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Healthcare

Over 20 AFM members are involved in healthcare.  

In January 2017, members of the British Health Care Society became members of AFM, extending the number of health insurers in our membership.  Our members help millions of people to fund health care and, in a time when public finances are under pressure, play a vital role in complementing the care provided by the NHS. We estimate that each year our healthcare and protection members pay claims of around £400 million.  A significant proportion of these claims produce direct savings to the National Health Service.  

Our members also provide rehabilitation support, which enables employees to get back to work earlier, saving their empoyer, and the welfare state, money. We covered these issues and provide case studies of the work of the sector in our response to the government's Green Paper on 'Improving Lives', which you can download here. In November 2017 we launched new independent research, from OAC consultants on the contribution of the sector to savings in the NHS and welfare state, as well as for employers and individuals.  The report is available to download here.

Following this, AFM presented a proposal to HM Treasury, for it to exempt mutual health cash plans from Insurance Premium Tax.  IPT had had a very harmful effect on this market, and OAC's report contains estimates that the total benefits to the welfare budget and society in general of an exemption would significant exceed the amount of IPT paid.

AFM’s work on healthcare includes sharing good practice, regular meetings of our Health Committee, and demonstrating the benefits of healthcare provided by our members, through research and by representing our members with regulators and policymakers, and in talking to the media.

Mutual insurers, friendly societies and not-for-profit insurers have a long history in helping people take responsibility for their healthcare.  Before the National Health Service was established, most working people relied on their local society to help them in times of ill-health or old age. Today, the sector continues to provide vital support to people, and to work alongside the NHS.  And whilst the NHS provides free healthcare for UK citizens, you may have to join a waiting list for treatment or pay extra for some aspects of keeping healthy yourself.  It need not be expensive to buy health insurance and many employers also offer some form of health cover.

There are generally two types of health insurance products provided by members of AFM:

  • Private medical insurance gives you access to private diagnosis and treatment should you fall ill or be injured; it covers planned, not emergency, treatment.
  • Health cash plans are designed to help you claim money back towards some of you and your family's everyday healthcare expenses

What is a Private Medical Insurance?

Private Medical Insurance (PMI) provides private treatment should you fall ill.  PMI allows you to speed up the treatment of many medical conditions, including surgery and medical tests.

What you are covered for depends on your provider, though typically this includes:

  • inpatient treatment
  • outpatient treatment- for example to see a consultant
  • hospital accomodation and nursing care
  • exclusive approved drugs which are not available on the NHS
  • complementary and alternative health therapy

Long-term treatment, pregnancy and accident and emergency tend to be excluded from PMI.

Premiums tend to increase with age, but restricting the type of cover or agreeing to pay an excess can keep costs affordable.

What is a Health Cash Plan?

An inexpensive insurance policy that provides cover for the cost of everyday healthcare, such as routine check-ups and protection against unexpected costs such as specialist consultations, diagnostic tests, hospital stays and therapy for minor injuries and ailments.

Generally, the premium is fixed at the same level for all policyholders, regardless of their age or the number of claims that they make, and there is no need for a medical examination.  Children under 18 are usually covered for free. 

There is usually a fixed annual limit for claiming in each benefit category (e.g. Optical, Dental, etc.) and you can claim as often as you need to until you have reached your limit.   Claims are made after the customer has paid for the treatment or service, and are usually reimbursed within less than a week.

Health cash plans cover an extensive range of treatments; the most common ones are:

  • Dentist: Both check-ups and dental treatments, including seeing the hygienist
  • Optician: Eye tests and prescription glasses or (often) contact lenses
  • Chiropody: Foot treatment and advice
  • Physiotherapy: Sometimes coupled with osteopathy 
  • Mental health: awareness and support
  • Maternity payments: Cash, paid when a child is born 
  • Complementary health: Osteopathy, chiropractic, homeopathy and acupuncture by a registered practitioner 
  • Hospital in-patient: Cash paid for each night spent in hospital 
  • Hospital parental stay: Cash paid when a parent spends the night in hospital with an ill child. 
  • Special consultation: Repayment of fees paid towards a consultant physician or surgeon. 
  • Personal accident, death and funeral benefits: Cash paid out in the event of accident or death. 
  • NHS prescriptions: Some policies pay back on the cost of a limited number of prescriptions. 
  • Health screening: the policy may pay for an annual health screening. 
  • Others: Surgical or hearing aids, redundancy payouts, day surgery, recuperation grants, occupational therapy, diet advice, paternity grants, adoption grants, infertility grants. Many providers also have helplines for a range of subjects.