3 Private medical insurance

Question 1

How many people are covered by PMI in UK?

Answer 1

Almost 6.8m

Question 2

How many people are covered by cash plans in UK?

Answer 2

3.4m

Question 3

How many people are covered by dental insurance and capitation in UK?

Answer 3

3.4m

Question 4

Revenue generated from healthcare insurance

Answer 4

£6bn

Question 5

Purpose of PMI

Answer 5

Pay costs of secondary acute care received outside NHS

Question 6

Acute condition

Answer 6

Likely to respond quickly to treatment to return you to full state of health

Question 7

Chronic conidtion

Answer 7

1. needs ongoing monitoring
2. Needs ongoing relief of symptoms
3. Requires rehab/training
4. Continues indefinitely
5. No known cure
6. Comes back (or is likely to)

Question 8

Does PMI pay fro chronic?

Answer 8

PMI usually pays for acute flare-ups of chronic conditions and their initial diagnosis

Question 9

SoBP

Answer 9

Statement of Best Practice – regularly reviewed by ABI for sales of PMI

Question 10

Rolling PMI

Answer 10

Benefits and premiums may be changed at x days notice – policy renewed each month

Question 11

FCA requirements for renewal

Answer 11

1. Disclose last year’s premium
2. Encourage shopping around
3. Further emphasise shopping around when renewed 4 or more times

Question 12

Long-term insurance cancellation terms

Answer 12

1. Failure to pay premiums
2. Death
3. Moving abroad
4. Suspected fraud
5. Insurer withdraws from market

Question 13

Highest banded hospitals

Answer 13

– Usually NHS teaching hospitals
– Or private hospitals around London

Question 14

What do hospital charges apply to?

Answer 14

1. Accommodation and nursing
2. Operating theatre
3. Surgical drugs and dressings
4. Prosthesis
5. Day case treatment
6. Comp meds

Question 15

5 categories for determining procedure costs

Answer 15

1. CMO
2. Major plus
3. Major
4. Intermediate
5. Minor

Question 16

CCSD abbreviation

Answer 16

Clinical Coding and Schedule development

Question 17

ISCs abbreviation

Answer 17

Industry Standard Codes

Question 18

Advantages of CCSD

Answer 18

Can be updated as new technologies emerge and best practices change

Question 19

Common outpatient benefits

Answer 19

1. Pathology
2. Radiology
3. Physio
4. Consultations

Question 20

Major exposure to costs to insurers

Answer 20

1. Hospital charges
2. Specialist fees

Question 21

Payment discounts definition

Answer 21

Discounts for paying annually or by direct debit

Question 22

Earned discounts

Answer 22

Points accrued for adopting a healthy lifestyle

Question 23

% of PMI market covered by co-paid

Answer 23

78%

Question 24

4 main categories of personal PMI

Answer 24

1. Comprehensive
2. Mid range
3. Basic
4. International

Question 25

Two types of basic policies

Answer 25

Four- or six-week policies and limited benefit policies

Question 26

Four or six week policies

Answer 26

Covered where NHS list for treatment is 4 or more weeks – commences from the date specialist recommends treatment

Question 27

Why were many six-week policies removed

Answer 27

1. Hard to police 2. Usage varied depending on NHS supply

Question 28

Limited benefit policies

Answer 28

These restrict monetary amounts payable and/or frequency at which benefits are paid

Question 29

Examples of restricting outpatient benefits

Answer 29

1. Hospital cover 2. Low financial limits 3. Necessity

Question 30

Medical savings plan

Answer 30

Savings plan used to fund some medical costs or large excess

Question 31

Menu benefits

Answer 31

Allows member to choose which options to include or exclude

Question 32

Small group scheme size

Answer 32

50 or less members

Question 33

SME plans size

Answer 33

Up to 250 employees covered

Question 34

Large plan size

Answer 34

250+ employees

Question 35

Cost plus contracts

Answer 35

Insured pays for cost of claims in full, topping up any shortfalls.

Question 36

Can you include budgeting contracts in cash plans?

Answer 36

No these are excluded – E.g, paying monthly for disposable contact lenses or a dental capitation scheme

Question 37

Cash plan waiting periods

Answer 37

Usually an initial period (typically 3-6 months)

Question 38

Dental insurance type of insurance

Answer 38

Annually renewable general insurance policy (subject to 12% IPT)

Question 39

Capitation plan

Answer 39

1. Initial examination places customer in risk group 2. Fees paid monthly to the provider, who pays dentist