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Health: Private Medical Insurance

Volume 722: debated on Monday 15 November 2010


Asked By

To ask Her Majesty’s Government whether the imposition of fixed fee schedules and restricted hospital and consultant networks for the provision of services to private medical insurance subscribers, as now practised by the two principal insurers in this field, is in the public interest.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a policyholder with AXA PPP.

My Lords, private medical insurers are entitled to offer policies on a variety of terms and offering different levels of benefit. The Financial Services Authority’s Insurance Conduct of Business Sourcebook does not prevent insurers restricting choice of healthcare provider. However, it does require that the insurer provides information on any such restrictions. Provided that policyholders are covered as they expect in the event of a claim, this is to the benefit of consumers as cost control serves to keep premiums at an affordable level.

I thank the Minister for that reply. Is he aware that the Office of Fair Trading is receiving a large number of complaints from individuals who believed that they had fully comprehensive healthcare insurance with organisations such as BUPA and PPP but are now finding in many instances that their recovery is only partial, that they are restricted in the choice of consultant to whom they may be referred, despite their GP’s advice, and also that they are not allowed to go to certain hospitals? Is this not contrary to the policy that should be carried out, and is the Minister aware that last week my noble friend Lord Crisp said that private healthcare insurance was becoming a lottery, and that the Financial Services Authority should examine the matter in the light of these complaints?

My Lords, private medical insurance policies are held by some 6 million people. I am grateful to the noble Lord, who is a very distinguished member of the profession, for drawing attention to this matter because it is clearly important for those 6 million people and for the country as a whole that this is a well functioning market. However, that market is the business of the policyholders, the insurance companies and the doctors. The FSA’s role is to make sure that essentially policyholders are sold policies on terms that are fully disclosed to them and that those terms are upheld. In June this year, the FSA carried out a review of the conduct of business rules and found no evidence of risk of consumer detriment in the PMI market which could be addressed by changing its regulatory approach. However, I am sure that the FSA, like the OFT, hears complaints coming in.

My Lords, is my noble friend aware that quite often medical insurance companies require a direct debit payment and that it is only after the direct debit payment has been made that they inform the person that certain things which they thought were going to continue to be covered no longer are?

My Lords, I do not pretend to be an expert on the precise ways in which medical insurers carry out every aspect of their business, but clearly, as I said, it is critical that people understand what policies they are buying and that the policy terms are met. That is the critical interest of the Financial Services Authority in this matter.

My Lords, would the Minister care to comment on the complaints from National Health Service consultants that, when there is a failure by the private healthcare system, patients are put into the National Health Service in front of other people? Would he also care to comment on my view that there is no comprehensive healthcare policy through private insurance and that everyone in the country is dependent on the NHS?

My Lords, I am happy to confirm the really critical point, which is that the National Health Service is available to the population as a whole and that this is therefore an area in which the nation has access to the best-quality healthcare. If, on top of that, people wish to invest their money in private healthcare policies, it is important that those policies work effectively. However, as the noble Baroness points out, it is critical that the health service is there for everyone. As she raises the question of complaints, it is worth pointing out that the complaints that are relevant to this Question are those that go to the Financial Services Authority or the Financial Ombudsman Service. The latest figures that I have are for 2008. There were 514 complaints to the Financial Ombudsman Service in that year, of which 170 were upheld, and that represents one complaint upheld for every 8,000 people treated under private medical insurance.

My Lords, the Minister says that the FSA is content that the system is working well. However, does he accept that many people who feel that they have been let down by their policies do not share that view? As the noble Lord, Lord Crisp, pointed out last week, this problem seems to be more general than just one or two people not reading their instructions properly. Could the Minister possibly go back to the FSA and ask it to look at this problem again in the light of the concerns that have been raised about it in recent months?

I thank my noble friend for raising that point. Of course I am happy to convey to the FSA the points that have been raised this afternoon.

My Lords, the noble Lord has taken a remarkably complacent view in his answers about the position of policyholders. Surely the FSA’s responsibility to ensure that financial institutions treat their customers fairly requires that this matter be investigated and that better information be given to policyholders about the limitations of their cover.

My Lords, I think I have responded to the noble Lord’s points in the answers that I have given to a number of questions.

My Lords, I declare a similar interest to that of the noble Lord, Lord Walton. Is not the trouble the fact that the terms, which many of the 6 million knew they had, understood they had and have had over many years, are often changed so that people can no longer go to the doctors and hospitals recommended by their GPs, but have to go to ones nominated by the company? People cannot deal with that situation because, when they took out the policy, they had the cover that they required. In many cases, they no longer are offered the cover they thought they had and had reason to expect that they had.

My Lords, as I have said, it is absolutely the focus of the FSA and the conduct of business rules that people who buy private medical insurance, just as they buy household or any other insurance, are properly sold and have explained to them the terms of the policy and that the terms of the policy are carried through. Normally, these are annual policies and the terms of policies in this area, just as in other areas of insurance that no doubt we all buy, change from year to year.