Summary

If you are considering buying Health Insurance read this article. "Sorry - youre not covered" are the words policyholders dread. But it does happen. Do your homework and find out why. An understanding of the pitfalls may help you select the right policy.

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Author: Michael Challinerthe majority being covered through their employers. The problem is that few have really studied their policy documents and many misunderstand what is covered. And perhaps just as important, what isnt. If you expect health insurance to pay all your health costs, youre mistaken.

Health insurance is designed to provide protection for curable, short-term health problems and allow policyholders to jump the NHS queues to see consultants, be diagnosed, receive surgery or be treated. That sounds fine, but before you buy you need to appreciate the treatments and situations that fall outside the scope of the cover.

But first a word of warning. This article does not relate to any specific policy and the terms and conditions issued by individual insurers do vary. So please ensure you also check your policy documents. After reading this article, youll know what to look out for!

Sorry - its a chronic condition (car insurance )

If a condition can be cured and is not a long-term problem, your insurance company will classify it as acute and should meet the cost. If your problem is incurable or its ( pet insurance ) a problem that, despite appropriate treatment, will be with you for a long time, then your insurance company will classify it as chronic - and no, you wont be covered.

But drawing a firm line between what is acute and what is chronic is fraught with problems, and leads to the biggest area of conflict between insurer and policyholder.

Everyone agrees that diabetes and asthma are chronic conditions as youre likely to suffer from them for the rest of your life. So those sorts of condition are not covered.

Problems arise when the medical team initially considers a patients illness to be ( car insurance quotes ) curable, but the condition subsequently deteriorates and the doctors change their mind, its now become incurable. This can happen especially in the treatment of some types of cancer. (loans)

In these circumstances, the condition is initially defined as acute ( secured loans ) and is therefore insured, but deteriorates and becomes chronic - and outside the terms of cover. This is possible as insurers retain the right to reclassify a condition from acute to chronic during treatment.

Sorry - its too long term
The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define "long-term". You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.

Sorry - its preventative
Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.

Again, the problem of definition arises. Sometimes it is arguable whether ( home insurance quotes ) a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be used in the early stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer returning for women who have a particularly virulent form of the cancer known as HER2. In this situation, is Herceptin offering a cure or is it a preventative? (home insurance)

Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Healthcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.

Sorry - the drug is not approved
Two of the main attractions for taking out health insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But theres a rider.

Unless the drug has been approved for use by the NHS in England and Wales, by the Institute for Health and Clinical Excellence, your insurer is unlikely to approve its use. The problem is that the Institutes brief is not simply to decide whether a drug works, but to carry out a cost/benefit analysis to ensure that the benefits to the nation outweigh the financial costs of using it in the NHS. Not an easy brief - and one that has placed the Institute under scrutiny for the extended delays in drug approval. (car insurance cover)

The compromise hit on by the Financial Ombudsman is that if a health policy wont pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treatment is more expensive.

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