Choosing the right private medical insurance (PMI) in the UK can feel overwhelming. With household names like Aviva and Bupa competing against member-focused mutuals like The Exeter and WPA, how do you decide? At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we provide expert, impartial guidance.
How big brands compare to member-owned and specialist providers
The UK private health cover market is broadly split into two types of organisations: shareholder-owned giants and member-owned mutuals. Understanding this difference is the first step to finding the right policy for you.
Shareholder-Owned Insurers (e.g., Aviva, Bupa, AXA)
These are large, publicly or privately owned companies. Their primary responsibility is to generate profit for their shareholders.
- Strengths: Massive financial backing, extensive hospital networks, significant investment in technology (like digital GP apps), and strong brand recognition.
- Considerations: Business decisions are driven by profitability, which can influence premium pricing and policy features.
Mutual Insurers & Friendly Societies (e.g., The Exeter, WPA)
These organisations are owned by their members—the policyholders. They do not have external shareholders to pay.
- Strengths: Any profits are typically reinvested back into the business to improve services, keep premiums competitive, or enhance benefits. They often cultivate a strong focus on customer service and member satisfaction.
- Considerations: They may have smaller hospital networks or less brand visibility than the corporate giants, though their service and cover can be outstanding.
Here is a simple breakdown of the core differences:
| Feature | Shareholder-Owned Insurers (Aviva, Bupa) | Mutual / Not-for-Profit (The Exeter, WPA) |
|---|
| Ownership | Owned by private or public shareholders. | Owned by the policyholders (members). |
| Primary Goal | Generate profit for shareholders. | Serve the best interests of members. |
| Profits | Distributed to shareholders as dividends. | Reinvested into the business for member benefit. |
| Scale | Typically very large, with national/global reach. | Often smaller and more specialised. |
| Focus | Market share, profitability, and brand growth. | Member satisfaction, service quality, and long-term value. |
Insider Tip: Don't assume "big brand" means better or "mutual" means cheaper. The best provider depends entirely on your personal circumstances, health, and budget. An independent broker like WeCovr can compare them all for you.
At a Glance: Aviva vs Bupa vs The Exeter vs WPA
To make sense of your options, here’s a high-level comparison of these four leading UK PMI providers.
| Provider | Type | Best For... | Key Strengths | Potential Drawbacks |
|---|
| Aviva | Shareholder | Families and tech-savvy users | Excellent digital GP, strong mental health support, comprehensive hospital lists, highly trusted brand. | Premiums can be higher; No Claims Discount can be complex. |
| Bupa | Shareholder | Brand-conscious buyers, direct access | UK's most recognised health brand, access to Bupa-owned facilities, choice of NCD or fixed premiums. | Can be one of the more expensive options; some policies limit specialist choice. |
| The Exeter | Mutual | Older applicants, self-employed | Member-first ethos, simple policy wording, unlimited outpatient cover as standard, community rating at older ages. | Smaller hospital list than giants; less brand recognition. |
| WPA | Not-for-Profit | Those wanting control & cost-sharing | Freedom to choose your specialist, excellent customer service reputation, innovative co-payment options to reduce premiums. | Shared Responsibility model isn't for everyone; requires more active involvement from the member. |
Deep Dive: The Big Brands - Aviva and Bupa
The giants of the industry, Aviva and Bupa, account for a significant portion of the UK's private medical insurance market. Their scale allows them to offer extensive benefits and nationwide networks.
Aviva Healthier Solutions
As part of the UK's largest composite insurer, Aviva brings immense financial stability and trust to the table. Their flagship PMI policy, Healthier Solutions, is designed to be comprehensive and flexible.
Key Features:
- Digital GP: Aviva's policies typically include 24/7 access to a digital GP service, allowing for quick consultations and prescriptions without leaving home.
- Strong Mental Health Pathways: Aviva has invested heavily in mental health support, often providing direct access to therapists and mental health professionals without needing a GP referral first.
- "Expert Select" Hospital Option: To manage costs, customers can choose the "Expert Select" route, where Aviva guides them to a pre-approved specialist, often resulting in lower premiums.
- Extensive Hospital Lists: From the more affordable "Key" list to the comprehensive "Extended" list (which includes prime central London hospitals), you can tailor your access to care.
Aviva is a great fit for: Individuals and families who value a well-known, trusted brand, want excellent digital health tools, and require robust mental health cover.
Bupa By You
Bupa is arguably the most famous name in UK private health cover. Uniquely, they are not just an insurer but also a provider of health services, with their own clinics, hospitals, and care homes.
Key Features:
- Direct Access: For certain conditions like cancer and mental health, Bupa allows members to bypass the GP and speak directly to a specialist, speeding up the diagnosis and treatment process.
- Bupa-Branded Network: Policyholders gain access to the Bupa network of hospitals and clinics, which are known for their high standards of care.
- Flexible Premium Options: Bupa often gives you a choice: a traditional No-Claims Discount (NCD) model or the option to fix your premium for two years, providing budget certainty.
- Cancer Care Promise: Bupa provides extensive cancer cover, including support for eligible breakthrough drugs and treatments, even if they aren't available on the NHS.
Bupa is a great fit for: Those who prioritise the trust and recognition of a market-leading brand and value the potential for faster, direct access to specialist services.
Deep Dive: The Mutual & Specialist Insurers - The Exeter and WPA
Mutual and not-for-profit insurers offer a compelling alternative, focusing on member value over shareholder profit. They often excel in customer service and cater to specific demographics.
The Exeter Health+
The Exeter is a Friendly Society, meaning it’s owned by its members. This ethos is reflected in their straightforward and transparent approach to health insurance. They have won numerous awards for their service and products.
Key Features:
- Unlimited Out-patient Cover: Unlike many providers who offer modular out-patient limits (e.g., £500, £1,000), The Exeter’s core Health+ policy includes unlimited cover for specialist consultations and diagnostics. This simplifies the policy and provides great peace of mind.
- Community Rating for Older Ages: For members who join before 65 and maintain their policy, premiums from age 65 are "community-rated." This means your premium is based on the collective claims of that age group, not just your individual claims history, which can protect you from sharp price hikes in later life.
- Flexible Underwriting: The Exeter is often considered more accommodating for individuals with some past medical issues, making them a go-to choice for those who may have been declined or had exclusions placed elsewhere.
The Exeter is a great fit for: The self-employed, older applicants seeking long-term value, and anyone who prefers a simple, comprehensive policy from a member-first organisation.
WPA Flexible Health
Western Provident Association (WPA) is a not-for-profit insurer with a unique approach centred on "Shared Responsibility." This model is designed to keep premiums down by having the member co-pay for a portion of their treatment costs.
Key Features:
- Shared Responsibility / Co-payment: You agree to pay a percentage (e.g., 25%) of the cost of your treatment, up to an annual limit. In return, your monthly premium is significantly lower. This makes private healthcare more accessible.
- Freedom of Choice: WPA policies generally give you the freedom to choose your specialist and hospital, provided they fall within WPA’s recognised lists and fee guidelines.
- Exceptional Customer Service: As a not-for-profit, WPA consistently receives high praise for its UK-based, personal customer service.
- Advanced Cancer Care: WPA offers structured cancer benefits, including access to a wide range of licensed cancer drugs.
WPA is a great fit for: Individuals who want more control over their healthcare choices and are comfortable with a co-payment model in exchange for lower ongoing premiums.
Core Policy Features Compared: What Really Matters?
When comparing Aviva, Bupa, The Exeter, and WPA, the devil is in the detail. The price of your policy is determined by a few key choices you make. A WeCovr adviser can walk you through these options to find your perfect balance of cover and cost.
1. Underwriting: The Most Important Choice
Underwriting is how an insurer assesses your medical history to decide what they will and won't cover.
- Moratorium (Mori) Underwriting: This is the most common type. The insurer doesn't ask for your full medical history upfront. Instead, they will generally exclude any condition you've had symptoms, treatment, or advice for in the 5 years before your policy started. However, if you then go 2 continuous years on the policy without any issues relating to that condition, it may become eligible for cover.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire. The insurer reviews your history and states clearly from day one what is excluded. This provides certainty but can lead to permanent exclusions.
Critical Point: Standard UK private medical insurance is designed for new, acute conditions that arise after you take out the policy. It does not cover pre-existing conditions or long-term, chronic illnesses like diabetes or asthma.
2. Hospital Lists
Insurers group UK private hospitals into lists or tiers. The more comprehensive the list (e.g., including expensive central London hospitals), the higher your premium. Choosing a more restricted local or national list is a highly effective way to reduce costs.
3. Excess
The excess is the amount you agree to pay towards a claim each year. For example, if you have a £250 excess and your first claim is for £2,000, you pay the first £250 and the insurer pays the remaining £1,750.
- Higher Excess = Lower Premium. Choosing a £500 or £1,000 excess can significantly cut your monthly cost.
4. The 6-Week Option
This is a popular cost-saving feature. If the NHS can provide the in-patient treatment you need within 6 weeks of it being recommended, you agree to use the NHS. If the NHS wait time is longer than 6 weeks, your private cover kicks in. This hugely reduces the risk for the insurer and, therefore, your premium.
5. Out-patient Cover
This covers diagnostic tests and consultations with a specialist where you aren't admitted to a hospital bed.
- Options: Policies range from no out-patient cover (relying on the NHS for diagnostics) to limited cover (e.g., £500, £1,000) or fully comprehensive cover. The Exeter is notable for including unlimited out-patient cover as standard on its main policy.
Real-Life Scenarios: Which Provider is Best for You?
The "best" PMI provider is different for everyone. Let's look at some common scenarios.
-
Scenario 1: The Young Family (Ages 35 & 33, one child)
- Priorities: Quick access to a GP, mental health support for parental stress, and reassurance of fast diagnostics for their child.
- Strong Contenders:
- Aviva: The excellent digital GP is a huge plus for busy parents. Strong mental health cover is also a key benefit.
- Bupa: The trusted brand name provides peace of mind, and family policies are easy to set up.
-
Scenario 2: The Self-Employed Consultant (Age 48)
- Priorities: Minimising time off work, certainty of cover, and long-term value.
- Strong Contenders:
- The Exeter: The unlimited out-patient cover provides certainty for diagnostics, and their clear policy wording is a bonus. The potential for more flexible underwriting is also a key draw.
- WPA: The co-payment model can make premiums very affordable for a business owner managing their own finances, provided they are happy to share the cost of treatment.
-
Scenario 3: The Early Retiree (Age 67)
- Priorities: Managing premium costs in later life, comprehensive cover for age-related conditions, and good customer service.
- Strong Contenders:
- The Exeter: Their community-rated pricing from age 65 onwards is specifically designed to manage premium increases, making them a standout choice for older applicants.
- WPA: The shared responsibility model can also work well, allowing for comprehensive cover at a manageable premium by sharing the cost.
Why Use a Broker like WeCovr to Compare Policies?
Trying to compare Aviva vs Bupa vs The Exeter vs WPA on your own is complex and time-consuming. An independent, FCA-authorised broker like WeCovr acts as your expert guide.
- Whole-of-Market Access: We compare policies from all these leading insurers and more, not just one or two.
- Expert, Unbiased Advice: We don't work for the insurers; we work for you. We'll explain the pros and cons of each policy based on your specific needs.
- No Extra Cost: Our service is free to you. We are paid a commission by the insurer you choose, but this does not affect the premium you pay.
- Exclusive Benefits: When you arrange a policy with WeCovr, you get complimentary access to our AI-powered nutrition app, CalorieHero, and can receive discounts on other insurance products like life or income protection cover.
- Hassle-Free Process: We handle the paperwork and can even help with policy queries or claims down the line. Our high customer satisfaction ratings reflect our commitment to service.
Making the right choice today ensures you have the best possible protection when you need it most.
Does private health insurance cover pre-existing conditions?
Generally, no. Standard UK private medical insurance is designed to cover acute conditions that arise after your policy begins. Pre-existing conditions, which are any illnesses or injuries you have had symptoms, advice, or treatment for in the years before taking out cover, are typically excluded. The same applies to chronic conditions like diabetes or high blood pressure, which require ongoing management rather than a curative treatment.
What is the difference between a mutual and a shareholder-owned insurer?
A shareholder-owned insurer, like Aviva, is a company whose primary purpose is to generate profit for its external shareholders. A mutual insurer or friendly society, like The Exeter, is owned by its policyholders (members). Mutuals do not have shareholders and reinvest profits back into the business to benefit members, for example through better services or more stable premiums.
How much does private health insurance cost in the UK?
The cost of private health insurance in the UK varies widely based on age, location, chosen cover level, and the insurer. A basic policy for a young, healthy individual might start from £30-£40 per month, while comprehensive cover for an older person or family could be £150 per month or more. Factors like hospital list, excess, and out-patient limits have the biggest impact on price. The best way to get an accurate figure is to get a personalised comparison quote.
Find Your Perfect UK Private Health Cover Today
The choice between a corporate giant and a member-owned mutual is a personal one. Aviva and Bupa offer scale and extensive digital tools, while The Exeter and WPA provide a member-focused ethos with unique benefits. The best policy is the one that fits your budget, health needs, and personal preferences.
Don't navigate this complex market alone. A WeCovr expert can provide a free, no-obligation market review, comparing all the top providers to find the perfect private medical insurance for you.
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