June 04th, 2013

Author - Mark Tomlinson

Private Medical Insurance – Blogpost 1 – An Overview

I came into the world of Private Medical Insurance (PMI) after benefitting from my own personal cover that I had several years back when I was working in ‘Corporate World’ for Lloyds TSB. At that time, I was coaching children’s rugby and football and was impressed with how quickly I was fit again to return to coaching after I had developed a groin pain/strain which I later found out to be a ‘Gilmore’s Groin’ (or ‘Sportsman’s Hernia’) – I had anticipated several months’ absence (for a Consultation, Scan & Bi-Lateral Keyhole Surgery), but my PMI saw me diagnosed and operated upon pretty much inside a week or two maximum and I was back coaching very quickly, following a short recovery period. Indeed as it was at the back end of the summer, I didn’t really miss hardly any of the new season.

Without this personal experience, I would not have even considered working in the field of Private Health Insurance (don’t be confused – an interchangeable term for PMI) when I left my role as a Senior Manager in Lloyds TSB on Voluntary Redundancy in June 2010 after 27 years in banking (TSB from ’83 to ‘95, then LTSB – and a whole host of roles, from Branch Manager to various Head Office positions).

And this mirrors my experience since then – most of my Customers that are ex-Corporate have had PMI previously through their employment and, generally, understand the benefits – and have often experienced them first hand previously (or at least within their family). However, many people that haven’t had PMI previously do not have the same understanding (quite understandably) of ‘Why’ they should want to pay for something that, to a greater or lesser extent, they can enjoy for free on the National Health Service (NHS).

Consequently, when asked to write an occasional article for CAP Business Club, I thought I would look to try to provide a series of brief articles that can help to inform on the general principles (and benefits) of PMI.  These articles will not be written from a specific WPA perspective, but will look to inform more generally – although for legal/compliance purposes, I should point out that I am a Director of CHG Solutions Ltd, which is an Appointed Representative of WPA, and I can therefore only provide advice on WPA policies.

So – to start – PMI is just that – Private Medical Insurance. It is an insurance policy whose main benefits are the ability to access Private Medical services (whether diagnosis or treatment) when needed for illness or, sometimes, injury. It is generally taken out either by an individual or family – or by a company to cover their employees (and maybe their employees’ families). These two sources of cover (private or company) will generally be broadly similar, but will typically differ a little in the way they are structured and accessed. One of the major positives of PMI though, from either source, is flexibility – i.e. the range of different cover levels available, designed to meet the needs of different Customers, along with variables such as types of treatment that are included, any financial limits, any limitations on where treatment can be provided and any contribution required from the Policyholder (whether by way of an ‘excess’ or some form of ‘co-payment’ – I’ll expand on these in a future post). These factors all ensure a very broad range of costs from ‘not very much’, to ‘blimey that’s a fair amount’.

As with all insurance, as well as the summary (typically a brochure, or ‘Key Facts’ sheet) there will be a policy guide.  This includes the full Terms & Conditions. These are not (generally) designed to catch Customers out, and so they should not be indecipherable.  They are important as they aim, as far as possible, to give clarity on the exact scope of the cover in any given circumstances – to reduce the likelihood of dispute if circumstances arise where the extent of cover could be unclear. If/when you take out PMI it is definitely worth investing 30-60 minutes to become reasonably familiar with the Policy Guide.

Well – that’s it for now (I have to collect my son from his friends) – but next time, I’ll try to go into a little more depth on the specifics of what PMI is designed to cover.  In the meantime, don’t forget – ‘PMI – putting you in hospital quickly’.