What do primary care, dental/optical benefits include & what not

Many policyholders are surprised to learn that as standard their medical insurance won’t include cover for primary care treatment, routine dental work, or a change in optical prescription. Adding these options to your policy can give you increased peace of mind and expand the scope of your cover, giving you a comprehensive policy ideal to suit the needs of a family.

Primary care benefit

What is primary care?

Primary care includes healthcare at the first point of contact, such as that you receive from your local doctors surgery via your GP or practice nurse. It covers any healthcare you receive whilst under the overall care of your GP. So if your GP refers you for physiotherapy or osteopathy this would also be classed as primary care, similarly if you are sent for an ultrasound or X-ray at the hospital where the results go back to your GP for analysis.

Primary care also includes community healthcare services such as those offered by pharmacies, dentists and opticians.

What benefits are included?

Primary care benefit under your insurance policy generally covers for the following:

  • GP referred physiotherapy, osteopathy, chiropractics or acupuncture – your standard policy will cover you for these treatments if they are recommended by a hospital consultant, but not if they are recommended by your GP. They are particularly useful benefits as if you suffer from back problems you can receive speedy treatment without having to wait around on the NHS.

  • GP referred scans such as CT, MRI, PET, X-ray and ultrasound – At the first sign of alarm your GP may choose to check the results of these scans for themselves rather than referring you straight on to see a specialist. Your normal policy would not cover your for this, as it is classed as primary care until you are under the care of a hospital specialist. This benefit can speed up getting your test results back and help you avoid NHS waiting lists.

  • Blood tests where the results go back to the GP – if you need any blood tests normally these can be taken in your local practice, but you may be waiting for a while to be seen by a practice nurse. With this additional benefit you can have your blood tests privately at your earliest convenience.

What isn’t included?

  • Private GP consultations – You still need to visit your usual NHS GP or alternatively pay for a private GP appointment yourself.

  • Unlimited primary care – Like all additional benefits the primary care option will have a limit. Usually this is around £1000 per year with a maximum of 10 sessions of physiotherapy treatment per condition.

  • Pharmacy prescriptions – The cost for private prescriptions are not included.

  • Private accident and emergency – Some private hospitals offer an accident and emergency service. This is not included in the primary care benefit and your insurer expects you to use the NHS facilities or self fund.

Dental and optical benefits

What do these include?

  • Dental benefits – these include cover for your annual routine dental check up and any treatment you may need such as fillings, and more expensive treatments like crowns and caps.

  • Optical benefits – If you’ve had a change in prescription your insurer can cover the costs of your optical consultation and any new glasses or contact lenses up to a certain sum.

What isn’t included?

  • Orthodontics – braces and other orthodontic treatments are not generally covered.

  • Periodontics – tooth implants are not covered due to the excessive cost involved.

  • Oral surgery – in most policies if you need a procedure in hospital with an oral surgeon this is covered by the core component of your policy already.

  • Veneers – these are primarily cosmetic in nature to approve the whiteness and appearance of the teeth, as such they will not be covered by your policy.

  • Monthly contact lenses – the optical benefit is only designed to cover unexpected costs that come following a change in prescription. You can still purchase contact lenses, but you will have to buy them in bulk at the point you are notified of a prescription change.

  • Corrective laser eye surgery – this is only included under your policy for specific treatments, such as where it is necessary for the removal of cataracts etc.

Primary care and dental/optical benefits add valuable elements to any medical insurance policy. These are both aspects an average healthcare service user will be likely to use, so the chances are you’ll receive some benefit from paying out for these additional options. If you want to make your policy as comprehensive as possible and cover for an increasing number of scenarios then it’s worth taking out these additional options.

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