Am I covered by my private medical insurance?

The myths

• You can buy cover just to cover overseas treatment.
• International insurance from Company X will protect you.
• Policies have a worldwide extension so cover must apply.
• Insurances with non UK cover will pay for overseas treatment.

The reality

• There is no specific cover for those planning to go overseas for treatment.
• International insurances are for expatriates not UK residents.
• Worldwide extensions are for emergencies only.
• Very few policies cover treatment outside the UK, and even when they do, most of the treatments you go overseas for are not covered.

The detail

With the rise of popularity of overseas treatment, private medical insurers have been adding specific exclusions to policies that exclude overseas treatment.

Even if you have a policy that does not have such an exclusion, insurers can argue that you live in the UK so would be expected to be treated in the UK

Your policy may restrict treatment to a specific type or group of hospitals, or even hospitals listed by name. Non-UK hospitals will not be on these lists, so no claim can be made.

Policies have specific exclusions-such as;

• cosmetic surgery
• dental treatment
• reconstructive surgery
• treatment at spas and health hydros
• overseas treatment and repatriation
• weight loss treatment
• complications from excluded conditions
• fertility and sexual problems
• sex changes
• experimental treatment
• unrecognised providers and facilities

The exclusion which normally applies even if not specifically excluded by the policy is a pre-existing condition. This can be interpreted in many ways to include anything you knew or suspected or have had treatment for, even if you have recovered.

A small number of insurers will consider requests to pay for treatment outside the UK. But, this will only be for treatment that would have been covered in the UK, and will exclude travel and other non-medical costs. The logic that travel plus treatment could be cheaper for the insurer than paying for UK treatment will cut no ice.

Some insurers will consider treatment abroad where it is not available in the UK. In such cases, insurers will meet the equivalent UK costs of the treatment, but not travel costs, only if cover applies had treatment been available in the UK. In the UK almost all medical procedures are available privately, so the extension is less generous than it sounds, while some of the overseas treatments would be excluded as experimental treatments.

One of the few policies which allow customers to get treatment anywhere in the world only covers listed treatments, few of which are the sort of thing that people go overseas for.