TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands that choosing private medical insurance in the UK can feel complex. This guide simplifies the process, providing you with the essential questions to ensure you find the right cover for your needs and budget. WeCovr's checklist of key questions every buyer should ask Navigating the world of private medical insurance (PMI) requires a bit of homework.
Key takeaways
- Chronic Condition: A condition that continues long-term and cannot be cured, only managed. Examples include diabetes, asthma, and high blood pressure.
- Pre-existing Condition: Any illness or injury you had symptoms of, or received advice or treatment for, before taking out the policy.
- Chronic Conditions: As mentioned, long-term management of conditions like diabetes or arthritis is not covered.
- Pre-existing Conditions: Any medical issues you had before the policy began.
- Emergency Services: Treatment in an Accident & Emergency (A&E) department. The NHS provides emergency care for everyone in the UK. PMI is for planned, non-emergency treatment.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands that choosing private medical insurance in the UK can feel complex. This guide simplifies the process, providing you with the essential questions to ensure you find the right cover for your needs and budget.
WeCovr's checklist of key questions every buyer should ask
Navigating the world of private medical insurance (PMI) requires a bit of homework. To make an informed decision, you need to look beyond the monthly premium and understand the intricacies of the policy. Think of it as investing in your future health and peace of mind. Getting it right means having a safety net you can rely on when you need it most.
This comprehensive checklist is designed to empower you. We'll walk through the ten most important questions, demystifying the jargon and highlighting the details that truly matter.
1. What does the policy actually cover?
This is the most fundamental question. At its heart, private medical insurance in the UK is designed to cover the cost of treatment for acute conditions that arise after your policy has started.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of conditions like hernias, cataracts, or joint problems requiring replacement.
CRITICAL POINT: Standard UK private medical insurance does not cover chronic or pre-existing conditions.
- Chronic Condition: A condition that continues long-term and cannot be cured, only managed. Examples include diabetes, asthma, and high blood pressure.
- Pre-existing Condition: Any illness or injury you had symptoms of, or received advice or treatment for, before taking out the policy.
The core of any PMI policy is built around three types of care:
| Type of Care | Description | Real-Life Example |
|---|---|---|
| In-patient | You are admitted to a hospital and stay overnight for one or more nights for treatment. | Having a planned hip replacement surgery and staying in hospital for several days to recover. |
| Day-patient | You are admitted to a hospital or clinic for a planned procedure but do not stay overnight. | Undergoing cataract surgery or an endoscopy and going home the same day. |
| Out-patient | You visit a hospital or clinic for a consultation, diagnosis, or treatment but are not admitted. | Seeing a specialist consultant, having diagnostic tests like an MRI scan, or attending a physiotherapy session. |
Most entry-level policies cover in-patient and day-patient care as standard. Comprehensive plans will also include extensive out-patient cover. Understanding this distinction is key to managing your budget and expectations.
2. What are the exclusions and limitations?
Knowing what isn't covered is just as important as knowing what is. Every policy has a list of general exclusions. While these vary slightly between insurers, they almost always include:
- Chronic Conditions: As mentioned, long-term management of conditions like diabetes or arthritis is not covered.
- Pre-existing Conditions: Any medical issues you had before the policy began.
- Emergency Services: Treatment in an Accident & Emergency (A&E) department. The NHS provides emergency care for everyone in the UK. PMI is for planned, non-emergency treatment.
- Normal Pregnancy & Childbirth: Routine maternity care is excluded, though some comprehensive policies may cover complications.
- Cosmetic Surgery: Procedures that are not medically necessary.
- Self-inflicted Injuries: Including those related to substance abuse.
- Mobility Aids: Items like wheelchairs or stairlifts.
- Experimental Treatment: Therapies or drugs that are not yet approved by mainstream medical bodies.
Don't let this list put you off. The purpose of PMI is to complement the NHS, not replace it. It gives you control and choice over eligible, acute conditions, helping you bypass long waiting lists. According to NHS England data for 2025, the number of people on waiting lists for consultant-led elective care remains a significant concern, reinforcing the value of having a private alternative.
3. How does the underwriting process work?
'Underwriting' is how an insurer assesses your medical history to decide the terms of your policy. In the UK, there are two main types.
Full Medical Underwriting (FMU)
With FMU, you complete a detailed health questionnaire when you apply. You must declare your full medical history. The insurer then assesses this information and will state clearly from the outset which conditions, if any, will be excluded from your cover.
- Pros: Certainty from day one. You know exactly what is and isn't covered.
- Cons: A more time-consuming application process.
Moratorium (Mori) Underwriting
This is the most common and simpler option. You don't need to provide your full medical history upfront. Instead, the insurer automatically excludes any condition for which you've had symptoms, medication, or advice in the 5 years before your policy started.
However, if you then go for a set period without any treatment, advice, or symptoms for that condition (usually 2 continuous years after your policy starts), the insurer may add it to your cover.
- Pros: Quick and easy to set up.
- Cons: Less certainty. A condition you thought was minor could be excluded when you come to claim.
Here’s a simple comparison:
| Feature | Full Medical Underwriting (FMU) | Moratorium (Mori) Underwriting |
|---|---|---|
| Application | Long health questionnaire required. | No initial medical questions. |
| Exclusions | Clearly defined in your policy documents from the start. | General exclusions for conditions from the last 5 years. |
| Clarity | High. You know what's covered immediately. | Lower. The claims process can be slower as history is checked then. |
| Best For | People who want absolute clarity and have a complex medical history. | People in good health who want a quick and simple start. |
A specialist PMI broker like WeCovr can explain these options in detail and help you decide which is the right fit for your circumstances.
4. What is the excess and how does it affect my premium?
An 'excess' is the amount you agree to pay towards the cost of a claim. For example, if your policy has a £250 excess and your eligible treatment costs £3,000, you pay the first £250 and the insurer pays the remaining £2,750.
The excess is usually payable once per policy year, per person. You can choose your excess level, and this has a direct impact on your monthly premium.
The rule is simple: a higher excess leads to a lower premium.
| Excess Level | Example Monthly Premium* | How it Works |
|---|---|---|
| £0 | £85 | You pay nothing towards your claim; premiums are highest. |
| £250 | £70 | A popular, balanced option. |
| £500 | £60 | A good way to reduce premiums if you can afford the initial outlay. |
| £1,000 | £45 | Offers the lowest premiums but requires a significant contribution at claim time. |
*Premiums are illustrative for a 40-year-old non-smoker and will vary based on many factors.
Choosing the right excess is about balancing affordability with risk. Consider how much you could comfortably pay if you needed to make a claim tomorrow.
5. Which hospitals can I use?
Insurers don't provide access to every private hospital in the country on every policy. They group hospitals into lists or tiers, and your choice of list affects your premium.
- Local/Trust Hospital Lists: These offer access to a selection of local private hospitals or private patient units within NHS hospitals. This is the most budget-friendly option.
- National Lists: A broader choice of hospitals across the UK, excluding the most expensive facilities (often in Central London). This is the most common choice.
- Premium/London Lists: Includes all hospitals in the national list plus the top-tier private hospitals in Central London, which are known for their high costs. This is the most expensive option.
When getting a quote, think about where you would want to be treated. Do you need access to a specific specialist hospital, or are you happy with the options in your local area? WeCovr’s advisors can help you compare policies based on which hospitals are most important to you, ensuring you don’t pay for access you don’t need.
6. Are there limits on treatments like therapies or diagnostics?
While the best private health cover provides generous benefits, almost all policies have limits. These can be:
- An Overall Annual Limit (illustrative): A maximum amount the policy will pay out in a single year (e.g., £1 million or often 'unlimited').
- Per-Treatment Limits: Specific limits on certain types of care, especially for out-patient cover.
It’s crucial to check the small print for limits on:
- Diagnostics: The number of MRI, CT, and PET scans covered.
- Therapies (illustrative): The number of sessions for physiotherapy, osteopathy, or chiropractic treatment (e.g., up to £1,000 per year or a set number of sessions).
- Mental Health: Cover for talking therapies or psychiatric treatment is often an add-on and may have its own financial or session-based limits.
| Policy Tier | Out-patient Cover Limit | Complementary Therapies Limit | Mental Health Cover |
|---|---|---|---|
| Entry-Level | £0 or up to £500 | Often not included | Usually an add-on |
| Mid-Range | £1,000 - £1,500 | Up to £500 | Often included with limits |
| Comprehensive | Fully Covered | Fully Covered | More extensive cover included |
These limits are a key way insurers differentiate their products. A cheaper policy might look appealing, but if its out-patient limit is too low, you could end up paying for consultations and scans yourself.
7. What extra benefits are included?
The UK private medical insurance market is highly competitive, so providers often include valuable extra benefits to stand out. These can significantly enhance the value of your policy. Look out for:
- Digital GP / Virtual GP Services: 24/7 access to a GP via phone or video call. This is incredibly convenient, allowing you to get medical advice, prescriptions, and referrals without leaving your home.
- Wellness Programmes & Discounts: Many insurers offer rewards for healthy living, such as discounted gym memberships, wearable tech, or even cinema tickets.
- Mental Health Support: Beyond formal treatment, many policies now include access to 24/7 helplines, stress counselling sessions, and mental wellbeing apps.
- Second Opinion Services: Access to world-leading specialists to review your diagnosis and treatment plan.
When you buy a policy through WeCovr, you also get complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to support your health goals. Furthermore, customers who purchase PMI or life insurance with us are often eligible for discounts on other types of cover, providing even greater value.
8. How will my premium change over time?
Your initial premium is not fixed for life. It's important to understand why your payments will likely increase each year at renewal. There are three main drivers:
- Age: As we get older, the statistical likelihood of needing medical treatment increases. Most insurers use age-based pricing bands, so your premium will go up each year as you move into a new band.
- Medical Inflation: The cost of medical technology, new drugs, and specialist expertise rises faster than standard inflation. This is factored into your renewal price to ensure the insurer can cover the cost of future treatments. Typically, this adds 5-8% per year.
- Claims History: Some, but not all, insurers use a No-Claims Discount (NCD) system, similar to car insurance. If you don't make a claim, your discount increases. If you do claim, your discount may be reduced, leading to a higher premium the following year.
It’s also worth noting that all premiums are subject to Insurance Premium Tax (IPT), a government tax currently set at 12%. Any changes to IPT will affect your premium.
9. What is the claims process like?
A policy is only as good as its claims service. You want a process that is simple, quick, and stress-free. The typical claims journey looks like this:
- Visit your GP: If you have a medical concern, your first port of call is usually your NHS GP. They will assess you and, if necessary, provide an 'open referral' to a specialist.
- Contact your Insurer: Before you book any appointments or treatment, you must call your insurer’s claims line. This is called pre-authorisation.
- Get Authorisation: You will provide your insurer with your symptoms and referral details. They will check your cover and confirm if the condition and proposed treatment are eligible. They will give you an authorisation number and a list of approved specialists or hospitals.
- Book Your Treatment: You can now book your consultation or procedure with the authorised specialist.
- Direct Settlement: The best part of PMI is that the bills are handled for you. The hospital or specialist will send their invoice directly to your insurer for payment. You only need to pay your excess (if applicable).
A smooth claims process is a hallmark of the best PMI providers. High customer satisfaction ratings on independent review websites are a good indicator of a company that looks after its members.
10. Why should I use a broker instead of going direct?
While you can buy private medical insurance direct from an insurer, using an independent, FCA-authorised broker like WeCovr offers several significant advantages, at no extra cost to you.
| Feature | Using a Broker (like WeCovr) | Going Direct to an Insurer |
|---|---|---|
| Choice | Compare policies from a wide range of leading UK insurers. | Limited to the products offered by that one company. |
| Advice | Expert, impartial guidance to find the policy that best suits your specific needs and budget. | Advice is biased towards their own products. |
| Price | Brokers can find the most competitive prices across the market. | You may not get the best value available. |
| Simplicity | We do the hard work of comparing features, limits, and hospital lists for you. | You have to do all the research and comparison yourself. |
| Support | Ongoing support, including help at renewal or if you have issues with a claim. | Support is limited to that insurer's customer service team. |
| Cost | The service is free. Brokers are paid a commission by the insurer you choose. | The price is the same, but without the expert guidance. |
Using a broker ensures you get a holistic view of the market. We can explain the subtle but crucial differences between policies that you might otherwise miss, helping you avoid costly mistakes and securing a private health cover plan that truly protects you.
Frequently Asked Questions (FAQs)
Is private medical insurance worth it if I have the NHS?
Can I get health insurance for a pre-existing condition?
Can I add my family to my health insurance policy?
Ready to Find the Right Cover?
Answering these ten questions will put you in a strong position to choose the right private medical insurance. The next step is to see what's available.
Contact WeCovr today for a free, no-obligation quote. Our expert advisors will compare leading UK providers for you, answer all your questions, and help you find the perfect policy for your peace of mind.
Sources
- Department for Transport (DfT): Road safety and transport statistics.
- DVLA / DVSA: UK vehicle and driving regulatory guidance.
- Association of British Insurers (ABI): Motor insurance market and claims publications.
- Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.
