Bilateral cataract surgery in spring, a total knee replacement in autumn — what an over-65s policy covered in full, and the switch that made it work.
How comprehensive retiree cover funded cataract and knee replacement in a single year
Bilateral cataract surgery in the spring, total knee replacement in the autumn — both funded in full at Spire and Optegra by a policy designed for over-65s.
Client profile
Married retired couple in Hampshire, aged 68 and 71. PMI held continuously since age 45; switched to The Exeter Health+ at age 65 on PremierPMI advice for better value and full cover.
The problem
- The wife (68) developed bilateral cataracts affecting driving and reading. NHS wait in her area was 22 weeks.
- The husband (71) had progressive left knee osteoarthritis limiting his cycling. NHS orthopaedic wait was 48 weeks.
- Both wanted to travel the following summer — timeline mattered.
What PremierPMI did
- Adviser reviewed policy schedule for both members; confirmed cataract and TKR fully covered including robotic-assisted surgery and premium IOL upgrade options.
- Booked ophthalmology consultation at Optegra for wife; orthopaedic consultation at Spire for husband — both within 7 days.
- Managed pre-authorisation for bilateral cataract with premium multifocal IOL (£1,200 per eye co-pay) and robotic-assisted TKR.
How the case unfolded
| Point in time | What happened |
|---|---|
| March — Wife day 1 | Ophthalmology consultation at Optegra, biometry completed |
| March — Day 22 | First eye cataract surgery with multifocal IOL |
| May — Day 63 | Second eye cataract surgery |
| May — Day 70 | Wife spectacle-independent |
| August — Husband day 1 | Orthopaedic consultation at Spire, MRI referred |
| August — Day 10 | MRI confirms end-stage knee OA |
| September — Day 45 | Robotic-assisted total knee replacement (MAKO) |
| October — Day 70 | Walking without stick, physio ongoing |
| December — Day 105 | Both members fit; family holiday booked for spring |
Outcome
- Combined treatment value £38,400. £2,550 co-pay for premium IOL upgrade; remainder funded in full by The Exeter Health+.
- Both members recovered fully and travelled the following summer. Renewal held at standard age-band pricing.
- Family policy premium remains outstanding value for their age band and cover level.
Outcome in numbers
- Combined treatments funded: 3 procedures
- Combined treatment value: ~£38,400
- Combined couple monthly premium: £392
- Co-pay (premium IOL upgrade only): £2,550
- NHS wait avoided (combined): 70+ weeks
- Return to full function: 10 weeks post TKR
In the client's words
“Between us we had a wait of well over a year on the NHS. With The Exeter — placed for us by our PremierPMI adviser — we had every procedure done in nine months and were fit to travel. At our age, this is the difference between an active retirement and a diminished one.” — Anonymised couple, Hampshire — The Exeter Health+ policy
Policy cost at the time of placement: £392.00. Illustrative — premiums are individually underwritten.
PremierPMI is a UK private medical insurance broker specialising in whole-of-market placement across 10+ leading UK health insurers including Bupa, AXA Health, Aviva, Vitality, WPA, Freedom Health, The Exeter, General & Medical and National Friendly. FCA regulated (Tesha Family Ltd, FRN 1029667). Speak to a broker on 020 4525 0884, WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk.
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