused cover
altogether. Some will cover existing conditions on a
‘moratorium basis’, meaning that any illness
or condition that has occurred in the five years before
taking out the policy will not be covered for a specified
period – usually two years – after the policy
is taken out.
This may well apply to any medical condition that occurs
as a result of a pre-existing condition so you should
always read the cover terms properly before purchasing
a policy
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