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Common Questions about Health Insurance

Below is a list of common questions that our customers ask about policies recommended by Usay Health Insurance.

Will I be covered for pre-existing medical conditions?

Cover for pre-existing medical conditions differs from provider to provider so it is important to speak to one of our fully trained advisers by getting a quote via the form on the right. Some providers will offer customers the opportunity to be covered for pre-existing conditions. In most cases, the way in which your policy was underwritten eg, moratorium underwriting (LINK to glossary) or Full Medical Underwriting (LINK to glossary), will affect whether you can be covered for pre-existing medical conditions.

What conditions will I not be covered for?

In most cases, the following conditions/treatments will not be covered by private medical insurance but check with one of our fully trained advisers as cover differs from policy to policy.

alcohol abuse
IVF treatment
birth control eg, a vasectomy
cosmetic surgery (for vanity purposes)
deafness (caused by old age)
end-stage or chronic kidney failure treatment
gender reassignment
self-inflicted injuries eg, attempted suicide
STDs, HIV & AIDS

What are the differences between primary, secondary and tertiary care?

Primary care includes your local GP, A&E, dentist, opticians and ambulances. These services are operated by the NHS and they will be your first point of contact whether it is an emergency or not.

Secondary care is where the real value of having private medical cover lies. For example, if your GP was to see you first, they can refer you on to a specialist in a private hospital. Here you get all the benefits of private healthcare, particularly the benefit of choosing where and when to be seen, as well as by whom.

Tertiary care refers to being treated in a specialist hospital within the insurer’s network of private hospitals. For example, if you need treatment on your knee, you may be treated at a hospital with a good reputation for knee surgery.

What are chronic conditions?

Chronic conditions are those which are either indefinite, can resurface after a period of time and/or have no known cure, such as asthma, diabetes and arthritis. If the condition is not excluded from cover in the first instance, most policies may offer cover for acute flare-ups of these chronic conditions.

What are pre-existing medical conditions?

Pre-existing medical conditions are conditions that the customer has or has previously had, before the policy start date. These may include disability, illness and injuries.

What is moratorium underwriting and full medical underwriting (FMU)?

Moratorium (5,2,2) is a type of underwriting which is often referred to as underwriting at the point of claim. When setting up your private medical insurance policy, you will not have to disclose any pre-existing medical conditions. However, any pre-existing conditions are not covered for the first 2 years of the policy. A pre-existing condition is any condition for which you have had ‘symptoms’, ‘treatment’ or ‘advice’ on during the last 5 years. After the first 2 years of the policy any of your pre-existing conditions may be covered, provided that you have had no 'symptoms', 'treatment' or 'advice' during that period. If you have had 'symptoms', 'treatment' or 'advice' then your moratorium will continue for a further 2 years (for that condition) before being eligible for cover. The benefit of this form of underwriting is that it does not permanently exclude pre-existing conditions from cover, and there is no medical declaration to complete.

Full Medical Underwriting (FMU) requires you to disclose information about your medical history. The benefit that comes with FMU is the peace of mind that you definitely know what you will and won’t be covered for; it’s there in black and white.

What are the differences between outpatient, day patient and inpatient?

The term outpatient can refer to a private consultation with a specialist. The consultant will be able to diagnose your condition prior to hospital admission (should you require this). Another example of outpatient treatment may be private physiotherapy sessions.

Day patient describes your status if you need a simple operation/procedure/test that can be performed without an overnight stay in hospital. This is often referred to as ‘day surgery’ or ‘day case’.

Inpatient refers to a stay in hospital of one night or more. This is common for conditions that warrant more complicated operations/procedures or monitoring of a patient.

If I become ill, can I go directly to a private hospital?

No. In all instances you should use primary care services as your first point of contact. These include your local GP and A&E. After being treated with the support of these services, further diagnosis and/or treatment will subsequently take place in a private hospital, provided your condition and treatment option is covered by your policy.

Will my family’s medical history affect my premium?

No. When taking details of medical history we only focus on the individual customer, not conditions that could be prevalent in a family such as breast cancer or heart disease, unless you are already diagnosed, have had symptoms and or treatment on these conditions.

Will I be covered for dental and/or optical treatment?

Both dental and optical cover are available as added extras on some policies.

Will I be covered for complications during pregnancy?

Although treatment for routine pregnancy is not usually covered, many private medical insurance providers cover complications during pregnancy and childbirth. In some cases there may be a qualifying period before a claim can be made.

How does No Claims Discount work in health insurance?

No Claims Discount (NCD) works differently in health insurance compared to most other types of insurance, particularly as customers can begin their policy with a high level of discount. Any claims made on the policy will lower the rate of NCD. It is possible to protect your NCD on some policies, even if you claim.

What is the ‘cooling off’ period?

If a customer wants to cancel a policy and claim a full refund, it must be cancelled within the cooling off period. The cooling off period is a regulation brought in by the FSA (LINK) which is usually set at 14, 21 or 30 days but depends on the provider.

Will I be covered abroad?

This tends to differ from provider to provider. For example, some of the Aviva and General & Medical policies can provide some cover for emergency inpatient or day patient treatment when a customer is overseas; IMG policies allow customers to be treated anywhere in the world, depending on their specified region of cover (Europe; worldwide; worldwide inc. USA and Canada). To find out more, have a chat with one of our fully-trained, impartial advisers by filling out the form to your right.

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Common Questions about Health Insurance

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