Reducing premium by an outpatient limit: Is it a sacrifice too far?

Private medical insurers are committed to flexible policies that meet the needs of the customer, giving you increased options to tailor your benefits. As standard most policies include an unlimited outpatient benefit. In order to reduce the cost of your premium you can opt to reduce your level of out patient cover under the policy. Although this may seem attractive as it makes your policy more affordable, is it a sacrifice too far?

Lets take a look at what a reduced outpatient benefit could mean for your medical insurance cover.

What does outpatient cover include?

Outpatients receive treatment or advice without being admitted to a hospital facility. Often they will visit the hospital for a consultation with a specialist, or come in for an injection or scan and leave straight after. Outpatients won’t have their own hospital bed, and neither will they need any medically supervised period of recovery. Some common outpatient activities include the following.

  • Consultations with your consultant where no treatment is taking place. These usually include initial appointments, discussions regarding which course of treatment to pursue, and check-ups following an operation.

  • Treatments such as physiotherapy, chiropractics, osteopathy and acupuncture – Where you come in for a 30/60 minute treatment session and leave straight after.

  • Any outpatient diagnostic scans such as MRI, CT, PET, ultrasound or X-ray.

  • Minor procedures such as injections.

What kind of limits can you set on OP cover?

Your insurer will be pretty flexible but generally speaking you’ll be given the following options for your outpatient limits.

  • Monetary limit – Choose a financial limit for your outpatient treatment. Usually you can opt for either £500 or £1000 per policy year.

  • Consultation limit – Choose cover for a specified number of consultations each policy year. This means you will only be covered up to that number of consultations, and for no other kind of outpatient diagnostics or treatment.

  • Conditional limit – You can choose a conditional outpatient limit with some insurers. This means you’re covered for your outpatient treatment if it meets certain specified conditions. For example, you can choose to be covered for outpatient diagnostics if they lead to in or day patient treatment within 6 months.

Advantages of outpatient limits

  • Reduced premiums – Reducing the cost of your premiums can make private medical insurance more affordable. You can save a considerable amount by choosing a policy with an outpatient limit.

  • Individual needs – Some customers only want to use private medical cover for serious in-patient procedures. They don’t mind using the NHS for some illnesses.

  • Limit is per person per policy year – Each person on your policy has an outpatient limit which is distinct from each other. Your outpatient limit also renews at the start of your new policy year.

  • Specialists hold NHS posts – Your private specialist will also hold an NHS post, so if you’ve used all your outpatient limit, you don’t have to pay their private consultation charges and can revert back to the NHS.

Disadvantages of outpatient limits

  • Transferring from private cover to the NHS can be tricky. You’ll be put back on the NHS waiting list and may have a considerable wait before you get to see your consultant.

  • Outpatient treatments are expensive – Many people take out this option thinking they can just pay for private outpatient appointments and scans themselves, and are shocked when the realise the cost of this. An MRI scan for example can cost up to £1500 depending on the hospital you use.

  • Pairing outpatient limits with an excess on your policy can be confusing. This is best illustrated by an example. So lets imagine you have a £1000 outpatient limit and £1000 excess. You haven’t had any previous treatment this policy year and your GP refers you for an outpatient consultation, ultrasound and X-ray totalling £1000. You will actually receive no benefit under your insurance policy as you will pay £1000 for your excess, which will also max out your outpatient limit for this policy year. This is a leading cause of complaints with reduced outpatient policies, but insurers continue to sell this option as due to the price they are some of the most popular policies available.

Don’t be too quick to sell your outpatient benefits, if the time comes when you need to use them, they could save you a lot of stress and hassle. However, if you’re after a no-frills economy policy that you only want to use in the case of serious illness, reducing your outpatient limits could be a useful option. The choice is yours, just don’t let the financial benefit blind you to the downsides.

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