Health Insurance - shieldwise (2024)

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We understand the unique needs of UK residents. Whether you use your new to health insurance, or looking for a better plan we can find the right cover for you.

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At Shieldwise, we match you with a certified provider for optimal health insurance that could save you money, give you better cover, or both.

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Our expert advisors take the time to get to know you better. We work with you to understand your needs and then recommend the best, customized cover.

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Here are some frequently asked questions about health insurance. Have a different question? Contact us today.

How does health insurance work?

If you have health insurance you can arrange to receive fast private treatment in a few easy steps:

If you suspect something is wrong with your health, visit your GP and tell them that you have private health insurance.

If you need treatment, your GP will be able to immediately refer you to a leading specialist and private hospital of your choice.

You must inform your insurance company that you want to make a claim on your policy and confirm your cover.

When your health insurance company provides approval your GP will book your appointment with the specialist. This will be paid for by your insurer.

Health insurance will not cover medical emergencies. If you require emergency treatment you will need to visit Accident and Emergency on the NHS as normal. However, once your health is stabilised your health insurance will cover your continued private treatment.

What types of health insurance policies are available?

Budget policies are the cheapest form of health insurance but they will normally only provide cover for in-patient and day-patient treatment with limits on the amount you can claim. Mid-range. Most mid-range health insurance policies cover full in-patient and day-patient treatment and selected outpatient treatments. Mid-range policies are a good option if you want the benefits of private healthcare at an affordable price.

Comprehensive health insurance policies are the most expensive option but provide full in-patient, day-patient, and outpatient cover, with benefits like psychiatric cover and complementary therapy included.

What hospitals can I use with my health insurance cover?

Every health insurance policy comes with a list of approved hospitals which may vary, depending on how much you pay. For example, not all policies will cover premium hospitals in London.

Make sure you are happy with your hospital list before buying your health insurance policy, especially if there is a particular private hospital you would want to use.

What factors will affect the cost of my health insurance?

Health insurance premiums are determined by different factors that can increase or decrease the monthly cost.

Naturally, your current health and medical history is an important factor for insurers and some providers will offer discounted premiums and cashback if you exercise regularly and eat healthily. If you smoke you may experience higher premiums than non-smokers and your age will also impact the cost of your policy.

What will health insurance not cover?

Health insurance is not designed to cover emergency medical treatment but it will cover your treatment once your condition has stabilised.

Typically health insurance will not provide cover for any of the following; pregnancy, fertility treatment, cosmetic treatment, gender reassignment, or any other voluntary medical treatment. Health insurance does not usually cover the treatment of chronic conditions but it may provide healthcare to stabilise a chronic condition if there is a serious flare-up of the condition.

Can I cover pre-existing conditions?

Health insurance is designed to cover conditions that you develop after taking out your policy. However, the type of underwriting you choose will determine whether your pre-existing conditions are covered in the future. There are three main types of underwriting:

Moratorium: Moratorium policies will normally exclude cover for any condition you have experienced in the previous 5 years. However, if you receive no symptoms, treatment or advice for that condition in the first two years of the policy you will regain cover for it.

Full medical underwriting (FMU): FMU policies require you to provide your full medical history on application. Usually your insurer will exclude cover for pre-existing conditions, but you will be made aware of these exclusions before you commit to buying the policy.

Switch: Switch underwriting allows you to change insurers without losing cover for conditions you have suffered since taking out your old policy. Will my health insurance payments change?

Your health insurance premiums may increase as you get older as you are more likely to claim on your policy. The level of increase will vary depending on your insurer and policy. It is worth reviewing your policy every year to make sure you are getting the right level of cover for the lowest price.

Who is private health insurance suitable for?

The simple answer – everyone! Private health insurance means peace of mind knowing that help is at hand when you need it.

We also know that everyone has different cover requirements and budgets, which is why we offer a range of policies to choose from.

Are there any age restrictions to taking out a policy?

You must be over 18 to take out your own policy with Health-on-Line. If you are younger than this, you would qualify as a “dependent” on a parent or carer’s policy.

There are no upper age limits, so whether you are 19 or 90 you can still take out a policy with us (although bear in mind, the older you are, the higher the costs of the policy).

Why should I buy health insurance?

You should purchase health insurance so that you don’t lose your lifelong savings while paying for medical bills in a critical situation.

How will health insurance pay for my emergency medical expenses?

Your health insurance will either pay your hospital bills directly if opted for the cashless facility or it will reimburse any payment made by you towards medical expenses incurred due to an illness or injury.

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Health Insurance - shieldwise (2024)

FAQs

What is the 85% MLR rule? ›

If an insurance company spends less than 80% (85% in the large group market) of premium on medical care and efforts to improve the quality of care, they must refund the portion of premium that exceeded this limit. This rule is commonly known as the 80/20 rule or the Medical Loss Ratio (MLR) rule.

What is a good MLR score? ›

Commercial for-profit insurers must meet a minimum MLR of 75% for Group insurance and 65% for Individual insurance. Not-for-profit insurers must meet a minimum MLR of 80% for Group and Individual insurance.

What is the lowest income to qualify for Medicaid? ›

The income limits based on household size are:
  • One person: $17,609.
  • Two people: $23,792.
  • Three people: $​​29,974.
  • Four people: $​​36,156.
  • Five people: $​​42,339.

What questions does healthcare.gov ask? ›

Your Marketplace application will ask you for information about any job-based plan you or anyone in your household is eligible for. It will ask you for employer contact information for each person in your household who has a job.

How do I calculate my MLR rebate? ›

The MLR for each insurer is calculated by dividing the amount of health insurance premiums spent on clinical services and quality improvement by the total amount of health insurance premiums collected.

What is the 80 20 rule in insurance? ›

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

What is a good MLR in healthcare? ›

The ACA requires health insurers in the individual and small group markets to spend at least 80% of their premium revenues on clinical care and quality improvements. For the large group market, the MLR requirement is 85%.

How is MLR calculated? ›

For example, let's say an insurer uses $850 out of a customer's $1,050 monthly premium to pay for that customer's medical claims. The insurer also pays $50 in taxes and fees, so we'd subtract $50 from the premium. They can calculate their MLR by taking $850 divided by $1000, which is 0.85, or 85%.

Do you want a high or low MLR? ›

As insurers are likely already aware, a good MLR is 80 or 85 percent (depending on the organization size). Falling short of the federal minimum MLR for a given year means delivering rebates to policyholders.

Can I get Medi-Cal if I own a house? ›

The state looks at other countable assets, such as what funds they have in a bank account. Someone who owns their own home could qualify for Medi-Cal benefits in their golden years to pay for their long-term care needs. However, the lenient attitude toward the house ends after the person receiving benefits dies.

What is the highest income to be eligible for Medicaid? ›

Who is eligible for California Medicaid?
Household Size*Maximum Income Level (Per Year)
1$20,030
2$27,186
3$34,341
4$41,496
4 more rows

Does Medi-Cal look at gross or net income? ›

Keep in mind that these are countable income limits, which is your gross income minus certain deductions. Your gross income can be much higher than your countable income. For example, an individual with no unearned income can make $76,320 a year in gross income and still be eligible for this program.

Is HealthCare.gov worth it? ›

Consumers who went on HealthCare.gov, compared plans, and selected the plan that best fit their health and financial needs paid 38 percent less per month on average than the consumers whose plans were automatically renewed. Plans purchased on HealthCare.gov are comprehensive and guaranteed to cover the essentials.

Is HealthCare.gov and Obamacare the same thing? ›

HealthCare.gov is a health insurance exchange website operated by the United States federal government under the provisions of the Affordable Care Act or ACA, commonly referred to as "Obamacare", which currently serves the residents of the U.S. states which have opted not to create their own state exchanges.

What are 3 questions to ask when you speak to a HealthCare provider? ›

Questions to ask your doctor about your diagnosis
  • What may have caused this condition? Will it be permanent?
  • How is this condition treated or managed? What will be the long-term effects on my life?
  • How can I learn more about my condition?
Feb 3, 2020

What is the MLR rule for the ACA? ›

The ACA requires health insurers in the individual and small group markets to spend at least 80% of their premium revenues on clinical care and quality improvements. For the large group market, the MLR requirement is 85%.

What is the minimum MLR for Medicare Advantage? ›

Statute requires that Medicare Advantage organizations and Part D sponsors are subject to financial penalties, and other enforcement actions if the 85 percent medical loss ratio (MLR) is not met.

Why did I get a MLR rebate? ›

The health care reform law requires insurance companies to pay annual rebates if the MLR for groups of health insurance policies issued in a state is less than 85 percent for large employer group policies and 80 percent for most small employer group policies and individual policies.

What is the MLR requirement for ACA? ›

In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans.

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