of HEALTH INSURANCE
Ten myths
Health Insurance (also known as private medical insurance) is often hindered by confusion, negative user experience and press; even more so in a post-Covid-19 world. In a bid to make sense of health insurance, its true purpose and benefits, COVER and WPA have joined forces to provide a fact-based reality check for advisors and their clients on 10 commonly held myths and why they still exist.
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Private medical insurance was a waste of money during the pandemic
MYTH
Health insurers never put customers first
PMI only ever covers the cost of treatments
PMI only appeals to rich, older people
PMI options are vague and not useful on an individual basis
Rising premiums and the need to protect no claims discounts sometimes prevent people from claiming
Most options within your insurance policy are wasteful and the benefits often not applicable to employees
PMI firms 'rely' on people never claiming to make money
It's difficult to get PMI if you have a complex medical history
Health insurers are slow and complicated to do business with
present
Health insurance is often hindered by confusion and negative user experience and press; even more so in a post-Covid-19 world. In a bid to make sense of health insurance, its true purpose and benefits, COVER and WPA have joined forces to provide a fact-based reality check for advisers and their clients on 10 commonly held myths and why they still exist.
Health insurance is often hindered by confusion and negative user experience and press; even more so in a post-Covid-19 world.
In a bid to make sense of health insurance, its true purpose and benefits, COVER and WPA have joined forces to provide a fact-based reality check for advisers and their clients on 10 commonly held myths and why they still exist.
Coming soon
COMING SOON
Virtual appointments with GPs and consultants facilitated by PMI and without any relaxation in care standards, were indispensable during the pandemic. Indeed, PMI policies have become valued for their ability to offer added-value services like remote GP services, online mental health support and video physiotherapy.
Last year WPA became the first insurer to offer an ‘instant’ health insurance claims authorisation process, enabling customers to get real-time authorisation of initial treatment without needing to speak to anyone. With a third of customers registered for their WPA Health app, this is proving a popular feature.
People are using their PMI policies to help with cancer diagnosis and treatment – an area the NHS had previously excelled in
80%
50,000
1/3
fewer people had been diagnosed with cancer in the UK than during the previous year
of GP appointments took place face-to-face prior to the pandemic. This fell to under a half a year ago
of WPA customers have registered for the WPA Health app
The estimated number of people in England waiting for hospital treatment
5 million
A Temporary Blip
The facts
As soon as normal service resumed with growing queues for NHS treatment, PMI has in fact become viewed as more valuable than ever. Data from price comparison website and broker ActiveQuote shows that sales of PMI to first-time customers increased by 100% on average between November 2020 and January 2021 compared to between March and May 2020. Of course, a primary attraction of PMI is its ability to enable you to jump the NHS queue and, with recent NHS data showing almost five million people in England are waiting for hospital treatment, that queue is now longer than ever. Brian Walters, managing director of specialist PMI broker Regency Health, explains: “Policyholders are making use of their PMI when they might otherwise have used the NHS and, although it's true that waiting times to see private consultants are longer than usual, they still pale in comparison to waiting times on the NHS.”
No more ‘profits over people’
The myth that PMI has been a waste of money during the pandemic has been further exploded by the decision by some – but by no means all – insurers to compensate customers for when they weren’t able to derive maximum value from their policies. WPA has been both the most transparent and the first to act. Kathryn Vellacott explains: “As a not-for-profit company, our focus is on our customers, and we remain committed to not profiting from the pandemic and ensuring our benefits are useful.” WPA provided a customer rebate worth around 40% of monthly medical premiums in April 2020, followed by similar rebate in June 2020 costing in the region of £8m. “It was the right thing to do at the right time and I’m pleased another insurer has followed suit, albeit a year later,” concludes Vellacott.
REALITY CHECK
This was followed in June by a similar rebate costing in the region of £8m.
£8m
JUNE
2020
WPA provide a customer rebate worth around 40% of monthly medical premiums.
40%
APRIL
Rightly, customers wondered why they paid a premium for a private service that they could not use due to ongoing pandemic restrictions and private hospitals being requisitioned by the NHS
Kathryn Vellacott, business development general manager at WPA
1
The MYTH
Last October MacMillan Cancer Support estimated:
“We allowed our customers to tailor benefits, modify their options, take breaks from policies yet still allowed them to protect their medical underwriting”
Liam McClelland, business development manager, mid and large corporates at WPA
GlobalData insurance analyst Yasha Kuruvilla says this was an important move for the UK industry, where premium rebates are not very common because WPA’s early move may help to “postpone the erosion of customer relationships.”
NEXT MYTH
PREVIOUS MYTH
HOME
SELECT A MYTH
The stats don’t lie
If this myth was true, the Financial Ombudsman Service (FOS) would be continually upholding complaints against PMI providers. Between January 1st and March 31st 2021, the FOS had 422 new complaints about PMI and dental insurance but only 16% were upheld – less than half the average uphold rate for financial services products generally.
Insurance must be chosen wisely
Amy Saber, general manager of retail insurance at WPA
2
There is a popular misconception that greedy and unscrupulous health insurers are always out to make profits at the expense of their customers
Much of this myth has been perpetuated by negative press coverage about companies in all areas of insurance not paying out claims
422
The number of complaints to the Financial Ombudsman Service against PMI providers last year
16%
Only 16% of complaints to the FOS were upheld last year – less than half the average uphold rate
WPA
Cigna
Aviva
Bupa
Vitality
AXA
None/ Don't know
62%
31%
24%
21%
19%
62% of consultants surveyed by Populus would commend WPA – twice as many as the nearest competitor*
As with other areas such as cover, features and technological prowess, some insurers have better claims capabilities than others. So, it is important to select the most suitable fit for individuals or employees. Edward Watling, senior employee benefits consultant at Mattioli Woods, says “The key is ensuring that your
66%
43%
33%
22%
20%
14%
Insurers ranked for allowing customers to exercise their clinical judgement and freedom*
WPA: Proving people come first
No referral restrictions
People first
For not-for-profit insurers there is simply no incentive not to put customers first as they are unhampered by the demands of shareholders. WPA’s Amy Saber says: “Our focus is not on short-term gains or increasing premiums but offering health insurance and services to the masses that are honest and transparent and of the sort that we want for ourselves and our families.” Importantly, she adds, the group trains all staff regularly to deal with customers on an individual basis at what is normally a stressful or vulnerable time. “It is important we look at the challenges on a case-by-case basis, rather than apply a blanket approach to all claims.”
Health insurers that have the best comprehension of clinical matters*
28%
8%
6%
3%
35%
In many cases insurers were simply declining claims excluded by their policy wordings – often, for example, because of chronic or pre-existing conditions. WPA, which is unusual in volunteering details of FOS complaints against it, has had less than 10 FOS adjudications against it in 10 years. But, sadly, it is only those claims that don’t get paid that tend to make good stories, so these are the ones that are picked up and heard about the most.
insurance provider has your interests at heart and that it will be there for you if you do make a claim. That factors into everything an insurer does. “The process of applying and setting up PMI needs to be easy, the claims process should be straightforward, and solutions for claims challenges should always be forthcoming. The insurers that cannot offer that know they will lose customers quickly.”
Ensuring customers are not restricted in where they choose to seek treatment – whereas many other insurers only allow claimants to use a set list of providers.
Choice beyond no claims discounts
Being one of the very few insurers not to offer PMI with no-claims discounts, because it believes people who need to make a claim should have the option not to be penalised.
Pandemic-driven benefits
Providing access to free phone lines, and a limited number of structured counselling sessions, over and above standard options in a year when mental health jumped to the top of the agenda.
*Source: Populus
Moving towards a new future normal
Tara Gale, SME general manager at WPA
3
PMI only ever covers the cost of treatments. In the past, PMI focussed on covering treatment costs. For example, a decade ago, PMI focused on a level of service that was similar to the NHS, but at a quicker pace.
Rather than wait six months for a hip replacement [via the NHS], customers were able to book the same operation the following week
The next normal of virtual care
Healthcare growth potential by segment by 2022, CAGR ,%
Outpatient
1 Compound annual growth rate.
Virtual care
113%
4
Retail clinics
Outpatient behavioural health
7%
Ambulatory surgery center
Inpatient rehabilitation facility
Hospitals
2%
Long term acute care
-2%
Skilled nursing facility
-3%
Inpatient
The WPA Health App: A snapshot
CLICK TO EXPLORE
Insurers now offer much more than the traditional suite of benefits. Gale explains: “Today insurers offer a range of free value added extras to improve and help the health of their customers”. As such, modern PMI can include GP services, aftercare, preventative healthcare information and helplines designed to complement what is available on the NHS. Paul Roberts, lead consultant at specialist intermediary IHC, emphasises that much of this evolution has come about from simply “listening” to customers. He says “Insurers add value by being advocates for the general health of individual and business customers and providing them with choice and support. If in that process they can offer more options and services then that is superb, and retention rates increase substantially.” Technology has made healthcare more accessible to customers and enabled them to access treatment or support in a new, digital and modern way. Covid-19 has also helped boost the popularity of free preventative physical and mental wellbeing facilities accessible from home, often via an App offering everything from stress helplines and virtual counselling sessions to physiotherapy videos.
Authorising health insurance claims to get their treatment journey started in real-time 24/7 without needing to speak to anyone at WPA – an industry first, currently unique to WPA
Accessing remote GPs who can prescribe medication and refer to specialists for treatment - popular during lockdown
Tracking claims and remaining benefits – all in one place
Viewing membership literature
Submitting claims for cash benefits with the majority being paid within 2 days
Source: McKinsey analysis
This trend for PMI to extend well beyond merely the cost of treatments is set to continue as insurers work alongside the NHS to develop virtual and face-to-face services. For example, cancer screenings are normally only available on the NHS at specific ages – around 50 for breast cancer mammograms and 25 for cervical smear tests.
However, WPA’s Gale says: “We do see cases of cancer in individuals much younger than that. So, should we as insurers look to offer cervical screening from the age of 20? Preventative therapy treatment is another area we are actively researching. As we move to a hybrid way of working, how can we prevent long-term conditions like musculoskeletal injuries earlier?”
Sending and receiving messages securely
The workplace boom
With an NHS free at the point of use, PMI has traditionally been perceived as a “luxury” item for wealthy older people. PMI is seen as extending choice beyond NHS availability, providing patients with more control of their care, waiting times and privacy
The ethos of PMI has evolved from only taking care of people when they were sick, to today focusing on preventative care, wellbeing and so much more
The times, they are a-changin
The growing trend for technology in healthcare
Which of the following medical services, if any, have you accessed during the coronavirus pandemic?
Source:PwC
11%
10%
9%
49%
Phone consultation with GP or specialist
Face to face consultation with GP or specialist
NHS 111 phone line
NHS 111 website
Video consultation with GP or specialist
This myth has become decidedly dated, as the NHS has come under increasing strain and insurers have developed more innovative and affordable solutions for customers.
“It’s easy to see why this myth has evolved as time has gone by. [But] the ethos behind medical insurance has changed in recent years”
77.6%
It is a fact that
Headline average PMI premiums, which surveys tend to put in the region of £2,011 a year*, are certainly not insignificant. But, in fact, many modern budget formats allow customers to pay much less through innovations such as Shared Responsibility. Annual premiums could be anywhere between £350 - £1,500 depending upon type of cover you’re after - a basic or comprehensive plan, your age, where you live and what hospitals you’d like to use. The ability of PMI, aided by new technology, to now go well beyond taking care of people when they are sick and to allow them to better control long-term health and to have access to services for minor illnesses, mental wellbeing and other benefits has also greatly broadened its appeal. Additionally, the fact that nowadays you may not even need to speak to someone to start a claim has certainly cut through barriers. Liam McClelland says “WPA is engaging with customers via their phones in their pockets. Even young individuals who are fit and healthy, in their prime and overly optimistic about their health, are realising that health cover is a worthwhile investment.”
Thinking about your own health, have you used technology or medical devices at home to monitor any of the following?
In particular, businesses are looking at how services can be tailored to different employees and the challenges they may face at different life stages. Liam McClelland says “There's a definite need to provide support based on where you are in your life and the path you're on. In fact, younger generations may need more support in their 20s. “The younger generations appear to be more mindful of their wider health and wellbeing than perhaps the generations before them, meaning a benefit solution should be adapted to support the specific needs of each employer's workforce.”
Tailored future
“There may be opportunities for employers to support women around periods, contraception, menopause, or cancer screening and concerns for men around suicide levels and mental health support”
*Source: LaingBuisson Health Cover Market Report 2020
Weight
36%
27%
26%
17%
Steps
Heart rate
Sleep
Blood pressure
Temperature
Blood sugar
of PMI policies are paid for by employers*
A trend for employers to offer PMI to their workforces has also significantly boosted the numbers of younger people with cover, regardless of income. Companies of all sizes are increasingly appreciating that its ability to slash absenteeism and presenteeism costs means it has major benefits for the employer as well as the employee. PMI enables employees to choose to have consultations and operations at times that fit in with their own and their colleagues’ workloads and offers them access to a range of wellness benefits that can boost productivity by helping them stay fit and healthy over the longer term. Edward Watling, senior employee benefits consultant at Mattioli Woods, says “PMI has rarely been something an individual under the age of 25 or so would have invested in themselves but, from an employer’s perspective, it is beneficial to offer it to all employees, regardless of age, sex, and wealth.”
Services accessed by clients during the coronavirus pandemic
Technology/medical devices used by clients at home to monitor their own health including:
Additionally, the fact that nowadays you may not even need to speak to someone to start a claim has certainly cut through barriers. Liam McClelland says “WPA is engaging with customers via their phones in their pockets. Even young individuals who are fit and healthy, in their prime and overly optimistic about their health, are realising that health cover is a worthwhile investment.”
Getting more tangible
5
A traditional, mis-founded complaint about PMI is that not every option on a policy seems useful, with some appearing to be vague, or not applicable to policyholders
“The ethos of PMI has evolved from only taking care of people when they were sick, to today focusing on preventative care, wellbeing and so much more”
Variety is the spice of life
Customers today have much more available in terms of services, and better choice about where and with whom to seek treatment than ever before. This includes tangible benefits such as optical and dental cover, health screening, remote GP and health & wellbeing lines often offered at a cost to the insurer rather than to the customer. Richard Tutill, business development manager at WPA, says “A decade ago, health insurance was there when needed, while today the many tangible benefits on offer make it useable on a regular basis for everyday health needs.” WPA’s policies provide a range of bolt-on options, with its popular Premier policy offering a variety of levels within each option. This allows policies to be more tailored than they ever have been before – and its offering is continuing to evolve.
The evolution of health insurance over the past decade has seen a myriad of value-added services brought in and bolted on to traditional health insurance policies. As a result, part of the confusion permeating this myth may lie in the fact customers do not always understand the benefits on offer to them, as they may not leap out as immediately relevant on an individual basis. Paul Roberts, lead consultant at specialist intermediary IHC, explains: “It’s unfair to label PMI policies as vague. The truth is there are tens of thousands of different styles of policies on offer across a range of different types of insurers that have been set up to serve a variety of businesses and individuals of all ages and wealth. These policies must be able to support customers in their time of need.”
Flexible health brochure
Richard Tutill, business development manager at WPA
“Access to the best hospital for diagnosis or treatment of your condition should be a clinical choice, not a commercial decision driven by a health insurer”
Essentials
A good value surgery-only Policy for fast-track private surgery, offering in-patient and day-patient benefits when you need non-emergency (elective) surgery for a diagnosed medical condition. Includes benefit towards dental care and optical treatment. No benefit is available for out-patient treatment/investigations or for cancer surgery. Maximum annual benefit limit: £50,000 per person.
Premier
Over 62%* of members choose this Policy due to its range of Optional Extras. Multiple Shared Responsibility ®(co-payment) levels are available. No maximum annual benefit limit. * Based on the number of Policies sold across the Flexible Health product range between 01.04.19 and 31.03.20.
In addition to the in-patient, day-patient and out-patient benefits, Elite also offers valuable cash benefits, such as dental care and optical treatment. Multiple Shared Responsibility ®(co-payment) levels are available. No maximum annual benefit limit.
Elite
Optional extras
Advanced Cancer Drugs
Extra Out-patient - two levels Cancer Care Overseas Emergency Treatment Dental Care Premium Hospitals
Premium Hospitals
Choice is key
Perhaps more importantly, it is the prospect of consultant choice, which offers the policyholder more control about who to see, when and where, that is most appealing in modern policies. For example, some health insurers limit consultant choice or where you can be treated. Options that are not always convenient for the customer. WPA believes the customer should also be in control of their own health choices. Indeed, Tutill believes this choice is vital in tailoring the best plans for individuals. “Access to the best hospital for diagnosis or treatment of your condition should be a clinical choice, not a commercial decision driven by a health insurer,” he explains. As a result, WPA members have access to over 600 hospitals throughout the UK, allowing customers to choose one near them or to suit their specific needs and budget. By focusing on services that meaningfully and measurably improve healthcare, WPA is also trying to ensure its customers remain informed to ensure policies are personalised as much as they can be.
WPA members have access to over 1,300 private hospitals, clinics and NHS wings across the UK
PMI is no longer only about an annual renewal process because hand in hand with the increased flexibility comes a real need for customer control and understanding of a policy.
Charlie MacEwan, corporate communications director at WPA
6
No claims discounts can deter PMI policyholders from claiming. Few customers want to lose precious discounts built up over years by making a claim, particularly when premiums will inevitably rise when they claim
The point of a health insurance policy is to claim if you are ill
A question of choice
There is also the issue of whether the penalties incurred from losing no claims discounts are reasonable. Some policyholders have experienced premium increases of over £1,000 on annual policies after claiming for only a few hundred pounds. Brian Walters, managing director of specialist PMI broker Regency Health, says “Regrettably, it’s the case that policyholders may see sharp increases at renewal following a claim, which is something that the industry needs to work on. “This issue is particularly egregious where the claims-related increase outweighs the cost of the claim itself, which calls into question whether the product is delivering fair value to customers.”
PMI, like other insurance, is priced to reflect the risk being taken on. So, factors such as age, location, state of health and lifestyle choices have an impact on premiums because they have a bearing on the likelihood of policyholders claiming. However, the practice of offering a no claims discount is a step too far for some. WPA believes that is all about choice and customers should be able to choose an alternative to having one. For WPA, deciding to protect your no claims discount by not claiming for a dented bumper on car insurance is one thing, but postponing a claim that could have severe repercussions for your health is quite another. Charlie MacEwan says “The point of a health insurance policy is to claim if you are ill. Key is that the mechanics of a no claims discount are explained and thoroughly understood before the purchase.”
“Inevitably, when customers contact us, it will be at a time when it's potentially more difficult for them physically or mentally, with the strain of an injury or illness on their shoulders. More strain [from insurers] is the last thing someone needs when they’re unwell”
Amy Saber, general manager, retail at WPA
Disproportionate increases
“This issue is particularly egregious where the claims-related increase outweighs the cost of the claim itself, which calls into question whether the product is delivering fair value to customers”
Brian Walters, managing director of specialist PMI broker Regency Health
“This issue is particularly egregious where the claims-related increase outweighs the cost of the claim itself, which calls into question whether the product is delivering fair value to customers.” WPA has a different approach where premiums reflect the claims of the many.
How are premiums worked out?
Customer A - Pooled rating
Customer B – No claims discount
Customer A, a 45 year old, living in Reading, had to have a hip replaced in 2018 and their insurer (WPA) has paid over £12,500 for this claim to-date.
Customer B has had a back problem which has not been resolved by physiotherapy so he was advised to have an MRI which cost £305.
Customer A gets premium increase in the region of 7 – 10% whilst customer B loses 3 levels of No Claims discount and experiences an increase of circa. 30%
Standing out from the crowd
Going against the grain is never easy but WPA’s stance ties into a wider notion of placing the customer at the heart of the insurance process. Amy Saber, general manager, retail at WPA, says “We are passionate about not wanting to influence behaviour by customers feeling they have a financial burden on their policy in years to come.”
Customer A
Customer B
No claims discount
Sharon Shier, head of product development at WPA
7
Most people feel insurance is a ‘one-size fits all’ policy. But healthcare services and treatments very rarely follow a linear pathway
No claim, no pain
This peace of mind is also highly valued by employers providing group schemes because they know that, if necessary, employees can always receive treatment at a time suitable to their workloads and to those of their colleagues. Additionally, employers benefit from the knowledge that modern PMI schemes now offer a whole raft of features that can help prevent employees from being ill in the first place, such as:
Not needing to claim on a policy you have paid into for many years can in fact be seen as a good thing because it means you have remained fit and healthy. Edward Watling, senior employee benefits consultant at Mattioli Woods, says “Car and buildings insurance is mandatory by law, yet no-one actually wants to crash their car or see their house burn down. “Customers can fail to realise that insurance is designed to cover an unfortunate event in the future, not the past. Policies are not wasted if you don’t use them.”
“Employers can then identify the value-added benefits they have chosen that are being readily received and the ones they may need to further promote to employees”
Enlightened self-interest from employers
Empowering employees
Sharon Shier says, “These are not wasteful benefits. Businesses need a tailored programme that helps them attract and retain the best people through this benefit and as part of an overall remuneration package.” Usually, employees can personalise care from flexible modular policies according to their individual preferences, with cover also sometimes extending to family members.
24-hour
Phone lines
EAPS
Employee assistance programmes (EAPs) which also include stress counselling, debt management and legal services too.
Health screening
Information and videos on diet, fitness and other aspects of wellness.
Data dependency
Predictive analytics tools can now collect data from a variety of sources to better understand and predict the behaviour of customers, helping insurers to manage their relationships, claims and underwriting. Shier says, “While employees can log onto an online portal via an App and understand how much of their benefits have been used, employers receiving the same data in anonymised format can better understand usage by benefits and costs.
This allows individuals to think about what is important to them and what they can and cannot self-fund, making them feel empowered as opposed to paying for a benefit they will never use. They also benefit from the peace of mind of knowing they have immediate access to private treatment if needed.
“It’s much better if clients take out insurance when they are fit and healthy”
Edward Watling, senior employee benefits consultant at Mattioli Woods
8
There remains a misconception in some quarters that private medical insurers will do their best to wriggle out of paying claims. This has led some to believe health insurers ‘rely’ on customers never claiming to make their profit
Customers must be able to claim when they need to and want to...
Robust regulation
As a rule and sometimes referred to as the premiums of the many paying for the claims of the few, PMI providers base their business models on the diversification of their customer bases, aiming to quantify individual risks and redistribute them across a much larger portfolio of customers that collectively poses less risk. A proportion of the average business model also focuses on premiums to increase profits, with underwriters working out the terms policy holders are offered at outset with actuaries providing input about future morbidity rates.
Even if insurers wanted to adopt such a business model, the current regulatory framework simply would not allow it. Health Insurers operate within the strict regulatory framework provided by the Financial Conduct Authority (FCA) whose aim is to make financial markets work well so that consumers get a fair deal. Firms must always act in their customers’ best interest and there are stringent fines for those that transgress. Charlie MacEwan says: “Treating customers fairly echoes throughout our industry and regulation is there to help us ensure that we all have customer focussed cultures thereby ensuring the best outcomes for them.”
Diversification needs
Vive la difference
But no two insurers are the same and those with not-for-profit structures, like WPA, are not subject to pressure from shareholders. MacEwan continues: “Ensuring the money that customers spend with insurers is redistributed into creating better services is key to making sure the industry and our products are valued.”
The WPA way
Although, like any business, WPA must make enough money to cover its costs, any surplus is reinvested into the business, services, training and people. Without any ‘owners’, the vanity subjects of turnover, profit and market share cease to exist. Consequently, a focus of the Leadership Team is how customers are being looked after – how long it is taking to pay claims, answer the telephone calls, complaints and compliments along with other customer-focused metrics. IT developments are measured on how they will improve the experience of customers. Unlike many other insurers, WPA has an alternative to no claims discounts because these can deter people who are ill from claiming – the purpose of having a policy in the first place. And it was the first UK insurer to pay rebates in 2020 when access to private healthcare was constrained during lockdown – something which, 20 months on, major players in this sector have still to do. WPA’s proactive stance in observing lockdown claim levels and insisting that customers enjoyed appropriate rebates in both April and June 2020 is in fact the polar opposite of relying on customers not to make claims.
WPA was the first UK insurer to pay rebates in 2020 when access to private healthcare was constrained during lockdown
Mark Southern, sales and marketing director at WPA
9
The idea that you can’t get affordable PMI cover if you have a complex medical history has long been seen as a hurdle for many suffering from conditions such as diabetes or high blood pressure
Even though PMI has traditionally excluded pre-existing conditions and lengthy ongoing ‘chronic conditions’, many of those with either can still obtain cost-effective and usable policies
The ongoing conundrum
This outlook is applied to hundreds of chronic conditions by insurers. Take cancer: although cancer often becomes chronic, most PMI policies no longer exclude it when it does. Millions of sufferers from other common chronic conditions – such as asthma, diabetes, epilepsy or bad backs – may also be able to obtain cover for everything apart from the condition in question (or even for the condition subject to certain restrictions). Southern adds: “Today many people live with a range of chronic conditions managed very well by the NHS, meaning the condition can simply be removed from a policy and the customer still allowed to be covered for a plethora of other illnesses and treatments, and benefit from additional tailored services.”
This myth for many is now truly outdated for two key reasons: medical science has progressed and the insurance sector has evolved. Arguably, if a customer has an ongoing condition that is flaring up currently, they are requiring insurance for a ‘known’ event, and that is not the purpose of PMI. However, if it is a condition that has been under control for a long period of time, controlled with medication, there is an open conversation to be had with an insurer, according to Edward Watling, senior employee benefits consultant at Mattioli Woods. Dialogue is important in this situation, says Mark Southern: “We need to have conversations that draw out the needs of the customer and not make assumptions about a condition, the treatment, and whether it would be covered or not. The customer also needs to be prepared to share the details and clarify symptomatic conditions.”
Bounce it off an advisor
The key to finding a policy if a customer has such a condition is to use a skilled advisor who can search for the best provider and tease out the demands and needs of the customer, without making assumptions about the condition, the treatment, or their impact on a generic policy. Southern continues: “Experience of having dealt with a huge number of different scenarios, and understanding what is possible, is essential to securing a client a suitable policy.”
“We need to have conversations that draw out the needs of the customer and not make assumptions about a condition”
The merits of moratorium
Individuals with pre-existing conditions can even gain cover without having to disclose their full medical history by opting for a policy that uses ‘moratorium’ underwriting. This will typically exclude pre-existing conditions from the previous five years for a set period – most commonly two years. If no symptoms or treatments occur within these two years, then the pre-existing conditions will start being covered. But Watling warns that moratorium wordings and the claims ethos of various insurers differ, so businesses and individuals must pick an insurer that is right for them.
“It’s essential for businesses to understand they have the right quality of insurer base for the majority of their employees, otherwise it will be of no use. To simply go for a firm with the cheapest premiums is wrong because it will not serve the purpose”
George Dowse-Brenan, business development manager at WPA
10
The perception that dealing with PMI providers can be a lumbering and tortuous process, particularly regarding the filling of application forms and making a claim, may have been valid years ago
A decade ago, almost every customer was completing a fully underwritten application form that would involve submitting a hand-written form, either through the post or having to scan and email it in. Something, I am glad to say that is no longer the case
Bypassing the GP
The complexity of healthcare is such that customers can suffer from up to 10,000 conditions, choose from 14,000 consultants or 22,000 therapists or visit one of hundreds of hospitals! But significant enabling developments from WPA are helping to simplify options and solutions so that they can help customers with services that are right for them.
Reducing the need to get information from GPs at the claims stage, which could often take two weeks, has been a particularly interesting development for the industry, allowing many decisions to be virtually instantaneous. For example, many insurers now create a dynamic form, which goes straight to the specialist with specific questions needing clarification, cutting out the need to see a claimant’s entire medical records. Although WPA was striving to become paperless when Dowse-Brenan first joined 11 years ago, the drive is now more towards end-to-end digital solutions, with customers making contact via Apps or secure portals from the start. He explains: “A lot of our technological development today is in-house and we have a growing IT development team.”
“We have created ‘WPA bespoke technology’, specific to our purposes and that is what helps speed up the pace and meet customer needs”
Onwards and upwards
In the wake of Covid-19, the pressure for health insurers to move quickly and make the claims process smoother is ongoing; KPMG has even described the pandemic as the “wake-up call the industry needed”. WPA adds it will most likely lead the insurance sector to accelerate business innovation and shift more quickly from physical to digital channels and products, with end-to-end automation and optimization of processes from intake through to claims. Dowse-Brenan agrees there is still plenty more to come - although this will never be at the expense of keeping health insurance personal.
“I think there's still a way to go with perhaps what a customer might expect in terms of doing everything from their phone, as with other industries. Health is complex and it is our job to make it straightforward for customers”
DELOS
A pioneering and award-winning automated claims technology, which augments the customer services teams’ decision making, guiding them through the claims process and playing a pivotal role in achieving consistency and simplicity
WPA Health App
Putting policies into the hands of customers and available 24/7. It remains the only UK health insurer app to authorise claims and has undergone a 15-fold increase in usage in the last year
iZone portal
For intermediaries that provide a self-serve capability, allowing them to log on and run the most common types of admin changes instantaneously
