A number of years ago, Exeter Family Friendly (then simply Exeter Friendly) introduced a range of PMI plans that had the unique selling point of age-on-entry pricing. The marketing slogan that Exeter used to promote the product was ‘the age you join is the age you stay’, which provided ongoing reassurance to policyholders that they were not subject to the age-related increases that affect most PMI policies.

The scheme is now closed to new members but existing members continue to enjoy this benefit and are very loyal toward their insurer as a result. Policyholders do still see annual increases for medical inflation and these can be reasonably substantial, but still less than is customary. The downside is that the policies are subject to stringent financial limits on cancer treatment and it is this, I assume, that sustains the age-on-entry pricing.

I mention this only to illustrate the problem that the PMI market has with annual increases and the difficulty of overcoming this problem. Medical inflation is rampant and this is the primary reason—aside from age—why PMI policies are subject to annual increases well in excess of general inflation. Consumers buying PMI need to be made aware of this fact so that their expectations are set accordingly.

When National Friendly (then National Deposit) introduced its ‘Healthcare Deposit Account’, the USP was that premiums were fixed for life (later changed to five years). Naturally, this had tremendous appeal to consumers, especially those who had experienced significant annual increases. This was not traditional PMI, though: the flip-side of the fixed premiums was that members had to contribute a percentage of their claims and were subject to overall financial limits.

Predictably, the fixed-price model (whether for life or for five years) has proved to be unsustainable, despite the aforementioned controls. Whatever the appeal of fixed premiums, it is self-evident that they will not be viable in a market with high inflation. For consumers, National Friendly withdrawing from the PMI market reinforces the old adage that, if something seems too good to be true, it probably is. 

For the PMI broking community, the National Friendly debacle is a lesson learned. Those brokers who recommended the original product will have had the unenviable task of apprising their clients of the recently announced changes. It is impossible to make a future-proof recommendation when advising on a product that is usually an annually renewable contract, but, nonetheless, brokers should be critically engaged with the products that they are selling.

I whiled away an hour in a Cheltenham pub last week with Andrew Sandilands, business development manager at Freedom Healthnet and a veteran of the PMI industry. Andrew was keen to talk to me about Freedom’s new ‘Elite’ plan, which is PMI in the traditional sense and therefore marks a departure from the approach that the insurer is known for, which it describes as ‘hybrid cashplan health insurance’. 

The Elite plan is a modular product, comprised of a core component and six optional modules. The plan design is sound and the product is reasonably competitive; it strikes me as the sort of policy that will be recommended when a client has very specific circumstances or requirements. In particular, it may be suitable for large families because any number of children are charged at a fixed percentage of their parents’ premium.

Modular plans are becoming more popular as insurers look to offer choice to consumers and flexibility to brokers. PruHealth opted for modularity when it restructured its product range last month and at least one other insurer will be bringing a modular plan to market this year. Market leaders Bupa and AXA PPP have yet to embrace the concept in the individual market, although the latter distribute a modular product through Health-on-line. Aviva offer what is essentially a modular product but conceptually more sophisticated, in my view.

I am largely indifferent to modularity: a policy will meet with my recommendation if it is contractually sound and best meets the client’s requirements, regardless of how it is structured. Modular plans nearly always resolve into something resembling a fixed product anyway, so it makes little practical difference.

My one reservation with modular plans is that the ‘Key Facts’ documents are often confusing for consumers, because they simply list all of the available options. This is less of an issue with an intermediated sale, because it is incumbent upon the broker to draw the client’s attention to the main benefits and limitations of the plan. Nonetheless, the policy summary should still provide an overview of the plan benefits without the client having to refer to supplementary material.

Insurers could solve this problem by producing Key Facts documents with check-boxes next to the various modules so that the broker or direct salesperson can indicate more clearly to the client how the policy has been configured. Policy summaries are often sent by email or self-printed by the broker house, so they could be provided in editable PDF format for this purpose. Expect to see more modular plans as insurers refresh their product ranges.

In a not entirely unexpected development, National Friendly (formerly National Deposit) has announced that it will be pulling out of the PMI market as of five o’clock this evening. This follows some unpalatable changes to existing policies that I wrote about here back in January and affects both National Friendly’s own-branded products and policies marketed under the Healthguard name.

National Friendly has indicated that all existing plans will continue on the same terms, which should provide some reassurance to existing policyholders. However, given recent developments and the contractual scope for further changes, those concerned should seek advice from a suitably qualified independent broker.

I was not a proponent of National Friendly’s PMI products but, nonetheless, I consider its withdrawal to represent a loss to the market. This further narrowing of the field weakens the individual PMI market, in particular, which is already suffering from a paucity of good products. I shall elaborate on this concern in a future post.

Regency Health clients will be unaffected by this development.

Last week, Bupa announced that it would no longer sell plans that imposed limits on cancer treatment. This headline caused some consternation among Bupa policyholders, many of whom were told when they took out their plans that Bupa provided industry-leading cancer cover without financial or time limits on treatment.

To clarify, the limits that have now been removed only applied to corporate plans, not SME or individual policies. The key point that seems to have been missed in most of the reporting on this story is that the benefit limits applied to all treatment, not just treatment for cancer (props to Health Insurance magazine for noting this).

In December 2009, Bupa introduced an option whereby corporates could control cost by specifying an annual limit for their employees, typically £25k or £50k. The insurer soon found, though, that these limits were often insufficient for members being treated for cancer, which was at odds with Bupa’s long-standing ethos of covering cancer in full at every stage of the illness.

Effectively, Bupa has taken the decision that it would rather not compromise its principles on cancer care for the sake of competing in a cost-conscious area of the market. Cancer is an emotive topic and insurers can tarnish their reputations by withdrawing cover for cancer at a critical stage of the illness, even where contractual limitations have been pre-agreed.

This development re-unifies Bupa’s cancer offering and marks the provider out as the only insurer to offer full cover for cancer (including palliative care) across its entire product range. This says much about Bupa’s philosophy and would, with better PR, have made for a powerful marketing message. Instead, it appeared as though the market leader was playing catch-up with its competitors.

The wires are buzzing this morning with news that the European Court of Justice has, as anticipated, outlawed the use of gender as a variable for actuaries to set insurance premiums.

The ruling will not apply immediately (or retrospectively) as had been feared, but from 21 December 2012, giving insurers adequate time to update their pricing and systems.

Some PMI insurers will be required to equalise their prices, but the overall effect on the market will be slight, because most insurers do not price on gender. Financial protection products such as life and income protection insurance will be more significantly affected.

Lest anyone think that this development will actually benefit consumers, insurers will have to increase their premiums to comply with the legislation, pricing some people out of the market.

Update: PruHealth, one of the two PMI insurers to price on gender, has announced that it will be equalising its prices from 1 April 2011.

The insurer National Friendly (formerly National Deposit) has announced some changes to its original ‘Healthcare Deposit Account’ plan, which will take effect from 14 March 2011.

Previously, individual policyholders under 65 were expected to contribute 10 per cent toward their treatment costs, while those aged 65 and over were expected to contribute 25 per cent. These contributions, dubbed ‘Own Share’, have now been increased to 25 and 40 per cent respectively. Contributions for couples and families have also been significantly increased.

The Own Share contributions are intended to be funded from the policyholder’s deposit account, into which 50 per cent of the premium is paid. Members who need to claim may now find that the balance of their deposit account is insufficient and needs topping-up. Affected policies are those taken out prior to February 2010 with membership numbers prefixed HC2.

National Friendly is offering a transfer to its new plan, which maintains the previous Own Share percentages. The new product is markedly different, however: only 25 per cent of the premium is paid into the deposit account and premiums are fixed for five years, rather than for life—a key selling point of the original plan. Dental and optical benefits have also been removed.

In National Friendly’s favour, the policy wording does clearly state that the Own Share percentages ‘are not fixed forever’ and that they may be changed in exceptional circumstances. Those exceptional circumstances would have been foreseeable, though, so barely two months’ notice is less than ideal—especially for those in the midst of a claim. Affected policyholders should discuss the changes with their adviser.

For the record, we always felt that the original product was unsustainable and therefore declined to recommend it.

As part of a raft of product changes, PruHealth has announced today that it will be withdrawing its fixed moratorium from 28 February 2011. From 1 March, the insurer will be moving to a standard ‘rolling’ moratorium (see my earlier post for definitions), leaving Exeter Family Friendly as the only insurer to offer the fixed variant.

This is significant for the individual PMI market because a fixed moratorium is the only way that an adviser can ultimately guarantee cover for pre-existing conditions. PruHealth’s moratorium was therefore a very useful tool in the adviser’s armoury and its withdrawal will make it more difficult to place clients with adverse medical histories.

In other developments, PruHealth has also announced that its new range of policies will not be subject to ‘fee maxima’ (where the insurer will only pay what is customary and reasonable for any given procedure). Most PMI policies are subject to fee maxima, which can lead to shortfalls where the consultant and/or anaesthetist charge outside of guidelines.

The issue of fee guidelines is something that’s attracting a fair bit of attention at the moment, so I’ll address it in more detail in a future post. For now, suffice it to say that PruHealth’s abandonment of fee maxima is a welcome development.

Chartis (formerly AIG) has announced that it is to pull out of the UK private medical insurance market. Existing HealthChoice policyholders will be given notice that their policies will be cancelled at renewal and will therefore need to arrange alternative cover.

This is disappointing news that will present practical difficulties for some Chartis policyholders, especially those that are undergoing treatment or have treatment planned. Chartis members that can move to a new insurer with ongoing cover for pre-existing conditions should do so at the earliest opportunity, to avoid a scenario where a new medical condition arises before the renewal date, thus complicating a transfer.

This is a sobering reminder that private medical insurance policies are annual contracts, with no obligation for the insurer to offer renewal terms. Fortunately, this is a very rare occurrence, and should not dent consumer confidence in the UK health insurance market. Existing Chartis members should seek advice from a specialist PMI broker.

The protection provider PruProtect (sister company of PruHealth) has introduced a new PMI plan. More of a module than a standalone product, the ‘Health Cover’ plan can only be purchased as a bolt-on to one of Pru’s protection policies: life, income protection or critical illness cover, or a combination thereof. 

Three levels of cover are available: comprehensive and mid-range plans (comparable to PruHealth’s ‘Comprehensive’ and ‘Select’ policies) and a third plan that provides cover for heart and cancer conditions only. Early indications are that this third plan is particularly well-priced and may appeal to protection customers who have otherwise decided against PMI. 

For members who want to combine critical illness cover and PMI, PruProtect offer what they call the ‘Health Cover Optimiser’. According to the insurer, this will cost ‘up to 25 per cent less’ than buying the two products separately. On diagnosis of a serious illness, the member can either take the lump sum from their critical illness policy or opt for a smaller sum and have their private-sector treatment funded.

The underwriting terms—full medical underwriting for adults and moratorium underwriting for children—are fairly inflexible, but to be expected given that the PMI policy is ancillary to a protection product. This is a weakness of the plan, though, especially given that underwriting on traditional PMI policies is becoming ever more flexible. At the end of the protection term, members will be given the opportunity of transferring to PruHealth with no further underwriting.

This is an interesting development and another innovative offering from PruProtect, but it does raise concerns that protection advisers may recommend the Health Cover plan for the sake of convenience when a market review might expose a better option for the client—both in terms of price and cover for pre-existing conditions.