If you have private medical insurance through your
employer or through your own private medical, health cash, dental or similar
insurance plan then the legal position is completely different from the NHS
one. Nobody knows yet whether or not the cross-border directive will apply to
UK citizens with private medical insurance.
Nobody knows if private medical insurance will be referred
to in the forthcoming legislation which will formalise the application of the
EU Directive in the UK. Even if the Directive does apply, there may be many
practical and legal problems. The safest course is to assume that the new law
does not give you any extra rights on your insurance. But, this does not mean
that your insurance does not cover overseas treatment.
Does my insurance cover treatment outside the UK?
Most UK health insurances have a specific clause that excludes any non-emergency treatment outside the UK. Even if there is no specific
clause, if the insurance limits you to treatment in certain pre-selected
hospital groups , then by implication, treatment is limited to the UK. A
handful of policies will allow non-emergency treatment anywhere in Europe. A
few insurers will consider EU treatment on request.
What extras are covered?
If your insurer allows treatment outside the UK, this will
be limited to medical treatment only. So the insurance will not pay travel, accommodation
or ancillary costs either for the patient or any travelling companion.
What types of treatment are covered ?
This will depend on
what your policy covers. Most health insurance policies do not cover cosmetic
surgery, cosmetic dentistry, fertility treatment or obesity treatment.
Is it likely that insurers will cover EU treatment?
A handful of insurers do now. A few are expected to extend
cover to EU countries but they will probably limit it to a few pre-selected
hospitals. Even if the new law is held to apply in general to private medical insurance,
in practice it will have little effect. This is because most health insurance
gives a free or very wide choice of hospitals. So except in a few exceptional
cases, there will always be a UK hospital that can offer private treatment
within the necessary time limits.
The key thing to remember is that the cross-border rules do
not offer you a full and free choice of treatment anywhere in the EU, whether it
is paid for by private health insurance or the NHS, as there are rules and
restrictions.
How do I know what my policy covers?
If the policy is arranged and paid for by your employer you
should contact them. If you have a personal policy, then contact the insurer.
Can I get treatment abroad and then claim from my insurance?
If your insurance does allow EU treatment, then a few health
cash/dental and specialist health policies will allow you to arrange, pay for
and have EU treatment and then seek to claim what portion of the total costs is
due from insurers. Most private medical policies will insist that you contact
them for their permission before arranging anything. The safest course of
action is to contact your insurers before seeking EU treatment. Hoping that
they will reimburse you afterwards may leave you seriously out-of-pocket.
Anything else I should consider
This area is a new one for most health insurers, so they may
not have the answers. To avoid misunderstanding, if the insurance call centre
says that your insurance will pay for overseas treatment, insist on the answer in
writing from a named person.
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