Health insurance is planned to submit 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 appreciated the treatments and situations that fall outside the scope of the cover.

But first a word of warning. This report performs not relate to any specific policy and the terms and conditions issued by individual insurance companies do vary. So please ensure you also check your insurance policy documents. After reading that article, you’ll know what to look out for!

Sorry – it is a chronic condition

If a condition can be cured and is not a long-term trouble, your insurance organization will classify it as acute and should balance the cost. If your trouble is incurable or it is a problem that, despite appropriate treatment, will be able to be in you for a endless time, then your insurance company will classify it as chronic – and no, you won’t be treated.

But drawing a firm line between how is acute and how is chronic is fraught with troubles, and leads to the top neighborhood of conflict between insurer and policyholder.

Everyone agrees that diabetes and asthma are chronic conditions as you’re likely to suffer from them for the rest of your life. So those kinds of condition are not treated.

troubles arise when the medical team initially considers a patients’ illness to be curable, but the condition subsequently deteriorates and the doctors change such a mind, it’s now become incurable. This can happen specially in the service of some types of cancer.

In these conditions, the condition is initially defined as acute and is therefore insured, but degenerates and gets chronic – and outside the terms of cover. This is possible as insurance companies keep the right to reclassify a condition from acute to chronic during intervention.

Sorry – it’s too long term
The insurance organization will not pay out for long term treatment. But you need to check your insurance policy documents to see how they define “long-term”. You can come to find the situation where a course of drugs extends for say 12 months, but the insurance company will clearly pay for ten months.

Sorry – it’s preventative
Your insurance policy is projected to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are exhausted to prevent an illness.

Again, the challenges of definition arises. Sometimes it is arguable whether a care is preventative or a cure. Take the drug Herceptin for example. This drug can be employed in the the beginning of stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer coming back 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?

policy societies are split on the debate. Norwich Union, WPA, BUPA and Standard lifespan Healthcare serves to 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 policy are: to jump the queues at the NHS, and to get the newly drafted treatments and drugs. But there is 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 insurance company is unlikely to approve its use. The question is that the Institute’s brief is not simply to find out whether a drug works, but to carry out a cost/benefit analysis to secure 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.

The compromise hit on by the Financial Ombudsman is this if a health policy won’t pay for the use of experimental treatments, then it ought to meet the cost of an ratified conventional intervention provided the policyholder footing the bill for the balance if the experimental treatment is a greater amount of expensive.

Sorry – it is a existent transaction

The basic principle is that if you are already suffering from a condition when you start on a policy, then that state of affairs “pre-exists” the insurance policy and any says for its service are invalid.

For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to insure you. After all they need a simple picture of your medical understanding before they quote. For many applications, the insurance company will, providing your approval, also write to your GP for a small amount of details of your medical history. They like to own a complete picture.

So lets say There are those years ago you injured your knee fiddling football. It appeared to recover but now it turns out that you have a torn cartilage and need an operation. The insurer could argue such a now is a pre-existing order and you have to pay for its’ intervention.

Some insurance companies try to accommodate such white areas with a moratorium provision within your policy. These provisions typically say overly so extended as you have been heard symptom free for two years relating to any condition you’ve suffered from within the last 5 years, then they will pay for subsequent intervention. Not all policies have these moratorium provisions and the time periods do fluctuate between insurance companies. You should carefully study your insurance.

Sorry – its not treated

Health insurance is an annual contract – clearly like your car policy. So when it comes to renewal, your insurer is at liberty to review not clearly your premium but moreover change the conditions on which your cover is provided.

Therefore, if your policy comes up for renewal mid way within a course of intervention, it is possible to find that your new insurance no longer covers that particular treatment. This spells that you will undergo to lower end the plan for the meet of the intervention.

Furthermore, through regular advances in medical research, more and a greater number of circumstances are turning out treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.

This hits the insurance companies’ pocket in two ways. With more conditions making reclassified as acute, the number of reports is raising. And there is also a trend for new treatments to lose more – Herceptin being a good example. The net result is this the insurance companies are finding themselves having to pay out far more. This is inevitably passed returning to you through increased renewal premiums. And in an attempt to influence this possibility exposure, insurance companies have a trend to tweak their definitions and exclusions. This implies that you must looked at your renewal find out closely before you decide to renew.

So when you are planning to Health policy, be aware that anything and everything is not constantly brown and white. And if you have got insurance insurance policy and need treatment, constantly contact your insurance company without delay and get them to confirm that your intervention is indeed covered

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