Health Cover for Me is a private medical insurance plan designed to work alongside and complement th...
Health Cover for Me is a private medical insurance plan designed to work alongside and complement the NHS. The plan offers a wide range of unlimited cover for inpatient and day-patient treatment; outpatient treatment; cancer; manipulative treatment; private ambulance; home nursing; and parental accommodation. Additional cash benefits are available for NHS treatment (£250 a night) and hospice donation (£250).
Access to online literature
The policy wording and quotations are available online. The product can be purchased online although there is no discount for purchasing policy via the internet.
Minimum and maximum ages for cover
The minimum age at entry is 18 attained and the maximum joining age is 79 attained. Premiums are based on the age at entry. There is no upper age limit for cover to cease for existing clients. The planholder may include dependent children up to 21 years of age or up to their 25th birthday if they are in full-time education.
Premium frequency
Premiums are paid monthly by direct debit.
Discounts
There are two forms of health discount available, based upon body mass index (BMI) and smoker status. If the policyholder's BMI is below 25, they will benefit from a 10% reduction in their premium. Non-smokers who have not smoked tobacco within the last 12 months will receive a further 10% reduction to their premium.
Waiver of premium
Not offered
Premium loading applied to pre-existing conditions
May be excluded
Compulsory excess applied
There is no compulsory or optional excess with this plan. However, in order to reduce the premiums payable, the policyholder can choose a co-payment amount.
Shared responsibility %
The planholder can choose a co-payment amount, the maximum being 50%. The planholder has a choice of 10%, 25% or 50% co-payment. This would result in maximum payments per person, per year, of £2,000, £5,000 or £10,000 respectively.
Claims pre-authorisation service
It is a requirement that all claims are pre-authorised by the society before treatment is received to ensure the fees are eligible for benefit.
Claims settled direct with hospital
Yes
Select hospital list used
There is list of over 300 NHS and private hospitals and a number of private clinics offered by this plan. There are no hospital bands with this plan.
Plan pays for diagnosis
There is an unlimited payment for diagnostic tests, including CT, MRI, PET scans and outpatient surgery.
Inpatient costs
There is an unlimited payment for inpatient and day-patient treatment, including consultant and specialist fees, diagnostic tests, hospital charges including any necessary prosthesis such as knee braces. There is an unlimited payment for inpatient and day-patient treatment, including consultant and specialist fees. There is an unlimited payment for inpatient and day-patient treatment, including diagnostic tests. Radiotherapy including when it is given for pain relief. There is an unlimited payment for all stages of cancer, in hospitals, at home (if chemotherapy is needed) and a donation to the hospice if admitted. All types of drug therapy for cancer covered, including chemotherapy and drugs to maintain any remission.
Inpatient physiotherapy
There is an unlimited payment for physiotherapy and other manipulative treatments such as osteopathy, podiatry and chiropractic treatment.
In-and out patient psychiatric treatment
Not covered
Costs of parent accompanying a child
There is an unlimited payment for inpatient parental accommodation.
NHS cash benefit
£250 a night paid if the policyholder has free inpatient treatment under the NHS. There is no maximum number of nights and there is no maximum cash limit a year.
Outpatient consultation costs
There is an unlimited payment for outpatient treatment, including consultant and specialist fees, diagnostic tests including CT, MRI, PET scans and outpatient surgery.
Outpatient radiotherapy
Radiotherapy including when it is given for pain relief covered. There is an unlimited payment for all stages of cancer. All types of drug therapy for cancer covered, including chemotherapy and drugs to maintain any remission.
Outpatient physiotherapy
There is an unlimited payment for physiotherapy and other manipulative treatments such as osteopathy, podiatry and chiropractic treatment.
Alternative medicine
Unlimited cover is available for certain forms of alternative medicine, namely osteopathy, podiatry and chiropractic treatment. Herbalist, acupuncture and homeopath is not covered.
Cover for cost of maternity complications
Illnesses arising while pregnant or undergoing childbirth would be covered. There is no deferred period for pregnancy complications.
Cover for cost of ambulance services
Unlimited cover is available for medically essential travel to, from or between hospitals in a private road ambulance, in connection with inpatient or day-patient treatment.
Routine dental treatment or orosurgery
Not covered
Cover for cost of ambulance services
Unlimited cover is available for medically essential travel to, from or between hospitals in a private road ambulance, in connection with inpatient or day-patient treatment.
Cover for home nursing costs
Unlimited cover is available for medically required home nursing, following authorised inpatient and day-patient treatment.
Medical helpline
The policy gives access to a GP helpline, which is open 24 hours a day and seven days a week. This is provided by an independent company selected by Exeter Friendly Society. Policyholders can take advantage of this service at any time, so they do not need to wait until you need to make a claim.
Maximum annual benefit amount
There is no overall maximum annual benefit limit.
General exclusions
The types of care that are not covered under Health Cover for Me are:
- Routine consultations with a GP, optician and dentist
- Preventative screening procedures and tests
- Emergency treatment in an accident and emergency department
- Ongoing or long-term conditions, often known as chronic conditions
- Pre-existing conditions that have been excluded
- Treatment in a nursing home
- Treatment that has not been authorised
- Outpatient drugs and dressings.
There are some parts of the body and some treatments that are not covered. These are:
1) Eyes, teeth and ears:
- Preventative treatments for eyes, teeth and hearing are not covered
- This includes sight tests, regular check ups, spectacles, surgical treatment to correct long or short sightedness, crowns, implants, bridges, dentures and treatment for deafness, hearing aids and cochlear implants.
However, disease of these organs is covered so, for example, cataracts, corneal grafts and wisdom teeth (if treatment takes place in hospital) are covered.
2) Pregnancy and fertility treatment or investigations in connection with:
- Pregnancy or childbirth
- Abortion
- Any form of assisted reproduction such as in vitro fertilisation
- Infertility.
Important note - pregnancy or childbirth are not considered to be illnesses and are therefore not covered under Health Cover for Me.
However, illnesses arising while pregnant or undergoing childbirth would be covered.
3) Transplants:
- Transplant operations
- Investigations done before a transplant operation, or treatment needed as a result of a transplant operation.
However, corneal and skin grafts are not covered. Bone marrow and stem cell transplants for cancer are covered.
4) Regular or long-term renal dialysis in chronic or end-stage kidney failure
5) Cosmetic and plastic surgery
6) Treatment required as a result of an injury sustained while training for or participating in, sport for which you receive payment or sponsorship (other than travel costs)
7) Mental and psychological treatment:
- For depression and/or
- stress and/or
- mental illness and/or
- psychiatric disorders and/or
- psychological disorders.
8) Complementary treatment, such as acupuncture, speech therapy, dietician, homeopathy and pain clinics
Only physiotherapy, osteopathy, podiatry and chiropractic treatments are covered with Health Cover for Me.
Analyst's comment
Launched in November, Health Cover for Me offers a wide range of unlimited cover for the main treatments and is designed to complement the NHS; it has one of the more generous NHS cash benefits at £250 a night.
It is disappointing that the plan does not cover outpatients' psychiatric treatments where many plans on the market do at least offer some cover. Also, the plan is weak in respect of alternative medicine covers - like many plans, osteopath and chiropractor services are covered but the lack of cover for acupuncture and homeopathy is out of line with the market.
Health Cover for Me is designed to be a simple, easy to understand private medical insurance plan that is intended to be used, to wit Exeter has shunned the 'No Claims Discount' (NCD) feature. The rationale is that NCDs, particularly those that are not earned and are available from day one, are little more than a deferred premium and have the effect of dissuading policyholders from claiming, especially for minor ailments.
There is no compulsory excess - a feature of some plans on the market - but neither can the policyholder opt for a voluntary excess, which is a common feature employed by many plans to help with affordability. However, it does offer a shared responsibility feature where the policyholder can opt to pay a proportion of the claim in return for a lower premium. This is possibly fairer and resonates with the Treating Customers Fairly initiative.
Ben Heffer, Principal consultant, life and protection, Defaqto.
