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IF7 > 3 Private medical insurance > Flashcards

3 Private medical insurance Flashcards

1
Q

How many people are covered by PMI in UK?

A

Almost 6.8m

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2
Q

How many people are covered by cash plans in UK?

A

3.4m

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3
Q

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

A

3.4m

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4
Q

Revenue generated from healthcare insurance

A

£6bn

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5
Q

Purpose of PMI

A

Pay costs of secondary acute care received outside NHS

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6
Q

Acute condition

A

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

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7
Q

Chronic conidtion

A
  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)
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8
Q

Does PMI pay fro chronic?

A

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

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9
Q

SoBP

A

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

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10
Q

Rolling PMI

A

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

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11
Q

FCA requirements for renewal

A
  1. Disclose last year’s premium
  2. Encourage shopping around
  3. Further emphasise shopping around when renewed 4 or more times
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12
Q

Long-term insurance cancellation terms

A
  1. Failure to pay premiums
  2. Death
  3. Moving abroad
  4. Suspected fraud
  5. Insurer withdraws from market
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13
Q

Highest banded hospitals

A

– Usually NHS teaching hospitals
– Or private hospitals around London

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14
Q

What do hospital charges apply to?

A
  1. Accommodation and nursing
  2. Operating theatre
  3. Surgical drugs and dressings
  4. Prosthesis
  5. Day case treatment
  6. Comp meds
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15
Q

5 categories for determining procedure costs

A
  1. CMO
  2. Major plus
  3. Major
  4. Intermediate
  5. Minor
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16
Q

CCSD abbreviation

A

Clinical Coding and Schedule development

17
Q

ISCs abbreviation

A

Industry Standard Codes

18
Q

Advantages of CCSD

A

Can be updated as new technologies emerge and best practices change

19
Q

Common outpatient benefits

A
  1. Pathology
  2. Radiology
  3. Physio
  4. Consultations
20
Q

Major exposure to costs to insurers

A
  1. Hospital charges
  2. Specialist fees
21
Q

Payment discounts definition

A

Discounts for paying annually or by direct debit

22
Q

Earned discounts

A

Points accrued for adopting a healthy lifestyle

23
Q

% of PMI market covered by co-paid

A

78%

24
Q

4 main categories of personal PMI

A
  1. Comprehensive
  2. Mid range
  3. Basic
  4. International
25
Q

Two types of basic policies

A

Four- or six-week policies and limited benefit policies

26
Q

Four or six week policies

A

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

27
Q

Why were many six-week policies removed

A
  1. Hard to police
  2. Usage varied depending on NHS supply
28
Q

Limited benefit policies

A

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

29
Q

Examples of restricting outpatient benefits

A
  1. Hospital cover
  2. Low financial limits
  3. Necessity
30
Q

Medical savings plan

A

Savings plan used to fund some medical costs or large excess

31
Q

Menu benefits

A

Allows member to choose which options to include or exclude

32
Q

Small group scheme size

A

50 or less members

33
Q

SME plans size

A

Up to 250 employees covered

34
Q

Large plan size

A

250+ employees

35
Q

Cost plus contracts

A

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

36
Q

Can you include budgeting contracts in cash plans?

A

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

37
Q

Cash plan waiting periods

A

Usually an initial period (typically 3-6 months)

38
Q

Dental insurance type of insurance

A

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

39
Q

Capitation plan

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

IF7 (11 decks)

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