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Wiki Articles - Health Insurance - It's Important To Know What's Not Insured!
Around 7 million people in the UK are covered by health insurance, the majority being covered through their employers. The problem is that few have really studied their policy documents and many misunderstand what is covered. And perhaps just as important, what isn't. If you expect health insurance to pay all your health costs, you're mistaken.
Health insu
Health insu
According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product
rance is designed to provide protection for curable, short-term health problems and allow policyholders to jump the NHS queues to see consultants, be diagnosed, receive surgery or be treated. That sounds fine, but before you buy you need to appreciate the treatments and situations that fall outside the scope of the cover.
But first a word of warning. This
But first a word of warning. This
; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.
Examples of combination products may in
Examples of combination products may in
rticle does not relate to any specific policy and the terms and conditions issued by individual insurers do vary. So please ensure you also check your policy documents. After reading this article, you'll know what to look out for!
Sorry – it's a chronic condition
If a condition can be cured and is not a long-term problem, your insurance company will class
Sorry – it's a chronic condition
If a condition can be cured and is not a long-term problem, your insurance company will class
lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.
fy it as acute and should meet the cost. If your problem is incurable or it's a problem that, despite appropriate treatment, will be with you for a long time, then your insurance company will classify it as chronic - and no, you won't be covered.
But drawing a firm line between what is acute and what is chronic is fraught with problems, and leads to the bi
But drawing a firm line between what is acute and what is chronic is fraught with problems, and leads to the bi
here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe
gest area of conflict between insurer and policyholder.
Everyone agrees that diabetes and asthma are chronic conditions as you're likely to suffer from them for the rest of your life. So those sorts of condition are not covered.
Problems arise when the medical team initially considers a patients' illness to be curable, but the condition subsequently deter
Everyone agrees that diabetes and asthma are chronic conditions as you're likely to suffer from them for the rest of your life. So those sorts of condition are not covered.
Problems arise when the medical team initially considers a patients' illness to be curable, but the condition subsequently deter
d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.
Combination pro
Combination pro
orates and the doctors change their mind, it's now become incurable. This can happen especially in the treatment of some types of cancer.
In these circumstances, the condition is initially defined as acute and is therefore insured, but deteriorates and becomes chronic - and outside the terms of cover. This is possible as insurers retain the right to reclas
In these circumstances, the condition is initially defined as acute and is therefore insured, but deteriorates and becomes chronic - and outside the terms of cover. This is possible as insurers retain the right to reclas
ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc
ify a condition from acute to chronic during treatment.
Sorry - it's too long term
The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define “long-term”. You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.
Sorry
Sorry - it's too long term
The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define “long-term”. You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.
Sorry
easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi
– it's preventative
Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.
Again, the problem of definition arises. Sometimes it is arguable whether a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be
Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.
Again, the problem of definition arises. Sometimes it is arguable whether a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be
nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically
sed in the early stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer returning for women who have a particularly virulent form of the cancer known as HER2. In this situation, is Herceptin offering a cure or is it a preventative?
Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Heal
Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Heal
and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ
hcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.
Sorry – the drug is not approved
Two of the main attractions for taking out health insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But there's a rider.
Unless the drug has been approved for use by the NHS in England and
Sorry – the drug is not approved
Two of the main attractions for taking out health insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But there's a rider.
Unless the drug has been approved for use by the NHS in England and
ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi
Wales, by the Institute for Health and Clinical Excellence, your insurer is unlikely to approve its use. The problem is that the Institute's brief is not simply to decide whether a drug works, but to carry out a cost/benefit analysis to ensure that the benefits to the nation outweigh the financial costs of using it in the NHS. Not an easy brief - and one th
ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.
Following aspects would a
Following aspects would a
at has placed the Institute under scrutiny for the extended delays in drug approval.
The compromise hit on by the Financial Ombudsman is that if a health policy won't pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treat
The compromise hit on by the Financial Ombudsman is that if a health policy won't pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treat
dd to the challenges in developing combination products:
Which markets to tap where the combination products can do fairly well?
Which combination prod
Which markets to tap where the combination products can do fairly well?
Which combination prod
ent is more expensive.
Sorry – it's a pre-existing condition
The basic principle is that if you are already suffering from a condition when you start a policy, then that condition “pre-exists” the policy and any claims for its treatment are invalid.
For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to
Sorry – it's a pre-existing condition
The basic principle is that if you are already suffering from a condition when you start a policy, then that condition “pre-exists” the policy and any claims for its treatment are invalid.
For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to
cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin
nsure you. After all they need a clear picture of your medical condition before they quote. For many applications, the insurer will, with your approval, also write to your GP for specific details of your medical history. They like to have a complete picture.
So lets say some years ago you injured your knee playing football. It appeared to recover but now i
So lets say some years ago you injured your knee playing football. It appeared to recover but now i
tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
turns out that you have a torn cartilage and need an operation. The insurer could argue that this is a pre-existing condition and you have to pay for its' treatment.
Some insurers try to accommodate these grey areas with a moratorium provision within your policy. These provisions typically say that so long as you have been symptom free for two years relat
Some insurers try to accommodate these grey areas with a moratorium provision within your policy. These provisions typically say that so long as you have been symptom free for two years relat
t?
As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel
As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel
ng to any condition you've suffered from within the last 5 years, then they will pay for subsequent treatment. Not all policies have these moratorium provisions and the time periods do vary between insurers. You should carefully read your policy.
Sorry – its not covered
Health Insurance is an annual contract – just like your car insurance. So when it come
Sorry – its not covered
Health Insurance is an annual contract – just like your car insurance. So when it come
ping new procedures for reviewing their safety, efficacy and quality.
Professional from academic institutions, pharmaceutical industries, health care indust
Professional from academic institutions, pharmaceutical industries, health care indust
to renewal, your insurer is at liberty to review not only your premium but also change the conditions on which your cover is provided.
Therefore, if your policy comes up for renewal mid way through a course of treatment, it's possible to find that your new policy no longer covers that particular treatment. This means that you will have to foot the bill fo
Therefore, if your policy comes up for renewal mid way through a course of treatment, it's possible to find that your new policy no longer covers that particular treatment. This means that you will have to foot the bill fo
y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products
the balance of the treatment.
Furthermore, with ongoing advances in medical research, more and more conditions are becoming treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.
This hits the insurers' pocket in two ways. With more conditions being reclassified as acute, the number of claims is i
Furthermore, with ongoing advances in medical research, more and more conditions are becoming treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.
This hits the insurers' pocket in two ways. With more conditions being reclassified as acute, the number of claims is i
.
As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de
As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de
creasing. And there's also a trend for new treatments to cost more – Herceptin being a good example. The net result is that the insurers are finding themselves having to pay out far more. This is inevitably passed back to you through increased renewal premiums. And in an attempt to reduce their risk exposure, insurers have a tendency to adjust their definit
elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.
Companies that provide selfless information through particip
Companies that provide selfless information through particip
ons and exclusions. This means that you must read your renewal notice closely before you decide to renew.
So when you are considering Health Insurance, be aware that everything is not always black and white. And if you've got insurance and need treatment, always contact your insurer without delay and get them to confirm that your treatment is indeed covere
So when you are considering Health Insurance, be aware that everything is not always black and white. And if you've got insurance and need treatment, always contact your insurer without delay and get them to confirm that your treatment is indeed covere
tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products
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