A Guide to Health Cover for the Self-Employed By Charlotte Beugge FS 28452 BCMS 538164 in association with wpa.org.uk EMS 505226 IS 553152 1
The UK economy depends upon the millions of people working for themselves, owning and running their own businesses. Despite being fundamental to the economy, they get the least support and yet the most onerous burdens from Government! So it is right that they should support themselves and take sensible precautions to protect their families, their businesses and their health. In a nut-shell: self-employed? No work, no pay. This guide is about your health. WPA is a not-for-profit medical insurer with over 110 years experience of helping people fund their healthcare. With our strong community of Self-employed customers, we are pleased to offer this Guide to Health Cover for the Selfemployed. Contents Introduction 2 The NHS and the self-employed 3 Why you need private health cover 4 What kind of cover do you need? 5 Is it worth the cost? 5 What you want from your health insurance 7 What s on offer 8 How to choose the right cover 10 The big C 13 Useful contacts 16
Introduction The Self-employed are the powerhouse of the UK economy. The entrepreneurial spirit of the close to four million Britons who work for themselves is what s made us one of the most successful economies in the world. While there are obvious advantages to being self-employed, such self-reliance comes at a cost. Bluntly, if you don t work, you don t earn. There will be no employer paying you when you take duvet days or more seriously when you are off work for a long time due to illness. And, apart from that, who is going to mind the shop when you are off? If you can t mind your business because you are too ill to work, your customers are going to go elsewhere. So it s easy to reach the opinion that when you work for yourself, you can t afford to be sick. Yet it s going to happen to you at some point. Most of us will at some time suffer a condition debilitating enough to demand we stay off work. And while our National Health Service does the best it can with limited resources, it s not geared up to the needs of the self-employed. Waiting times to see a doctor are lengthening 70% of GPs surveyed for the Royal College of General Practitioners said patients will have to wait longer to see them over the next two years*. And if you re referred to a specialist by your GP there will be more waiting. Figures from the NHS** found that average wait to be referred for inpatient treatment was 8.7 weeks with 91.7% being seen within 18 weeks. Waiting more than four months to see a specialist is the last thing a self-employed person needs: your condition could mean you are unable to work at your full capacity and hence your income could be affected. And of course you won t be able to pick and choose your appointment times or will have much choice over where you go for treatment. If you re self-employed it s impossible to make your work fit round hospital treatment yet that s what you ll have to do if you rely on the NHS. That s why health cover is a necessity for many of the self-employed. And, for once, you ll be rewarded for your hard work. Health insurers like the self-employed because their self-reliance means they are less likely to claim than employees. As such, they may pay lower premiums. But health insurance is a minefield - whereas there used to be one type of Policy to fit all, today you can get a plan that suits your needs. This guide will explain what s on offer and how the self-employed can find the right kind of medical insurance plan for their needs. But first, we look at what the problems are with our National Health Service and why it seems to be failing the needs of Britain s self-employed. * Royal College of General Practitioners http://www.rcgp.org.uk/news/2013/august/longerwaiting-times-for-gp-appointments-predicted.aspx ** Statistical press notice June 20th 2013 Waiting times data to April 2013 http://www.england.nhs.uk/statistics/2013/08/15/ referral-to-treatment-waiting-times-statistics-june-2013/ 2
The NHS and the self-employed More than sixty years after it was created, our National Health Service is challenged under the increasing demands made of it. But the service we remain so justly proud of is cracking under the strain of an increasing population and a curb on expenditure. And it s likely to get worse. Currently, waiting lists for treatment at NHS hospitals are the longest in five years. In June there were nearly 2.9 million Britons waiting to see doctors and specialists up a massive 250,000 on the previous year.** It all adds up to a toxic brew if you are self-employed. While an employee with a sympathetic employer can easily take the time off work for appointments, it s not so easy if you are self-employed. Neither can you take long periods off work waiting for treatment: because if you don t work, you don t earn. So maybe you will choose to struggle on and work but that could make your condition worse. Given this, it s easy to see why health insurance which allows policyholders to see specialists quickly and be treated in private hospitals if the need be is a good idea, particularly for the self-employed. In these difficult times few self-employed people will have spare money but it could be a false economy to do without medical insurance. Could you spare the time and bear the stress of waiting for an appointment for weeks? Would your business survive you being unable to work? And wouldn t you prefer to be able to choose when you see a specialist and where? Is health insurance worth it for the selfemployed and how do you find the right policy and provider? ** Statistical press notice June 20th 2013 Waiting times data to April 2013 http://www.england.nhs.uk/statistics/2013/08/15/ referral-to-treatment-waiting-times-statistics-june-2013/ 3
Why you need private health cover You may already have life insurance and, possibly, critical illness insurance. Both are good ideas if you re self-employed as they offer you the kind of benefit that employees often get through their companies. But arguably they are not as vital as health insurance. If you are ill then you want to be seen quickly, at a hospital of your choice with a consultant you feel happy with and you don t need the added hassle of arguing about every tiny cost. If you re self-employed, you should see health insurance as your back-up should things go wrong. You want things sorted quickly and you want things done the way you want - with health insurance you regain the upper hand. The size and monetary constraints of the NHS mean that you can feel as if you are spiralling out of control as you have no choice but to fit in with its timetable and locations. As a self-employed businessman or woman, you will be pleased to know that you should pay less for your medical cover than an employee. As many of the self-employed work on tight budgets, this is particularly important. And as you won t get any tax benefits (see box below) cost containment is even more vital. TAXING STUFF If you are self-employed, then you will not be able to offset the cost of your health insurance premiums against your profits. However, if you are incorporated basically this means you have set yourself up as a company and pay yourself through dividends - then you can offset the cost of health insurance premiums against your profits. You will then only have to pay tax on the value of your medical insurance as a benefit in kind which will significantly cut your costs. Before you rush into incorporation, seek the advice of an accountant. There are costs involved and you may have to pay corporation tax which is fiendishly complicated compared with income tax. Also, if you change your mind later and want to un incorporate it will be costly in both time and money terms. So for most of the self-employed, you cannot get tax relief on your medical insurance which makes it particularly important to get the right kind of cover at the right price. After all, it s your money paying for it. 4
What kind of cover do you need? The days of one size fits all on medical insurance have long gone. These days you can pick and choose what you want from a plan. For the self-employed, the most important element that health insurance offers them is speed you won t be waiting in queues for treatment. With health insurance, there s an advantage to being self-employed. Some insurers have worked out that as the self-employed get ill less than the rest of the population, they are a better insurance risk and this means they pay less for cover than employees. Is it worth the cost? Only you can decide whether you want to pay for health cover. No-one underestimates the financial strains of being self-employed these days. Add on the red tape required to run a business in the UK these days, it s amazing that so many of us run our own businesses. Not all health insurance policies are the same, of course. Some insurers will direct where and when their customers are treated. That is rather against the whole idea of health insurance which should give policyholders the freedom and choice they are paying for. But if you own equipment or premises for your business, you will have them insured so that should anything happen, you can continue to work and make money. Health insurance is just like that it is there as a sleeping partner which will step in to help if there is a problem that needs sorting quickly. And remember with health insurance that the earlier you take cover, the better. Premiums rise with age and no medical insurer will cover you for conditions you had before you took out the policy. So, the sooner the better as unfortunately age brings with it the increasing chance of serious illness. 5
What you want from your health insurance Self-employed people know what they want and that s just as true of health cover as anything else. Know where you stand: There s nothing worse than being under the impression that you are covered only to find out too late that you re not. Make sure you know exactly what you re covered for and what s excluded from the outset. You want treatment quickly and in clean, efficient hospitals when you need it. That s the main reason why you took out cover in the first place. You don t want an insurer who makes claiming difficult. The Financial Ombudsman Service (FOS) website will show you how many complaints have been made against insurers. Some insurers also have the details of the number of FOS complaints upheld against them. From this you will get an idea how insurers treat their customers; You want an easy claims procedure. It is distressing enough to be ill without having to quibble about every part of every claim. Price. You don t want to pay over the odds but neither do you want to take out what seems to be a bargain plan only to find premiums rocket in future years. The self-employed in particular need to be treated as a special case. There is no point in taking out a plan that does not suit your needs when there are bespoke plans out there suited to your needs. With some insurers, the different needs of the selfemployed customers are responded to. Their self reliance and their desire to look after their own needs are reflected in the cover and its cost. 6
Just as important as knowing what you want from your health cover is knowing what you don t want or need: Let s assume your GP recommends that you see a particular consultant for your treatment. Some health insurers allow customers, in conjunction with their GP to choose their consultant while others have approved consultant lists basically, it is based on cost and low cost is rarely a proxy for quality. If the one you ve been recommended isn t on that list then you either have to find another or pay the difference yourself. That s all you need if you are unwell and particularly if your business is suffering with all the extra time you ll have to take off to find help that your insurer approves of. Health insurance is meant to be there as a backup if anything goes wrong. But when your health is at risk you don t want to put off claiming your condition won t cure itself. If you are not claiming because you are worried that a claim will result in your premiums rocketing then you have the wrong policy. The self-employed are naturally cost conscious. So health plans that promise no-claims discounts may seem attractive. But they can be a false economy make one claim and your premiums could go through the roof. Self reliance is the motif of the self employed. So being told which hospital/course of treatment you can/can t have goes against the grain. Make sure your health insurer gives you choices and lets you make the decisions about where and when you are treated. Waiting list plans. With these, if your GP says that the wait for your treatment on the NHS exceeds the waiting criteria (usually six weeks), the policy springs into action and you can go private. However, any wait even a couple of weeks will be too long for many of the time-poor self-employed. Do make sure before opting for a policy that you know what you are buying. That means reading the small print so you know what you are covered for. Some policies may limit the extent you are covered for cancer drugs, for example. Other insurers will allow you to bolt on extra cancer cover. Comprehensive policies will pay for advanced drugs otherwise unavailable on the NHS. 7
What s on offer These days, the variety of medical insurance plans is such that at times it can appear confusing. We will examine each different type in the next chapter, but first there are some universal truths that cover all health insurance plans. What is health insurance meant to do? Health insurance, whatever the policy type, is there to cover the cost of private treatment for acute conditions. An acute condition is, broadly, a disease, illness or condition that will respond to treatment and such care that will bring you back to the state of health you were in before you contracted it or full recovery. What it won t cover is so-called chronic conditions. These are conditions that will not improve from treatment: all medical intervention can do is alleviate the symptoms and pain. A commonly-known chronic condition is Alzheimer s. Health insurance usually covers you for in-patient tests; surgery whether as an in-patient or outpatient; nursing care and hospital treatment. Often, psychiatric conditions are excluded. And you usually won t be covered for certain conditions or treatments as a matter of course: for example, normal pregnancy; infertility; cosmetic surgery; organ transplant; kidney dialysis; HIV/Aids and any conditions that result from drug abuse or self-inflicted injury. Depending on the policy, health insurance will also cover out-patient diagnostic tests and consultations. Some plans may make cash payments if you receive treatment as an NHS in-patient and others may include cover when you are abroad. Few if any plans will cover you for accident and emergency admissions or provide access to private general practitioners (GPs). Pre-existing conditions will not be covered either. 8
How to choose the right cover It can be a false economy to go for the cheapest cover but at the same time, noone particularly the cost-conscious selfemployed businessman wants to waste money on things they don t need. Firstly, you need to decide what level of treatment you want cover for. All plans will include inpatient treatment that is, care where you need to stay in hospital overnight or longer. They will also include day patient treatment which again, means admittance to hospital but you don t need to stay overnight. What some cheaper policies will exclude is outpatient treatment that given in an outpatient clinic or consulting room which does not require you to be admitted to hospital. Others will include out-patient cover but will limit the amount you can claim for outpatient consultants fees and diagnostic tests. Some may also exclude or limit the amount you can claim for therapy received on an out-patient basis this can be a sensible economy as you may be willing to pay for your own osteopathy or physiotherapy treatment. Another factor that can influence how much you pay for cover is whether you will be happy being limited to a set number of hospitals, selected by your insurer, or do you want to go wherever you wish for your care? The second option will be more expensive. But you may find that the consultant your GP has recommended will only work out of certain hospitals. If your insurer won t cover you for that hospital, then you will need to find another consultant. That will, for many self-employed people, be too much of a hassle to bear. While the all bells and whistles of a fully comprehensive, no excess plan may be the gold standard, it comes at a cost. And you may not need all the attachments nor be willing to pay for them. By excluding, say, out-patient care, you could cut your costs dramatically. Then, if you need out-patient care you can go through the NHS or pay for your own private treatment. Or you could opt for a plan where you pay the first part of any claim with the insurer paying the rest. Such plans can be dramatically cheaper than traditional cover. And what about adding elements on to your cover or just taking out insurance for particular conditions or treatments? Let s look at all these options in more detail. 9
Flexible plans With this type of health cover, you choose a base level of cover and add or take things away. So, for example, you could choose to exclude out-patient consultations with a specialist; physiotherapy and diagnostic tests such as blood and ultrasound tests. But then you may want to add things on. You could, for example, bolt on a cash benefit which will pay up if you are hospitalised overnight this could be particularly useful for the self-employed. Or you could enhance some other options, such as increasing the amount that will be paid for therapy. Self-employed businessmen and women who travel abroad can extend their policies to include overseas cover. And you could add on dental cover. As an added incentive, the selfemployed may be offered a discount as they tend to claim less than employees. Pros and Cons for the self-employed You get to choose what you want to cover rather than being dictated to by an insurance company. You keep your costs in check by adding on and taking away elements. Opting for cash benefits which are paid when you are hospitalised could help make up for income lost from your business. You need to make sure that you aren t excluding too many things for the sake of saving money it could be a false economy if you need to claim. 10
Cash plans Much cheaper than traditional health cover, these plans help customers make most of their NHS care. NHS Top-Up plans don t actually insure you for private care. Instead, they make cash payments (with set limits) if you are admitted to an NHS hospital or need other treatment within the NHS. They will also make payments for optical, dental and physiotherapy. Some traditional medical insurance plans include elements of top-up plans in that they may make payments if you opt for NHS treatment. Pros and Cons for the self-employed Less expensive cover could cost just a few pounds a week depending on your age. But you aren t getting private medical treatment, just payments that you could use to fund such treatment. As private medical treatment is expensive you might soon find that your money is spent. If you are happy being treated on the NHS in some parts of the country there are no waiting lists for some treatments then cash plans can work as they pay you money for each night you spend on an NHS ward. For a small businessman who does not earn when he s ill this can be a comfort. 11
Shared Responsibility plans With this type of plan you agree to pay a set percentage of any claim and as a result slice your premiums significantly. It works like this. You agree to pay up to a certain monetary limit each year say, a limit of 1,000. Because you are sharing the costs with the health insurer, it pays a percentage of the claim say, 75%, and you pay the remaining 25%. But if your claim is a large one and your 25% would come to more than the 1,000 you have agreed to pay, you won t have to pay any amount on top of this your costs will always be contained at 1,000 for that year. So, basically, when you ve paid the excess the insurer will pick up all the bills after that. Pros and Cons for the self-employed Far cheaper premiums than traditional cover. You know precisely how much the maximum you will have to pay will be and therefore cost containment is easier. It fits in with the self-employed ethic of self-reliance and taking responsibility for your own needs. Still offers fully comprehensive medical cover so no limitations on which hospitals you use. And you can choose whether to enhance limits on out-patient care and therapy as well as whether you add on other benefits such as worldwide care. 12
The big C Cancer is a terrifying illness. But it is not the death sentence it used to be. Half of those currently with cancer diagnoses will live for more than five years and overall survival rates have doubled in 40 years. Thanks to advances in medical research, drugs are now so advanced that once terminal conditions can now be treated. Yet in the UK, survival rates for many cancers are lower than in other Western European countries. And while some of the most advanced drugs have been available on the NHS through the Cancer Drugs Fund since April 2011 the fund, which is worth 200 million a year, will come to an end in 2014. After this, the government will introduce a new way of setting prices for cancer drugs with the aim of making more drugs routinely available in the NHS. nursing plus stays in hospital. Given this, it s easy to see how a typical medical insurance claim for cancer can nowadays easily climb into six figures thanks to the increasing cost of these drugs and the sophistication of the treatment available. So it s important to make sure that if you have health insurance, you know what you are covered for if you are diagnosed with cancer. The last thing you need if you have such news is the added worry about what treatment you ll get particularly if you have a business to run at the same time. *** Cancer Research UK http://www.cancerresearchuk.org/cancer-info/ cancerstats/keyfacts/allcancerscombined/ So far, around 30,000 NHS patients have been given cancer drugs that are banned for prescription on the NHS by NICE, the body which rules on which drugs can be prescribed on the NHS. But that still leaves a lot of people who might otherwise benefit from the drugs. Figures from Cancer Research UK*** show there are around 890 cancer diagnoses every day in the UK. These drugs are hugely expensive a year s course can easily cost tens of thousands of pounds a year or more. And administering the treatment is pricey and patients will need specialist 13
How to buy You can buy health insurance in three ways: direct from the company; from an independent financial adviser or through an agent typically a bank, building society or a retailer. In all cases, you may be buying over the phone, face to face, via the internet or by post. Once you are issued with your policy documents you usually have at least 14 days in which you can cancel the plan regardless of how you bought the policy. There are financial advisers who specialise in health insurance as readily found on the web. Just like every other type of insurance, the sale and operation of health insurance is regulated by the Financial Conduct Authority. This means that you have access to the Financial Ombudsman Service if you have a complaint about how you were sold your plan or if you have complaints about your claim. And as with any other insurance, your first port of call for making a complaint is the company itself or, if it relates to the sale of the plan, the adviser who sold it to you. If you aren t satisfied with the outcome of the company s internal complaints procedure, then you can go to the Financial Ombudsman who will look into the matter for you. Straightforward health insurance complaints (as opposed to those dealing with critical illness insurance) are only a small part of the Ombudsman s caseload as generally these days policies are written so clearly that there can be little confusion as to what is and isn t covered. Problems can however stem from policyholders who fail to disclose all their health details to their insurer when they were sold the plan. If you don t give accurate details of your health, you risk the insurer turning down your claim at a later date. If in doubt of a past illness s relevance, then disclose it. Useful contacts: 14
Useful contacts The Financial Conduct Authority Consumer Helpline 0800 111 6768 www.fca.gov.uk Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London E14 9SR Telephone: 0845 080 1800 www.financial-ombudsman.org.uk Complaints data: http://www.ombudsman-complaints-data.org.uk About the author Charlotte Beugge is a freelance reporter. She started her career at The Daily Telegraph and during her 11 years at the paper, she had various roles including City news reporter, investment correspondent and deputy personal finance editor. She then spent 11 years at the Daily Mail s multi-award winning Money Mail personal finance section as deputy editor. For the last three years she has been a freelance, working for a number of publications including The Times, The Sunday Telegraph, The Daily Telegraph, Good Housekeeping magazine as well as a number of websites and specialist trade publications including Financial Adviser. Western Provident Association Limited Rivergate House, Blackbrook Park, Taunton, Somerset, TA1 2PE Registered in England No. 475557 WPA is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. The member state of the insurer is the United Kingdom. WPA is a registered service mark of Western Provident Association Limited. 09/13489