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FAQs - Private Medical Insurance (PMI)

 

What is Private Medical Insurance?

Private Medical Insurance is designed to cover the cost of private medical treatment for "acute" conditions

What is an "acute" condition?

A disease illness or injury that is likely to respond quickly to treatment and returns you to your state of health that you were in before the disease, illness or injury, or which leads to a full recovery.

What will I be covered for?

Usually included are:

  • In-patient diagnostic tests and specialist consultations
  • Surgery as an in-patient or day patient
  • Hospital accommodation and nursing costs
  • Cover can include out-patient diagnostic tests, consultations and treatment with specialists.
  • Cover does not include GP services, chronic conditions and accident and emergency admissions

 

What is a "chronic" condition, and are these covered?

A chronic condition is a disease, illness or injury which has at least one of the following characteristics:

  • It continues indefinitely and has no known cure
  • You need to be rehabilitated, or specially trained to cope with it
  • It requires long term monitoring, consultations, check ups examinations or tests
  • It is permanent, and does not respond to treatment

  • Unfortunately treatment for "chronic" conditions are not covered, however an "acute" episode of a chronic condition may be covered.

 

How much will it cost?

This will depend on several factors including your age, the type of cover you require, if you are willing to accept an excess on the policy.

I have a pre-existing medical condition. Will this be covered?

It is possible the condition may be covered but unlikely. Generally insurers will exclude cover for pre-existing conditions.

If my pre-existing condition is not covered I may as well not apply?

Although your existing medical condition will probably be excluded if you suffer from any new unrelated conditions they would be included therefore Private Medical Insurance is still worth considering.

Will I need to provide evidence of health?

Yes, most insurers will ask you to complete a form detailing your medical history. If necessary they may write to your doctor for more information. Exclusions or special conditions to cover may apply as a result

 

If I don't want to supply evidence of health is there an alternative?

An alternative is the moratorium option as explained below.

A moratorium does not require your medical history details, instead you will not be covered for any medical condition which previously existed (usually) in the last 5 years. Cover for these conditions may be covered in the future providing it can be proved that you have not received treatment, tests or advice for these conditions for a continuous period ( usually 2 years ) after the policy has started.

How do I choose the right cover?

There are many types of cover and you need to seek expert advice. There are various types of cover including.

  • In-patient treatment (requires an overnight stay in hospital)
  • Day-patient (requires admitting into a hospital for treatment but no overnight stay)
  • Out-patient (gives treatment at a hospital consulting room or out patient clinic but are not admitted as an in/day patient)
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