Group Health Insurance is not open to everybody...

Posted by Proactive Medical & Life on Friday, January 17, 2014

This week, I would like to give you some guidance on how to manage your Private Medical Insurance policies. Both, the Individual Family policies, and more specifically, the Company/Group schemes that so many families are insured with.

Never before in the Health Insurance market, has there been such high premium rate rises. The insurance companies have experienced up to 45% rise in claims and are passing on their losses to their customers resulting in people being asked to pay out premiums that they never dreamt they would have to. And for those who either cannot afford it, or are unable to Switch their cover elsewhere at a reduced premium for fear of compromising years of cover, they are well and truly stuck.

Also, with regard to Group schemes, we have received a number of calls from distressed people, asking us to manage the issues surrounding their group schemes. The idea, as you know with a group scheme is that if somehow, a number of families whose main family members are employed by the company, a group policy can be set up, with the possibility of lower premiums, or have the benefit of the inclusion of various medical conditions they would otherwise have difficulty getting cover for if they were perhaps on an individual scheme. Whilst the theory might make sense with regard to covering certain medical conditions, this manner of thinking especially regarding premium costs is in fact erroneous, and is also fraught with other problems.

The reasons are very simple and I hope you will take heed.  Firstly, as you know, corporate schemes are designed for employees of a company, this ensures that the company does not suffer too much disruption when one of their team is sick or needs treatment. It also offers an employment incentive, and as an ancillary benefit to an employment package offered it gives the workers peace of mind in the event of a medical necessity.

Usually, in my estimation, whilst a lot of families are legitimately employed by the company, a lot are not. I am aware that I may be writing something here that might frustrate or annoy people, but I assure you that my incentive here is to offer honest guidance, and not to take the moral high ground. That is not my job.  But it is in fact the truth to say, that most of these schemes are considered illegitimate. And there have been cases where the insurance company has picked up on this, resulting in the settlement of large claims being refused on the grounds that the member on the schedule is in fact not legitimately an employee. Whilst this does not happen often, it is certainly a risk I would encourage you to avoid, considering the scale of some serious claims.

Also, very often, the premiums are not lower than if the family would be covered on an individual policy. Indeed, they could most probably increase their cover, sometimes reduce their premiums and be insured with award winning companies, that are mutually funded such as Exeter Family Friendly (voted no1 in the WHICH Report 2011/12). They are also non claims related which means the premium will not go up the following year in the event of a claim being made, as is the case with most other policies.

An example of a recent case in which we dealt with a group scheme that was being transferred onto another insurance company by a corporate broker resulted in their policy going up from £9000 to £17,000. We examined each family individually, made sure we could retain the cover for their medical conditions and split the policy up, putting each family on separate individual policies. In effect, their cover was increased, and the premiums were lowered without compromising on the cover.

As specialist insurance consultants we pride ourselves on a first class product and award winning service. Proactive Medical & Life Ltd been chosen by the industry as the 2011 award-winners of the “Best Individual Health Insurance Broker” at The Health Insurance Awards 2011. Shortlisted for Best Trust intermediary 2013 and finalist in the Corporate Adviser awards 2014.

"The information in this article is for information purposes only, and is not meant to be interpreted as individual advice."

Tags: group health insurance  health insurance  company medical insurance schemes  switch cover  premium increases  private medical insurance  indvidual vs group cover 

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