What women's health issues your insurance cover & what won't

Making a claim can be stressful at the best of times, but when it’s for a condition you find personal and may be embarrassed to discuss, it can be particularly unsettling. Claims for women’s health issues are often complex and regularly expert knowledge is required to assess these kind of claims. In order to provide policyholders with high quality customer service many insurers have condition management teams in place which have specialist knowledge and training in women’s health issues. You’ll be able to speak to a female advisor who deals with claims like yours every day, so don’t worry they’ll put your mind at ease and deal with your claim in a sensitive and reassuring manner.

Although claims for women’s health issues are usually dealt with by a distinct team the criteria for approving a claim is the same as with any other. Your claim must satisfy the following components:

  • Underwriting – You will not be able to claim for any condition which is excluded on your policy, or doesn’t satisfy any moratorium period attached to your policy. For more information on the underwriting applicable to your policy check your policy documents.

  • Acute medical condition – Private medical insurance is designed to cover acute conditions which are short term in nature. If your condition is ongoing and requires regular maintenance it may not be covered.

  • Eligible specialist, hospital and treatment – Your claim must meet the general conditions imposed on your policy regarding use of an approved specialist, clinically approved treatment and a hospital from your policy list.

Conditions that will generally be managed by your insurers women’s health unit include the following:

  • Complications during pregnancy and birth, including;
    • Miscarriage – Many women don’t realise they can generally use their private policy to cover them for any treatment or surgery needed as a result of a miscarriage. While it may seem daunting dealing with an insurance company during this traumatic time, generally all it takes is a phone call and you can benefit from the seclusion of your own room in a private facility.

    • Molar pregnancy – An abnormality of conception whereby the pregnancy must be terminated to avoid risk of cancerous growths.

    • Eclampsia and Pre-eclampsia – Conditions related to high blood pressure in pregnant women, these can be extremely dangerous and require close monitoring and in some cases immediate delivery.

    • Ectopic pregnancy – Where the foetus is implanted outside the womb and can risk rupture of the fallopian tubes if it’s allowed to grow.

  • Menopause – While the menopause is a natural part of ageing it can cause problematic side effects such as stress incontinence, mental health issues and excess sweating. Your insurer will generally cover you for treatment of acute symptoms but if the problem becomes ongoing and requires regular maintenance it could be regarded as chronic and cover will cease.

  • Period problems – Your insurer will cover a variety of problems including heavy periods, irregular periods and painful periods to help discover and treat the cause of the problem.

  • Problems related to the womb and uterus – Conditions such as endometriosis, poly-cystic ovary syndrome and fibroids will be generally be covered under your policy.

  • Breast issues – Breast pain and tenderness or the discovery of any lumps will fall under the remit of the women’s health team at your insurance company.

Women’s health issues your insurer won’t cover:

  • Smear tests – These are classed as primary care which falls outside the remit of your medical insurance policy. However if anything is discovered during your smear test which necessitates further investigations then your insurer could help you with this.

  • Healthy pregnancy and birth – Normal pregnancy is not a medical condition, so you won’t be covered for any ultrasound scans or check ups. However, in the event problems arise your insurer will be on hand to help with any treatment or surgery you may need.

  • Well woman clinics – Again these are classed as primary care so are not covered under your policy.

  • Long term hormone therapy – This would be regarded as a chronic condition which falls outside the remit of your medical insurance policy. However, if treatment could remedy the problem for good then cover may be available for surgery.

No-one wants to talk about their personal health issues with a stranger, yet this means many women are missing out on benefits available to them. Ultimately speedy private treatment could help get you better sooner and may ever save your life, so don’t be afraid to call your insurer for these conditions. You’ll be guaranteed confidentiality and a kind listening ear, and if you like you can even get your partner to call and give consent for them to deal with your claim.

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