Health insurance companies are sometimes accused of not being clear in what they do and do not offer. In the past there were many stories of people making a claim only to find that they were not covered in their hour of need because of different interpretations of the ‘small print’. A new commitment from medical insurance company PruHealth means that consumers should feel more reassured.

PruHealth have announced a new “Cover Check” commitment which it says will assure that they are ‘fully transparent’ about what is covered by their private medical insurance policies. It says that they will make limits or exclusions very clear and they will also make clear where members need to make choices that will affect their levels of cover.

On 1st March Pru Health will be launching a new range of products following its purchase of Standard Life Healthcare UK. The current offerings from Standard Life and PruHealth will be phased out over the next 18 months.

Commenting on the new products, Neville Koopowitz, Pru Health, chief executive said:

‘The key challenge was to get a new offering going from day one following the merger. We treated the new product like a blank sheet of paper and embarked on extensive market research with existing clients to produce this flexible offering.’

One of the complaints of PruHealth customers is the demise of their free membership offerings. Free gym memberships was a real crowd puller and attracted much interest with individuals and the media in general.

Since the scheme’s introduction in 2006 members have seen an erosion in the gym membership offering and from this year anyone taking out a policy with them will only get 25% off their gym membership and the same applies to existing customers.

A PruHealth spokeswoman said:

‘The move to the flat rate gym discount is designed to better meet the wider needs of our customer base. The gym-goer community only represents a small minority of our customer base.

‘Our customers want lower health premiums, quality of cover and choice, rather than simply cheap gym deals.’

It will be interesting to see what PruHealth’s new offerings will be in March when their new products are launched. In the health insurance industry they have a reputation for comprehensive cover. What will differentiate them from other health insurance companies?

Recent figures published this week show that 11,362 patients were looked after in mixed wards in December. The government have committed to eradicating mixed care wards where possible and from April 1st hospitals will be fined £250 a day for each patient that says in mixed sex accommodation.

If the new rule were already in existence the total revenue generated from December would have come to £2,845,500. According to health minister Andrew Langley, any funds raised through fines will be invested into patient care.

This is the first time that data on mixed wards has been published. The figures show that across England there were 8.1 breaches per 1,000 hospital stays. The lowest breach rate is in Yorkshire and Humber (1.2%) and the highest in the North West (13%).

Lansley said the numbers highlighted: ‘an unacceptable level of breaches in which patient dignity has been compromised.

‘Publishing these figures in itself revolutionises accountability to patients but that’s just the start. By April, we expect every hospital to be capable of meeting the single sex accommodation standard.’

He said the Government was increasing the number of single rooms in the NHS to combat the problem.

The previous labour government stated that they were committed to single sex wards and had set targets that had not been fully met during their term in office.

Katherine Murphy, the chief executive of the Patients Association, said:

‘Mixed-sex wards compromise a patient’s dignity, and we therefore welcome the government’s commitment to ending mixed-sex wards but are concerned that fines are not the best way to do this.

‘Fines will not be a good enough incentive, and ultimately it will be the patients who pay the price as they cut into already squeezed budgets.

‘It is too easy to carry on paying the fine, avoid the blame and, above all, avoid taking the action needed.’

With health insurance you do not need to wait very long to have diagnostic treatments or operations. You see your GP, they refer you and usually within a few days you can get in to see a specialist. With the NHS however, this is not the case. Waiting lists have been an issue since the NHS started. Recently it was thought that the conservatives would push to remove the national targets for maximum waiting times but after a review last year the targets are now here to stay.

Currently the waiting time targets are as follows:

• 2 weeks wait to see a specialist if cancer is suspected
• 31 day wait from diagnosis to treatment
• 62 day wait from referral to treatment

The NHS waiting time figures show that the targets are having a positive effect with an average success rate of over 90%. The labour government had been working on these targets for a number of years with increasing success as time went on.

The main reason for the targets is to help save more lives. As with most diseases the earlier it is caught the better the chances of recovery. This may not just be a physiological factor but a psychological one too. If a patient has less stress their chances of a good may recovery improve.

Cancer death rates
In England more than 250,000 people are diagnosed with cancer every year. 130,000 die from the disease. The UK are very behind other European countries when it comes to cancer survival rates. The aim of the government is to save a further 5,000 lives a year by 2014/15. This would bring us more inline with the figures available from other countries.

Big Cancer Plans
Keeping the current waiting time targets is only part of the government’s plan to improve cancer survival rates. Other initiatives include:

• Encouraging people to come forward if they have concerns about their health
• Improved screening
• Better access to new cancer drugs

Cancer health insurance is another option for people but if this is one of your concerns it is very important to get the right cover for you and your family.  Having the right questions to ask when you are shopping around for the right cover is very important.

Reduce your cover?
You could stay with the same provider but drop a policy. That way you still have some health insurance but at a reduced premium. You will of course have to loose some cover, for example, you may have less in terms of the overall costs that the insurance company will pay or you could loose out on psychiatric cover.

Pay less with the same level of cover?
Some companies allow you to take the option of paying more excess in order to reduce your monthly premium. This is helpful on a monthly basis but of course you have to be able to cover the extra excess amount should you need to. This is quite a common practise and some quite high excess choices are available from companies like General Medical, Freedom, CS Healthcare and Health Online.

Some companies also give you a discount if you pay for the whole year of cover in advance. Freedom Healthnet medical insurance, for example offer to knock 6% off the cost of your private medical insurance.

Change your health insurance provider
Moving from one company to another because it provides a cheaper premium for the same amount of cover is a no brainer. However, check that the policies are comparable. Sometimes there can be what seem like subtle differences between policies which actually turn out to be quite major if you do need to make a claim. Just bear in mind that cheap health insurance does not have to be poor quality insurance.  Comparison sites like moneysupermarket.com are invaluable in researching the health insurance market.

Take out a more specific policy
There are policies out there that are very specific. It means that your level of cover is reduced but people often choose this type of policy if they have particular health worries. There are children only policies and health insurance for cancer only policies for example. Bupa have a policy that just covers cancer and heart problems, the Bupa Select Heart and Cancer Policy and Childsure offer a structured cover for the children in your family.

Co-Payment
Co-Payment, or shared responsibility policies, as they are also known, mean that you share some of your health care costs with the private health insurance company. This greatly reduces your monthly payments. WPA, for example, offer a Shared Responsibility scheme where you pay 25% of treatment costs up to an annual maximum of either £500, £3,000 or £5,000. Anything over these maximums and the insurer will pay.

The report calls for significant investment in mental health services which it says will not only benefit the individual but also society and ultimately will save the country money. The report says:

‘Reducing sickness absence and promoting an early return to work following an episode of illness are important strategies as part of a public mental health policy.

Dealing with ‘presenteeism’ (going to work when unfit to work) and managing work environments so that they become healthier is also a significant challenge in a harsh economic climate where unemployment is a threat.’

Even though mental health services cost the government more than any other NHS sector many individuals, families and organisations agree with psychiatrists and are not happy with the resources that are available and would like to see an increase in provision.

Mental health issues are often not the first thing that people think of when considering medical insurance. However with an estimated 10% of people suffering with a mental health problem at any one time it is well worth considering. However once you have decided to look for a policy with psychiatric cover it is not as straightforward as you might think.

Due to the fact that many people suffer with mental illness of one form or another over the course of their lives it is an expensive type of cover for health insurance companies to provide. In effect this means that many private health insurance companies do not provide psychiatric health cover at all.

Some of the more expensive health insurers provide comprehensive cover which includes psychiatry. Some companies include it in their more expensive policies and others include it as an additional option which incurs an increase in your monthly premium. There is a great degree of variance between what different policies offer you as you can see in the examples below.

Pruhealth includes psychiatric cover in two of its health policies: Comprehensive and Select Core Value.

Comprehensive Health Insurance
Outpatient cover: combined £20,000 per year
Inpatient cover: combined £20,000 per year

Select Core Value Health Insurance
Outpatient cover: combined £7,000 per year with a sub limit of £759
Inpatient cover: combined £7,000 per year

Freedom Healthnet offers cheap health insurance cover and provides psychiatric health care as an optional extra as part of their top health insurance product, Platinum Plus.

Platinum Plus Health Insurance
Outpatient cover: £1,500 per policy year
Inpatient cover: a maximum of £10,000

Be aware that if a psychiatric condition becomes chronic then your health insurance company will not continue to cover your costs indefinitely.. Once a condition moves from the acute to the chronic stage then it is no longer coverable by any insurance company.

Jade Goody raised the awareness about the importance of cervical screening in the early detection of cervical cancer. Unfortunately the positive effects of her plight have petered off and less women have come forward for screening this year.

In 2008/9 the NHS Cervical Screening Programme saw record numbers of women coming forward to be tested. It was thought that this was as a direct result of the Big Brothers public struggle with cervical cancer. 3.6 million women were tested that year.

In the last year the figures have dropped to 3.3 million for women aged 25 – 64 but in the 25 to 49 age group the figures fell from three million to just 2.6 million in 2009-10.

Screening is very effective in detecting early cell changes that can be a precursor to cancer in the cervix. NHS Information Centre chief executive Tim Straughan said:

‘Screening is vital to catch changes to the cervix which may develop into cervical cancer. This report is important in helping NHS professionals and the public understand what percentage of eligible women is being screened.

‘The 2008-09 peak in numbers attending screening, which may be due in part to publicity surrounding the late Jade Goody’s battle with cervical cancer, appears not to have been sustained this year.’

Its not just the NHS that encourage women to come forward for cervical screening, private health insurance companies are also keen to see women come forward. Some medical insurance companies offer discounts to health insurance premiums when people undertake health screening. PruHealth, for example, offer discounts when you have health screens. This enables people to take an active part in their own wellbeing, pre-empt possible problems early and reduce their monthly premiums in the process.

Additionally Pruhealth have negotiated discounts with screening providers so that there is more incentive for their members access the services that they need. For example, Classic Female Screen from BUPA Wellness normally retails at £440, but its possible for a PruHealth member to  get it for £250 or less (Platinum members only pay £25).

Despite the efforts of the NHS in getting women to come forward for free screening more needs to be done. Dr Claire Knight, Cancer Research UK’s health information officer, said:

‘Our main concern is these figures show that consistently one in five women are still not going for screening.

‘Cervical cancer is one of the few cancers that can be prevented through screening, by picking up early changes in the cells that can lead to the disease. Even though we now have the HPV vaccine it’s still important women go for cervical screening when they’re invited.’

Their Health & Stuff policy is designed to help with the costs of health insurance and not to provide unlimed cover. Under the terms of the policy you agree to pay 10% of your cover amount. You can take cover out for £2,500, £5,000, £10,000 and £20,000. If your health bills come to more than that amount you also have to pay the extra.

The policy is family friendly:

• No extra cost to add children between 3 months and five years old
• You can add children up to the age of 21
• If your children are in full time education they can stay on your policy until they are 25

The policy also offers you the chance to reduce your premiums. There are discounts available if you have a healthy body mass index and if you have been a non-smoker for at least a year.

What’s good?
Health & Stuff will also cover you for all stages of cancer care including palliative care. This is unusual in the health insurance world. Cancer health insurance has come under a lot of scrutiny over the last few year as increasing medical costs are making full cancer cover prohibitive. This policy means that you can get comprehensive cover up to the agreed amount.

On average private medical health insurance policies will only allow you to stay in hospital with your child until they are around 12 years of age. The Health & Stuff policy enables you to stay with a child up the age of 18 as long as they are covered.

The Health & Stuff policy documents are  very clear and self-explanatory. Talking to Health Insurance Magazine, Andy Chapman, chief executive of Pioneer and Exeter Friendly Society said:

‘We go out of our way to ensure that people have confidence in the company. We’ve done a lot of things to simplify things, ensuring our customers understand what they’re buying, ensuring that every piece of literature is understandable and giving them confidence that when they need to claim they can claim.’

What’s not as good?

• You have to choose from 300 hospitals across the UK
• Your policy will not cover complementary medicine although it does cover: physiotherapy, osteopathy, podiatry and chiropractic treatment.

Exclusions to the policy
The following are not covered by the policy

• Out-patient drugs and dressings
• Renal Dialysis
• Major organ transplants
• Mental & psychological treatment
• Treatments in nursing homes
• Preventative screening procedures
• Pregnancy and fertility treatment
• Complementary treatments other than those specified
• Professional sports injuries
• Cosmetic and plastic surgery (unless medically required)

In both NHS and private medical establishments correct handwashing procedures have been taught and implemented in an attempt to cut down on infections, particularly those that are specifically transmitted in hospital such as C.Difficile and MRSA. Today is Global Handwashing Day which aims to encourage the habit of handwashing across the world.

The message that organisers are trying to convey is that washing hands with soap and water can save lives.

‘Turning handwashing with soap before eating and after using the toilet into an ingrained habit could save more lives than any single vaccine or medical intervention, cutting deaths from diarrhea by almost half and deaths from acute respiratory infections by one-quarter.’

A recent study at a UK service station found that 30% of women and 60% of men do not wash their hands after going to the toilet.

The main focus of Global Handwashing day will be around schools and children with the view that if you can positively influence a child when they grow up they will pass their good habits onto their children.

Research has found that handwashing with water alone is not enough. Using only water to handwash is very common across the world but using soap is less so. The campaign teaches people to always wash their hands with soap for a minimum of 20 seconds.

According to the London School of Hygiene and Tropical Medicine:
‘More than 1 in four people have faecal matter on their hands! Britain’s 12M cases of norovirus, gastroenteritis, MRSA, E-Coli and now Swine Flu infections are mainly down to dirty hands. washitoff!’

In the UK the rate of infections in NHS and private hospitals is on the decline due to stringent handwashing policy. Despite consumer pressure private medical establishments are not obliged to publish their infection rate statistics at the moment but those that do generally indicate that levels are lower than those in the NHS. NHS statistics have to be published for everyone to see and a great hospital guide, which includes infectious disease statistics, is available on the Doctor Foster site.

Worldwide there are still major handwashing problems in hospitals. In Indian hospitals, for example, it is reported that up to one third of patients admitted contract an infection during their hospital stay. Dr Dilip Mathai, head of department of internal medicine, Christian Medical College, Vellore said:

‘…. in India, even the simple hand wash protocol is not followed. Use of equipment without sterilisation is also not uncommon.’

Today there will be hundreds of handwashing events all over the world including handwashing demonstrations, handwashing parties, free soap giveaways and competitions.  In the UK this is has important implications for hospitals as it will encourage patients and their visitors to also take some responsibility for their own health when possible.

Bowel cancer is the third highest cancer diagnosis in the UK next to lung and breast cancer. According to the government the screening programme, which will cost £60m, could save more than 3,000 lives a year and will replace the previous government’s scheme that gets people to send in a stool sample for analysis through the post.

The screening programme will use a technology called the Flexi-scope which consists of a rectal probe which enables early cancer detection through fibre optic technology.

Chief Executive of Cancer Research, Harpal Kumar said:

‘Flexiscope needs to be brought in as soon as possible. Every week of delay will risk scores of lives. Because it will prevent so many cancers, adding this test to the bowel screening programme will spare tens of thousands of families the anxiety and suffering associated with a cancer diagnosis whilst also saving the NHS money.

‘This procedure offers us a tremendous opportunity to push bowel cancer down the league table of cancer cases in the UK.’

Health Secretary Andrew Lansley has been announcing new measures to combat cancer over the last week or so. The plans include a £50 million fund to support new cancer drugs and £43 for increasing radiotherapy services.

Mr Lansley said on Monday:

‘I want the NHS to deliver cancer survival rates comparable to the rest of the world.

‘We’re going to introduce an exciting new screening test for bowel cancer which could save up to 3,000 lives a year. We have secured the funding for a four-year roll out and will, subject to the green light from the UK National Screening Committee, begin pilots from spring next year.’

One way of buying medical insurance and sticking to a budget is to cover yourself and your family for some of the costs of private medical care and rely on the NHS for the rest. Some policies are available that only cover you for inpatient care: for your operation bills and your stay in hospital but no, or reduced cover for outpatient appointments. Others provide a restricted combination of the two.

Here are some comparisons for a non-smoking family of four, Anne, aged 40, Derek, aged 42 and Emily and John aged 15 and 10 respectively.

Medical insurance company, Freedom Healthnet allow you to have cover only for inpatient costs. Unlike other policies Freedom include chemotherapy and radiotherapy as part of the insurance cover. Freedom provide a cash lump sum to their customers who can then pick when, where and with whom they have their treatment. Alternatively they can choose to have it with the NHS and keep the cash.

Freedom Gold Inpatient Family
Cost: £44.06
Excess: £100

What is covered?
Up to £30,000 of inpatient care
Hospital Charges
Specialist/Consultancy Fees
Surgeons, Anaesthetists and Physicians fees
Diagnostic Tests
Radiology/Pathology
Radiotherapy/Chemotherapy
Physiotherapy
Minor Surgical Procedure
Discount: 6% discount for annual payment

WPA are a non-profit organisation and they won best UK insurer for Customer Care at the British Insurance Awards

WPA Flexible Health Family
Cost: £33.84
Excess: none

What is Covered?
Inpatient and Daycare Treatment
Hospital Charges
Specialist/Consultancy Fees
Out-Patient Treatment
Consultation with specialist
Physiotherapy
NHS Cash Benefit

An interesting feature of the WPA policy is that it will cover patients for cancer drugs that are not covered by the NHS for up to £50,000.

Patient Choice Essential Hospital Treatment Plan – Family
Cost: £57.75
Excess: None

What is covered?
Inpatient
Hospital Charges
Specialist/Consultancy Fees
Diagnostic Tests: surgical and endoscopic procedures only
Radiotherapy/Chemotherapy : £15,000 payable per course of treatment
Physiotherapy
Outpatient
Radiotherapy/Chemotherapy : £15,000 payable per course of treatment
Additional Benefits
NHS Cash Benefit
Minor Surgical Procedure

The main advice is to consider what you can afford to pay out for your health insurance and then look for the best deals out there.

Figures taken from moneysupermarket.com on 5th October 2010