It is the insurance buyer’s prerogative to find out and understand the rights of policyholders before purchasing personal health insurance (PMI). It is important to carefully read the terms and conditions of the policy document and know exactly what is not covered.
Some key facts to consider before buying health insurance:
Regulation
The Prudential Regulatory Authority (PRA) and the Financial Conduct Authority (FCA) regulate private health insurance policies in the UK. This was previously done by the Financial Services Authority (FSA).
complaints
The FCA requires private health insurance providers and brokers to have complaints procedures. If you are not satisfied with the response of the insurance company in resolving a problem, you can contact the Financial Ombudsman Service (FOS). It is a free and independent service for resolving disputes.
Compensation
The Financial Services Compensation Scheme (FSCS) is the UK statutory fund for licensed financial services customers. It is an independent organization established under the Financial Services and Markets Act 2000. In the event of the insurer’s insolvency or inability to honor a claim, the FSCS pays compensation to the policyholder.
Privacy
The Data Protection Act 1998 and ancillary laws require health insurance companies to treat personal information, including medical details, confidentially. Insurers are required to inform policyholders about the use of personal information and the circumstances in which such information is shared with third parties. Policyholders have the right to seek details of the information an insurer has on them.
Medical History Statement
Health insurance providers require the purchaser to disclose their medical history on the coverage application at the time of purchase. This is done in two ways.
• Full medical subscription: This involves declaring your complete medical history. It is advisable to disclose everything and not withhold any information. An insurer has the right to deny a claim if it is later discovered that you already had or have had a particular condition in the past. It’s important to note that health insurance companies generally do not provide coverage for “pre-existing conditions” when you first start a new policy.
• Subscription of moratorium: Most insurance companies offer this option when personal medical history details are not required. With a moratorium scheme, you do not have to provide detailed medical information; however, pre-existing conditions within the last five years from the policy start date are not covered under the plan, unless you have been free of symptoms or treatment for a period of two consecutive years.
