Individual health insurance - Flexible Health FAQs

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Frequently asked questions - Flexible Health insurance

Do you cover pre-existing conditions?
If you have chosen Moratorium Underwriting:
Benefit will not be provided for at least 2 years for any pre-existing condition(s) which you or any family member(s) applying for cover have had during the 5 years before your policy starts, or any new symptoms/conditions that start in the first 14 days of your policy (90 days for cancer conditions, whether diagnosed or not).

Pre-existing conditions are medical condition(s) and other directly related conditions, for which treatment was received and/or medication was prescribed or professional advice was sought or where symptoms existed (whether the underlying condition has been diagnosed or not).

If you or any family member(s) applying for cover do not have symptoms, treatment, medication or advice for pre-existing conditions for 2 continuous years after your policy starts, then benefit may be provided within the terms of your policy.

It is important that you or any family member(s) applying for cover do not delay seeking medical advice or treatment for any condition during the moratorium period.

If you have chosen Full Medical Underwriting:
Benefit will not be provided for pre-existing conditions that you had when you took out the policy unless declared to and accepted in writing by WPA. Benefit is also not available for any medical conditions/symptoms, whether diagnosed or not, if these arise in the first 14 days of the start if the Policy.

If you have chosen to Switch with Continued Personal Medical Exclusions (CPME):
You and your family member(s) applying for cover will have any existing personal exclusions from your current insurance policy carried over, if you/they have previously been subject to full medical underwriting and if there has been no break in insurance cover since underwriting. You are not required to have been fully medically underwritten with your last insurer, as long as there has been no break in cover from the time you initially underwent full medical underwriting.

You and your family member(s) applying for cover will need to answer a few questions about your medical history. On occasions, it may be necessary to apply additional personal exclusions to your new WPA policy. You will not be covered for medical conditions that started before you took out your previous insurance (the point that you underwent full medical underwriting).

If you have chosen to Switch with Continued Moratorium:
Benefit will be provided in line with the Moratorium Underwriting term of your current insurer.

The benefits and terms and conditions of your new WPA policy will apply; it is only the dates of underwriting with your current insurer that will be matched. There must be no break in insurance cover since underwriting.

Your WPA policy will not provide benefit for pre-existing long-term medical conditions (and related conditions) which are likely to require regular or periodic treatment, medication or advice. This is because the Moratorium symptom-free period starts each time you receive such treatment, so it’s unlikely you’ll ever have two consecutive years free of treatment.

It is important that you or any family member(s) applying for cover do not delay seeking medical advice or treatment for any condition during the moratorium period.
Do I need to complete a medical questionnaire to join your policy?
Full Medical Underwriting (FMU)
By providing us with your detailed medical history you will have certainty as to what is covered. If you wish to join on a FMU basis you will need to complete a medical questionnaire.

Moratorium Underwriting
With Moratorium you and any family member(s) applying for cover do not have to provide full medical history details on application; however, we may request more detailed information from your doctor of any family member(s) for each new condition claimed for.

You and any family member(s) applying for cover must satisfy the following criteria to join on a Moratorium basis.
  • Have never been diagnosed with any disease/abnormality of the heart or cardiac function, stroke, cancers or recommended to undergo regular screening owing to your family history.
  • For joint and back conditions: have never had a surgical procedure/arthroscopy (keyhole surgery).

    Note
    If you have had a knee arthroscopy you may be able to join on a Moratorium basis if you also meet ALL of the following criteria:
    • Your surgery was more than 5 years ago;
    • You have been symptom/treatment free for more than 5 years;
    • The surgery was NOT on your anterior cruciate ligament.
  • Have a Body Mass Index (BMI) below 35.
Switch Underwriting - Continued Moratorium
With Continued Moratorium, you and any family member(s) applying for cover do not have to provide full medical history details on application; however, we may request more detailed information from your GP of any family member(s) for each new condition claimed for.

You and any family member(s) applying for cover must satisfy the following criteria to join on a Continued Moratorium basis.
  • In the last 12 months, have not had any consultations, tests, investigations or treatment and do not have any undiagnosed symptoms or pending future treatment.
  • Have never been diagnosed with any disease/abnormality of the heart or cardiac function, stroke, cancers or recommended to undergo regular screening owing to your family history.
  • For joint and back conditions: have never had a surgical procedure/arthroscopy (keyhole surgery).

    Note
    If you have had a knee arthroscopy you may be able to join on a Continued Moratorium basis if you also meet ALL of the following criteria:
    • Your surgery was more than 5 years ago;
    • You have been symptom/treatment free for more than 5 years;
    • The surgery was NOT on your anterior cruciate ligament.
  • Have a Body Mass Index (BMI) below 35.
Switch Underwriting - Continued Personal Medical Exclusions
You and your family member(s) applying for cover will have any existing personal exclusions from your current insurance policy carried over, if you/they have previously been subject to full medical underwriting and if there has been no break in insurance cover since underwriting. You are not required to have been fully medically underwritten with your last insurer, as long as there has been no break in cover from the time you initially underwent full medical underwriting.

You and your family member(s) applying for cover will need to answer a few questions about your medical history. On occasions, it may be necessary to apply additional personal exclusions to your new WPA policy. You will not be covered for medical conditions that started before you took out your previous insurance (the point that you underwent full medical underwriting).

You must answer the following questions on behalf of yourself and any family member(s) you wish to insure.

1. HEART/CARDIAC/STROKE/CANCER

Have you or any family member(s) to be covered ever been diagnosed with any disease/abnormality of the heart or cardiac function, stroke or cancers or undergoing regular screening for cancer owing to your family history?

2. JOINT/BACK

Have you or any family member(s) to be covered ever had a surgical procedure/arthroscopy (keyhole surgery) for a joint or back condition?

3. ONGOING SYMPTOMS

Do you or any family member(s) to be covered have any ongoing symptoms or conditions for which medication is prescribed or for which surgical or medical treatment is planned or will be necessary in the future?

To learn more see our joining terms
How do I join WPA?
You can buy online, alternatively you can discuss your needs over the phone, or one of our local representatives can meet you to discuss your requirements.
What is the maximum joining age?
The maximum joining age is 65 but renewal terms are offered each year thereafter. (Other policies are available for those over the age of 65.)
How much does it cost?
The price of your policy will depend on a number of factors, including - your age, where you live, level of cover and Shared Responsibility (co-payment); you can tailor your cover to suit your needs.
What is the maximum annual limit I can claim?
Essentials has an overall maximum limit of £50,000 per person per year, premier and elite do not have an annual maximum limit.
Can I tailor my cover?
You can choose between Essentials, Premier and Elite. Essentials provides cover for non-emergency surgery when not related to cancer, Premier offers enhanced cover, Elite is our most extensive level of cover. Across all policies you can further tailor your cover by adding extras.
Can I change my cover after I have joined?
When you first join your policy, you can change your level of cover within the first 14 days of receiving your full policy documentation (or 28 days if you join online). After that, you can amend your cover at renewal (which is the anniversary of your original policy start date).

If you transfer from Essentials to either Premier or Elite you must complete a medical declaration. Personal medical exclusions may then apply. (This is not required for transfers from Premier to Elite unless you are enhancing your cancer cover).

If you would like to add cancer cover or advanced cancer drugs extras from a future renewal, you will be asked to complete a cancer specific medical declaration. You will not be covered for any cancers or symptoms later diagnosed as cancerous if these occur before, at or within 90 days of that renewal date.

Qualifying periods may apply to some of the extras (e.g. Premium Hospitals and Extra Out-Patient).
Do my premiums increase because I make a claim?
Unlike with some insurers ´no claims discount´ schemes, we do not penalise you with higher premiums because you make a claim.
Can I cancel my policy at any time?
If, when you first take out your policy, you are not satisfied with the policy and the benefit it provides you have the right to cancel your policy provided you notify us within 14 days (28 days if you purchased online) of receiving your policy documents. Cancellations cannot be backdated. If you cancel your policy and you chose to pay the premium by monthly instalments we reserve the right to make a reasonable charge to reflect the cost to us.
What hospitals can I use?
You have access to over 600 hospitals across the UK. Please note though that within the Flexible Health range, Essentials does not provide cover in the premium hospitals (which are primarily based in Central London) and Premier and Elite offer a choice of adding cover in the premium hospitals to the policy.
What are premium hospitals?
WPA provides an extensive choice of hospitals as standard including all BMI, Nuffield Health, Spire, Ramsay independent private hospitals and Private Wings of NHS hospitals. You can also extend this choice by adding this premium hospitals extra - these hospitals are primarily based in Central London and listed below:

  • BUPA Cromwell Hospital
  • 30 Devonshire Street
  • Harley Street at Queen´s (Romford, Essex);
  • Harley Street at UCH
  • Harley Street Clinic
  • Lister Hospital
  • London Clinic
  • Portland Hospital
  • Princess Grace Hospital
  • Royal Marsden Hospital (London and Surrey)
  • The London Bridge Hospital
  • LOC – Leaders in Oncology Care
  • The National Hospital for Neurology and Neurosurgery
  • University College London
  • Wellington Hospital
What are chronic conditions?
A disease, illness, or injury that has one or more of the following characteristics:

  • It needs ongoing or long-term monitoring through consultations, examinations, checkups, and/or tests;
  • It needs ongoing or long-term control or relief of symptoms;
  • It requires your rehabilitation or for you to be specially trained to cope with it;
  • It continues indefinitely;
  • It has no known cure;
  • It comes back or is likely to come back.


Flexible Health does not cover chronic conditions. We may provide cover for initial investigations needed to diagnose a new condition and the initial short-term treatment up to the point of stabilisation - a period not exceeding 3 months. You should contact us in these circumstances for pre-approval.
Do you cover for pregnancy?
We do not cover any investigations, care or treatment arising from or related to pregnancy, fertility problems, assisted conception, contraception, miscarriage, sterilisation and child birth.
What is Shared Responsibility (co-payment)?
You agree to pay a set percentage of any claim and as a result reduce your premiums significantly.

It´s similar to an excess but better because you can benefit from even the smallest of claims. You agree to pay up to a certain monetary limit each year - say, a limit of £500. Because you are sharing the costs with WPA, we pay 75% of the claim and you pay the remaining 25%. But if your claim is a large one and your 25% would come to more than the £500 you have agreed to pay, you won´t have to pay any amount on top of this - your costs will always be contained at £500 for that year. So, basically, when you´ve paid the ´excess´ we will pick up all the bills after that. View the Shared Responsibility example page.
Do you cover emergency treatment?
Premier and Elite: Private hospital admissions are for planned treatment only and so we will not pay benefit for emergency admission into a private hospital unless we have authorised this and you have first had a consultation with a specialist and he/she has decided to admit you. If in a medical emergency, you are admitted to an NHS hospital via A&E we will be able to provide cover once your condition has been stabilised and the transfer to the private bed is arranged by your specialist at your own request, subject to our prior authorisation.

Essentials only covers non-emergency, planned (elective) surgical treatment of a diagnosed condition and therefore doesn´t provide any form of emergency cover.
How can I claim?
Simply start by visiting your GP. Once your GP refers you to a specialist or therapist, you should contact us in advance. All claims must be pre-authorised before you commence any treatment. For instant authorisation of claims 24 hours a day, 7 days a week, visit wpa.org.uk/claim Alternatively contact us on 0345 122 3100.
Do you cover cancer?
Elite provides cover for cancer surgery, radiotherapy, chemotherapy, specialist consultations which are customary and reasonable, monitoring, advanced cancer drugs given with curative intent which are not readily available on the NHS. As cancer treatment is often given in NHS facilities (especially out of London) we offer an NHS hospital cash benefit option. This provides £200* per day/night or £150* per out-patient diagnostic scan (MRI, CT or PET scans), procedure, blood test and radiotherapy/chemotherapy session up to £6,000 per year where you are treated (at no charge) as an NHS patient.

* Where you receive treatment (as an NHS patient) in one of the defined London NHS Hospitals, the benefit limits shown on the table will increase by £100 per day/night/session up to the same maximum annual limits shown. For a full list visit wpa.org.uk/central.

Please note you are not covered for cancers that occurred before or within the first 90 days of your policy starting, whether the cancer has been formally diagnosed or not.

This is an optional extra under the Premier policy.

This cancer cover is not available under the Essentials policy.

Alternatively Essentials offer advanced cancer drugs cancer cover:
Essentials offer advanced cancer drugs as an optional extra. This option provides each person with up to £50,000 lifetime benefit towards the cost of providing cancer drugs which are not available on the NHS. The drugs must be prescribed by the UK consultant in charge of your cancer treatment and have curative intent. The £50,000 benefit limit is applied across the lifetime of each person while they are insured by this policy (not per policy year). The advanced cancer drugs cover will cease from the renewal date following your 66th birthday.

Find out more about the benefits that our health insurance offers you.

See what´s not covered in detail.


* For full terms click here.



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