When considering private medical insurance in the UK, it’s vital to get expert advice. At WeCovr, an FCA-authorised broker that has helped arrange over 800,000 policies, we know that one of the biggest questions people have is about hospital access. So, are all hospitals covered by all insurers?
The short answer is no. This guide will explain why.
The ins and outs of hospital lists, restricted networks, and how to get access where you want it
One of the most common misconceptions about private medical insurance (PMI) is that once you have a policy, you can choose any private hospital in the country for your treatment. In reality, every insurer has a "hospital list" or "network," and the one your policy uses dictates where you can and cannot be treated.
Think of it like a mobile phone contract. Some plans give you unlimited data anywhere in the world, while others might restrict you to the UK or have a smaller data allowance. Hospital lists work in a similar way: some give you access to every top-tier facility, while others offer a more limited, budget-friendly selection.
Understanding these lists is the single most important step in ensuring your private health cover meets your expectations and gives you access to care exactly where you want it.
What Exactly is a Hospital List?
A hospital list is a directory of hospitals, clinics, and sometimes diagnostic centres that an insurer has a pre-arranged agreement with. These agreements are not just about which hospitals are included, but also about the cost of treatment.
Insurers negotiate rates for everything from a simple blood test to complex heart surgery with these hospital groups. By creating a network of approved facilities, they can:
- Control Costs: By negotiating fixed prices, insurers can manage their expenses and, in turn, offer more competitive premiums to you. A hospital outside their network could charge significantly more for the same procedure.
- Ensure Quality Standards: Insurers vet the hospitals on their lists to ensure they meet specific standards for clinical excellence, patient safety, and facilities.
- Streamline the Process: Having formal agreements makes the process of authorising treatment and settling bills much smoother for you, the hospital, and the insurer.
Without these networks, the cost of private medical insurance in the UK would be significantly higher, putting it out of reach for many. The trade-off is that your choice of hospital is determined by the list attached to your policy.
The Different Tiers of Hospital Lists Explained
To cater for different budgets and needs, insurers typically offer several tiers of hospital lists. While the names vary between providers (e.g., "Key," "Signature," "Guided"), they generally fall into three main categories.
| List Tier | Typical Coverage | Cost Impact | Best For... |
|---|
| Comprehensive / Premium | All major UK private hospitals, including the most prestigious Central London facilities. | Highest Premiums | Maximum choice and access to world-renowned specialists, especially for those living or working in London. |
| Standard / Nationwide | A wide selection of private hospitals across the UK, but typically excludes the most expensive Central London hospitals. | Medium Premiums | A great balance of cost and nationwide access for the majority of people in the UK. |
| Restricted / Guided | A limited selection of partner hospitals, often from a single hospital group (like Nuffield Health or Spire), or a list of local options. | Lowest Premiums | Budget-conscious buyers or those who are happy with the specific local hospitals included on the list. |
Let's break these down further.
1. Comprehensive (or Premium) Hospital Lists
This is the top-tier option. It grants you access to virtually any recognised private hospital in the UK, including the exclusive and highly specialised facilities in Central London. If you want the absolute freedom to choose your hospital and consultant without geographical restriction, this is the list for you. Naturally, this level of choice comes with the highest monthly premium.
2. Standard (or Nationwide) Hospital Lists
This is the most popular choice for UK customers. It provides excellent coverage with a wide range of high-quality private hospitals across the country. The main difference is the exclusion of the most expensive Central London hospitals. For someone living in Manchester, Bristol, or Edinburgh, this list offers fantastic choice without the added cost of covering facilities they are unlikely to use.
3. Restricted (or Guided) Hospital Lists
This is the most budget-friendly option. A restricted list will limit your choice to a smaller, curated selection of hospitals. Sometimes, this might be a list of hospitals in your local area. In other cases, it might be a "guided" option, where the insurer directs you to one of a few specific facilities to ensure costs are managed. This can be an excellent way to make private health cover more affordable, provided you are happy with the hospitals available to you.
An expert PMI broker, such as WeCovr, can instantly compare these different tiers across multiple insurers to find the sweet spot between the access you want and a premium you're comfortable with.
The "Central London" Factor: Why It Demands a Special Category
You'll notice Central London is the main distinguishing factor between hospital list tiers. But why?
Hospitals in postcodes like W1, WC1, and NW1 face significantly higher operating costs – from property rents to staff wages. They also often house the UK's most advanced diagnostic equipment and attract world-leading specialists, commanding higher fees.
A few examples of these prestigious hospitals include:
- The London Clinic
- The Wellington Hospital
- The Lister Hospital
- King Edward VII's Hospital
- HCA Hospitals at The Shard
Including these hospitals on your policy can increase your premium by 20-40%, or even more. Therefore, if you don't live or work near London and have no specific reason to want treatment there, choosing a list that excludes them is one of the easiest ways to make your private medical insurance more affordable.
Real-life example:
- Sarah, living in Leeds, wants comprehensive private health cover. Her local Nuffield and Spire hospitals offer excellent care. By choosing a "Standard" list that excludes Central London, she gets the access she needs and saves over £30 a month on her premium compared to a "Comprehensive" plan.
- David, a director working in the City of London, wants the option to be treated near his office by a specific specialist based at The London Clinic. He opts for a "Comprehensive" list. The higher premium is a price he's willing to pay for that specific convenience and choice.
What Happens If My Preferred Hospital Isn't On My List?
This is a critical question and highlights the importance of checking your hospital list before you buy a policy.
If you already have a policy and need treatment:
Unfortunately, your insurer will not cover treatment at a hospital that is not on your agreed list. If you approach them for authorisation, they will decline the request for that specific facility and instead direct you to a hospital that is on your list.
Your only option to use the out-of-network hospital would be to fund the treatment yourself, known as "self-pay." This defeats the purpose of having insurance.
The best time to solve this problem is before it happens.
When you are looking for a policy, make a list of one or two local private hospitals you would be happy to use. When you speak to an adviser, tell them which hospitals are important to you. At WeCovr, this is a standard part of our fact-finding process. We can then filter out any policies that don't include your preferred facilities, ensuring you never face this problem down the line.
A Crucial Reminder: PMI is for Acute, Not Chronic, Conditions
It's vital to be clear about what private medical insurance is designed for. All standard UK PMI policies, regardless of the insurer or hospital list, are designed to cover acute conditions.
- An Acute Condition is a disease, illness, or injury that is short-term, is likely to respond quickly to treatment, and where you can expect to return to your previous state of health. Examples include cataracts, a hernia, joint pain requiring a hip replacement, or diagnosing the source of new symptoms.
PMI is not designed to cover:
- Pre-existing Conditions: Any medical condition for which you have experienced symptoms, received medication, or sought advice from a medical professional before the start date of your policy. These are almost always excluded for a set period or entirely.
- Chronic Conditions: Long-term conditions that require ongoing management and have no known cure. Examples include diabetes, asthma, high blood pressure, and Crohn's disease. While PMI may cover the initial diagnosis of a chronic condition, it will not cover the long-term, routine management. This remains the responsibility of the NHS.
How to Choose the Right Hospital List for You: A 5-Step Guide
Choosing the right hospital list doesn't have to be complicated. Follow these simple steps to make the right decision.
- Assess Your Location and Geography: Where do you live? Where do you work? Look up the private hospitals in a reasonable radius of these locations. Would you be happy to be treated there?
- Define Your Priorities: Is your number one priority the lowest possible price? If so, a restricted or guided list could be perfect. Or is maximum choice and flexibility more important? In that case, a standard or comprehensive list is a better fit.
- Consider Travel: Do you travel frequently across the UK? If so, a nationwide network will give you peace of mind that you can access care wherever you are.
- Check the Details: Never assume a hospital is covered. Before finalising your application, ask to see the specific hospital directory for the policy you've chosen. Double-check that any hospitals you care about are on it.
- Speak to an Expert: This is the simplest and most effective step. An independent broker does all this legwork for you. By telling us your postcode and preferences, WeCovr can instantly compare dozens of policies and hospital lists from the UK's leading insurers, presenting you with clear options that match your needs and budget. Our advice comes at no cost to you.
Beyond the Hospital List: Other Factors Affecting Your Care
While the hospital list is a major component of your policy, a few other elements can affect your treatment journey:
- Outpatient Cover: This covers consultations and diagnostic tests that don't require a hospital bed. Some policies have a financial limit (e.g., £1,000 per year) on outpatient cover. A lower limit can reduce your premium but might mean you need to pay for some diagnostic scans yourself.
- Guided Consultant Options: Some insurers offer "guided" options not just for hospitals, but for specialists too. With these plans (like Vitality's Consultant Select), the insurer provides a shortlist of approved specialists for your condition. This is another cost-control measure that can lower your premium, but it reduces your freedom to choose any consultant you wish.
- NHS Cash Benefit: A valuable feature on many policies. If you choose to have your treatment on the NHS (for example, if you're happy with the NHS waiting time for your procedure), the insurer will pay you a fixed cash amount for each night you spend in an NHS hospital. This can be a useful perk, rewarding you for using the public system and saving the insurer a larger claim.
Using Your PMI to Foster a Healthier Lifestyle
Modern private health cover is evolving. It's no longer just a safety net for when you're unwell; it's a tool to help you stay healthy. Many of the best PMI providers now include incredible wellness benefits.
- Activity Rewards: Insurers like Vitality and Aviva have pioneered programmes that reward you for being active. By tracking your steps, workouts, or gym visits, you can earn points that lead to coffee vouchers, cinema tickets, and even direct reductions on your insurance premium at renewal.
- Mental Health Support: Recognising the growing need for mental wellbeing, most PMI policies now offer extensive support. This often includes 24/7 access to a digital GP, telephone counselling helplines, and access to therapy sessions, often without needing a GP referral. Given that the Office for National Statistics (ONS) reported around 1 in 5 adults experiencing some form of depression in early 2021, this support is more valuable than ever.
- Extra Perks from WeCovr: At WeCovr, we believe in adding value. That's why when you take out a private medical insurance policy with us, we provide complimentary access to our AI-powered diet and nutrition app, CalorieHero. We also offer our clients exclusive discounts on other policies, such as life insurance or income protection, helping you build a complete financial safety net for less.
This proactive approach to health helps you get more value from your policy every single day, not just when you need to make a claim.
Can I change my hospital list mid-way through my policy term?
Generally, you cannot change your hospital list during your one-year policy term. Changes, such as upgrading from a standard list to a comprehensive one, can only be made at your annual renewal. Downgrading your hospital list at renewal is often a very effective way to reduce your premium if your circumstances have changed.
What is a "guided option" or "consultant panel"?
A "guided option" is a feature offered by some insurers to help keep premiums down. Instead of having complete freedom to choose any hospital or specialist, the insurer will 'guide' you by providing a shortlist of high-quality, cost-effective options for your treatment. This is a great way to save money, as long as you are comfortable with having your choice directed by the insurer.
Does private health insurance cover pre-existing or chronic conditions?
No. Standard private medical insurance in the UK is specifically designed to cover new, acute medical conditions that arise after your policy begins. It does not cover the treatment of pre-existing conditions (those you had before taking out cover) or the ongoing management of long-term, chronic conditions like diabetes or asthma.
How do I find out which hospitals are near me and included on a policy?
While you could try to gather and compare lists from each insurer yourself, this is very time-consuming. The simplest and most effective way is to speak to an independent broker like WeCovr. We have access to the up-to-date hospital lists for all major UK insurers and can quickly cross-reference them with your location and preferences to find the perfect match for you, at no extra cost.
Your Health, Your Choice
Navigating the world of hospital lists, policy options, and insurance jargon can feel overwhelming. But it doesn't have to be. The key takeaway is that you have control. By understanding how hospital lists work, you can make an informed decision and build a policy that provides precisely the access and peace of mind you need.
At WeCovr, our friendly, expert advisers are here to demystify the process. We compare the UK's leading insurers to find cover that fits your life and your budget.
Ready to find the right private health cover with the right hospital access? Get your free, no-obligation quote from WeCovr today and let our experts guide you.