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Hospital Treatment Plans

Personal Plans - Medical Insurance (PMI)

Hospital Treatment Plans

This is a slightly different approach than traditional medical insurance, but ultimately these type of plans can provide an equal amount of reassurance but without the price tag associated to traditional medical insurance.

Hospital Treatment Plans have for many years been used throughout the world as an alternative to traditional medical insurance. Largely, used by groups to provide cost effect healthcare cover for commonly claimed conditions, they have now started to forge a name for themselves in the UK market.

Within the UK healthcare market, Hospital Cash Plans are filing a gap between general cash plans and low cost medical insurance. These plans are also freely available to groups of all sizes, individuals and families alike.

So what is a Hospital Treatment Plan?

Quite simply, the policy works on a similar basis to medical insurance in that when you join, you are taken on an underwritten basis; either a moratorium or a full medical declaration. You may even have a policy benefit table which looks similar to that of a medical insurance contract; however the difference becomes more noticeable at the point of using the policy (claiming).

Instead of you receiving treatment at a hospital and your insurer dealing exclusively with the hospital, you, the patient are able to participate in this process. The core principle of a HTP is that the insurer releases the funds to you – and you can then purchase your own treatment directly.

Although this may sound daunting; in the majority of cases it is not, and can be financially beneficial to the member. This approach enables the member (you) to make some important decisions about your treatment;

Where you have treatment – you can even choose to go overseas for treatment if more competitively priced…

Cheaper procedure costs – many hospitals prefer to take ‘self-pay’ patients as it removes a layer of bureaucracy and means improved cash -flow for the hospital.

Awareness of costs – by taking a practical role in your treatment, you will be fully aware of all the costs involved, and able to bypass any superfluous expenses.

In most cases, the benefit paid will exceed the cost of the procedure. You are able to retain the balance of this saving which is yours to do as you please (tax free).
From the insurer’s perspective, they are better able to manage their expenses as they will be issuing a fixed benefit rather than the usual ‘pay as incurred’ approach. This saves money in both policy administration and claims.

How much benefit would I receive?

To ensure that your policy is able to meet your needs, the insurer determines the value of a claim by referencing the procedure against national OPCS codes. In the majority of cases the benefit allocated to each code will be slightly higher than the OPCS reference to allow for hidden costs (drugs & dressings etc). This system is used by most insurers and even the NHS to benchmark procedure costs.

Once the benefit has been determined, and the claim authorised; the money will be released to your bank account for you to do as you feel appropriate. Needless to say, you could choose to keep the money and receive treatment under the NHS; however the core objective of health insurance is to provide swift and timely treatment at a place of your choosing.

As you have paid an Insurance Premium Tax on the premium you pay, the benefit you receive is treated as tax free.

Who is a Hospital Treatment Plan suitable for?

They are ideally suited to group schemes of all sizes who wish to provide a valuable benefit to their staff but without the burden of traditional medical insurance. In some cases, as a group you can set up schemes that cover only the key areas where you are most likely to experience waiting lists under the
NHS – at a remarkably low premium.

Additionally, they are equally affective for Individuals and Family’s of all ages as they provide valuable peace of mind at a reduced cost. By keeping well within your budget, you are afforded the option of considering a policy excess to further reduce your premium cost. The excess will either be deducted from the benefit paid, or you may have to pay the first part of your claim direct.

What benefits can I expect?

The benefit matrix on most policies will look and feel just like a traditional medical insurance policy. The main difference is that there may be an overall limit to the policy such as £50,000, £100,000 or full cover.

The policy does not restrict you to simply Hospital Costs only either. Most policies today will also provide cover for Out-patient consultations and diagnostic tests as well as aftercare, seeing a therapist or even a psychiatrist.

Will my policy stop if I make a claim?

No. If you reach your chosen benefit level set out by the plan it will not cancel the policy. However, you may have to wait until after your policy renewal date before being able to access further benefits.

Your plan is renewable, so each year on the anniversary of the plan inception, you will be invited to renew at a revised premium. Just like medical insurance; the premium will increase a little each year due to your ageing and medical inflation.

Is there any exclusion to this type of cover?

Yes. In keeping with traditional medical insurance plans, there are a number of conditions that will not be covered under the plan, in the main, these include:

Cosmetic Surgery
Pre-existing medical conditions
Chronic conditions
HIV / AIDS
Cosmetic Surgery
Drug, solvent and alcohol abuse
GP consultations (including claim form completion)
Pregnancy and infertility
Dental treatment