Chronic conditions
All PMI companies who are members of the Association of British Insurers are required to provide the following information about chronic conditions using standard wording and examples.
The following information is designed to explain what a chronic condition is and how we would deal with any claims you make for a condition which we consider to be chronic.
Q. What is a chronic condition?
A. A chronic condition is a disease, illness or injury that has at least one the following characteristics:
- it continues indefinitely and has no known cure
- it comes back or is likely to come back
- it is permanent
- you need to be rehabilitated or specially trained to cope with it
- it needs long-term monitoring, consultations, check-ups, examinations or tests.
We will not cover chronic conditions following the initial diagnosis and therapy. Please note, however, that we do not consider cancer to be a chronic condition.
The following answers and examples are designed specifically to address chronic conditions and how they are dealt with, but are all subject to the compulsory excess, where applicable.
Q. What does this mean in practice?
A. When you are referred to a specialist by your General Practitioner, we will request some information about the condition for which you wish to claim benefits. We will check this (and any supporting information) to make sure that it is eligible for benefits. If we consider the condition for which you need treatment to be chronic, we will only cover the initial investigations leading to a confirmed diagnosis, and the treatment needed to stabilise the condition, providing the treatment is covered by the benefits provided under your chosen plan.
We will not pay for any treatment once the diagnosis has been made and the condition has been stabilised.
Q. What if your condition gets worse?
A. In some cases, we will pay for further treatment if your condition gets worse. We may pay for treatment relating to an acute episode of a chronic condition. For example, we consider asthma to be a chronic condition and do not pay for any ongoing treatment or monitoring. However, an asthma attack would be classed as an acute episode. We may consider paying for this providing that particular treatment is covered under the plan and there is benefit available. In order to consider this we usually request a medical report or ask for additional information. Please note: Under the terms of a UK plan, the emergency ruling would apply. Under the terms of an International plan, cover is available for emergencies, once authorised.
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