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What is Private Group Medical Insurance?

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Private medical insurance is an insurance policy where, in return for a premium, or monthly fee, the insurer will arrange payment for the treatment of most acute illnesses or injuries. The extent of benefit available towards the treatment will depend upon the level of cover chosen. Generally, the higher the level of cover, the higher the premium.

Private medical insurance can be used to cover just one individual, an individual and their partner, a whole family or even individuals within a company. The premium will be dependent upon the number of people covered, their ages, their geographical location (when a company scheme) and the underwriting terms on their insurance policy.

How does the health insurance provider decide what to exclude?

The exclusions, if any, applied to the scheme at inception will depend on the type of underwriting criteria applied by the insurer. Underwriting involves an assessment of the risks involved in insuring a particular individual including the likelihood they will need to make a claim and the cost of the claims they are likely to make. The underwriting criteria that can be applied to a group scheme are as follows:

  • Moratorium
  • Full underwriting
  • Medical history disregarded
  • Flat rated
  • Age related

The difference in underwriting criteria is explained below:

Moratorium Underwriting

All group members of the scheme will be covered by the insurer however, any medical conditions, or related conditions, for which the employee has had treatment, advice, or knowledge of in the last 5 years prior to joining the scheme will not be covered for a period of two years. Once the employee has been a scheme member for two continuous years, benefits will be payable for such conditions, providing that no treatment or advice has been sought during that period.

Full Underwriting

Each individual member of the group medical scheme will be given a medical declaration form to complete. Once completed this form will be assessed by the underwriters at the insurer who will offer cover based on the risk of any future claims. Any serious or ongoing medical condition is likely to be permanently excluded.

Medical History Disregarded

This method of underwriting is commonly used for large group schemes of 20 or more employees. Due to the size of the scheme the underwriting criteria applied is classified as Medical History Disregarded. This means any previous medical conditions that the employees may have had are disregarded by the insurer and will be covered, providing that the condition falls within the terms and conditions of the policy.

Flat rate schemes

Due to size of the scheme, the premium will be calculated based upon the number of employees, irrelevant of their age, individual medical history, and the claims history of the company.

The advantage of this is that the employee's current and ongoing medical conditions will be covered providing that these conditions are covered within the terms and conditions of the scheme.

Age related

The premium is calculated based on the number of employees, their specific ages and the overall claims history of the scheme. Each individual employee's medical history is disregarded and they will enjoy cover for pre-existing conditions providing that the conditions are covered within the policy rules.

Do all health insurance providers cover exactly the same benefits?

In short, no! The cover will significantly vary based upon the insurer selected and the level of cover.

There are three levels of cover offered by most insurers:

  • Budget
  • Mid-range
  • Comprehensive

Within these levels of cover, the numerous insurers offer differing features (unique selling points) which our team of highly trained consultants will explain to you.

Which healthcare insurance policy would we recommend for your company?

This will depend upon a number of factors such as:

  • Budget available
  • The industry in which you operate
  • The importance you place on helping your employees return to work as soon as possible after serious illness
  • The importance your employees place upon having medical insurance

In order to understand your unique insurance requirements we will complete a full fact find to ensure that we only recommend a healthcare policy that suits your company's individual needs

Do health insurance premiums increase in the future?

This will /may depend upon a number of factors:-

  • The claims history of the healthcare insurance scheme
  • Medical inflation
  • Changes in membership
  • Pending and ongoing claims
  • Enhancement to or removal of benefits
  • No claims discounts

At the anniversary of your Group Medical Insurance policy we will complete an updated fact find to ensure that your current policy is still the most appropriate and competitive plan to meet your circumstances.

What to do if you have a complaint?

Chase Templeton has a complaints procedure, details of which are available upon request and in summary are:

The general requirements of our internal complaints handling procedure (ICP) are governed by legislation and the Financial Services Authority (FSA) rules (in particular, handbook section DISP). Under the requirements we must have in place and operate appropriate and effective internal complaint handling procedures (which must be written down) for handling any expression of dissatisfaction, whether oral or written, and whether justified or not, from or on behalf of an eligible complainant about provision of, or failure to provide, a financial services activity.

As a general principle we aim to resolve complaints at the earliest possible stage. This is not only better for the customer, but more efficient for the firm. Timelines are in place as the maximum period within which action should be taken and are not targets.

Within five business days - After receiving a complaint we must issue an Acknowledgement within five business days with a summary of the complaint. The letter must contain details of our internal complaints-handling procedure.

Within four weeks - We should issue a letter providing a final response within four weeks of receiving a complaint if wecan. This should detail any final offer we make to the customer.

If we are unable to issue a final response then we must send a holding response explaining why we are not able to resolve the complaint, possibly mentioning reasons for the delay and indicating when we will make further contact.

Within eight weeks the final response will provide a summary of the outcome and, where appropriate, offer redress. We will include contact details for the ombudsman in case the person making the complaint is unhappy with our final response. We should send this response within eight weeks of receiving the initial complaint. If this is not possible, we must write to the person making the complaint explaining why we cannot resolve it, and letting them know of their right to go to the ombudsman.

How do I pay my Medical Insurance premiums?

The most popular means of payment is a monthly direct debit, although some people pay annually in advance by direct debit or cheque.

Some medical insurance companies do ask for the first month's premium by cheque, if so you will be asked to enclose a cheque with your application form. The cheque must always be made payable to the medical insurance company, not Chase Templeton Ltd or the introducer. Never make payments in cash.

Who looks after me in the future?

A designated consultant will provide support to you if you have any queries about your cover or wish to remove or add employees to the scheme. At renewal your consultant will complete a new fact find to ensure that your requirements have not changed. In addition, we will complete a full market review for you to ensure that the current insurer is still the most appropriate to meet your company requirements.

How is a healthcare insurance claim made and processed?

The first step in any claims process is referral by a GP for further investigation or treatment.

Once, your GP has referred you, call the healthcare insurer on the helpline and they will provide you all the details of how to make a claim. They will clarify your entitlement to claim and detail any limitation in cover. They will also provide assistance to you about hospitals and specialists in your area locally, nationally and when necessary worldwide.

If you have any problem with the process or seek additional clarification at the time of making a claim our team is there to assist you.

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I already have Medical Insurance

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