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Flashcards in PMI Deck (23)
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1

What is PMI

annually renewable policy

2

Dos not cover chronic conditions

like Asthma

3

Acute Condition v Chronic Condition

a disease, illness or injury likely to respond to treatment
chronic needs long term monitoring incurable

4

PMI Benefits

1 access to medical and surgical treatment
2 get private hospital of your choice
3 convenience
4 avoids waiting for treatment
5 Access to a Private Room
6 Ability choose consultant of your choice
7 Peace of mind - access to medical attention
8 speed

5

Types of Cover

Personal or
Corporate

6

Personal Products

Can be single, married or family
Can be paid annual, quarterly or monthly
Some insurer offer total healthcare packages
Some policies are age restricted
Range - Comp, Std, Budget, Senior and International

7

Corporate

May have different categories of cover

8

Large Group Schemes

Cover 50+ members
Usually include pre existing conditions
premiums calc to group claim history

9

Small Group Schemes

less than 50 members
underwritten and administered as individual plans
Discount will be given on size of group and claim history
Pre existing conditions excluded
Less Flexible to large schemes

10

Core Benefits

Care benefits as follows:
Hospital Charges - benefit prov for paying hospital charges in respect of in patient and day case. Includes accommodation, theatre fees, diagnotics (x rays etc), drugs and dressings and prostheses

Most products do not cover non medical costs eg meals, tel calls
Most providers Band Hospitals
Within one hospital

11

Surgeon and Anaesthetist for surgical procs

some insurers classify complexities
Minor removal of a skin Lesion
Intermediate - removal an impacted tooth
major hysterectomy
Major plus total hip replacement
Complex major eg heart surgury

12

Other benefits

Physicians fees
Outpatient Charges eg consulations, MRI, Physio
Cancer not usually a core benefit

13

Flexible Benefit Packages

Allow customise benefits
eg nomination of hospitals, overseas cover, employee assistance programmes

14

Flex Schems

include PMI, Life Assuranc, IRP, Health Cash Plans

15

taxation of PMI schemes

Personal Schemes - no tax relief and premiums subject to IPT (10% from 1/10/16), benefits tax free

Corporate Group Schemes - If cost met by employer treated as P11d, benefits tax free

16

Underwriting

Principles
1 use standard exclusions
2 Moratoria underwriting
3 declared medical history

17

Standard Exclusions

generally include
pre existing conditions
Pregnancy or child birth
HIV, AIDS
Alcohol or solvent abuse
cosmetic
war, invasion
private GP treatment

18

Moratoria Underwriting

often referred to as point of claim underwriting

19

Underwriting for Corporate Business

Normally all employees of categorised by age, employee status and length of service.

20

Small Schemes

risk in managed by price according to claim history of all employees. Additional factors:
No of eligible employees
type of industry
geography
occupations

May offer no worse terms
Before offering term underwriters will investigate:
size of scheme
when last underwritten
loss ratio with existing insurer
cover has changed
Category of employees

21

Premium Loading

products so pre existing conditions are incorporated. Maybe necessary to get more info from GP. Calcs include
smoking
occupation
weight and height
alcohol consumption
exercise plan

22

Claims

Before claim procedure
1 Most insist check before claiming
2 Normally Gp or specialist complete claim form
3 member will be advised how claim will be paid

23

Managed Care

Insurer intervenes in decision surrounding care, maybe in differ ways
Pre Authorisation - prior to admission
Case Management - high cost of complex treatments
Concurrent Review check the on-going need