Frequently Asked Questions about Medical Insurance

Frequently Asked Questions (1) What conditions are usually not included in medical insurance?
Almost all policies will not cover chronic conditions (e.g., asthma, diabetes, hepatitis). And based on your medical history, they will also define the pre-existing conditions that they will not include in their coverage.
Most policies will also rule out drug abuse, self-inflicted injuries, and injuries caused by 'hazardous pursuits' (dangerous hobbies which one consciously engaged in knowing the risks). Voluntary treatment like gender reassignment and cosmetic surgery is not included, and neither is pregnancy- or infertility-related tests and treatments.
Very few insurance policies will pay for experimental drugs or procedures, organ transplants, kidney dialysis, and HIV/Aids.
What if I have a chronic condition, but haven't experienced symptoms for several years?
Some insurance companies will allow delayed coverage, meaning they will set a waiting period from the time your policy takes effect (typically two years) before they will reimburse any tests or treatments related to that condition. However, this does not apply to conditions which need regular preventive treatment.
Will having a disability affect my medical insurance coverage?
You will not be refused insurance because you are disabled, but your disability will be treated like a pre-existing condition and any tests or treatments related to it will not be included in the coverage. For more specific guidelines, call the Association of British Insurers at 020 7600 3333 for the information sheet, 'Insurance for disabled people'.
How can I lower my premiums?
You can lower your premiums by limiting your coverage and paying the excess. Another option is to receive treatment from accredited hospitals (ask your insurance provider for the list), and downgrading hospital accommodation. You can also ask your insurance agent to tailor-fit a package for you, by combining different insurance packages, removing items which you don't need or at low-risk for, and attaching insurance riders to cover what's important. While premiums may not necessarily be lower, they are cost-effective in the sense that you are paying for exactly what you want and need.
What if I choose to cancel my policy?
Some insurance companies will set a maximum number of weeks or months after the start of the policy in which you can cancel it and still get a refund. Others will offer limited refund. It is always best to change insurance providers at the end of a policy year, rather than abruptly canceling it and losing the benefits which you had already begun paying for.
What factors can cause an increase in premiums?
Some of the economic factors that will cause an increase across-the-board are the rising costs of private medical treatment, medicines, and tests.
However, you may be asked to pay a higher premium if you are older (because of the increased risks for illness and injury), or if your medical history reveals you are at high risk (e.g., high-stress or very hazardous job, smoking, previous heart attack or stroke, etc.).
What is the process of making a claim?
If it is not an emergency situation, call your insurance company to clarify if the test or treatment is included in your coverage. You and your general practitioner will be asked to submit a claim form, which will be provided by the insurance company. If you are being referred to a specialist, or are required to take tests or check into the hospital, you may need a letter of endorsement from your general practitioner.
Some doctors will charge a small fee that will not be reimbursed by the insurance provider. You will also have to pay for tests or treatments you chose to include as excess.