Private Medical Insurance & Associated Insurances
Core concepts
PMI questions test inpatient vs outpatient, day-case, excesses, waiting periods, pre-existing conditions, moratorium vs full medical underwriting, and underwriting declarations. Know associated covers: critical illness, income protection, and personal accident.
Understand critical illness (lump sum on diagnosis of a listed condition), income protection (replaces a percentage of income while unable to work), and personal accident (fixed benefits for accidental injury). Know deferred periods, indemnity vs benefit bases, and occupational vs own-occupation definitions.
Traps
- Confusing PMI (reimburses treatment costs) with critical illness (lump sum).
- Assuming moratorium underwriting covers conditions present at inception - usually excluded for a period.
- Mixing deferred period (income protection) with waiting period (PMI).
- Overlooking own-occupation vs any-occupation definitions.
Rule of thumb
Match the product to the risk: medical costs → PMI; loss of income → income protection; serious diagnosis → critical illness; accidental injury → personal accident.
Worked example
A client cannot work for 6 months after illness. Income protection with a 13-week deferred period pays a monthly benefit from week 13, typically capped at 50–70% of income.