PMI

Question 1

What is PMI

Answer 1

annually renewable policy

Question 2

Dos not cover chronic conditions

Answer 2

like Asthma

Question 3

Acute Condition v Chronic Condition

Answer 3

a disease, illness or injury likely to respond to treatment

chronic needs long term monitoring incurable

Question 4

PMI Benefits

Answer 4

1 access to medical and surgical treatment
2 get private hospital of your choice
3 convenience
4 avoids waiting for treatment
5 Access to a Private Room
6 Ability choose consultant of your choice
7 Peace of mind - access to medical attention
8 speed

Question 5

Types of Cover

Answer 5

Personal or

Corporate

Question 6

Personal Products

Answer 6

Can be single, married or family
Can be paid annual, quarterly or monthly
Some insurer offer total healthcare packages
Some policies are age restricted
Range - Comp, Std, Budget, Senior and International

Question 7

Corporate

Answer 7

May have different categories of cover

Question 8

Large Group Schemes

Answer 8

Cover 50+ members
Usually include pre existing conditions
premiums calc to group claim history

Question 9

Small Group Schemes

Answer 9

less than 50 members
underwritten and administered as individual plans
Discount will be given on size of group and claim history
Pre existing conditions excluded
Less Flexible to large schemes

Question 10

Core Benefits

Answer 10

Care benefits as follows:
Hospital Charges - benefit prov for paying hospital charges in respect of in patient and day case. Includes accommodation, theatre fees, diagnotics (x rays etc), drugs and dressings and prostheses

Most products do not cover non medical costs eg meals, tel calls
Most providers Band Hospitals
Within one hospital

Question 11

Surgeon and Anaesthetist for surgical procs

Answer 11

some insurers classify complexities
Minor  removal of a skin Lesion
Intermediate - removal an impacted tooth
major hysterectomy
Major plus total hip replacement
Complex major eg heart surgury

Question 12

Other benefits

Answer 12

Physicians fees
Outpatient Charges eg consulations, MRI, Physio
Cancer not usually a core benefit

Question 13

Flexible Benefit Packages

Answer 13

Allow customise benefits

eg nomination of hospitals, overseas cover, employee assistance programmes

Question 14

Flex Schems

Answer 14

include PMI, Life Assuranc, IRP, Health Cash Plans

Question 15

taxation of PMI schemes

Answer 15

Personal Schemes - no tax relief and premiums subject to IPT (10% from 1/10/16), benefits tax free

Corporate Group Schemes - If cost met by employer treated as P11d, benefits tax free

Question 16

Underwriting

Answer 16

Principles
1 use standard exclusions
2 Moratoria underwriting
3 declared medical history

Question 17

Standard Exclusions

Answer 17

generally include
pre existing conditions
Pregnancy or child birth
HIV, AIDS
Alcohol or solvent abuse
cosmetic
war, invasion
private GP treatment

Question 18

Moratoria Underwriting

Answer 18

often referred to as point of claim underwriting

Question 19

Underwriting for Corporate Business

Answer 19

Normally all employees of categorised by age, employee status and length of service.

Question 20

Small Schemes

Answer 20

risk in managed by price according to claim history of all employees. Additional factors:
No of eligible employees
type of industry
geography
occupations

May offer no worse terms
Before offering term underwriters will investigate:
size of scheme
when last underwritten
loss ratio with existing insurer
cover has changed
Category of employees

Question 21

Premium Loading

Answer 21

products so pre existing conditions are incorporated. Maybe necessary to get more info from GP. Calcs include
smoking
occupation
weight and height
alcohol consumption
exercise plan

Question 22

Claims

Answer 22

Before claim procedure
1 Most insist check before claiming
2 Normally Gp or specialist complete claim form
3 member will be advised how claim will be paid

Question 23

Managed Care

Answer 23

Insurer intervenes in decision surrounding care, maybe in differ ways
Pre Authorisation - prior to admission
Case Management - high cost of complex treatments
Concurrent Review check the on-going need