In an effort to substantially reduce premiums many policyholders choose to opt for a 6 week rule when taking out a medical insurance policy. The idea behind this is that if treatment is available fast enough on the NHS, they will go down that route rather than using their policy. Despite this benefit being a popular one, many people fail to fully understand the scope of the 6 week rule, which can lead to disappointment when making a claim. Knowing the facts upfront will help you make the right decision regarding the 6 week rule, saving any nasty shocks later.
What is the 6 week rule?
For those who would prefer to use private hospitals at all times, the 6 week rule is not for you.
The 6 week rule applies to your policy for any in or day patient diagnostic tests or treatment. If you can obtain these procedures on the NHS within 6 weeks of being referred for them then your insurance will not cover you to go privately. This is ideal if your main motivation for taking out private healthcare is the peace of mind that you will be seen quickly, and it doesn’t matter if this is via the NHS.
For those who would prefer to use private hospitals at all times, the 6 week rule is not for you.
Does the 6 week rule apply for all kinds of healthcare?
No – it only applies to in and day patient treatment or diagnostics. All outpatient healthcare is excluded from the 6 week rule.
Usually when you visit your GP and are given a referral to see a private consultant this is initially for an outpatient consultation, so the 6 week rule wouldn’t apply here. However if you see the consultant and he recommends you have a scope for diagnostic purposes, this is usually a day patient procedure, so then the 6 week rule would apply for this part of your claim.
How is it verified?
It varies between insurers, but generally the claims department will get in touch with local NHS hospitals in your area to make inquiries regarding the length of the waiting lists. If the list is longer than 6 weeks, you will be covered to have the treatment privately.
How can you appeal a decision?
You can only appeal a decision if you’ll be physically waiting longer than a 6 week period to have your procedure or treatment. Your insurer might have found the average waiting time for your procedure is 5 weeks and so denied your claim. Despite this individual cases can vary, and in your instance you could be waiting longer.
You’ll need to get proof in writing if possible, and ring your insurer explaining the situation. They should be able to contact your specialists secretary for verification, and provided you’ll be waiting above 6 weeks they’ll reverse their decision and cover you privately.
Advantages of the 6 week rule
Premium reductions – on average you’ll receive a discount of around 20% which could make the policy a lot more affordable.
Peace of mind – although you’re limiting your cover you still have the peace of mind you can access the treatment you need within a 6 week period.
Quality of the NHS – The NHS is renowned across the world for its excellent levels of care. Private consultants must also hold an NHS post as a requirement of the General Medical Council, so you’ll be seeing the same specialists and getting the same high quality of care.
Disadvantages of the 6 week rule
No private cover for emergency admissions – If you need to be admitted urgently as an emergency, your policy will not cover you for private treatment with a 6 week rule. This means if you have a sudden onset condition such as a heart attack or a stroke, you will not be covered privately. Many people don’t realise this, and when their family members make a claim it can be a huge disappointment.
NHS wards and hospitals – If a procedure can be done in less than 6 weeks then you have to use the NHS. The quality of care might be the same but the facilities are not. It can be annoying if you’ve been paying out for private cover to have to stay on a shared ward, rather than having your own private room.
Stressful – Waiting to find out if your procedure will be covered privately can add more stress at a time when you’re unwell and should be taking it easy.
As the 6 week rule offers savings of up to 20% it can be a great option to reduce your premium and make your policy more affordable. However, it reduces the benefits on your policy and can stop you accessing private treatment when you want it the most, such as during an extended hospital stay after a heart attack or stroke. Consider how important staying in a private hospital is for you and your family, before making a final decision.
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