Page 92 - IDF Journal 2023

92
IDF News – Spring 2023
Understanding Medical Insurance
Simon Cross
“I started in private general practice
in the summer of 1977, some months after completing Vocational Training, having been the first entrant onto what was the Westminster Medical School GP Training Scheme. I had spent a few months at the end of my training seeking a post in an NHS practice but, in that era, there were between 50 and 80 applicants for every partnership post and I was never successful, though always interviewed. How times have changed.
I went to a meeting with Leon
Screen, then the chief executive
at what was called the Family Practitioner Committee in Bishops Bridge Road W2, the hiring body
for family doctors. He advised me
to give up my ambitions for a while and consider a post as a salaried assistant, patronisingly advising me that some further experience would be worthwhile and discounting both my membership of two Royal Colleges and my years in the NHS hospital service. I walked away and never looked back.
Once I started, a familiar request in the consulting room was from patients seeking advice about healthcare insurance. In those days, there was very little to choose from and I had
no experience upon which to base any recommendation. It was the answer to a prayer when specialised broking arrived. Just as patients need a holding hand and an advocate to help and guide them wisely through the options available throughout the private sector, so we, as healthcare professionals, need and welcome the specialised advice for our patients to enable them to select correctly from the minefield of available insurance possibilities which has since emerged. Bravo”.
Dr Martin Scurr, GP and Founding IDF Member
Private Medical Insurance (PMI) and its complexity can sometimes be confusing. With so many variations of product and underwriting choice, it is imperative to ensure that you understand the small print. For a broker, with a varied choice of products, it is important to provide clients with the most suitable cover. During the initial discussion it is vital to understand and gain a clear, transparent picture of any medical conditions past or present.
Asking 5 simple medical history questions informs us of the ideal providers to approach and with direct access to
the underwriters, we can obtain clear information on exclusions and review timelines for lifting those exclusions where possible.
Underwriting
This is where a broker should earn their worth, to ensure that the correct cover is obtained.
Relationships between brokers and the provider underwriters are important, allowing pre-existing conditions to be discussed for clarification on timelines of eligible cover, which is crucial.
The three main areas of underwriting can be broken down as follows:
Full medical underwriting (FMU)
With full disclosure of any current or past health conditions, underwriters then assess and confirm in writing exclusions (if any) and the time frame for when they could be reviewable.
Acute conditions, for example cruciate ligament last treated 4/5years ago, would be eligible for cover immediately with most providers.
An acute episode in the 2 years prior
to joining, would generally be excluded for up to 2 years. Then, a GP report confirming no advice or treatment during the 2-year period of membership will generally see the exclusion lifted.
Chronic conditions, such as heart disease or diabetes, would be excluded permanently. However, high blood pressure or high cholesterol which is controlled on medication (not more than 2 drugs), without any associated heart conditions and treated at GP level, would
again generally be covered by most providers with no exclusions.
WHY FMU?
FMU offers more transparency from the outset, is designed for virgin members, is occasionally less costly, and may cover some conditions that moratorium underwriting excludes.
Moratorium
Moratorium underwriting is the most straightforward option, as there are no medical questions, just a statement which needs to be understood.
‘Any medical conditions or symptoms that you have had in the last 5 years, will be excluded for at least 2 years. After 2 years, if you have been symptom and treatment free, that condition will become eligible for treatment’
It is important to note what the provider considers treatment includes advice, medication, and tests.
Why Moratorium?
Moratorium offers a window of opportunity to have pre-existing conditions covered. For example, someone who had a hip replacement 3 years ago, joins today and then goes 2 years treatment and symptom free will then be eligible for treatment for that condition.
Switch/continued personal medical exclusions
Switch/continued personal medical exclusions (CPME) is underwriting for individuals who already have existing cover and who wish to move to another provider with pre-existing conditions covered. It is subject to 3 or 4 questions.
Most providers will ask:
1. In the last 5 years, have you had any
treatment for heart, stroke, cancer,
diabetes or mental illness?
2. In the last 12 months, have you seen
a specialist or had any hospital test or
treatment?
3. Do you have any treatment planned or
pending?
4. How many claims have you had in the last 5 years?