Questions and Answers
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Key Features
- Private Medical Insurance
- Aims, Commitment and Risks
- Questions and Answers
- Other Information
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Application Forms
- Application Form for Officers/Staff (51KB)
- Application Form for Partner/Spouse (51KB)
- Application Form for Children (50KB)
- Direct Debit Mandate Form...
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Additional Information
- Brochure (2220KB)...
- Policy Specimen (114KB)...
- How To Make A Claim (57KB)...
- Contact us for further information
What is an MPFS Private Medical Insurance (PMI) Plan?
It is a tailored healthcare plan designed to cover the costs of private medical treatment (see 'Table of Benefits'). Benefits under the plan can be claimed at any point during the treatment process providing your Doctor referred you to a specialist consultant in the first instance. This can be particularly useful where the NHS is unable to provide you with a prompt service.
Cover is available for you, your partner and children, and unlike some plans our premiums are not age related. We have instead opted for a co-payment scheme where anyone 40 or over who makes a claim is asked to make a limited contribution towards the cost of treatment (see 'What are the charges?').
Who can take out a plan?
The main insured must work for the Police Service and be 44 or under when joining. Partners must also be under the age of 45. However, cover will continue until age 60 for all adults (or until the main insured leaves service if earlier). Cover is also available for resident dependant children, but will cease on their 19th birthday unless they are in full time education in which case cover will cease on their 22nd birthday. Partners and children can be added to or removed from the policy at any time.
How does the plan work?
Let's say that you have a condition that requires treatment at a hospital or clinic and your Doctor decides to refer you to a consultant. If you can be treated quickly through the NHS, there is a cash benefit payable for each night spent in hospital (see 'Table of Benefits'). However, if you would prefer to go private, or there is a significant delay or waiting list before you can be treated or even before you can be seen by a consultant under the NHS, just follow the steps below and we will do the rest!
Step 1
Contact us to obtain a claim form which you complete and return to us. It will save time if you have an open "referral letter" from your Doctor which you can send us with the form.
Step 2
We then contact your Doctor for any further information that is required to assess and all being well approve your claim.
Step 3
We use a specialist company, Medical Care Direct (MCD) to find a consultant and/or a convenient hospital who can perform the treatment you need at a time that suits you.
Step 4
We provide the money to meet the cost of your treatment subject to the stated limits (see 'Table of Benefits'), which is paid direct to the consultant and/or hospital on your behalf, often before you have even attended the hospital.
Step 5
You will be contacted following your admission to hospital, normally just after your operation/treatment to ensure all is well, and the same will happen when you return home. In the unlikely event that you have any problems or concerns, they can be addressed quickly.
Hospital Cash Benefit
If you have NHS treatment which involves an overnight stay in hospital, you contact us shortly after returning home to obtain a claim form which you complete and return to us. We then contact your Doctor for confirmation and once approved the funds are paid directly to you. We will even pay this benefit to you if you have to stay overnight in a hospital outside the UK but within the EU (we may need to contact the EU hospital before we can pay you under these circumstances).
How much does the plan cost?
The premium is the same for all adults, £36.75 per month (including Insurance Premium Tax) in 2009. If you wish to cover children, the premium is £14.70 per month per child. We may change the premium payments for members covered by this plan because of factors such as our claims costs, but we will tell you beforehand if we are going to do this.
How do I pay for the plan?
If you are a member of the Metropolitan or City of London Police Service the premiums are paid by salary deduction, otherwise payments are made by direct debit.
What conditions and treatments does the plan cover?
The cover is wide-ranging and competitive. Full details are provided in the table of benefits. For more information on any specific areas, in particular for a list of general conditions and exclusions, please contact us and ask to see a copy policy document
What are the charges?
The premiums shown above include all the costs for administration, underwriting, and fees payable for any medical examinations which we may ask you to attend. However, if you are 40 or over at the time a claim is made, you may have to pay a proportion of the cost. This proportion applies to the first £4,000 of the cost of treatment. We pay the rest of the cost above this level up to the limits shown in the table of benefits.. The table below gives you the co-payment details:
| Age at time of claim | Amount of your contributions (co-payment) |
|---|---|
| Under 40 | Nil |
| 40-44 | 10% of the cost of treatment (up to a maximum of £400) |
| 45-49 | 20% of the cost of treatment (up to a maximum of £800) |
| 50-54 | 35% of the cost of treatment (up to a maximum of £1,400) |
| 55-59 | 50% of the cost of treatment (up to a maximum of £2,000) |
Table of Benefits
| Category | Benefit Payable | Other Information |
|---|---|---|
| Hospital Charges | Paid in full up to 140 nights/days per year | Includes accommodation, nursing care, theatre fees and consumables, surgical drugs and dressings, diagnostic procedures, body scans, physiotherapy, pathology and eligible prostheses for treatment at the selected hospital. |
| Specialist Services | Paid in full up | Surgeon's anaesthetist's and physician's fees for in-patient treatment. |
| Radiotherapy/ Chemotherapy | Paid in full | For specialist services, hospital charges and necessary drugs administered at the time of treatment. |
| Specialist Consultations | Up to £600 per year | Including second opinions if required. |
| Diagnostic Tests | Up to £2,000 per year | Includes maxima of £750 in total for procedures such as x-rays, ECG and pathological tests, and £1,250 in total for CT and/or MRI scans. These entitlements include radiologist's fees when appropriate. |
| Home Nursing | £30 per day up to 30 days per year | Payable for medical as opposed to domestic reasons. Must be undertaken under the supervision of the attending specialist. |
| Private Ambulance | Up to £300 per year | Payable towards the cost of private road ambulance to, from or between hospitals. The use of the ambulance must be medically essential and required in connection with eligible in-patient treatment or day-patient treatment. |
| Minor Surgical Procedures | Up to £750 per year | When undertaken at the specialist's consulting rooms. |
| Hospital Cash Benefit | £125 per night up to a maximum of £2,500 per year | Paid for in-patient treatment when the patient is admitted to a NHS or a non-UK EU hospital bed and no fees for treatment are incurred under the policy. A co-payment will not be required for this benefit. |
What about tax?
Present UK tax law and HMRC practice means you don't:
- get tax relief on premiums, nor
- pay tax on any benefits claimed under the plan.
This may change in the future.
How do I apply?
Fill in the appropriate application form(s) and send them to our contact address. The main insured (who must work for the police service) should complete form A. If you wish to extend cover to a spouse or partner, you should both complete form B, and to extend cover to children please complete form C on their behalf.
It is important that you consider the questions carefully for each
If you have a pre-existing condition that may need treatment in the future, we will usually exclude it from cover along with any conditions related to it (see 'When will the plan NOT pay out?'). We will call you prior to issuing the policy document to advise you of any proposed exclusions; once agreed those exclusions will appear on the policy schedule you receive from us when we have processed your application. (The same process will also apply for any members of your family included in your application.)
When WILL the plan pay out?
We will make all the necessary arrangements, and pay for the consultations/treatment required, provided that:
- You follow the laid down claims procedure, including any co-payment contribution where necessary, and
- Your condition is not excluded and your treatment is covered (see 'Table of Benefits' and
- Your premiums are up to date.
When will the plan NOT pay out?
We will not pay for any consultation/treatment:
- for any condition which you already had when you started the plan unless you disclosed it to us and we accepted it.
- where the condition or symptoms begin during the first 3 months of the plan (unless due to an accident),
- sought without referral from your GP and/or without being pre-authorised by us,
- for any chronic condition following the initial diagnosis and therapy (that is, treatment which requires long-term specialist management without the prospect of a full recovery),
- for dental conditions (unless due to an accident),
- where it arises from, or is in any way connected with, excess alcohol intake or drug or substance abuse,
- for convalescence and/or rehabilitation,
- for routine/preventative health checks or medical screening, vaccinations or immunisation,
- for out-patient drugs, dressings or surgical appliances,
- for cosmetic or reconstructive treatment, or any treatment that relates to or is needed because of previous cosmetic or reconstructive surgery,
- for pregnancy, childbirth, male or female birth control, abortion, any form of assisted reproduction, impotence, infertility or congenital defects or conditions,
- for breast enlargement/reduction,
- for Hormone Replacement Therapy and directly related conditions,
- for regular or long-term renal dialysis in chronic or end-stage kidney failure,
- for organ or bone marrow transplants,
- for Acquired Immune Deficiency Syndrome (AIDS) and all diseases caused by HIV,
- for sexually transmitted diseases,
- for, or arising from, sex change,
- for experimental and/or unproven treatment or drug therapy,
- for depression, mental illness, psychiatric disorders or psychological disorders,
- where it is as a result of wilfully self-inflicted injury or attempted suicide, or
- where it arises from or is any way attributable to, injuries sustained as a result of participating in professional sports or hazardous sports or activities, except where such activities are part of the duties of the Insured Person as a Police Officer or a member of Police Staff.
Can I change my mind?
You will have 30 days from the time you receive your policy document and schedule to review them. If, during this period, you decide to change your mind, you will receive a full refund of any premiums you have paid, providing that you have not already made a claim.
What if I stop paying premiums?
We will not authorise treatment and if a premium remains outstanding for more than 30 days your plan including cover for all insured persons will end. The plan has no cash in value at any time.
What if I die?
Your plan including cover for all insured persons will end.
Is there any other information available that can help me decide which PMI policy to buy?
The policy document gives full details of the cover provided - a specimen copy is available on request should you wish to see this before making your decision. The Association of British Insurers (ABI) also produce a guide entitled 'Are you buying PMI' - this can be downloaded from their website www.abi.org.uk".