Childrens Health Insurance Whats Covered Under Family PMI
As an FCA-authorised broker that has arranged over 900,000 policies, WeCovr understands that your child’s health is your top priority. This guide to children's private medical insurance in the UK offers clarity on what a family policy covers, helping you make an informed decision for your loved ones.
Explains common benefits (GP access, outpatient care, drugs), exclusions (chronic, developmental issues), and best policies for dependents
Navigating the world of private medical insurance (PMI) can feel complex, especially when it involves your children. You want the reassurance of knowing they can get expert medical care quickly, but what does a policy actually include? And more importantly, what does it leave out?
This comprehensive guide breaks down everything you need to know about adding children to a family PMI policy. We'll explore the valuable benefits like fast-track GP access and specialist care, clarify the crucial exclusions such as chronic and developmental conditions, and help you identify the features that make a policy right for your family's needs.
Why Consider Private Health Insurance for Your Children?
While the UK is rightly proud of the National Health Service (NHS), it is currently facing unprecedented strain. As of late 2024, NHS England reported a waiting list of over 7.5 million treatments, with many patients, including children, waiting months for specialist consultations and routine procedures.
For parents, these delays can be a source of significant anxiety. A child in pain or discomfort needs help as soon as possible, not just for their physical wellbeing but for their mental health and to minimise disruption to their education and social life.
This is where Private Medical Insurance (PMI) acts as a valuable supplement to the NHS. It's not a replacement—A&E, emergency services, and GP registration remain with the NHS—but it offers a parallel route to fast, convenient, and high-quality care for non-emergency conditions.
Key advantages of children's health insurance:
- Speedy Access: Bypass long NHS waiting lists for specialist consultations, diagnostic scans, and elective surgery.
- Choice and Control: Choose the specialist, consultant, and hospital where your child receives treatment.
- Comfort and Privacy: Access to private rooms in hospitals, making a stressful time more comfortable for both child and parent.
- Peace of Mind: The reassurance that you have a plan in place to access care when you need it most.
What's Typically Covered by Children's Health Insurance? A Detailed Breakdown
A family PMI policy is designed to cover the cost of treating acute conditions—illnesses or injuries that are likely to respond quickly to treatment and return you to your previous state of health. Let's look at the core components of cover.
Inpatient and Day-Patient Treatment
This is the cornerstone of any health insurance policy. It covers treatment that requires a hospital bed, either overnight (inpatient) or for the day (day-patient).
What's included:
- Hospital Fees: The cost of the room, nursing care, and meals.
- Specialist Fees: Fees for the surgeons, anaesthetists, and other consultants involved in your child's care.
- Surgical Procedures: The costs associated with the operating theatre and the procedure itself.
- Medication and Dressings: All drugs and supplies administered during the hospital stay.
Real-Life Example: Your 7-year-old son suffers from recurrent, severe tonsillitis, causing him to miss school frequently. Your NHS GP refers him to an ENT specialist, but the waiting list is nine months. With PMI, you can get a private referral, see a specialist within a week, and have a tonsillectomy scheduled for a few weeks later in a private hospital.
Outpatient Care
Outpatient cover is for diagnosis and treatment that doesn't require a hospital stay. This is often one of the most-used parts of a family policy. The level of outpatient cover is a key variable that affects your premium—policies can range from no outpatient cover to a few hundred pounds, or fully comprehensive cover.
What's included:
- Specialist Consultations: Appointments with consultants like paediatricians, dermatologists, or orthopaedic surgeons following a GP referral.
- Diagnostic Tests & Scans: Crucial for getting a swift diagnosis. This includes MRI scans, CT scans, X-rays, and blood tests.
- Therapies: Post-operative or post-injury treatment from physiotherapists, osteopaths, and sometimes speech therapists (for non-developmental issues).
Rapid Access to Private GPs
One of the most convenient features of modern PMI policies is the inclusion of a digital or virtual GP service. For busy parents, this is a game-changer.
- 24/7 Access: Book a video or phone consultation with a GP at any time, often within a few hours.
- Convenience: No need to take time off work or take a sick child out of the house.
- Open Referrals: If needed, the private GP can provide an open referral to a specialist, speeding up the entire process of getting treatment.
Comprehensive Cancer Care
Cancer cover is a standard and extensive feature of almost all UK PMI policies. Insurers understand the critical importance of getting the best possible care for such a serious diagnosis.
Typical cancer cover includes:
- Full payment for chemotherapy, radiotherapy, and biological therapies.
- Access to advanced treatments and drugs that may not yet be available on the NHS due to cost.
- Ongoing monitoring and specialist consultations.
- Support services such as nutritional advice and counselling.
Mental Health Support
With growing awareness of mental health challenges among children and adolescents, many insurers have significantly enhanced their mental health cover.
What might be covered:
- Consultations: Access to child and adolescent psychiatrists or psychologists.
- Talking Therapies: A set number of sessions with a counsellor or therapist.
- Inpatient Treatment: Cover for psychiatric treatment requiring a hospital stay, though this can be limited.
It's important to check the specific limits on your policy, as some may cap the number of therapy sessions or the total financial benefit available per year.
The Critical Exclusions: What Isn't Covered by PMI?
Understanding the exclusions is just as important as knowing the benefits. It prevents surprises and ensures you have realistic expectations of your policy.
The Golden Rule: No Cover for Chronic or Pre-existing Conditions
This is the single most important exclusion to understand. UK private medical insurance is designed for new, acute conditions that arise after you take out the policy.
-
Chronic Conditions: These are long-term conditions that cannot be cured, only managed. They are always excluded. Examples include:
- Asthma
- Diabetes (Type 1 or 2)
- Eczema
- Allergies
- Epilepsy
- Cystic Fibrosis
-
Pre-existing Conditions: This refers to any illness, injury, or symptom for which your child has had medication, advice, or treatment in the years before the policy started (typically the last 5 years for moratorium underwriting). For example, if your child had physiotherapy for knee pain before the policy began, future treatment for that same knee would be excluded.
Developmental and Learning Conditions
This is a key area of confusion for many parents. Conditions that are developmental in nature are not covered by private health insurance. PMI covers medical conditions, not developmental, behavioural, or learning differences.
Conditions typically excluded:
- Autism Spectrum Disorder (ASD)
- Attention Deficit Hyperactivity Disorder (ADHD)
- Dyslexia, Dyspraxia, and other specific learning difficulties
- Speech and language delays
Assessments and therapies for these conditions must be sought through the NHS or funded privately.
Routine, Preventive, and Emergency Care
PMI is for unplanned treatment, not routine health management or emergencies.
- A&E and Emergencies: If your child has a serious accident or a medical emergency, you must go to an NHS A&E. PMI does not cover emergency services.
- Routine Check-ups: Standard developmental checks are not covered.
- Vaccinations: Routine childhood immunisations are an NHS service.
- Dental and Optical: Routine dental check-ups and eye tests are excluded, though some policies offer them as a paid add-on. Major dental surgery required after an accident may be covered by some plans.
Summary of Cover: What's In vs. What's Out
| Feature or Condition | Typically Covered by Children's PMI? | Important Notes |
|---|---|---|
| Acute Conditions | ||
| Surgery for glue ear (grommets) | Yes | A classic example of a covered acute condition. |
| MRI scan for a knee injury | Yes | Covered under the outpatient diagnostics benefit. |
| Treatment for appendicitis | Yes | Inpatient surgery and hospital stay are covered. |
| Chronic Conditions | ||
| Management of asthma | No | This is a chronic condition and is excluded. |
| Insulin and monitoring for Type 1 Diabetes | No | This is a chronic condition and is excluded. |
| Creams and treatment for eczema | No | This is a chronic condition and is excluded. |
| Developmental Conditions | ||
| Assessment for Autism or ADHD | No | These are developmental, not medical, conditions. |
| Speech therapy for a language delay | No | Excluded as it's developmental. |
| Other | ||
| NHS A&E visit for a broken arm | No | Initial treatment is via the NHS. |
| Follow-up physiotherapy for a broken arm | Yes | Post-injury therapy is often covered. |
| Routine childhood vaccinations | No | Considered preventive care, handled by the NHS. |
How to Add a Child to Your Health Insurance Policy
There are two main ways to cover your child:
- Add them to your existing policy: Most individual or company policies allow you to add dependents, including a spouse and children, for an additional premium.
- Take out a new family policy: This covers you, your partner, and your children under a single plan.
Often, insuring a family is more cost-effective than taking out individual policies. Some insurers even offer incentives, such as:
- Free cover for newborns: Some providers will add your newborn to the policy for free until the next renewal.
- Discounts for multiple children: You might pay for the first child, with subsequent children added at a discount or for free.
When adding a child, you'll need to choose an underwriting method. The two most common are:
- Moratorium (Mori): This is the quickest option. The insurer doesn't ask for medical history upfront but automatically excludes any condition the child has had in the 5 years before joining. Cover for that condition can be added later if the child remains symptom-free and treatment-free for a continuous 2-year period after the policy starts.
- Full Medical Underwriting (FMU): You provide a full medical history for your child. The insurer assesses it and may place specific exclusions on the policy from the start. This can provide more certainty but may result in permanent exclusions for certain past issues.
A specialist PMI broker like WeCovr can talk you through the pros and cons of each method for your family's specific situation.
Choosing the Best Family Health Insurance Policy in the UK
With several major providers in the market, each offering different plans and benefits, making a choice can be daunting. Here’s what to focus on.
Key Factors to Compare
- Level of Outpatient Cover: This is a major driver of cost. A plan with £1,000 of outpatient cover will be significantly cheaper than one with unlimited cover. Think about how much you're likely to use it.
- Hospital List: Insurers have different tiers of hospital lists. A standard list will include most local private hospitals, while an extended list might include prime central London hospitals at a higher premium. Check that your local private facilities are on the list.
- Policy Excess: This is the amount you agree to pay towards the first claim each year. An excess of £250 or £500 can reduce your monthly premium significantly.
- No-Claims Discount (NCD): Similar to car insurance, your premium can decrease each year you don't make a claim. Check the NCD scale and how a claim will affect it.
- Added Benefits: Look for perks that add value for your family. For instance, clients who purchase PMI or Life Insurance through WeCovr gain complimentary access to the AI-powered calorie and nutrition tracker, CalorieHero, and may receive discounts on other insurance products like home or travel cover.
Top UK Providers for Family Health Insurance
- Bupa: A household name with a vast network of hospitals and a strong reputation for quality care.
- AXA Health: Known for flexible policies and excellent mental health support pathways through their "Stronger Minds" service.
- Aviva: Often provides excellent value, with comprehensive cancer cover and a well-regarded "Digital GP" service.
- Vitality: Unique in the market, Vitality rewards families for being active. You can earn points for exercise, which translate into cinema tickets, coffee, and even discounts on your premium. This can be a brilliant motivator for active families.
The Value of an Expert Broker
Instead of spending hours comparing these options yourself, a specialist broker can do the hard work for you. An independent broker like WeCovr is authorised by the Financial Conduct Authority (FCA) and has a duty to find the most suitable policy for your needs, not the insurer's.
Benefits of using WeCovr:
- Whole-of-Market Advice: We compare plans from all leading insurers.
- Expert Guidance: We explain the jargon and help you tailor a policy to your budget and needs.
- No Extra Cost: Our service is free to you; we are paid a commission by the insurer you choose.
- Application Support: We handle the paperwork and ensure your application is smooth and hassle-free.
Tips for Maintaining Your Child's Health & Wellbeing
While insurance is a safety net, prevention is always better than cure. Fostering healthy habits is one of the best gifts you can give your child.
- Balanced Diet: Encourage a diet rich in fruits, vegetables, and whole grains. The "5-a-day" rule is a great target. Limiting processed foods and sugary drinks can help prevent future health issues.
- Quality Sleep: Establish a consistent bedtime routine. According to the NHS, children aged 6-12 need 9-12 hours of sleep a night, while teenagers need 8-10 hours.
- Daily Activity: Aim for at least 60 minutes of moderate to vigorous physical activity every day. This could be anything from a structured sport to a family bike ride or a simple run around the park.
- Mindful Screen Time: Unmanaged screen time can affect sleep, mental health, and physical activity levels. Set clear boundaries and encourage "unplugged" creative play.
Frequently Asked Questions (FAQs) about Children's Health Insurance
Is it worth getting private health insurance for a child?
Does children's health insurance cover pre-existing or chronic conditions like asthma or eczema?
Are conditions like ADHD or autism covered by private medical insurance?
Can I get health insurance for my child only, without being on the policy myself?
Take the Next Step Towards Peace of Mind
Protecting your family's health is one of the most important investments you can make. With a clear understanding of what family PMI covers, you can choose a policy that provides a genuine safety net for your children.
Let us help you find the right private medical insurance for your family's unique needs and budget.
[Get Your Free, No-Obligation Family PMI Quote from WeCovr Today]
Related guides
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!
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.
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