FAQ- What is Private Medical Insurance ?

MRSA - THE FACTS

What is MRSA?

Staphylococus Aureus is a bacterium that is found in the nose of approximately 30% of the population. It colonises the nose and occasionally the skin, usually causing no ill effects to the individual. However, if it enters the body tissues it can cause infections such as boils and wound infections. Sometimes this bacterium is resistant to commonly used antibiotics and, if it is resistant to Flucloxacillin, it is called Methicillin Resistant Staphylococus Aureus, or MRSA (Flucloxacillin is used for treating patients, while Methicillin is used in the laboratory for testing the sensitivity of Staphylococus Aureus, but is not used therapeutically).

The chances of contracting MRSA in a NHS hospital are 30 times greater than the an independent sector hospital. One of the key interventions in minimising cross-infection from patient to staff and from staff to patient is by maintaing clean hospitals and thorough and effective hand decontamination between every patient contact, i.e. employing effective hygiene management and control systems.

What is Moratorium Underwriting?

With moratorium underwriting, the insurance company will take on each individual covered by the policy, but will exclude any medical condition where medical advice, medication, or treatment has been sought in a given period, usually five years before joining the plan.

Once the individual has been free of all medication, treatments, consultations and symptoms for that condition, or any related condition, for a given period after joining the plan, usually 2 years, they will automatically be covered for that condition.

There are some pre-existing conditions, such as heart problems, cancer and psychiatric conditions that will never be covered by the plan, as the member will have regular checkups and/or medication.

What is Full Underwriting?

With Full Underwriting, a medical declaration is given by each person to be covered by the plan. This information is then put before an underwriter, who will assess the risk factors for each person. Normally, any previous serious medical conditions, and possibly non-serious conditions, will be permanently excluded from cover. In extreme cases, cover may be refused.

Usually you are offered the choice of these two methods although some insurers only offer Full Underwriting. Regardless of underwriting styles it is important that all questions are answered in full as failure to disclose information could invalidate the policy.

I had an operation on my right knee recently. Will I be covered for any further treatment to it after my policy starts?

If you choose the moratorium option you would not be covered for any further treatment relating to your knee operation, or the condition for which it was performed, during your first two years of continuous cover. After that time provided you have had no treatment, medication or medical advice, including post operative checks, for your knee problem in the preceding two years then you would be covered for any further treatment.

If you choose to have a full medical assessment then you would be excluded from benefit for any further investigations and treatment related to your knee operation.

Some time after my cover begins, I go to a doctor for a routine visit. A heart condition is diagnosed and it must have started to develop before my policy began. What is the position?

If you choose the moratorium option you would be covered provided there were no symptoms evident by the time your policy commenced and you had no previous treatment for any related medical conditions, such as high blood pressure or chest pains..

If you choose to declare your medical history you would be covered provided there were no symptoms relating to your heart condition and you had no previous treatment for any related conditions, such as high blood pressure or chest pains which you should have disclosed to us at the time your policy commenced.

What if I suspect I am suffering from a condition (for example, I have a swelling in the groin area) but have not seen a doctor about it, nor received any firm diagnosis before my cover starts? Will I be covered if I need to have any investigations or treatment for the condition once my policy has started?

Under the moratorium option you would not be covered for any treatment you would have to have because of the swelling. This is because it was in existence before you took out the policy. If you declared your medical history to the Private Medical Insurance provider then you would declare all symptoms you were suffering from, whether or not a doctor had been consulted, and this would include the existence of the swelling. Those symptoms, the underlying cause of them and any related conditions would be excluded from benefit. It is probable that the Private Medical Insurance company would ask for a medical report from your doctor, when you applied to join so that you and they would know exactly what was being excluded from benefit.

How do regular check-ups affect the moratorium?

It depends what the check-ups are for. For example:

If you have a specific condition before your policy starts and your doctor, or specialist, recommends that you continue to have check-ups for that condition, then the Private Medical Insurance company will not cover the cost of private treatment received for that condition for a period of two years from the time your policy started.

Cover will then only apply once you have been discharged from care and have no further treatment, medication or advice for a continuous period of two years. In the same situation described above, if you choose to continue having check-ups for your own peace of mind even though you have been discharged from care, the Private Medical Insurance company will cover you for that condition (though not the routine check-ups) if you do not need any medication, treatment or advice for a continuous period of two years. If you have general health check-ups simply in the interests of maintaining good health and not for any particular condition, the Private Medical Insurance company we ignore them when applying the moratorium.