As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands that navigating the world of private medical insurance in the UK can feel complex. This guide will help you calculate potential savings by comparing guided consultant options against full choice policies and narrower hospital lists.
Estimate savings from guided options and narrower hospital lists
Choosing a private medical insurance (PMI) policy in the UK involves a crucial trade-off: choice versus cost. The more freedom you have to choose your specialist and hospital, the higher your premium will be. Conversely, accepting some limitations on your choice can lead to significant savings, often between 20% and 40%.
The two main levers you can pull to manage this balance are:
- Consultant Access: Deciding between a "Guided Consultant" list and "Full Choice" (or Open Referral).
- Hospital Network: Selecting a nationwide, local, or premium hospital list.
Understanding how these options work is the key to designing a policy that fits your budget without compromising on the quality of care you expect. This article will break down these choices, providing clear examples and tables to help you estimate your potential savings.
What Are Guided Consultant Options in PMI?
A "Guided Consultant" option, sometimes called a "Directed Care" or "Specialist Select" pathway, is a feature offered by most major UK insurers to help reduce the cost of your premium. Instead of you researching and choosing any specialist you like, the insurer provides a curated shortlist of approved consultants for your condition.
How a Guided Option Works: A Step-by-Step Guide
The process is straightforward and designed to be simple for the policyholder.
- GP Referral: You visit your NHS or a private GP who diagnoses your symptoms and provides an open referral letter for specialist treatment.
- Contact Your Insurer: You call your insurer's claims line with your referral details.
- Receive Your Shortlist: The insurer assesses your case and provides you with a list of 2 to 4 appropriate, fee-assured specialists in your area who have a strong track record for your specific condition.
- You Choose: You select the most convenient or preferred specialist from the list provided. The insurer then pre-authorises the treatment, and you can book your appointment.
The specialists on these lists are not randomly chosen. Insurers vet them based on clinical outcomes, professional standing, and their willingness to adhere to the insurer's fee guidelines, which helps control costs.
The Pros and Cons of Guided Consultant Lists
Like any policy feature, guided options come with clear advantages and potential drawbacks.
| Aspect | Pros (Advantages) | Cons (Disadvantages) |
|---|
| Cost | Significant Premium Savings: This is the primary benefit. By using consultants with pre-agreed rates, insurers pass savings of 20% or more on to you. | N/A |
| Choice | Simplified Process: Removes the "paradox of choice." You don't have to spend hours researching specialists; the insurer does the legwork for you. | Limited Selection: Your preferred or recommended specialist might not be on the insurer's guided list. |
| Quality | Vetted Professionals: Insurers select consultants based on performance and quality metrics, providing an extra layer of reassurance. | Potential for Inconvenience: The nearest specialist on the list might be further away than you would ideally like. |
| Speed | Potentially Faster Access: As the insurer has existing relationships, booking an appointment can sometimes be quicker. | Possible Delays: In some rare cases, if the specialists on the list are very busy, it could lead to a slightly longer wait. |
Which UK Insurers Offer Guided Options?
Most leading providers of private medical insurance in the UK offer a form of guided consultant list. Here are some of the main examples:
- Aviva: Their "Expert Select" option is a classic guided model. They use their network of specialists to find the right one for you, helping to reduce your premium.
- AXA Health: Their "Guided Option" works similarly. When you need treatment, you call them, and they'll find up to three suitable specialists for you to choose from.
- Bupa: Bupa's "Guided Care" is a key part of their Bupa By You policy. It offers significant savings in return for using their open referral network.
- Vitality: Vitality's "Consultant Select" offers a discount for agreeing to let them guide you to a specialist from their approved panel.
An expert PMI broker like WeCovr can compare these different guided options across the market to see which provider offers the best combination of price and access for your specific needs.
Understanding Full Choice (Open Referral) Policies
A "Full Choice" or "Open Referral" policy represents the traditional, premium approach to private health cover. It grants you the maximum level of freedom and control over your medical journey.
The Freedom of Full Choice
With a full choice policy, the process is driven by you and your GP.
- GP Recommendation: Your GP might recommend a specific specialist by name.
- Your Research: Alternatively, you can do your own research, ask for recommendations from friends or family, and find a consultant you feel comfortable with.
- Check with Your Insurer: As long as the specialist is recognised by your insurer and their fees are within the policy limits, you are free to choose them. The insurer simply needs to pre-authorise the consultation and any subsequent treatment.
This option is ideal for individuals who have a specific consultant in mind or who want complete autonomy over every aspect of their healthcare.
Pros and Cons of Full Choice
| Aspect | Pros (Advantages) | Cons (Disadvantages) |
|---|
| Choice | Maximum Flexibility: You can choose any recognised specialist in the UK, giving you ultimate control over your care. | Significantly Higher Premiums: This freedom comes at a cost, making it the most expensive option. |
| Peace of Mind | Access to Top Names: You can see a leading expert in a particular field, even if they are not on an insurer's guided list. | Burden of Research: The responsibility falls on you to vet and choose a suitable consultant. |
| Continuity | Stay with a Trusted Doctor: If you have previously seen a specialist you trust, you can continue your care with them. | Potential for Fee Shortfalls: If your chosen consultant charges more than the insurer's approved rate, you may have to pay the difference. |
How Hospital Lists Impact Your PMI Premiums
Alongside consultant choice, the hospital network you select is the other major factor that determines your premium. Insurers typically group hospitals into tiers based on their cost, which is heavily influenced by their location.
The Tiers of UK Hospital Lists
Most insurers use a three-tiered system, although the names may vary slightly.
-
Local or Essential Lists:
- What it is: A reduced list of private hospitals, often excluding those in major city centres, particularly central London. It might include some private wings of NHS hospitals and smaller independent providers.
- Who it's for: People who live outside major urban areas and are happy to be treated at their local private facility.
- Cost Impact: Lowest premium.
-
National or Countrywide Lists:
- What it is: A comprehensive network of several hundred private hospitals across the UK. This is the most common choice. It typically includes most private providers except for the most expensive, premier hospitals in central London.
- Who it's for: Most people in the UK. It provides excellent coverage nationwide, so you're covered whether you're at home or away.
- Cost Impact: Mid-range premium.
-
Premium or London Upgrade Lists:
- What it is: The all-inclusive list. It includes every hospital on the national list plus the most prestigious and expensive facilities in central London (e.g., The London Clinic, King Edward VII's Hospital, HCA hospitals at The Shard or London Bridge).
- Who it's for: People who live or work in central London and want access to these specific hospitals, or those who want the absolute certainty of being able to be treated anywhere.
- Cost Impact: Highest premium. Choosing this option can add 15-25% to your premium compared to a national list.
A Real-World Example: Choosing a Hospital List
Let's consider a hypothetical person: David, a 42-year-old non-smoker living in Bristol.
- Scenario 1: Local List. David is happy with the Spire and Nuffield Health hospitals in Bristol. He chooses a local list. His premium is lowest.
- Scenario 2: National List. David travels for work. He wants the flexibility to be treated in Manchester or Edinburgh if needed. He chooses the national list. His premium increases by about 10-15%.
- Scenario 3: London Upgrade. David's company has an office in London, and he wants the option to be treated at a top Harley Street clinic. He adds the London upgrade. His premium increases by a further 15-20% on top of the national list price.
The "Six Week Wait" Option Explained
Another popular way to reduce your premium is to add a "six week wait" option.
- How it works: If you need eligible in-patient or day-patient treatment, you first check the NHS waiting list for that procedure in your area.
- If the NHS wait is less than six weeks: You use the NHS for your treatment.
- If the NHS wait is more than six weeks: Your private medical insurance policy kicks in, and you can proceed with private treatment immediately.
This option can reduce your premium by 15-25% because you are agreeing to use the NHS when it can provide prompt care, reducing the risk for the insurer. It's a pragmatic compromise for many, offering the speed of private care precisely when the NHS is under the most pressure.
Calculating Your Potential Savings: A Practical Guide
To see how these choices interact, let's create a comparison table based on a hypothetical individual: a 45-year-old, non-smoking office worker living in Birmingham. These are illustrative estimates; your actual quote will depend on your personal circumstances.
| Policy Feature | Option A: Full Choice & Premium Cover | Option B: Guided Consultant & National List | Option C: Guided, National List & 6-Week Wait |
|---|
| Consultant Access | Full Choice (Open Referral) | Guided Consultant List | Guided Consultant List |
| Hospital List | Premium List (including Central London) | National List (excluding premium London) | National List (excluding premium London) |
| 6-Week Wait? | No | No | Yes |
| Estimated Monthly Premium | £120 | £85 | £65 |
| Estimated Annual Premium | £1,440 | £1,020 | £780 |
| Potential Annual Saving vs. A | N/A | £420 (approx. 29% saving) | £660 (approx. 46% saving) |
| Key Benefit | Maximum flexibility and choice | Balanced cost and comprehensive access | Lowest cost for essential private access |
This table clearly demonstrates that by making pragmatic choices—opting for a guided consultant list and a national hospital network—you can achieve substantial savings. Adding a six-week wait option reduces the cost even further, making private health cover much more accessible.
Why Use a Broker like WeCovr?
Calculating these trade-offs across multiple insurers can be time-consuming and confusing. This is where an independent PMI broker is invaluable. At WeCovr, our expert advisors provide a free, no-obligation service to:
- Understand Your Needs: We listen to what's important to you—be it budget, access to a specific hospital, or speed of treatment.
- Compare the Whole Market: We analyse policies from all leading UK providers to find the best fit.
- Explain the Options: We demystify the jargon, explaining the pros and cons of guided lists, hospital networks, and excess levels in plain English.
- Secure the Best Price: We ensure you get the most competitive premium for the level of cover you require.
It is vital to understand the fundamental purpose of private medical insurance in the UK.
Standard UK private medical insurance is designed to cover the diagnosis and treatment of new, acute conditions that arise after you take out your policy.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include joint replacements, cataract surgery, hernia repairs, and cancer treatment.
What Is NOT Covered by Standard PMI?
You must be aware of the standard exclusions that apply to almost all PMI policies:
- Pre-existing Conditions: Any medical condition you had symptoms of, received advice for, or were treated for before your policy started. Insurers manage this through two types of underwriting:
- Moratorium: The insurer automatically excludes conditions from the past five years. If you remain symptom-free and treatment-free for that condition for two continuous years after your policy starts, it may become eligible for cover.
- Full Medical Underwriting (FMU): You declare your full medical history upfront. The insurer then states precisely what is and isn't covered from the outset.
- Chronic Conditions: Long-term illnesses that cannot be cured, only managed. This includes conditions like diabetes, asthma, high blood pressure, and arthritis. PMI may cover an acute flare-up of a chronic condition, but not the day-to-day management.
- Emergency Services: A&E visits and ambulance transport remain the responsibility of the NHS.
- Other Standard Exclusions: Routine pregnancy and childbirth, cosmetic surgery (unless reconstructive), organ transplants, professional sports injuries, and treatment for addiction.
Beyond Cost: Additional Benefits and Wellness Programmes
Modern private medical insurance UK providers offer more than just treatment for illness. Many policies now include a suite of wellness benefits designed to keep you healthy.
Digital GP and Mental Health Support
Nearly all major PMI policies now include:
- 24/7 Digital GP: The ability to book a video or phone consultation with a GP, often within hours. This is incredibly convenient and helps you get advice quickly without leaving your home.
- Mental Health Support: Access to telephone counselling lines or a set number of face-to-face therapy sessions for conditions like stress, anxiety, and depression.
Rewards for Healthy Living
Some insurers, most notably Vitality, have built their entire model around rewarding healthy behaviour. Policyholders can earn points for tracking their activity, buying healthy food, and getting health checks. These points translate into real-world rewards like free cinema tickets, discounted gym memberships, and even lower premiums at renewal.
WeCovr's Exclusive Perks
As a WeCovr client, you get access to additional benefits at no extra cost.
- Complimentary CalorieHero App: All our health and life insurance clients receive free access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help support their health goals.
- Multi-Policy Discounts: When you take out a PMI policy with us, you can get discounts on other types of cover you might need, such as life insurance or income protection, helping you build a comprehensive financial safety net for less.
Our commitment to customer value is reflected in our high satisfaction ratings on independent review platforms.
Is a guided consultant option always cheaper than full choice?
Yes, in almost all cases. A policy with a guided consultant option will have a lower premium than an equivalent policy with full choice (open referral). This is because insurers negotiate preferential rates with the specialists on their guided lists, and they pass these cost savings directly on to you. The saving is typically in the range of 20-30%.
Can I change my hospital list or consultant option during my policy year?
Generally, you can only make changes to your core policy options, such as your hospital list or consultant access type, at your annual renewal. You cannot usually switch from a guided option to full choice, or add the London hospital list, midway through your policy year. This is why it's so important to get the right advice and choose the correct level of cover from the start.
Do I have to declare my pre-existing medical conditions when applying for PMI?
Yes, you absolutely must be honest about your medical history. Failing to declare pre-existing conditions can invalidate your policy. You will either apply on a "Moratorium" basis, where conditions from the last 5 years are automatically excluded for a 2-year waiting period, or on a "Full Medical Underwriting" basis, where you provide your full history for the insurer to make a specific decision on what is covered.
How does a PMI broker like WeCovr get paid?
A private medical insurance broker like WeCovr provides advice and arranges your policy at no cost to you. Our service is completely free for our clients. We are paid a commission by the insurance provider you choose to go with. This model allows us to offer impartial, expert advice focused on finding the best policy for your needs and budget, not on selling a particular product.
Navigating the choices between guided consultants, hospital lists, and other policy features can be daunting. The right decision can save you hundreds of pounds a year while still providing excellent private health cover.
Contact WeCovr today for a free, no-obligation quote. Our friendly, expert advisors will compare the UK's leading insurers to find the perfect policy for you.