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UK Private Health Insurance: Is PHI Still Worth It?

UK Private Health Insurance: Is PHI Still Worth It? 2025

UK Private Health Insurance: Navigating the Pay-As-You-Go & On-Demand Private Care Options – When Does PHI Still Make Sense?

The landscape of healthcare in the UK is undergoing a profound transformation. While the National Health Service (NHS) remains the bedrock of public healthcare, mounting pressures, exacerbated by an aging population and the lasting impacts of global events, have led to unprecedented waiting lists and accessibility challenges. In response, a vibrant and increasingly accessible private healthcare sector has emerged, offering options that extend beyond traditional private medical insurance (PMI).

This comprehensive guide delves into these evolving choices: from the flexibility of pay-as-you-go (PAYG) private care and the convenience of on-demand digital health platforms to the enduring value proposition of comprehensive private health insurance. Our aim is to provide clarity, helping you understand when each option makes sense and, crucially, when a robust private health insurance policy is still an indispensable safeguard for your health and financial well-being.

The Shifting Sands of UK Healthcare: Why Private Options Are on the Rise

The NHS, a source of immense national pride, is facing its toughest period in history. Demand consistently outstrips capacity, leading to a ripple effect across all services, from GP appointments to complex surgeries.

NHS Challenges in Numbers:

  • Waiting Lists: As of April 2024, the total number of people waiting for routine hospital treatment in England stood at approximately 7.54 million, with 309,300 patients waiting for over 52 weeks. This figure remains significantly higher than pre-pandemic levels (around 4.4 million in February 2020). Source: NHS England referral to treatment (RTT) data.
  • A&E Delays: Data consistently shows challenges in meeting the four-hour target for A&E departments, with many patients facing much longer waits for admission or discharge. In May 2024, only 74.9% of patients were seen within four hours. Source: NHS England A&E attendances and emergency admissions data.
  • GP Access: While many can secure same-day appointments for urgent needs, routine GP access can be challenging, with patients often waiting a week or more for a preferred time slot or specific clinician. The King's Fund highlights persistent concerns about GP workforce and access.

These statistics paint a clear picture: while the NHS strives to deliver excellent care, the sheer volume of demand means that accessing timely treatment for non-urgent conditions can be a significant challenge. This reality has spurred a surge in interest in private healthcare alternatives, driven by a desire for faster access, greater choice, and enhanced comfort.

Traditionally, private health insurance (PHI), also known as Private Medical Insurance (PMI), has been the primary gateway to private care. It acts as a financial safety net, covering the costs of eligible private medical treatment, from consultations and diagnostic tests to surgery and hospital stays. However, alongside this, a more granular, transactional approach to private healthcare has gained traction: pay-as-you-go services and the newer wave of on-demand digital platforms.

Understanding Pay-As-You-Go (PAYG) Private Healthcare

Pay-as-you-go private healthcare is exactly what it sounds like: you pay directly for each service you receive, as and when you need it, without the need for an insurance policy. This model offers unparalleled flexibility and direct control over your healthcare spending.

What Services are Available on a PAYG Basis?

Almost any private medical service can be accessed on a PAYG basis, though costs vary dramatically. Common services include:

  • GP Appointments: Many private clinics offer immediate or same-day appointments, often lasting longer than typical NHS slots, allowing for more in-depth discussions.
  • Consultations with Specialists: If you have a specific concern and wish to see a consultant without a GP referral or NHS wait, you can book and pay directly. However, some consultants still prefer a GP letter, even for private patients.
  • Diagnostic Tests: This is a popular PAYG option for those seeking quick answers. It includes blood tests, X-rays, MRI scans, CT scans, and ultrasound scans.
  • Minor Procedures: Small surgical procedures that can be performed in an outpatient setting, such as mole removal or injections for joint pain.
  • Physiotherapy & Other Therapies: Direct access to services like physiotherapy, osteopathy, chiropractic treatment, and counselling or psychotherapy sessions.
  • Health Checks & Screenings: Comprehensive health assessments tailored to age and gender, often including various blood tests and physical examinations.

Benefits of PAYG Private Care:

  • Immediate Access: Often the quickest way to get an appointment or a diagnostic test, bypassing NHS waiting lists.
  • No Long-Term Commitment: You only pay for the services you use, making it ideal for sporadic or minor health concerns.
  • Transparency in Pricing: Most private providers publish their price lists, allowing you to know the cost upfront (though follow-up costs can add up).
  • Choice of Consultant/Clinic: You have the freedom to choose your preferred specialist or facility.
  • Control: You decide exactly what services you pay for and when.

Drawbacks of PAYG Private Care:

  • Potentially High Cost for Complex Conditions: While a single consultation might seem affordable, a full course of treatment, including diagnostics, specialist fees, surgery, and follow-up care, can quickly escalate into tens of thousands of pounds. This is where the true financial risk lies.
  • No Coverage for Unforeseen Emergencies: PAYG doesn't protect you from the financial burden of a sudden, severe illness or accident requiring extensive hospitalisation and treatment. These costs would be entirely your responsibility.
  • Administrative Burden: You are responsible for finding providers, booking appointments, managing referrals between different specialists, and paying invoices.
  • Lack of Financial Protection: Without insurance, you bear 100% of the financial risk. A serious illness could lead to significant financial distress.

Table 1: Typical Pay-As-You-Go Private Healthcare Costs (Illustrative)

Service TypeTypical Cost Range (GBP)What's Included / Notes
GP Consultation£50 - £15015-30 minute appointment, in-person or virtual.
Does not include prescriptions or referrals to specialists (these incur separate costs).
Specialist Consultation£180 - £350 (initial)
£120 - £250 (follow-up)
First appointment with a consultant (e.g., orthopaedic surgeon, dermatologist).
May or may not include a letter to your GP.
Diagnostic tests or procedures recommended will be extra.
Blood Tests£50 - £200+ (depending on tests)Basic profiles (e.g., liver function, kidney function) are cheaper.
More comprehensive hormone panels or specific antibody tests will be more expensive.
Includes phlebotomy fee and laboratory analysis.
X-ray£100 - £250Single area X-ray (e.g., chest, joint).
Includes radiologist's report.
Ultrasound Scan£150 - £400Single area scan (e.g., abdomen, joint, gynaecological).
Includes sonographer's report.
MRI Scan£350 - £800+Single area MRI (e.g., knee, brain, spine).
Costs vary by location and complexity.
Includes radiologist's report.
CT Scan£300 - £600+Single area CT scan.
May include contrast dye.
Includes radiologist's report.
Physiotherapy Session£50 - £100 per session30-60 minute session.
A course of treatment can require multiple sessions.
Minor Surgical Procedure£500 - £2,500+Examples: mole removal, ganglion cyst excision, carpal tunnel release.
Price typically includes surgeon's fee, theatre time, and local anaesthetic.
Excludes pre-operative tests or post-operative consultations.
Major Surgery£5,000 - £30,000+ (e.g., hip replacement)
£50,000+ (e.g., complex heart surgery, cancer treatment)
Can include surgeon's fee, anaesthetist's fee, hospital stay (per night), theatre costs, medications, follow-up care.
The cost for major procedures can be astronomical and is almost always impractical to self-fund for most individuals. This is where PHI offers crucial protection.

Note: These are illustrative costs and can vary significantly based on location (London vs. regional), specific clinic, consultant's seniority, and complexity of the case. Always obtain a detailed quote before proceeding.

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The Emergence of On-Demand Digital Healthcare Platforms

Building on the concept of PAYG, digital healthcare platforms have revolutionised how we access immediate medical advice. These platforms leverage technology to provide convenient, often round-the-clock access to healthcare professionals, primarily for non-emergency situations.

What are On-Demand Platforms?

These are typically app-based or web-based services that connect patients with healthcare providers, most commonly GPs, via video, phone, or secure messaging. Prominent examples in the UK include Babylon Health, Push Doctor, and Livi, as well as digital services offered by traditional private clinics.

Services Typically Offered:

  • Virtual GP Consultations: The core offering, allowing you to speak to a GP without leaving your home.
  • E-prescriptions: Prescriptions can often be sent electronically to a pharmacy of your choice.
  • Referrals: Where appropriate, digital GPs can issue private referrals to specialists.
  • Mental Health Support: Some platforms offer initial mental health assessments or access to talking therapies.
  • Digital Triage: AI-powered symptom checkers often guide users to the most appropriate service.

Benefits of On-Demand Digital Platforms:

  • Unmatched Convenience: Access medical advice from anywhere, often 24/7, without travel or waiting room time.
  • Rapid Access: Appointments can often be secured within minutes or hours, far quicker than traditional GP bookings.
  • Cost-Effective for Minor Issues: A single virtual GP consultation is significantly cheaper than an in-person private GP visit or even a minor A&E attendance.
  • Privacy: Some prefer the anonymity and privacy of a virtual consultation.

Limitations of On-Demand Digital Platforms:

  • Not Suitable for Emergencies: Crucially, these platforms are not for medical emergencies. Life-threatening conditions require immediate NHS or emergency service attention.
  • Lack of Physical Examination: While video consultations are effective for many conditions, a physical examination is impossible, which can limit diagnosis and treatment for certain ailments.
  • Continuity of Care: You might not speak to the same GP each time, which can hinder the development of a long-term understanding of your health history.
  • Dependence on Technology: Requires a stable internet connection and comfort with digital tools.
  • Data Privacy Concerns: As with any digital service, it's essential to understand how your health data is stored and protected. Reputable platforms adhere to strict UK data protection regulations (GDPR).

Table 2: On-Demand Digital Healthcare vs. Traditional Pay-As-You-Go Private Care

FeatureOn-Demand Digital Healthcare (e.g., Virtual GP Apps)Traditional Pay-As-You-Go Private Care (e.g., Private Clinic)
Primary Access MethodApp/Web-based, video or phone callIn-person at a clinic or hospital
Typical ServicesVirtual GP consultations, e-prescriptions, digital referrals, initial mental health assessments, symptom checkers.In-person GP consultations, specialist consultations, diagnostic tests (X-ray, MRI), minor/major surgeries, physiotherapy.
Speed of AccessOften minutes to hoursHours to days for GP, days to weeks for specialists/diagnostics (still faster than NHS).
Cost (Single Service)£20 - £60 (for a virtual GP consultation)£50 - £350 (for a GP or specialist consultation)
Hundreds to thousands for diagnostics/procedures.
Physical ExaminationNot possibleYes, integral to diagnosis and treatment.
Best ForMinor ailments (colds, rashes, UTIs), prescription refills, general medical advice, initial assessment.More complex conditions requiring physical examination, specialist opinion, diagnostic imaging, or procedures/surgery.
Continuity of CareVariable; may not see the same doctor consistently.More likely to see the same doctor/specialist for follow-ups within a specific episode of care.
Scope of ServiceLimited to remote assessment and advice.Full spectrum of private medical services, from consultations to complex surgical interventions.

Decoding Private Health Insurance (PHI): What It Covers (and Crucially, What It Doesn't)

Private Health Insurance (PHI), often referred to as Private Medical Insurance (PMI), serves a distinct and vital purpose within the UK healthcare ecosystem. It is designed to provide rapid access to private medical treatment for eligible acute conditions that develop after your policy starts. Understanding its scope, particularly its limitations, is paramount before considering a policy.

The Core Function: Covering Acute Conditions

PHI policies primarily cover the costs of diagnosis and treatment for acute conditions. An acute condition is generally defined as a disease, illness, or injury that is likely to respond quickly to treatment and return you to the state of health you were in immediately before the condition developed. Examples include:

  • A sudden back pain requiring physiotherapy or surgery.
  • A newly diagnosed hernia needing an operation.
  • A suspected appendicitis requiring diagnostic tests and potentially surgery.
  • A new cancer diagnosis requiring treatment.

CRITICAL CONSTRAINT: What Standard UK Private Health Insurance DOES NOT Cover

This is perhaps the most crucial point to understand about PHI:

Standard UK private health insurance policies DO NOT cover treatment for pre-existing conditions or chronic conditions.

Let's break down these definitions:

  • Pre-existing Condition: Any disease, illness, or injury for which you have had symptoms, medication, advice, or treatment before the start date of your policy, or a specified period (e.g., 2 years) before the policy start date. This is regardless of whether you had a formal diagnosis. For example, if you had knee pain a year ago but didn't get it fully diagnosed until after your policy started, it would likely be considered pre-existing and therefore excluded.
    • Why are they excluded? Insurance operates on the principle of covering unexpected future events. If a condition already exists or has manifested, it is no longer an "unexpected future event" for which risk can be pooled and actuarially calculated. Including pre-existing conditions would make policies prohibitively expensive for everyone.
  • Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics:
    • It needs long-term monitoring.
    • It does not have a cure.
    • It comes back or is likely to come back.
    • It needs rehabilitation.
    • It needs special training for the patient to cope with it.
    • Examples include diabetes, asthma, epilepsy, arthritis, high blood pressure, and many mental health conditions if they are ongoing and long-term.
    • Why are they excluded? Chronic conditions require ongoing, lifelong management and treatment. Providing indefinite coverage for such conditions would be financially unsustainable for insurers. PHI is designed for acute episodes that lead to recovery, not long-term disease management. The NHS remains the primary provider for chronic condition management in the UK.

It is absolutely vital for prospective policyholders to understand this distinction. PHI is for new, acute conditions, not for ongoing management of existing, long-term health issues.

What PHI Typically Covers (for eligible acute conditions):

  • Consultations: Fees for specialist consultations, following a GP referral.
  • Diagnostic Tests: A wide range of tests, including blood tests, X-rays, MRI scans, CT scans, ultrasounds, and endoscopies, when recommended by a specialist.
  • Hospital Stays: Costs for private hospital accommodation, nursing care, and theatre fees for in-patient (overnight stay) and day-patient (admitted and discharged the same day) treatments.
  • Surgery: Fees for surgeons and anaesthetists for eligible surgical procedures.
  • Cancer Treatment: Often a key benefit, covering chemotherapy, radiotherapy, targeted therapies, and associated consultations and scans. This may be included as standard or offered as an optional add-on.
  • Mental Health Support: Growing in prominence, many policies now include cover for talking therapies (e.g., CBT, counselling) and inpatient mental health treatment, provided the condition is acute and not pre-existing/chronic.
  • Physiotherapy and Complementary Therapies: Cover for a specified number of sessions, typically following a GP or specialist referral.
  • Rehabilitation: Post-treatment rehabilitation, such as physiotherapy or occupational therapy, to aid recovery.

Common Exclusions (Beyond Pre-existing & Chronic Conditions):

  • Emergency Services: PHI is not for emergencies. In a life-threatening situation, you should always go to an NHS A&E department.
  • Cosmetic Surgery: Procedures primarily for aesthetic improvement are typically excluded.
  • Fertility Treatment: IVF, fertility assessments, and other related treatments are generally not covered.
  • Normal Pregnancy & Childbirth: While complications may be covered, routine maternity care is usually excluded.
  • Organ Transplants: Typically excluded.
  • HIV/AIDS: Usually excluded.
  • Substance Abuse: Treatment for drug or alcohol addiction.
  • Experimental Treatment: Treatments not yet approved by regulatory bodies or considered experimental.

Types of PHI Policies & Underwriting Methods:

  • Comprehensive Plans: Offer the broadest range of benefits, covering most eligible acute conditions.
  • "Lite" Plans / Guided Options: More affordable plans that might limit your choice of hospitals (e.g., network-based plans), require you to accept the consultant chosen by the insurer, or have lower overall benefit limits.
  • Underwriting Methods:
    • Moratorium Underwriting: Most common. You don't disclose your full medical history upfront. Insurers will typically exclude conditions you've had symptoms of or treatment for in the last 5 years. If you go 2 years symptom-free and treatment-free after your policy starts, that condition may become covered.
    • Full Medical Underwriting (FMU): You provide your complete medical history at application. The insurer reviews this and states upfront what will and won't be covered. This offers more certainty from the outset.
    • Continued Personal Medical Exclusions (CPME): If you're switching from an existing policy, some insurers may offer to carry over your existing medical exclusions, often a good option for continuity.

Benefits of PHI:

  • Peace of Mind: Knowing you have a financial safety net for unexpected medical issues.
  • Faster Access to Treatment: Bypassing NHS waiting lists for eligible conditions, getting diagnosis and treatment more quickly.
  • Choice and Control: Often allows you to choose your consultant, hospital, and appointment times.
  • Comfort and Privacy: Access to private rooms in comfortable hospital environments.
  • Access to Latest Treatments: Potential access to drugs and treatments not yet routinely available on the NHS (though this varies by policy and insurer).

Drawbacks of PHI:

  • Cost: Premiums can be significant, particularly as you age or if you opt for comprehensive cover.
  • Exclusions: The strict exclusion of pre-existing and chronic conditions is a major limitation for many.
  • Complexity: Policies can be intricate, with various limits, excesses, and add-ons that require careful understanding.

PHI Uptake in the UK:

Despite the cost, private medical insurance remains a popular choice for many. According to LaingBuisson's UK Healthcare Market Review, the number of people covered by private medical insurance in the UK reached 5.7 million by the end of 2023, representing a significant increase and reflecting the ongoing pressures on the NHS. Many policies are provided through employer-sponsored schemes, highlighting the value placed on health benefits by businesses.

When Does Private Health Insurance Still Make Sense in the Age of PAYG and On-Demand?

Given the rise of flexible PAYG and convenient on-demand digital options, one might wonder if traditional private health insurance still holds its ground. The answer is a resounding yes, particularly when considering the financial risks and practical limitations of self-funding major medical events.

PHI serves a fundamentally different purpose than PAYG or on-demand services: it's about comprehensive financial protection and guaranteed access to a full spectrum of private care when faced with significant, unforeseen health challenges.

Scenario 1: Protection Against Unforeseen Major Illness or Injury

This is the cornerstone of PHI's value. While a £200 specialist consultation or a £500 MRI scan might be manageable on a PAYG basis, the costs associated with serious illnesses or complex surgical procedures are truly prohibitive for the vast majority of people.

  • Example: Cancer Treatment. A course of private cancer treatment, including specialist consultations, advanced diagnostics, surgery, chemotherapy, radiotherapy, and follow-up care, can easily run into tens of thousands, or even hundreds of thousands of pounds. According to a report by the Private Healthcare Information Network (PHIN), the average cost of private cancer care is substantial, with complex courses of treatment far exceeding annual salaries for many. A private health insurance policy, if cancer cover is included and the condition is acute and not pre-existing, would typically cover these monumental costs, providing access to cutting-edge treatments and private facilities without the patient bearing the financial burden.
  • Example: Hip or Knee Replacement. While not immediately life-threatening, waiting for such a procedure on the NHS can severely impact quality of life. A private hip replacement can cost upwards of £15,000 to £20,000 privately. Without PHI, this is a direct, substantial outlay.

PHI acts as your financial firewall, preventing a health crisis from becoming a financial catastrophe.

Scenario 2: Peace of Mind and Financial Security

The mental burden of worrying about potential medical bills can be immense. With PHI, you gain significant peace of mind, knowing that if an eligible acute condition arises, the costs of your treatment are covered. This allows you to focus on your recovery rather than navigating complex private billing or stressing about unexpected expenses. It's an investment in your future health security.

Scenario 3: Access to Specialist Care and Choice

While on-demand GPs offer quick advice, they are not a substitute for specialist intervention. PHI provides:

  • Bypassing NHS Waiting Lists: For non-urgent specialist consultations, diagnostics, and elective surgeries, PHI significantly reduces waiting times. If you need to see a cardiologist for a new heart murmur, or an orthopaedic surgeon for a nagging joint issue, PHI can get you an appointment and diagnosis much faster than the NHS average.
  • Choice of Consultant and Hospital: With PHI, you often have the freedom to choose your specialist (within the insurer's approved list) and the private hospital where you receive treatment. This allows you to select a consultant with a particular expertise or a hospital known for its facilities and comfort.
  • Private Facilities: PHI covers comfortable private rooms, often with en-suite facilities, a quiet environment for recovery, and flexible visiting hours – factors that significantly enhance the patient experience.

Scenario 4: Enhanced Well-being and Mental Health Support

Mental health is a growing concern, and access to timely support is critical. While the NHS offers mental health services, waiting lists for talking therapies can be long. Many comprehensive PHI policies now include substantial mental health benefits, covering:

  • Psychiatric Consultations: Access to private psychiatrists for diagnosis and medication management.
  • Talking Therapies: Coverage for sessions with private psychologists, psychotherapists, and counsellors, often without long waits.
  • Inpatient Mental Health Treatment: For more severe acute conditions, some policies will cover stays in private mental health facilities.

This can be invaluable for those seeking prompt, discreet mental health care for acute conditions.

Scenario 5: Corporate Health Insurance

For many, private health insurance is a benefit provided by their employer. Corporate schemes often offer more comprehensive coverage at a lower (or no) personal cost compared to individual plans, leveraging the collective bargaining power of the employer. This is a significant employee benefit, enhancing recruitment and retention, and ensuring employees can return to work quickly after illness. If you have access to a corporate scheme, it is almost always the most cost-effective and beneficial way to secure PHI.

The Hybrid Approach: Combining PHI with PAYG/On-Demand

For many individuals, the most pragmatic and cost-effective approach to private healthcare isn't an either/or choice, but a strategic combination of options. A hybrid model allows you to leverage the strengths of each, managing minor health concerns efficiently while maintaining crucial protection against major medical expenses.

How the Hybrid Approach Works:

The core idea is to use:

  • PAYG / On-Demand Services for Routine, Low-Cost Needs:
    • Minor ailments: A quick virtual GP consultation for a cold, flu, or simple rash.
    • Initial assessments: If you're unsure if a symptom warrants a specialist, an online GP can provide initial guidance.
    • Prescription renewals: For stable conditions.
    • Specific, isolated diagnostic tests: If you have a clear, isolated need for a single blood test or X-ray that isn't part of a larger medical episode.
    • One-off therapy sessions: Perhaps a single physiotherapy session for a minor strain.
  • Private Health Insurance for Anything Requiring Specialist Referral, Complex Diagnostics, or Hospital Treatment:
    • New, persistent, or worsening symptoms: If an on-demand GP suggests a specialist consultation or further investigation.
    • Referral to a specialist: Once you have a private GP referral, your PHI policy would then kick in to cover eligible specialist consultations, follow-up diagnostics, and any subsequent treatment.
    • Any condition potentially requiring surgery or inpatient care: This is where PHI truly shines.
    • Cancer treatment: If newly diagnosed and eligible under your policy.
    • Mental health treatment: For ongoing therapy or specialist psychiatric care.

This approach means you're not paying high premiums for a full-fat PHI policy just to cover a virtual GP visit, but you also aren't exposed to the crippling costs of a major illness if it arises. You pay small amounts for small needs, and your insurance covers the big risks.

Table 3: Hybrid Approach - When to Use Which Service

Health ScenarioRecommended ServiceRationale
Minor Ailment
(e.g., cold, cough, skin rash, mild infection)
On-Demand Digital GP (PAYG)
NHS GP (if not urgent)
Quick, convenient, and cost-effective for immediate advice or e-prescription without the need for physical examination. NHS GP is free but may have longer wait times.
Specific Diagnostic Need
(e.g., a standalone blood test, basic X-ray for minor injury)
PAYG Private Clinic/Diagnostic CentreIf you have a clear idea of the test needed and don't require further specialist consultation yet, paying directly can be faster and simpler than involving insurance.
New, Persistent Symptom
(e.g., unexplained pain, persistent fatigue, concerning lump)
On-Demand Digital GP (for initial assessment)
THEN PHI (for specialist referral & diagnostics)
Use digital GP for rapid initial assessment. If they recommend a specialist referral or further investigation, activate your PHI to cover the specialist consultation, diagnostic tests (e.g., MRI, endoscopy), and any subsequent treatment, bypassing NHS waits.
Requirement for Specialist Consultation/Surgery
(e.g., joint pain requiring orthopaedic review, digestive issues, cancer suspicion)
PHI (Private Health Insurance)This is the core strength of PHI. It covers the often substantial costs of specialist fees, hospital stays, surgical procedures, and follow-up care for eligible acute conditions. Trying to self-fund here is financially risky.
Ongoing Chronic Condition Management
(e.g., diabetes, asthma, high blood pressure)
NHS GP & Specialist TeamsStandard PHI policies do NOT cover chronic conditions. The NHS provides comprehensive, long-term management and support for these conditions.
Emergency Situations
(e.g., severe chest pain, sudden paralysis, major accident)
NHS A&E / Emergency ServicesPrivate health insurance is NOT for emergencies. Always call 999 or go to your nearest NHS A&E department immediately.

This integrated approach leverages the best of all worlds: the immediate convenience of digital care for minor issues, the targeted efficiency of PAYG for specific tests, and the comprehensive financial protection of PHI for major health events.

Key Considerations When Choosing Your Private Healthcare Path

Deciding on the best private healthcare strategy involves weighing several factors unique to your circumstances. It's a personal decision that balances cost, access, and peace of mind.

  1. Your Health Needs and History:
    • Are you generally healthy? If so, a PAYG approach for very minor issues combined with a "lite" PHI policy or a higher excess (deductible) might be cost-effective.
    • Do you have pre-existing conditions? Remember, standard PHI will NOT cover these. For these, you'll rely on the NHS or self-fund on a PAYG basis. Your PHI will be for any new, acute conditions that arise.
    • Do you have a family history of certain conditions? While this doesn't make them "pre-existing" for you, it might increase your desire for PHI protection against future acute onset.
  2. Your Budget and Financial Comfort:
    • Can you afford the monthly/annual premiums for PHI? These are fixed, predictable costs.
    • Can you comfortably self-fund a major medical event if it occurred? Consider the potential cost of a serious illness or surgery (e.g., £15,000+ for a hip replacement, £50,000+ for cancer treatment). If this level of expense would cause significant financial distress, PHI becomes a critical consideration.
    • What is your risk tolerance? Are you willing to gamble on staying healthy and self-funding if necessary, or do you prefer the certainty of insurance cover?
  3. Access Preferences:
    • How quickly do you need to see a doctor or specialist? Both PAYG and PHI offer faster access than the NHS, but PHI provides the framework for continued specialist care.
    • Do you value choice of consultant and hospital? PHI typically offers this, whereas PAYG requires you to research and select providers yourself for each stage.
    • Is a private room and comfortable hospital environment important to you? These are standard with PHI.
  4. Reliance on the NHS:
    • How comfortable are you relying solely on the NHS for all your healthcare needs, given current waiting lists and pressures? Many choose private options precisely to supplement the NHS, especially for non-urgent care.
    • Remember, for emergencies, the NHS is always the first port of call, regardless of your private provisions.
  5. Policy Nuances (for PHI):
    • Excess/Deductible: A voluntary amount you pay towards a claim. Opting for a higher excess can significantly reduce your premium.
    • Outpatient Limits: Some policies cap the number of outpatient consultations or diagnostic tests.
    • Underwriting Method: Understand the implications of moratorium vs. full medical underwriting for your pre-existing conditions.
    • Added Benefits: Check for mental health cover, physiotherapy limits, and cancer care options.
  6. The Role of a Broker:
    • Navigating the complexities of private health insurance policies, comparing different insurers (e.g., Aviva, AXA Health, Bupa, Vitality, WPA), and understanding the fine print can be daunting.
    • This is where WeCovr excels. As an expert insurance broker, we work with all the major UK insurers to help you compare plans, understand the nuances of each policy, and find the right coverage that precisely matches your needs and budget. We provide impartial advice, ensuring you make an informed decision without the sales pressure often associated with direct insurer channels. We can explain the difference between moratorium and full medical underwriting, guide you through the exclusions, and clarify what cancer or mental health cover entails.

The private healthcare sector in the UK is dynamic, constantly evolving in response to patient needs, technological advancements, and the ongoing pressures on the NHS. Several key trends are shaping its future:

  • Increased Integration of Digital and In-Person Services: The hybrid approach is becoming the norm. Insurers are integrating virtual GP services directly into their policies, and private clinics are offering more online booking and follow-up options. This seamless blend of digital convenience and physical care will continue to grow.
  • Focus on Preventative Health and Wellness Programmes: Beyond just treating illness, there's a growing emphasis on preventing it. Many PHI providers are incorporating wellness programmes, health assessments, gym discounts, and even wearables to encourage healthier lifestyles, aiming to reduce future claims and improve overall population health. Vitality, for example, is a leader in this space.
  • Personalised Medicine: Advances in genetics and data analytics are paving the way for more personalised diagnoses and treatment plans, especially in areas like cancer. Private providers are often quicker to adopt these cutting-edge approaches.
  • Continued Pressure on the NHS, Driving More Towards Private Options: Without a significant overhaul, the NHS is likely to remain under strain. This sustained pressure will inevitably continue to drive individuals and employers towards private solutions for quicker access and broader choice, making the private sector an increasingly integral part of the UK's healthcare provision.
  • The Growing Use of AI in Diagnostics and Consultations: Artificial intelligence will play an increasing role, from AI-powered symptom checkers and diagnostic image analysis to predictive analytics for health risks. This could enhance efficiency and accuracy in private healthcare settings.

Making an Informed Decision: Your Health, Your Choice

The decision of how to navigate private healthcare in the UK is a deeply personal one, influenced by your individual health profile, financial situation, and priorities. The options are no longer just binary – NHS or comprehensive PHI. The emergence of pay-as-you-go services and on-demand digital platforms has created a nuanced landscape that offers greater flexibility than ever before.

To summarise:

  • Pay-As-You-Go and On-Demand Services: Excellent for immediate, low-cost access to specific, minor health concerns or initial assessments. They offer convenience and transparency for routine or isolated medical needs. However, they expose you to significant financial risk for major illnesses or complex treatments.
  • Private Health Insurance (PHI): Provides essential financial protection against the substantial costs of unforeseen major acute illnesses or injuries. It guarantees faster access to specialist consultations, advanced diagnostics, surgery, and comprehensive cancer care, bypassing NHS waiting lists for eligible conditions. Crucially, remember that standard PHI policies do not cover pre-existing or chronic conditions. Your PHI is there for new, unexpected health challenges that arise after your policy begins.
  • The Hybrid Approach: Often the most sensible strategy, combining the convenience and cost-efficiency of PAYG/on-demand for minor issues with the comprehensive financial security of PHI for significant medical events.

Ultimately, making an informed decision requires understanding the fine print, comparing costs against benefits, and honestly assessing your risk appetite. This is where expert advice becomes invaluable. WeCovr is here to help you cut through the complexity. We compare tailored quotes from all leading UK private health insurers, offering impartial, expert guidance to help you find a policy that genuinely meets your needs and budget. We're committed to ensuring you understand exactly what you're buying, so you can make the best choice for your health and financial future.


Why private medical insurance and how does it work?

What is Private Medical Insurance?

Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.

How does it work?

Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:

• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment

Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.

Questions to ask yourself regarding private medical insurance

Just ask yourself:
👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?

Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.

Benefits offered by private medical insurance

Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:

Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.

Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.

Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.

Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.

Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.

Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.

Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.

Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.

Important Fact!

There is no need to wait until the renewal of your current policy.
We can look at a more suitable option mid-term!

Why is it important to get private medical insurance early?

👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.

👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.

Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.

It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.

You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.

By tapping the button below, you can book a free call with them in less than 30 seconds right now:

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1. Complete a brief form
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3. Enjoy your protection!
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Any questions?

Life Insurance and Private Medical Insurance cover you for two different purposes, so you will need to assess your needs but may wish to consider holding the two policies. Private Medical Insurance covers you if you get sick or need treatment and want or need to go privately. Life Insurance covers you in the case of death, giving a payout to family/those left behind.

Health insurance covers conditions that develop after your policy starts. Pre-existing conditions are typically not covered, and insurers may exclude related issues. Some policies may cover symptoms of pre-existing conditions under specific circumstances. Always review your policy's exclusions. Coverage for pre-existing medical conditions may be available if you currently hold a medical insurance policy or are transitioning from a company scheme. However, if you have never had medical insurance before or if your policy is not active at the moment, pre-existing conditions will not be covered. This limitation exists because health insurance is primarily intended to protect against unexpected health issues. To simplify, it's akin to getting into a car accident and then trying to obtain insurance coverage afterward to repair the vehicle — insurance companies typically do not cover such claims. Nevertheless, there is an option to gain coverage for pre-existing conditions after a two-year waiting period, subject to specific rules and conditions.

If you prefer to get straight into treatment in the private sector without the long waiting times with the NHS, or you just prefer the private sector anyway, without having to pay it all yourself, then you would need to have Private Medical Insurance to cover it. Sometimes treatments and drugs that are not covered by the NHS can be covered by Private Medical Insurance.

It's free to use WeCovr to find health insurance - we never charge you for quotes. Health or private medical insurance is an investment that can pay for itself the first time you might need medical treatment.

It depends on your personal choice and preferences. If you are prepared to limit yourself to NHS-covered treatments only and can or want to endure long waiting times to get into treatment, then yes, NHS might work for you. Your cover there is free. If you don't want to be exposed to long waiting times or if your treatment is not covered by the NHS, then you would benefit from Private Medical Insurance.

Private Medical Insurance is an important financial product that insurance companies take a lot of care and diligence so speaking to real human beings ensures that they understand your requirements fully so that you can get the right cover.

All of our partners are carefully vetted and authorised by the FCA, which means they are held to the highest standards that the FCA expects from them and treat all customers fairly!

Our revenue comes from commissions paid by the insurance providers when a policy is taken out through us. Essentially, when you choose to secure a policy from one of the providers we work with, they compensate us for facilitating the transaction. It's important to note that this commission does not impact the premium you pay. We remain committed to providing transparent and unbiased quotes to help you find the best insurance options tailored to your needs.

The cost of private health insurance depends on several factors, including your age, location, smoking status, and the type of policy you choose. Your health insurance policy is tailored to your needs, and the cost can vary based on the level of cover you require, such as the amount of excess and specific treatment allowances.

Private health insurance covers you for conditions that arise after your policy begins. You pay a monthly fee and can make claims for private healthcare covered by your policy. One of the main benefits of private healthcare is quicker access to treatment compared to the NHS, along with access to new drugs or specialist treatments.

Most health insurance covers private hospital stays and may include outpatient treatments like scans, tests, or appointments. Policies vary in coverage, and exclusions often include emergency treatment, maternity care, cosmetic surgery, and ongoing conditions present before the policy started.

Unfortunately, you cannot pay extra to have a pre-existing condition covered as part of your health insurance policy. However, you have access to support from a nurse or digital GP. If you have questions about what is covered under your policy, please contact us for clarification.

Your health insurance policy begins once you've selected your policy and set up your payment. After setup, you'll receive your cover documents detailing what is and isn't covered. It's important to review these details carefully as policies differ.

An excess is the amount you contribute towards treatment when you make a claim. Choosing a higher excess can reduce your policy's monthly cost but requires a larger contribution when claiming. WeCovr's experts will offer you flexible excess options depending on your preferences.

To reduce health insurance costs, consider choosing a higher excess, which lowers the monthly premium. However, ensure the plan still meets your needs. Other factors affecting cost include lifestyle choices like smoking and potential savings for couples or family plans.

There is no age limit for taking out health insurance, but age influences the policy's cost. The benefits of health insurance are consistent regardless of age. If you're considering health insurance, you can get a quote from WeCovr's experts regardless of your age.

Let WeCovr's experts do the legwork for you and compare health insurance plans at no cost to you to find the best fit for your needs. Consider individual, couple, or family plans and review coverage details thoroughly before choosing. WeCovr provides transparent information on coverage options for easy comparison.

Yes, you can add your partner (if you live at the same address) or dependents to your policy at any time. The cost of couple's or family health insurance depends on factors like location, age, health, and chosen excess. Contact WeCovr or your insurer for assistance in adding someone to your policy.

While WeCovr's private health insurance plans are tailored for the UK, we offer global health insurance options for those living or working abroad. For holiday coverage, travel insurance is recommended.

Comprehensive cover provides extensive benefits, including full outpatient services such as consultations, diagnostic tests, physiotherapy, and mental health therapies. Our team at WeCovr can assist in understanding the various coverage levels available.

Private health insurance typically does not cover dental treatment. However, WeCovr's experts can guide you to dental insurance policies offered by our partner insurers. Reach out to us to explore these options.

Yes, private health insurance covers cancer treatment from diagnosis through treatment. At WeCovr, we can help you navigate the cancer cover options that suit your needs.

At WeCovr, you have flexibility in adjusting your cover. Speak to our experts within 21 days of receiving your paperwork or at policy renewal to make changes.

Accessing a private GP appointment is fast and convenient with WeCovr's services, available through your digital platform provided under your chosen insurance plan.

Yes, family members on the same policy can potentially have different levels of cover tailored to their individual needs.

WeCovr works with insurers offering a range of cover levels to accommodate different budgets and needs. Our experts can discuss these options with you.

Discovering healthcare facilities and specialists is easy with WeCovr's resources. Contact us for personalised assistance by tapping one of the buttons above or below and filling in a few details for personalised assistance.

Fee-assured consultants provides transparency and no hidden costs for clients.

WeCovr prioritises mental health support with comprehensive coverage and access to specialist advice and services.

Children up to a certain age can be included in your policy, and we offer discounts for family coverage.

Like most health insurance plans, premiums may increase annually due to factors such as age and medical cost inflation.

The cost of health insurance varies based on several factors. Connect with our experts by tapping a button below and get your own personalised quote.

Private health insurance offers quicker access to consultations, treatments, and personalised care compared to the NHS.

Yes, WeCovr's experts can guide you which health insurance plans include coverage for physiotherapy treatments.

Immediate access to certain services like our digital GP app is available upon enrolment.

You can obtain a range of suitable quotes easily by tapping one of the buttons above or below and filling in a few details for personalised assistance.

Health insurance covers new conditions that arise after the policy starts. Pre-existing conditions and certain exclusions may apply.

WeCovr's experts help you arrange health insurance that simplifies access to private healthcare services, including consultations and treatments.

Outpatient cover includes consultations, physiotherapy, and mental health therapies outside hospital admissions.

Yes, you can use your health insurance cover immediately. You have access to a nurse through your helpline and can consult with a GP using the digital GP app. If you need to make a claim right away, we may require a medical report from your GP. Health insurance is designed to cover new conditions that arise after the policy has started.

No, health insurance does not cover A&E (Accident and Emergency) visits. Private hospitals do not typically have the facilities for handling A&E cases. In case of an emergency, please dial 999 or use the NHS emergency services. However, if you require follow-up treatment after an emergency situation, your private medical insurance may be able to assist.

Yes, many insurers offer rewards in leisure, wellbeing, and health. Speak to WeCovr's experts or visit your insurer's website for more details on member rewards.

You may continue your cover or get another own personal policy. If you continue your cover, existing or ongoing medical conditions might be covered depending on the level of cover you choose. Contact our friendly experts to discuss your options and find the right option for you.

You can tap one of the buttons above or below and fill in a quick form to arrange a call with us to discuss your options.

Your cover may be similar but not identical. We will help you find the right level of cover that suits your needs, and ongoing medical conditions may be covered. Contact our friendly advisers to explore all available options.

No, the price won't be the same as before since employers often contribute to the cost of employee cover. Additionally, different cover levels and medical histories may affect the price. Contact WeCovr's experts for detailed information.

You have a few weeks or months from leaving your job to decide to continue with your insurer or change to another one. Your policy may start the day after you left your work policy, and our experts can guide you through other available options.

After leaving your job, contact WeCovr's experts with your leave date to discuss available options.

Yes, ongoing treatment may be covered on your new personal policy, although it could affect the price. Contact our experts for personalised advice on your options.

Details on paying excess fees will be provided when you contact your insurer for treatment authorisation.

No, there is no excess fee for utilising these services.

Excess adjustments can be made at specific intervals during your policy term.

No claims discounts can impact renewal costs based on claims history.

Pre-existing conditions typically aren't covered but can be discussed with our healthcare specialists.

This involves health-related questions before policy enrolment to determine coverage.

Moratorium underwriting simplifies enrolment but may require health disclosures during claims.

Claims may require additional information if under moratorium underwriting.

Pre-existing conditions refer to medical issues existing before policy inception. A pre-existing condition is anything you've previously had medical treatment for, such as diabetes, heart disease, or asthma. Most insurance providers consider any condition you've had symptoms or treatment for in the past five years as pre-existing. Our experts at WeCovr can help you understand how pre-existing conditions affect your policy options.

While some insurance providers automatically renew your private healthcare cover, it's beneficial to compare policies when yours is about to end. This ensures you're still getting the best deal for the coverage you need. Our experts at WeCovr can assist you in finding the right policy for you.

Typically, you must be over 18 to take out your own policy, but minors can usually be included in a family policy. There may also be an upper age limit for private health insurance, and premiums typically increase with age. Our experts at WeCovr can provide guidance on age-related policy aspects.

Paying for health insurance annually often results in savings compared to monthly payments. However, this depends on your insurance provider. For help determining the most cost-effective option, consider consulting our experts at WeCovr.

If your employer offers private health insurance as part of your benefits package, you likely don't need additional cover. However, there may be limits on the cover you receive, and it may not extend to your entire family. Remember, any insurance you get through work only covers you while you're employed there.

If you don't have pre-existing conditions, a medical exam is usually not required. You'll just need to complete a medical history form and select your level of cover. However, if you're older, have a pre-existing condition, or lead an unhealthy lifestyle, a medical exam may be necessary. Our experts at WeCovr can clarify the requirements of different policies.

Many private health insurance providers now offer GP services, either digitally or face-to-face. This means you can often get a private GP appointment quickly, sometimes even on the same day. Our experts at WeCovr can help you find policies that offer GP services.

With private health insurance, you can often secure a GP appointment much quicker than with traditional methods, sometimes even on the same day. Our experts at WeCovr can help you find policies that offer quick GP appointment services.

Inpatient care refers to any treatment requiring a stay in a hospital or clinic for at least one night. Outpatient care refers to treatments or tests that don't require hospital admission, such as minor diagnostic tests or physiotherapy sessions. Our experts at WeCovr can help you understand the different types of care and find a policy that suits your needs.

Private health insurance covers your medical treatment if you fall ill, while critical illness cover provides additional financial help if you develop one of the critical illnesses listed in the policy, such as covering loss of income if you're unable to work. For assistance in understanding the differences and finding the right coverage, consult our experts at WeCovr.

Health insurance policies are designed for cover in the UK. For cover abroad, consider travel insurance for short trips or international health insurance for longer stays or if you have a holiday home overseas. Our experts at WeCovr can guide you in finding the appropriate coverage for your travel needs.

If your employer provides health insurance, it's considered a 'benefit in kind' and is not tax deductible. Your employer should calculate the tax you owe for your health insurance premiums and deduct it from your pay. There are some exceptions for small companies. For more information on tax implications, consider reaching out to our experts at WeCovr.

When you purchase a policy, you choose how much excess you pay, which is your contribution to the cost of treatment if you make a claim. The higher your excess, the lower your premium is likely to be. Our experts at WeCovr can help you understand how excess works and choose the right level for you.

These are two methods of underwriting a health insurance policy, relating to how insurance providers consider your pre-existing medical conditions when you take out cover. For help understanding the differences and choosing the right option for you, consult our experts at WeCovr.

Some private health insurance providers offer a no-claims discount, similar to car insurance. Every year you don't make a claim gives you an extra year of no-claims discount, potentially reducing your premium when you renew. Our experts at WeCovr can help you find policies that offer no-claims discounts.

To find the best health insurance for you, compare various policies to find one that offers the features you need at a price you can afford. Consider your personal circumstances and what you want from your policy. Our experts at WeCovr can assist you in evaluating your options and selecting the right coverage for you.

If you need treatment, a GP referral is not always necessary. However, this depends on how you plan to pay for your treatment. Most hospitals will allow you to book appointments with a consultant without a GP referral if you are paying out-of-pocket. If you have private medical insurance, you'll need to check the terms of your policy to see whether your insurer requires you to consult with a GP first (most insurers do). Some policies offer a direct booking system without a referral for certain conditions, such as counseling for mental health issues.

Yes, you can obtain financing for a loan to cover the cost of surgery. Many private healthcare companies have partnerships with finance companies to allow you to spread the cost of private treatment over time. You could also explore getting an ordinary loan from your bank if this option proves to be more cost-effective for you.

WeCovr has conducted extensive research into the cost of private health insurance in the UK. Click the link to find out more detailed information.

Yes, you can continue to receive treatment through the NHS even if you have private health insurance and have received private treatment in the past. This could be for rehabilitation after private surgery or for treatment that is not covered by your health insurance policy. For example, some cosmetic surgeries may be available through the NHS but are generally not covered by private medical insurance.

This is a difficult question to answer definitively. There are certain services that cannot be obtained privately, such as emergency treatment at an Accident and Emergency (A&E) department. Many NHS consultants also practice privately, so you could potentially see the same consultant regardless of whether you choose private or public healthcare. However, private healthcare typically offers shorter waiting times, guaranteed private rooms, and more relaxed visiting hours. Additionally, you may have access to treatments and drugs that are not routinely available through the NHS.

Yes, you can self-refer to a private specialist without the need for a GP referral. However, the British Medical Association believes that in most cases, it is best practice to start with your GP, as they are familiar with your medical history.

Yes, if you have a health concern and pay for private tests and scans but cannot afford to have private surgery, you should be able to have your test results transferred to an NHS provider for treatment.


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Who Are WeCovr?

WeCovr is an insurance specialist for people valuing their peace of mind and a great service.

👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.

Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!

Important Information

Since 2011, WeCovr has helped thousands of individuals, families, and businesses protect what matters most. We make it easy to get quotes for life insurance, critical illness cover, private medical insurance, and a wide range of other insurance types. We also provide embedded insurance solutions tailored for business partners and platforms.

Political And Credit Risks Ltd is a registered company in England and Wales. Company Number: 07691072. Data Protection Register Number: ZA207579. Registered Office: 22-45 Old Castle Street, London, E1 7NY. WeCovr is a trading style of Political And Credit Risks Ltd. Political And Credit Risks Ltd is Authorised and Regulated by the Financial Conduct Authority and is on the Financial Services Register under number 735613.

About WeCovr

WeCovr is your trusted partner for comprehensive insurance solutions. We help families and individuals find the right protection for their needs.