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In-Patient/ Day- Case Cover

In Patient only cover is the basic level of cover offered by all Insurers. It covers eligible medical treatment that requires at least an overnight stay. Hospital accommodation, surgeons fee, anaesthetists fee, other medical expenses while in the hospital. CT, MRI and PET scans are some examples of what may be covered.
For cover to apply under Day Case treatment, it must be medically essential for you to occupy a hospital bed to receive treatment and treatment must be provided by a consultant.

Out- Patient cover

Out- Patient cover is an optional cover than can be added on if you require it. Insurers usually have a variety of limits that you can select from. Examples of benefits that are covered are, consultations with Doctors, diagnostic tests, physiotherapy subject to policy limits.

Maternity

Maternity cover include payment for costs incurred for Ante and Post Natal treatment, medically necessary Caesarian, delivery and hospital costs. Subject to policy terms and conditions.

Evacuation/Repatriation

These options are worth considering as many countries have restricted medical facilities, and would not be able to provide treatments such as major surgery locally. Insurers offer Evacuation cover to transport you to, and treat you in nearest country of medical excellence. On the other hand, Repatriation cover is to transport you back to your country of residence in case of a medical emergency.

Geographical Areas of cover

International Medical plans generally allow you to select a geographical area of cover. Depending upon the Insurers, you could choose between the following:

  • Worldwide
  • Worldwide excluding USA
  • Specific geographical areas of cover – For example some Insurers provide cover for Indian subcontinents and/or Africa only.

The area restricts your cover to the geographical area you have selected. If you have Worldwide excluding USA cover, you will not be covered for planned treatment in USA.
The premiums for worldwide cover will typically be more expensive than worldwide excluding USA.

Pre- Existing Conditions

One of the most common exclusions of a Medical Insurance Policy is the exclusion of Pre- Existing Medical conditions. Prior to the inception of cover, Insurers require an application form to be submitted with a medical declaration. They will then underwrite the application and may decide to:

  • Place a loading on the annual premium and agree to cover the pre- existing condition, OR
  • Exclude the condition.

Underwriting

There are four types of underwriting :

Full Medical Underwriting

All pre –existing conditions may be excluded or a loading may be applied to cover them. You will be required to declare all your pre-existing conditions on an application form.

Continuous Personal Exclusion

When you have been covered by another Insurer, you can apply for cover on the basis of continuing with the personal exclusions that applied to you and your dependants with that other insurance policy. Your personal exclusions may be transferred over instead of excluding all your pre – existing conditions.  This facility may be available to company schemes (depending on Insurer) if you are moving to either same level of cover or lower level of cover, and not to Individuals. You will be underwritten if you upgrade your levels of cover.

Switch

When you have been covered by another Insurer, you can apply for cover on the basis of switching with the personal exclusions that applied to you and your dependants with that other insurance policy. Your personal exclusions may be transferred over instead of excluding all your pre – existing conditions.  This is subject to completion of a switch declaration form which will require you to declare certain conditions which may or may not be accepted subject to the discretion of the Insurer.

Medical History Disregarded

Depending on the size of the group (varies by Insurer) , Insurers may offer cover on a medical history disregarded basis. This means that no personal exclusions will be applied to your policy and cover will remain subject to the policy terms of the Insurer you choose. You will not be required to complete a medical declaration.

Excesses

An excess is the amount that the client must pay before the medical Insurance kicks in.  Excess are selected by the policyholder to reduce their premium. There are various levels of excesses that can be applied on an annual basis such as £100, £200 etc depending on the Insurer.  An example is as follows:

  • If the policy excess is £100, and you incur a medical bill of £500, you will be expected to pay for the first £100 and the Insurer will pay the balance as per policy terms and conditions.

Waiting periods

Insurers apply waiting periods for certain benefits to prevent policy holders from making claims immediately after taking up the cover.
One of the most common examples of waiting periods is for maternity cover – There is usually  waiting period of 10 to 12 months for maternity claims.
Please refer to your specific Insurer for more information.

Chronic conditions

A Chronic condition is a sickness, illness, disease or injury which has one or more of the following characteristics:-

  • Is recurrent in nature.
    Is without a known, generally recognised cure.
    Is not generally deemed to respond well to treatment.
    Requires palliative treatment
    Requires prolonged supervision or monitoring.
    Leads to permanent disability.

These conditions are generally covered but may be restricted by certain Insurers. Please  refer to the specific product you are interested in.

Amongst the underwriters we work with in the UK are:

Aviva, providing UK Healthcare through Goldstar Simply Health, providing UK Healthcare through Goldstar WPA, providing UK Healthcare through Goldstar

 

Amongst the underwriters we work with internationally are:

 Allianz, providing International Healthcare through Goldstar Axa PPP Healthcare, providing International and UK Healthcare through Goldstar   Cigna, providing International Healthcare through Goldstar

Goldstar Healthcare Limited is authorised and regulated by the Financial Conduct Authority. Financial Services Register No: 308480 http://www.fca.org.uk/register.

The rules and regulations made by The Financial Conduct Authority providing consumer protection will not normally apply to persons resident outside the United Kingdom.

Goldstar Healthcare Limited Registered Address: Lynton House, 304 Bensham Lane, London, CR7 7EQ. Registered in England & Wales, No. 04312301.

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