Health Insurance FAQ’s
A health policy may carry a compulsory excess or you can choose to have a voluntary excess which will give a discount on the premium. A policy excess means that any claim monies due to you will only be paid once you have reached the excess level of your plan. The excess is normally annual and is applied to the first valid claim the insurer receives in the policy year. If your treatment carries over into a new policy year then the excess will apply again for that year. Be aware when choosing a policy that a few insurers apply an excess for every medical condition rather than on an annual basis.
This is time you need to wait, after the start date of your policy, before you can claim. Pregnancy always carries a waiting time varying from 10 to 24 months. It is quite common for the Spanish and Portuguese insurers that apply waiting periods. For example: Victoria Seguros have a 2 month waiting period (except accidents) and a 12 month waiting period for some medical conditions.
This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the starting date of the policy. Exclusions for a pre-existing condition may be applied to the policy, depending whether the condition is on-going and the type and severity of the condition.
Medical insurance policies are designed to treat acute medical conditions, which is defined as sudden in onset and of short duration. A chronic condition is a disease, illness or injury that needs on-going or long-term treatment and monitoring through doctor consultations, examinations, check ups and/or tests, continues indefinitely and has no known cure.
Most standard policies exclude chronic conditions once the initial diagnosis has been made. They will cover all the investigations or tests leading up to diagnosis and any initial treatment to stabilise the condition, but not long-term treatment. Should you have an acute attack of a chronic condition then it is normal that the insurer will pay for further treatment until the condition is once again stabilised.
For example, asthma would be regarded as a chronic condition, however an acute asthma attack needing specialist or hospital treatment would be covered on the policy until the condition is stable once again.
Private Medical Insurance companies have 3 different types of underwriting for individuals:
- Full Medical Underwriting
- Continuing Personal Medical Exclusions (CPME) also known as Switch
Full Medical Underwriting
You will be asked to complete a medical questionnaire and to declare conditions that you have had previously or had, for example, in the previous 5 years. You will need to declare any medication that you are taking or any treatment that you are currently undergoing.
You will not be asked about any medical history but instead the insurer will not cover any medical conditions which existed in the last (usually) 5 years. However, after a continuous period of two years these conditions will be eligible for cover but only if you have not had symptoms, received treatment, taken medication, had tests and advice from your GP or Specialist.
CPME or Switch
If you transfer from one insurer to another, with no break in cover, you may be considered for cover on a Switch basis, whereby the new insurer takes you on with the same underwriting as on your old policy. This means if you have specific exclusions on your old policy then the new policy will also have these exclusions. Generally, you need to have had a year without hospital or specialist treatment and not to have had cancer or heart condition to be eligible.