The doctor will see you now

HEALTH INSURANCE SURVEY: gain more protection and you don't have to pay the earth, is the claim. We examine the range of different policies avai lable, from sick pay cover to insurance for the costs of going into a nursing h ome
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The Independent Online
When we fall ill, we are at our most vulnerable. It means that a stay in hospital is among the most stressful experiences we are likely to face. Which is why it is crucial to get the right treatment and care. The sad fact is that there is no guarantee of that with the National Health Service any longer. Even after we have overcome the long waiting list for an NHS hospital bed, crowded conditions can add to the agony.

The answer is to take out private medical insurance (PMI), which is designed to pay for the cost of expensive hospital treatment. Going "private" will generally offer you two main benefits. First, it should allow you to get treatment when you need it. Second, PMI should ensure you get the kind of treatment you prefer, which could mean a private room rather than a ward.

The marketplace for PMI has become much more competitive and the days when it was simply a choice between Bupa and PPP are long gone. Insurance companies such as Legal & General and Norwich Union have entered the market and there have been newcomers to the UK such as OHRA and Prime Health.

Also long gone is the notion of private medicine being prohibitively expensive. Indeed, the once-proud PPP healthcare now sells a budget scheme from pounds 8 a month. But despite the lower prices, taking a budget scheme could be a mistake. "Look at the scope of cover on some of the cheap products, it may not be enough," suggests Philip Watson, a director at John Charcol insurance brokers. "A typical going rate for a decent policy for a healthy male or female aged 25 to 40 should be pounds 25 to pounds 35 a month for reasonable cover outside London."

The cheaper the policy the fewer the benefits. Basically, budget schemes will only kick in if the treatment you need is not immediately available on the NHS. Indeed, some have time delays of six weeks before they will pay for treatment.

Most policies should include cover for surgery, such as coronary bypasses, hernia repairs and hip replacements, and other hospital charges and professional fees. Some schemes will also pay for minor surgery by doctors, nursing at home, treatment for pregnancy complications and parent accommodation charges. But you will be hard pushed to find a policy that covers long- term illnesses or degenerative diseases brought on by age. Self-inflicted conditions such as suicide attempts and drug or alcohol abuse are not covered, nor is Aids.

The trend in PMI policies is to go for cover that suits your lifestyle. It does mean examining the options to ensure you get the cover you need. But some of the newer products already offer a degree of flexibility. Legal & General's Lifetime health care, for instance, has been designed to meet different needs at three key stages in life: 18-39, 40-59 and 60 plus.

The theory is that we need different benefits at different ages, so the policies introduce and phase out health care benefits at appropriate stages. Legal & General says that this helps to reduce the cost of cover as policyholders do not have to pay for costly features that are not relevant to them.

There are other ways to reduce the cost of PMI. You can increase the "excess", where you agree to meet the first pounds 50, pounds 100 or pounds 250 of any claim, which will reduce the cost of premiums.

The option of a shared hospital room rather than a private one will also work out cheaper.

You should also look out for discounts for paying premiums annually or by direct debit.

A family policy can work out as good value and it is obviously worth checking the kind of cover for which you are eligible through your employer. If you do have a scheme in place through your job, check to see what you are covered for. Most group polices offer basic cover but some firms will allow employees to extend the cover for an additional premium.

It is also worth watching closely to see that your policy includes stress. "Between 10 and 20 per cent of hospital admissions are because of stress," according to John Charcol insurance brokers. Stress-related illnesses can be caused by divorce, death, redundancy, or are even conditions such as bulimia. Finding a policy that includes cover for these is clearly sensible.

It is also worth watching out for an extremely sharp practice known in the insurance industry as "moratorium underwriting". This is a catch with newly set-up policies that appear to offer instant cover but actually withhold cover on any pre-existing conditions you may have for the first two years of the policy. Both Norwich Union and Prime Health operate this system, which generally affects any condition you have suffered from in the previous five years.

You should also be wary of schemes that include "desig-nated local hospitals". Check where these are; the "local" hospital may be miles away, which will clearly be inconvenient if you need treatment.

Contacts: Bupa, 0800 600 500; Legal & General Lifetime HealthCare, 0500 669966; PPP healthcare, 0800 335555; Prime Health, 0800 779955; Norwich Union Health care, 0800 142142; OHRA, 01703 653663; John Charcol, 0800 9319393.

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