At Happl, we want to make sure you feel confident navigating your Private Medical Insurance (PMI) benefits. This guide will help you understand key aspects of your policy, including underwriting types, policy documents, excess, what’s typically not covered, and more.
Understanding Private Medical Insurance (PMI)
PMI is designed to cover the cost of private healthcare, from diagnostics to treatment, depending on your policy. It complements, rather than replaces, the NHS, offering faster access to specialists, treatment, and private facilities.
Types of Underwriting
Underwriting determines how pre-existing conditions are handled in your policy. The two common types are:
Moratorium (Mori):
Pre-existing conditions from the past 5 years are excluded initially.
If you remain symptom-free and treatment-free for two consecutive years after your policy starts, coverage may be reinstated for those conditions.
Medical History Disregarded (MHD):
You disclose your full medical history upfront.
The insurer will specify which conditions are covered or excluded based on your history.
How to Read Your Policy Documents
Your policy documents can seem complex, but here’s how to break them down:
Policy Schedule: Outlines your specific cover details, including start/end dates, excess amounts, and any personal exclusions.
Certificate of Insurance: Confirms your active coverage.
Policy Handbook: Explains the terms, conditions, what’s covered, exclusions, claims process, and definitions of medical terms.
Tip: Focus on sections labeled "What's Covered," "Exclusions," and "How to Make a Claim."
How Excess Works
What is Excess? It's the amount you pay towards a claim before the insurance covers the rest.
Per Claim vs. Per Policy Year:
Per Claim: You pay the excess every time you make a claim.
Per Policy Year: You pay the excess once per year, no matter how many claims you make.
Example: If your excess is £100 per policy year and you make three claims in a year, you only pay £100 once.
What’s Not Usually Covered (Common Exclusions)
While coverage can vary, common exclusions include:
Pre-existing conditions (On Mori policies)
Cosmetic surgery (unless medically necessary)
Routine pregnancy and childbirth
Fertility treatments
Experimental treatments
Injuries from dangerous sports or activities (unless covered specifically)
Chronic condition management (ongoing treatment vs. acute episodes)
Always refer to your policy handbook for the full list of exclusions.
Additional Benefits in Your Policy
You might have the following features in your PMI policy, check the description in Happl for more details.
Diagnostics Only Coverage: Quick access to tests like MRIs, blood tests, and consultations.
Therapies: Includes physiotherapy, osteopathy, chiropractic treatment.
Employee Assistance Programme (EAP): Confidential support for mental health, financial advice, and more.
Dentist & Optician Cashback: Reimbursements for dental and optical expenses.
Need Help?
If you’re unsure about any part of your policy or need assistance with a claim:
Contact Your Insurance Provider: Details are in your policy documents.
Reach Out to the Happl Team: We're here to help with any questions or concerns