2015 Star Ratings. Private Medical Insurance. Discussion paper

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1 2015 Star Ratings Private Medical Insurance Discussion paper Defaqto Limited All rights reserved. No parts of this publication may be reproduced in any form by any means, whether electronic, mechanical, optical or any other or be stored in a retrieval system without the express written permission of the publisher. The publisher has taken all reasonable measures to ensure the accuracy of the information and Ratings in this document and cannot accept responsibility or liability for errors in or omission from any information 1 given and for any consequences arising.

2 About this document This document outlines the key developments and trends that will inform the criteria we use for the 2015 Star Ratings for Private Medical Insurance covering Individual PMI, Group PMI and Offshore PMI and, based on these, sets out the areas where we would like to consult the industry as part of ensuring that our Ratings process remains robust and transparent. 2

3 Key developments and trends The market The latest report from Laing & Buisson in 2013 indicates that there was a slight increase in the number of private medical policies in 2012, of 1.1%, which it attributes to the rise of self-insured, trust-based schemes, but it reports that the market penetration of 10.8% is the lowest for 20 years. Judging by the penetration rates PMI is regarded by most as a nice to have and a luxury item. The most growth in the sector was experienced between 1986 and 1990 when almost 12% of the UK population was covered by PMI. Since then penetration has declined to between 10% and 11%. Most PMI is employer sponsored and we have seen a period when more employers have been seeking cost savings, at the same time vulnerable household budgets have reduced demand for individual cover. However, low penetration rates are to be expected in a country with a wide-ranging National Health Service paid for through taxation. More widely, a recent report by Key Note predicts the UK private healthcare market will grow by 2.6% in 2014 and reports year-on-year growth over the past five years. However, Key Note s figures include revenues in the long-term care sector, which accounted for 47.4% of the total private healthcare revenues, and bears little correlation with those purchasing private healthcare through PMI. Health Cash Plans (including Hospital Cash Plans) have proved a popular alternative to PMI in straitened times and corporate cash plan sales have received a boost at the expense of group PMI sales as employers seek to cut costs. With their emphasis on prevention and self-elective treatments, some regard Cash Plans as a more apposite employee benefit than PMI. Legislation and regulation In the individual health market, dissatisfaction with or concerns about the NHS drive interest in PMI. Consequently, reports in April that the proportion of patients waiting six weeks or longer for diagnostic tests had doubled over the previous 12 months to more than 2% - causing the NHS to fail its operational standard is significant. This could at least drive interest in six-week cover plans. Similarly, news stories about the cost effectiveness of some cancer drugs and whether they will be available on the NHS is a fillip to those who can afford it to consider purchasing PMI. Competition and Markets Authority (CMA) Review In April, the CMA taking over from the Competition Commission published the final report on its investigation into the private healthcare market. The report was initially instigated over concerns about competition issues in the private hospital sector. The CMA s report represents a softening of the provisional report published in January, which threatened significant reforms of the private hospital sector. However, its provisions include breaking up one London hospital group, ending commission payments from hospitals to consultants, and the publication of consultant outcomes and fee levels. The review is good news for PMI providers, which struggle to provide competitive premiums and control costs, although some commentators feel the final report has not gone far enough. 3

4 Open referral Much controversy surrounds the adoption of open referral by private medical insurers. It is clearly a way of controlling costs, an imperative in the face of medical inflation, but presented as a benefit to policyholders as a means of sourcing the most suitable consultant services. However, vociferous opponents argue that PMI should be about putting the individual in control and giving them choice, whereas open referral effectively takes that choice away. PMI commission payments Controlling costs of acquisition remains a problem for PMI providers. Traditional commission models are unsustainable in a market where customers are encouraged to shop around each year to find a more competitive premium for their cover. Consequently, insurers are in danger of making a loss on cases that do not remain on the books for very long. Some brokers purchase leads, which adds additional cost into the chain and drives up commissions. High up-front commissions have to be factored into the pricing which can mean that policies move more often, which is ultimately detrimental to the market. Many insurers would like to move to level commissions, which could increase customer loyalty and discourage churning but are forced to continue with the old model in order to compete for the remaining PMI business. Providers Defaqto s database has details of 60 individual PMI products from 19 providers, many of which have as many as five or six product offerings. In terms of distribution, few products are broker-only products. Indeed, only one provider regards itself as broker-only; most operate through brokers and direct channels. 73% 7% 20% Broker only Direct only Broker and direct Products/propositions Half of the products can be described as offering modular benefits, where the applicant can pick and choose which treatments to include, balancing cost to required cover. Typically though, providers have different versions of their product offering different levels of cover and then also within each version, 4

5 modular benefits can be chosen. This must be quite confusing for customers buying online without advice and there is a danger that something essential may be deselected in order to save money, resulting in a false economy. A quarter of products offer a six-week option such that the policy pays out for private services that are not available from the NHS within six weeks. Such cover may prove popular when it is reported that the NHS has failed its six-week waiting list standard, although this can prove to be a grey area for authorisations. 5

6 Key implications for the 2015 Ratings process No changes are proposed to the database or the Star Rating criteria as a result of these developments this year. There are three Star Ratings awarded in the PMI market for individual, group and offshore plans. The criteria used for the PMI Star Ratings are set out in the following tables, arranged thematically demonstrating the weighting between the various criteria types and the issues which are core. 4 and 5 Star rated products will necessarily have to score DNA points in each of these sections in order to achieve the aggregated score high enough to exceed the 4 and 5 Star benchmark. Additionally, they must meet the defined standard for the core criteria, which is mandatory for a 4 or 5 Star Rating. Features relating to the acquisitions process (19% of criteria) Six Week Option Not Offshore PMI Health Screening Discount Underwriting Method Compulsory Excess Core Criterion for 4 and 5 Star Optional Additional Excess Excess Type Number of Preferred Hospitals Core Criterion for 5 Star (Not Offshore PMI) Maximum Annual Benefit Core Criterion for 5 Star Out of Band Benefits Not Offshore PMI Out of Area Benefit Offshore PMI Only In-patient and day patient benefits (20% of criteria) IP/DP Hospital Charges Core Criterion for 5 Star IP/DP Consultant Fees Core Criterion for 5 Star Fees Limit Applies IP/DP Radio/Chemotherapy Core Criterion for 5 Star IP/DP Diagnostic Tests Core Criterion for 5 Star IP Intensive Care Offshore PMI Only IP/DP Physiotherapy IP/DP Psychiatric Cover Core Criterion for 5 Star IP Parent Accommodation-Child Child Maximum Age NHS Cash Maximum ( pa) Not Offshore PMI 6

7 Out-patient benefits (11% of criteria) OP Consultant/Specialist Core Criterion for 4 and 5 Star OP Radio/Chemotherapy Core Criterion for 4 and 5 Star OP Diagnostic Tests Core Criterion for 4 and 5 Star OP Physiotherapy OP Psychiatric Treatment OP Prescription Costs Cancer cover (13% of criteria) Radio/Chemotherapy Time Limit Core Criterion for 5 Star Stem Cell/Bone Marrow Transplants Core Criterion for 5 Star Biological Therapy Time Limit Core Criterion for 5 Star Hormonal Therapy Time Limit Core Criterion for 5 Star Registration Authority Core Criterion for 5 Star (Not Offshore PMI) Palliative Care Core Criterion for 5 Star Home Nursing Alternative therapies cover (6% of criteria) Alternative Medicine Osteopath Alternative Medicine Chiropractor Alternative Medicine Acupuncture Other treatments and benefits (17% of criteria) Deferred Period Maternity Complications Normal Maternity Costs Offshore PMI Only Private Ambulance GP Minor Surgery GP Other Fees Routine Dental Treatment Routine Optical Treatment Repatriation Cover Offshore PMI Only Organ Transplants Offshore PMI Only Help and support (8% of criteria) 7

8 Stress Counselling Medical Helpline Lifestyle Incentives Not Offshore PMI Overseas Assistance (SOS) Offshore PMI only Overseas benefits (6% of criteria) Overseas Cover Not Offshore PMI Overseas Treatment Not Offshore PMI Travel Insurance 8

9 Areas for discussion Based on the material in the preceding sections, feedback is invited on the following questions. Are the current criteria still relevant to the product and the Star Rating? Specifically, are there any criteria that are no longer relevant and should be stripped out? Are there any features and benefits of private medical insurance, which are not currently covered within the existing criteria set, that should form part of it going forward? Specifically, is there a case for making the Ratings more focussed on the customer with the inclusion of claims statistics data for PMI included by provider? 9

10 Appendix: Proposed 2015 criteria Based on the above analysis, we propose including the following criteria in our assessment process for the 2015 Ratings (core criteria are in bold text). Proposed criteria Individual PMI Six Week Option Alternative Medicine Chiropractor Discounted Health Screening Alternative Medicine Acupuncture Underwriting Method Radio/Chemotherapy Time Limit Compulsory Excess Stem Cell/Bone Marrow Transplants Optional Additional Excess Biological Therapy Time Limit (Months) Excess Type Hormonal Therapy Time Limit (Months) Number of Preferred Hospitals Registration Authority IP/DP Hospital Charges Palliative Care IP/DP Consultant Fees Out of Band Benefits Fees Limit Applies Deferred Period Maternity Complications IP/DP Radio/Chemotherapy Private Ambulance IP/DP Diagnostic Tests GP Minor Surgery IP/DP Physiotherapy GP Other Fees IP/DP Psychiatric Cover Routine Dental Treatment IP Parent Accompanying Child Routine Optical Treatment Child Maximum Age Home Nursing NHS Cash Maximum ( pa) Overseas Cover OP Consultant/Specialist Overseas Treatment OP Radio/Chemotherapy Travel Insurance OP Diagnostic Tests Stress Counselling OP Physiotherapy Medical Helpline OP Psychiatric Treatment Lifestyle Incentives OP Prescription Costs Maximum Annual Benefit Alternative Medicine Osteopath 10

11 Proposed criteria Group PMI Six Week Option Alternative Medicine Chiropractor Discounted Health Screening Alternative Medicine Acupuncture Underwriting Method Radio/Chemo Time Limit Compulsory Excess Stem Cell/Bone Marrow Transplant Optional Additional Excess Biological Therapy Limit (Months) Excess Type Hormonal Therapy Limit (Months) Number of Preferred Hospitals Registration Authority IP/DP Hospital Charges Palliative Care IP/DP Consultant Fees Out of Band Benefits Fees Limit Applies Deferred Period Maternity Complications IP/DP Radio/Chemotherapy Private Ambulance IP/DP Diagnostic Tests GP Minor Surgery IP/DP Physiotherapy GP Other Fees IP/DP Psychiatric Routine Dental Treatment IP Parent Accompanying Child Routine Optical Treatment Child Maximum Age Home Nursing NHS Cash Maximum ( pa) Overseas Cover OP Consultant/Specialist Overseas Treatment OP Radio/Chemotherapy Travel Insurance OP Diagnostic Tests Stress Counselling OP Physiotherapy GP Helpline OP Psychiatric Treatment Lifestyle Incentives OP Prescription Costs Maximum Annual Benefit Alternative Medicine Osteopath 11

12 Proposed criteria Offshore PMI Discounted Health Screening Alternative Medicine Acupuncture Underwriting Method Radio/Chemo Time Limit Compulsory Excess Stem Cell/Bone Marrow Transplant Optional Additional Excess Biological Therapy Limit (Months) Excess Type Hormonal Therapy Limit (Months) IP/DP Hospital Charges Palliative Care IP/DP Consultant Fees Out of Area Benefit Fees Limit Applies Deferred Period Maternity Complications IP/DP Radio/Chemotherapy Normal Maternity Costs IP/DP Diagnostic Tests Private Ambulance IP Intensive Care Physician Minor Surgery IP/DP Physiotherapy Physician Other Fees IP/DP Psychiatric Routine Dental Treatment IP Parent Accompanying Child Routine Optical Treatment Child Maximum Age Home Nursing OP Consultant/Specialist Overseas Assistance (SOS) OP Radio/Chemotherapy Business Travel OP Diagnostic Tests Repatriation Cover OP Physiotherapy Organ Transplants OP Psychiatric Treatment Travel Insurance OP Prescription Costs Stress Counselling Alternative Medicine Osteopath Medical Helpline Alternative Medicine Chiropractor Maximum Annual Benefit 12

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