Customising Your PMI What to Add or Skip
At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we understand that navigating the world of private medical insurance in the UK can feel complex. Our goal is to empower you with clear, expert guidance to build a policy that fits your health needs and your budget perfectly.
Martin Lewis recommends focusing on must-have cover—like inpatient care—and reconsidering extras to manage costs. Only pay for the cover you really need; ditch unnecessary extras. — MoneySavingExpert
This advice from one of the UK's most trusted consumer champions cuts to the very heart of smart private health insurance shopping. It’s not about buying the most expensive, all-inclusive policy; it’s about strategically building cover that protects you where you need it most, without paying for features you're unlikely to use.
Think of it like building a car online. You start with the essential engine and chassis (your core cover), and then you decide if you really need the panoramic sunroof and heated seats (the optional extras).
In this guide, we'll break down every component of a typical UK private medical insurance (PMI) policy, helping you decide what to add, what to consider skipping, and how to get the best possible value.
The Foundation of Every PMI Policy: Core Cover
Every private health insurance policy is built on a foundation of "core" cover. This is the absolute essential, non-negotiable part of your plan that covers the most significant medical costs. Without it, a policy offers very little protection.
Core cover typically includes:
- Inpatient Treatment: This covers costs when you are admitted to a hospital and stay overnight. This includes the hospital room, nursing care, surgeon and anaesthetist fees, specialist consultations, and diagnostic tests like MRI or CT scans while you are in hospital.
- Day-Patient Treatment: This is for when you are admitted to a hospital for a planned procedure or treatment but do not need to stay overnight. Examples include cataract surgery, arthroscopy, or certain minor surgical procedures.
- Cancer Cover: This is a huge reason many people take out PMI. Core policies almost always include extensive cancer cover, from diagnosis to treatment, including surgery, chemotherapy, and radiotherapy. The level of cover can vary, so it's always worth checking the details.
Why is Core Cover So Important?
Put simply, it covers the big, potentially bank-breaking expenses. An unexpected need for major surgery or a serious diagnosis could lead to significant costs if you were to pay for it yourself privately. More importantly, it provides a way to bypass long NHS waiting lists for these critical treatments.
According to NHS England data, the median waiting time for consultant-led elective care was around 14.5 weeks in mid-2024, with hundreds of thousands of patients waiting over a year. Core PMI cover is your safety net against these delays for serious, acute conditions.
Key Takeaway: Never skimp on core cover. It's the fundamental reason for having private medical insurance.
The Big Decision: Customising Your Outpatient Cover
This is where the customisation—and the potential for major cost savings—truly begins. Outpatient cover pays for medical care where you aren't admitted to a hospital.
Think of it this way:
- Inpatient: You're in a hospital bed overnight.
- Outpatient: You walk in, see a specialist or have a test, and walk out the same day.
What Does Outpatient Cover Include?
- Specialist Consultations: Seeing a consultant (like a cardiologist, dermatologist, or orthopaedic surgeon) after a GP referral.
- Diagnostic Tests and Scans: MRI scans, CT scans, X-rays, blood tests, and ultrasounds that are performed on an outpatient basis to diagnose a condition.
Insurers offer several levels of outpatient cover, which directly impacts your premium:
| Level of Outpatient Cover | What It Typically Means | Who It's For | Impact on Premium |
|---|---|---|---|
| None (or very limited) | You rely on the NHS for diagnosis. Your PMI only kicks in if you need inpatient or day-patient treatment. | Those on a tight budget who are happy with NHS diagnostic speeds but want private treatment. | Lowest Premium |
| Limited (e.g., £500-£1,500 limit) | Your policy covers outpatient costs up to a set financial limit per policy year. You pay for anything over this limit. | A good middle ground. It provides cover for a few consultations and tests without the cost of a fully comprehensive plan. | Medium Premium |
| Fully Comprehensive | All eligible outpatient consultations and diagnostics are covered in full, with no financial cap. | Those who want complete peace of mind and the fastest possible diagnostic journey from start to finish. | Highest Premium |
Our Expert Advice on Outpatient Cover
Following Martin Lewis's logic, this is a prime area to save money. Ask yourself:
- How quickly can I get a diagnostic scan in my local area on the NHS? This varies significantly. Check local NHS trust waiting times.
- Am I comfortable using the NHS for the initial diagnostic phase? If the answer is yes, you could save hundreds of pounds a year by opting for a limited or no-outpatient cover policy.
A popular and cost-effective strategy is to choose a mid-range limit, like £1,000. This is often enough to cover the initial consultations and scans needed to diagnose a common issue, getting you to the treatment stage (covered by your core policy) much faster.
Optional Extras: The 'Nice-to-Haves' You Can Add or Skip
Beyond outpatient cover, insurers offer a menu of additional benefits. Each one adds to the monthly premium, so you need to weigh the cost against the likelihood you'll use it.
1. Therapies Cover
This benefit covers treatment from recognised practitioners to help with recovery and musculoskeletal issues.
- What it includes: Physiotherapy, osteopathy, chiropractic treatment, and sometimes podiatry or acupuncture.
- Who should consider it? Anyone who is very active, plays sports, or has a history of joint or muscle problems. If you have a physically demanding job, this could be a very valuable add-on.
- The cost-saving alternative: Many people can access physiotherapy through the NHS, although there may be a wait. Others prefer to pay for sessions as and when they need them (£40-£70 per session), which can be cheaper than paying a higher monthly premium for a whole year.
Example: Adding therapies cover might increase your premium by £15 per month (£180 per year). If you only need two or three physiotherapy sessions a year, paying for them out-of-pocket could be more economical.
2. Mental Health Cover
Awareness of mental health has grown, and so has the PMI cover available. Standard policies often exclude mental health, so this is a specific add-on.
- What it includes: Typically covers consultations with a psychiatrist and sessions with a psychologist or therapist. It may have a financial limit or a cap on the number of sessions. It is designed for treating acute mental health conditions, not for managing long-term, chronic ones.
- Who should consider it? Anyone who wants the peace of mind of knowing they can access professional psychological support quickly. NHS waiting lists for talking therapies (like CBT) can be extremely long, often many months.
- The cost-saving alternative: Many employers now offer Employee Assistance Programmes (EAPs) which provide a limited number of free counselling sessions. Charities like Mind also offer support, and there are increasingly affordable private online therapy options.
3. Dental and Optical Cover
This is one of the most frequently skipped extras, as the value proposition can be questionable.
- What it includes: Usually provides a cash contribution towards routine check-ups, hygienist visits, glasses, and contact lenses. It may also cover a portion of unexpected major dental work (e.g., crowns, root canals), but often with many exclusions.
- Who should consider it? If you have a large family and want to budget for regular check-ups, it might be convenient.
- The cost-saving alternative: Dedicated dental and optical "cash plans" are often better value. These are different from PMI and simply give you money back for routine health expenses. For most people, simply putting aside £15-£20 a month into a savings account for dental/optical bills is the most efficient approach.
Summary Table: Add-Ons at a Glance
| Add-On | Is It a 'Must-Have' or 'Nice-to-Have'? | Consider Adding If... | Consider Skipping If... |
|---|---|---|---|
| Outpatient Cover | Varies (from Nice-to-Have to Must-Have) | You want the fastest possible diagnosis. | You are on a tight budget and comfortable with NHS diagnostic speeds. |
| Therapies | Nice-to-Have | You are very active, play sports, or have a manual job. | You are generally sedentary and rarely suffer from injuries. |
| Mental Health | Depends on personal priority | You want fast access to talking therapies without long waits. | You have access to an EAP or are comfortable with NHS/charity routes. |
| Dental & Optical | Nice-to-Have | You prefer an all-in-one policy and find budgeting difficult. | You are happy to pay-as-you-go or use a separate cash plan. |
Comparing all these options across different insurers can be overwhelming. This is where an independent PMI broker like WeCovr provides immense value. We can lay out all the options from across the market, explaining the real-world differences in cover and helping you find the perfect balance of protection and price, all at no cost to you.
The Big Three: Smart Ways to Reduce Your Premium
Beyond customising your cover, there are three key levers you can pull to significantly reduce your monthly payments.
1. The Excess
An excess is the amount you agree to pay towards a claim in any policy year. For example, if you have an excess of £250 and your eligible claim is £3,000, you pay the first £250 and the insurer pays the remaining £2,750.
- How it works: You can typically choose an excess from £0 up to £1,000 or more.
- The Rule: The higher your excess, the lower your monthly premium.
- Our Expert Advice: Choosing a small excess of £100 or £250 is a smart way to get a noticeable discount without exposing yourself to a huge upfront cost. A £0 excess policy is always the most expensive. Think about what you could comfortably afford to pay at short notice and set your excess at that level.
2. The Hospital List
Insurers group private hospitals into tiers or lists. The list you choose determines which hospitals you can use for your treatment.
- How it works: A "nationwide" list including the most expensive central London hospitals will result in a very high premium. A list that excludes these high-priced hospitals, or one that uses a network of partner hospitals, will be much cheaper.
- The Rule: The more restrictive your hospital list, the lower your premium.
- Our Expert Advice: Be realistic. Do you really need access to a hospital on Harley Street? For most people, a list that includes their local private hospital and other regional centres is more than adequate. Check which private hospitals are near your home and work, and ensure they are on the list you choose. This can be a source of huge savings.
3. The '6-Week Wait' Option
This is a clever option that integrates your PMI with the NHS.
- How it works: If you add the 6-week wait option, you agree to use the NHS for inpatient treatment if the NHS waiting list for that treatment is less than six weeks. If the waiting list is longer than six weeks, your private medical insurance kicks in immediately.
- The Rule: It only applies to inpatient care; your outpatient and day-patient cover are not affected.
- Our Expert Advice: This is one of the single biggest discounts you can get on your policy, often reducing premiums by 20-30%. Given the current state of NHS waiting lists for most procedures, it's highly likely that your PMI will be triggered. It’s a fantastic way to save money while still having a robust safety net for when the NHS can't see you quickly.
Critical Information: What UK PMI Does NOT Cover
It's just as important to understand what you aren't covered for. Private medical insurance is not a replacement for the NHS; it's designed to work alongside it.
Standard UK PMI policies DO NOT cover:
- Pre-existing Conditions: Any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy start date. For example, if you've been treated for arthritis in your knee before taking out a policy, that specific condition will not be covered.
- Chronic Conditions: These are long-term conditions that cannot be cured, only managed. Examples include diabetes, asthma, high blood pressure, and most types of arthritis. PMI is designed to cover acute conditions—illnesses that are short-lived and are expected to respond quickly to treatment (e.g., joint replacements, cataract surgery, hernia repair).
- A&E / Emergency Services: If you have a heart attack or are in a car accident, you should always call 999 and go to an NHS A&E department. Private hospitals are not equipped for major emergencies.
- Normal Pregnancy & Childbirth: Routine maternity care is not covered, though some policies may cover complications.
- Cosmetic Surgery: Procedures that are for aesthetic reasons are excluded, unless required for reconstruction after an accident or eligible surgery (e.g., breast reconstruction after a mastectomy).
Understanding these exclusions is vital to avoid disappointment at the point of a claim. Your policy is for new, eligible, acute conditions that arise after you join.
Unlocking Extra Value: Wellness and Member Benefits
Modern private health insurance is about more than just paying for treatment. Top providers are increasingly focused on helping you stay healthy in the first place, offering a range of wellness benefits and rewards.
These can include:
- Discounted Gym Memberships: Savings with major gym chains.
- Wearable Tech Deals: Reduced prices on Apple Watches or Fitbits.
- Health Screenings: Access to discounted or free health checks.
- Digital GP Services: 24/7 access to a GP via phone or video call, often included as standard.
At WeCovr, we enhance this value further for our clients. When you arrange private medical insurance with us, you not only get expert, impartial advice, but you also receive:
- Complimentary Access to CalorieHero: Our exclusive AI-powered calorie and nutrition tracking app to help you manage your diet and achieve your health goals.
- Multi-Policy Discounts: If you hold a PMI or Life Insurance policy through us, you can get attractive discounts on other types of cover you might need, like home or travel insurance.
These added benefits can make a significant difference, turning your policy from a simple safety net into a proactive tool for a healthier lifestyle.
Frequently Asked Questions (FAQs)
Do I need to have a medical exam to get private health insurance?
Can I switch my private medical insurance provider?
Is private medical insurance worth it if I'm young and healthy?
Your Next Step to Smarter Health Cover
Building the right private medical insurance policy is a balancing act. It's about securing robust protection for the big health events while being savvy about the extras you choose to pay for. By focusing on core cover, making smart choices on outpatient limits, and using tools like excess and hospital lists, you can create a high-quality policy that is surprisingly affordable.
Don't navigate this complex market alone. The expert team at WeCovr is here to provide free, impartial advice tailored to you. We'll compare leading UK providers, explain your options in plain English, and help you build the perfect policy.
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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