The Private Medical Insurance (Disentitlement to Tax Relief and Approved Benefits) Regulations 1994

Approved treatments and associated services

6.—(1) Subject to paragraph (5) below, the treatments, medical services and other matters the costs of which may, in the circumstances specified in paragraph (4) below, be indemnified under a contract are those specified in paragraph (2) below.

(2) The treatments, medical services and other matters specified in this paragraph are—

(a) treatment of the insured consisting of medical or surgical procedures (including diagnosis), the purpose of which is the relief of illness or injury,

(b) services provided to the insured of any of the kinds specified in paragraph (3) below when they are associated with such treatment, and

(c) drugs and dressings used in the course of such procedures or services.

(3) The kinds of services specified in this paragraph are—

(a) accommodation and other services (including nursing services) provided in a hospital where the insured is accommodated;

(b) nursing services provided in the insured’s home;

(c) accommodation provided for the purposes of convalescence for a period of not more than 14 days immediately following the discharge of the insured from a hospital where the insured has been accommodated;

(d) transport by private ambulance (including transport of one other person where medically necessary)—

(i) to or from a hospital where the insured is or has been accommodated, or

(ii) to or from a place where accommodation is provided for the purposes of convalescence;

(e) services consisting of—

(i) physiotherapy,

(ii) occupational therapy,

(iii) speech therapy,

(iv) chiropody and podiatry,

(v) prosthesis, and

(vi) orthopty,

including the provision of any equipment necessary for such services.

(4) The circumstances specified in this paragraph are where—

(a) treatment is given to the insured in a hospital as a resident or non-resident private patient by, or under the supervision of, a registered medical practitioner or registered dental practitioner, or

(b) treatment consisting of surgical procedures performed by a registered medical practitioner providing personal medical services for persons in a particular locality is given to the insured as a private patient of that practitioner, or

(c) services consisting of physiotherapy including the provision of any equipment necessary for physiotherapy are provided to the insured and are associated with treatment given to the insured by or under the supervision of a registered medical practitioner.

(5) The treatments specified in this regulation do not include any treatment which, during the period of five years preceding the date the contract was entered into, has not been provided free by the Secretary of State under the National Health Service Act 1977(1) or the National Health Service (Scotland) Act 1978(2), or by the Department of Health and Social Services for Northern Ireland under the Health and Personal Social Services (Northern Ireland) Order 1972(3), more often than it has been provided in the United Kingdom otherwise than under any of those enactments.

(6) For the purposes of this regulation—

(a) a service is associated with treatment if it is provided for the purposes of that treatment or is consequent upon it;

(b) references, however expressed, to the insured being accommodated in a hospital are references to the insured—

(i) being accommodated in a hospital as a private patient in circumstances where he is charged for the accommodation, or

(ii) being provided with treatment or services as a private patient in a hospital in circumstances where he is charged for the treatment or services;

(c) transport by private ambulance includes transport by air ambulance.

(7) In paragraphs (4) and (6) above “treatment” shall be construed in accordance with paragraph (2)(a) above, and in paragraph (6)(b)(ii) above “services” shall be construed in accordance with paragraph (2)(b) above.

(1)

1977 c. 49.

(2)

1978 c. 29.

(3)

S.I. 1972/1265 (N.I. 14).