Expatriates living and working in the UK can register with an NHS GP practice by filling out a GMS1 form (available to download at www.gov. uk) using the same details they used for their visa. Expatriates registered with an NHS GP practice

may be invited for NHS screening services, but they may have to pay for these services when they’re not provided by the GP practice. Outside of the NHS, there are many private GP clinics that offer primary care services for a fee. Many expatriates are offered private medical insurance by their employer, but it is important to note that visits to a GP clinic may not be covered by private medical insurance. It is imperative that employees find out what is and isn’t included in their coverage. Expatriates who work for large organisations may be provided with access to private primary care services, either on site or at a local private GP clinic. This is often the case within the law,banking and financial services sectors, where employers wish to ensure that their employees can get rapid access to primary care services.

When a GP has reason to believe a patient’s condition warrants further investigation, they will either refer them to a specialist clinic or to a consultant, who is an expert in that specific area of medicine.When an NHS patient is referred by their GP, an NHS hospital will allocate them an appointment time. This means that it’s unlikely the patient has control of who they will see or the appointment time and date. Expats registered with an NHS GP practice are not necessarily

entitled to free treatment in an NHS hospital. Both NHS GPs and private GPs can refer patients to a consultant in the private sector if the patient has private medical cover or wishes to cover the cost of their treatment themselves (self-pay).

It is also possible for patients to book an appointment directly with a private consultant or specialist without a GP referral,

but the British Medical Association (BMA) recommends getting a GP referral to ensure that the recommendation is appropriate. Those with private medical cover should also be aware that a GP referral is usually a pre-requisite to use

private medical insurance. Where a patient has private medical insurance, a GP may issue an ‘open referral’. This means

they are referring the patient to any consultant with expertise in the relevant specialty, rather than naming a specific consultant. The patient can then choose a consultant they would like to see. Often their insurance company will suggest a choice of consultants in that specialty from their approved list for the patient to decide between.

When a referral to a consultant is needed, patients will want to see the ‘best of the best’ for their particular condition, however, the financial implications of a private referral must also be taken into consideration. Consultants working in private hospitals are independent practitioners. Many of them provide their services to several independent healthcare

providers, and also work for the NHS alongside their private practice. The costs of diagnostics and treatment differ

across private hospitals and clinics, and the coverage on a private medical insurance policy may have capped limits or be restricted to certain hospitals. Any terms and restrictions should be explained by the insurance company when a patient contacts them to authorise the referral.Both patients with medical insurance and those who are self-paying would be best

placed to contact the consultant they have been recommended to ascertain consultation fees, charges for routine investigations and the level of surgical fees and where they operate, if clinic is a potential treatment pathway for their condition. Patient reviews for UK consultants are readily available online on various healthcare portals, such as www.doctify.com/uk and www.iwantgreatcare.org. Many consultants also have their own websites to provide some background into their expertise. Patients may also want to consider which private healthcare provider the consultant offers

their services at. Some consultants have the ability to refer patients on for further investigations or treatment within a wider independent healthcare network or hospital group. Gathering as much information as possible will certainly go a long way to make conversations with an insurance company easier. It will also ensure there are no financial surprises down the line for both those patients with private medical insurance and those who are self-paying.

Here are a few things to consider when you are looking for international private medical insurance:

Pre-existing medical conditions: some providers underwrite their plans on a moratorium basis. This means that any pre-existing medical conditions that you have will not be covered by the plan until a specified time period has elapsed. The benefit of a moratorium is that it allows a provider to keep their premiums down, that the application process is easier and quicker as you don’t have to fill in a medical questionnaire and there is no permanent exclusion of pre-existing medical conditions. An alternative is to look for a provider that medically underwrites their plans. This means that you will need to fill in a medical questionnaire when you apply for a plan and the provider will then tell you what conditions they will cover and what it will cost. If you have pre-existing conditions make sure you know exactly what will and won’t be covered on a plan

In-patient treatment claims: look for a provider that will pay the hospital or clinic direct for your in-patient treatment. If so, you will not be out of pocket while you wait for your claims to be settled. Make sure you choose a provider that offers you access to a 24 hour, multi-lingual helpline so you can get emergency assistance and approval for treatment at all times

Out-patient claims: where claims are settled through reimbursement, find out how quickly the provider pays out. Make sure there are no bank charges deducted from your reimbursement

Emergency evacuation and repatriation: in some parts of the world, high quality medical treatment is not readily available, so you may need to be evacuated by air ambulance. The most comprehensive emergency evacuation benefit will cover the patient’s evacuation, medical treatment and repatriation back to the country of residence and, in addition, will cover both travel and accommodation costs of the patient’s dependants. Some providers will evacuate you if there is no adequate treatment in your location, as well as in an emergency

Out-patient treatment: most plans will cover in-patient and emergency medical treatment, but not all of them cover out-patient treatment. Treatment that should be covered under the out-patient section of a PMI plan includes post-hospitalisation treatment, visits to your GP, diagnostic tests, consultants’ and specialists’ fees, psychiatric treatment, physiotherapy, complementary therapies, scans and treatment for allergies

Chronic and terminal conditions and HIV/ AIDS: if you develop a new chronic condition, a plan with high monetary limits for maintenance (for example routine check-ups and prescribed medicines) will give you peace of mind. If the worst happens and a condition is diagnosed as terminal, a plan that covers palliative treatment will ease the financial burden. HIV and AIDS are covered on some plans, often in a separate benefit

Wellness: with preventative medicine becoming increasingly important to your wellbeing, some providers will cover the costs of preventative tests such as cervical smear and prostrate cancer tests and vaccinations. Look out for other benefits that you can use when you are well, rather than in a medical emergency, for example hormone replacement therapy, treatment for allergies, complementary therapies, dental and maternity benefits

Dental: dental treatment can be expensive so only the top end plans tend to cover this. However, it can be invaluable if you want to access the highest quality, private dental treatment available

Maternity: when you are planning a baby, cover for private maternity treatment will make the process a lot easier for you. Some plans include maternity benefits as standard while others offer it as an optional add-on plan, meaning you only need to pay for the benefit when you need it

Add-on plans: some providers offer optional add-on plans that complement your main healthcare plan. For example, worldwide annual travel insurance, personal accident insurance and cover for maternity treatment

Non-medical benefits: some plans cover legal expenses if you suffer an injury as the result of a third party, a visit to a critically ill relative or for your body to be returned home should you die abroad:

Area of cover: you will have a choice of geographic area that your plan will cover. If you want cover in your home country, make sure you pick a provider and area of cover that allows this. Also look at whether the plan covers emergency medical treatment outside of your chosen geographic area of cover

War and terrorism: some PMI plans will cover you if you need treatment as a result of an act of war or terrorism. Make sure you read the benefit conditions and exclusions to find out if this will be covered

Reducing your premium: some providers offer a no claims discount (make sure this is not affected by claims for “wellness” treatments), special rates for families or the option to select a voluntary excess.

Useful websites