3 Private medical insurance Flashcards
How many people are covered by PMI in UK?
Almost 6.8m
How many people are covered by cash plans in UK?
3.4m
How many people are covered by dental insurance and capitation in UK?
3.4m
Revenue generated from healthcare insurance
£6bn
Purpose of PMI
Pay costs of secondary acute care received outside NHS
Acute condition
Likely to respond quickly to treatment to return you to full state of health
Chronic conidtion
- needs ongoing monitoring
- Needs ongoing relief of symptoms
- Requires rehab/training
- Continues indefinitely
- No known cure
- Comes back (or is likely to)
Does PMI pay fro chronic?
PMI usually pays for acute flare-ups of chronic conditions and their initial diagnosis
SoBP
Statement of Best Practice – regularly reviewed by ABI for sales of PMI
Rolling PMI
Benefits and premiums may be changed at x days notice – policy renewed each month
FCA requirements for renewal
- Disclose last year’s premium
- Encourage shopping around
- Further emphasise shopping around when renewed 4 or more times
Long-term insurance cancellation terms
- Failure to pay premiums
- Death
- Moving abroad
- Suspected fraud
- Insurer withdraws from market
Highest banded hospitals
– Usually NHS teaching hospitals
– Or private hospitals around London
What do hospital charges apply to?
- Accommodation and nursing
- Operating theatre
- Surgical drugs and dressings
- Prosthesis
- Day case treatment
- Comp meds
5 categories for determining procedure costs
- CMO
- Major plus
- Major
- Intermediate
- Minor
CCSD abbreviation
Clinical Coding and Schedule development
ISCs abbreviation
Industry Standard Codes
Advantages of CCSD
Can be updated as new technologies emerge and best practices change
Common outpatient benefits
- Pathology
- Radiology
- Physio
- Consultations
Major exposure to costs to insurers
- Hospital charges
- Specialist fees
Payment discounts definition
Discounts for paying annually or by direct debit
Earned discounts
Points accrued for adopting a healthy lifestyle
% of PMI market covered by co-paid
78%
4 main categories of personal PMI
- Comprehensive
- Mid range
- Basic
- International
Two types of basic policies
Four- or six-week policies and limited benefit policies
Four or six week policies
Covered where NHS list for treatment is 4 or more weeks – commences from the date specialist recommends treatment
Why were many six-week policies removed
- Hard to police
- Usage varied depending on NHS supply
Limited benefit policies
These restrict monetary amounts payable and/or frequency at which benefits are paid
Examples of restricting outpatient benefits
- Hospital cover
- Low financial limits
- Necessity
Medical savings plan
Savings plan used to fund some medical costs or large excess
Menu benefits
Allows member to choose which options to include or exclude
Small group scheme size
50 or less members
SME plans size
Up to 250 employees covered
Large plan size
250+ employees
Cost plus contracts
Insured pays for cost of claims in full, topping up any shortfalls.
Can you include budgeting contracts in cash plans?
No these are excluded – E.g, paying monthly for disposable contact lenses or a dental capitation scheme
Cash plan waiting periods
Usually an initial period (typically 3-6 months)
Dental insurance type of insurance
Annually renewable general insurance policy (subject to 12% IPT)
Capitation plan
- Initial examination places customer in risk group
- Fees paid monthly to the provider, who pays dentist
