Does PMI Cover Diabetes in the UK
WeCovr explains whether type 1 and type 2 diabetes are covered
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr is often asked if private medical insurance (PMI) in the UK covers diabetes. The short answer is that standard PMI policies are designed for acute, short-term conditions, not for managing long-term, chronic illnesses like diabetes.
This guide will explain everything you need to know. We’ll break down why this is the case, what exceptions might exist, and how PMI can still offer immense value to someone living with diabetes.
Understanding Diabetes: A UK Health Snapshot
Before we dive into the insurance details, it's helpful to understand what diabetes is and its prevalence in the UK.
Diabetes is a serious, lifelong condition where your blood glucose (sugar) level is too high. There are two main types:
- Type 1 Diabetes: An autoimmune condition where the body's immune system attacks and destroys the cells that produce insulin. It's not linked to age or lifestyle and accounts for around 8% of all diabetes cases in the UK.
- Type 2 Diabetes: This is where the body doesn't produce enough insulin, or the body's cells don't react to insulin properly. This type is far more common, accounting for about 90% of cases. While genetics and age are factors, it's often linked to lifestyle and being overweight.
According to the latest data from Diabetes UK, an estimated 5.6 million people will be living with diabetes in the UK by 2030. The condition is a significant challenge for the NHS, which currently spends around 10% of its entire budget—over £10 billion a year—on treating diabetes and its complications.
The NHS provides excellent, comprehensive care for managing diabetes, from diagnosis and education to medication and regular check-ups. Private medical insurance is not designed to replace this function. Instead, it's built to work alongside it.
The Core Principle of UK Private Health Cover: Acute vs. Chronic
To understand why diabetes isn't covered by a standard private health insurance policy, you must grasp the fundamental principle that underpins the entire UK market: the distinction between acute and chronic conditions.
-
An Acute Condition: This is a disease, illness, or injury that is likely to respond quickly to treatment. It's usually a one-off event that aims to return you to your previous state of health.
- Examples: A broken arm, appendicitis, gallstones, a hernia repair, or cataract surgery.
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A Chronic Condition: This is an illness that continues for a long period—often for life. It cannot be cured, only managed. It requires ongoing medical attention, monitoring, and medication.
- Examples: Diabetes, asthma, high blood pressure (hypertension), arthritis, and Crohn's disease.
Private medical insurance in the UK is designed exclusively to cover the diagnosis and treatment of new, eligible acute conditions that arise after your policy has started.
It is not designed to cover the routine, long-term management of chronic conditions. If it did, the predictable and ongoing costs would make premiums unaffordably high for everyone. The industry's model is based on insuring against the unexpected, not the inevitable.
So, Does PMI Cover Diabetes? The Direct Answer
No, standard private medical insurance policies do not cover the day-to-day management of either type 1 or type 2 diabetes. This is true whether you had the condition before you took out the policy (a pre-existing condition) or were diagnosed after your cover began.
This means your PMI plan will not pay for:
- GP or specialist appointments for routine diabetes management.
- Insulin, metformin, or any other ongoing diabetes medication.
- Blood glucose testing strips, monitors, or lancets.
- Insulin pumps or continuous glucose monitors (CGMs).
- Annual eye screening, foot checks, or kidney function tests related to diabetes management.
All of this essential care is provided by the NHS.
What PMI Does and Doesn't Cover for Diabetes
| Service or Treatment Related to Diabetes | Covered by the NHS? | Covered by Standard PMI? |
|---|---|---|
| Routine GP/specialist consultations | ✅ Yes | ❌ No |
| Insulin and other prescribed medications | ✅ Yes (subject to prescription charges in England) | ❌ No |
| Blood sugar monitoring equipment | ✅ Yes | ❌ No |
| Diabetes education programmes (e.g., DAFNE, DESMOND) | ✅ Yes | ❌ No |
| Annual eye, foot, and kidney checks | ✅ Yes | ❌ No |
| Treatment for a new, unrelated acute condition (e.g., hernia) | ✅ Yes (with waiting list) | ✅ Yes (promptly) |
The Important Exception: Acute Complications
Here is where it gets more nuanced. While PMI won't cover the management of diabetes itself, it may cover the treatment of a new, acute condition that could be a complication of diabetes.
This is a critical point. Your policy is not for your diabetes, but for unforeseen health issues.
Real-Life Example:
Sarah has had Type 2 diabetes for five years, which she manages through diet and medication via her NHS GP. She has a PMI policy with a major UK insurer. One day, her optician tells her she has developed cataracts in both eyes, which are impairing her vision. While cataracts can be more common in people with diabetes, the treatment is a one-off surgical procedure to restore sight—a classic acute intervention. Sarah calls her PMI provider. Because her policy covers cataract surgery, they approve the claim. Within a few weeks, she has the surgery done at a private hospital, avoiding a potentially long NHS wait. The PMI policy covered the acute problem (the cataracts), not the chronic one (the diabetes).
However, whether such a complication is covered depends entirely on your policy's terms and, most importantly, the type of underwriting you chose.
How Underwriting Affects Diabetes Coverage
When you apply for private health cover, the insurer assesses your medical history to decide what they will and won't cover. This is called underwriting. If you have diabetes, this process is crucial.
There are two main types:
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Moratorium Underwriting ("Mori") This is the most common type. The insurer doesn't ask for your full medical history upfront. Instead, they apply a general rule: they will automatically exclude any condition for which you have had symptoms, treatment, or advice in the 5 years before your policy started.
For a condition like diabetes, which requires constant monitoring and management, you will never satisfy the criteria to have it covered. A 'mori' policy will effectively mean that diabetes and anything related to it will be permanently excluded from cover.
-
Full Medical Underwriting (FMU) With FMU, you provide a full declaration of your medical history on your application form. The insurer's underwriting team reviews it and makes a specific decision.
If you declare diabetes, they will place a specific exclusion on your policy. This will be written clearly in your policy documents. It will typically state that diabetes mellitus and any related conditions are excluded from cover. This might include specific mentions of cardiovascular, kidney (renal), eye (ophthalmic), or nerve (neurological) conditions that arise as a result of diabetes.
Which is better? While moratorium underwriting can seem simpler, for someone with a declared chronic condition like diabetes, Full Medical Underwriting often provides greater clarity. You know from day one exactly what is and isn't covered, leaving no room for doubt when you need to make a claim. An expert PMI broker, like WeCovr, can help you understand the pros and cons of each and guide you to the best option for your situation.
Can I Still Get PMI If I Have Diabetes?
Absolutely, yes. Having diabetes does not prevent you from getting private medical insurance.
The policy will simply be set up to exclude your diabetes and its routine management. You will still be covered for a huge range of other health issues, which is the primary reason most people buy PMI.
This allows you to create a "best of both worlds" healthcare strategy:
- Use the NHS: For your world-class, comprehensive diabetes care.
- Use your PMI: To bypass NHS waiting lists for eligible acute conditions, such as:
- Cancer Treatment: Most policies offer extensive cancer cover, providing access to drugs and treatments not yet available on the NHS.
- Surgical Procedures: For things like joint replacements, hernia repairs, or gallbladder removal.
- Diagnostic Tests: Quickly get MRI, CT, and PET scans for new symptoms.
- Mental Health Support: Fast-track access to therapists and counsellors.
- A Private Room: In a comfortable private hospital during treatment.
PMI complements the NHS; it doesn't aim to replace it for chronic care.
Beyond Coverage: How PMI Adds Value for People with Diabetes
Even though PMI doesn't cover the clinical management of diabetes, the value-added benefits included in modern policies can be incredibly beneficial for promoting a healthy lifestyle—a cornerstone of good diabetes control.
1. Digital GP Services
Most leading PMI providers now include a 24/7 virtual GP service. This allows you to have a video or phone consultation with a GP from your smartphone, often within hours. It's perfect for:
- Quick advice on non-diabetes-related health worries.
- Getting a private prescription for minor ailments.
- Getting a referral to a specialist for a new, eligible condition.
This convenience helps you manage your overall health more proactively without needing to wait for an NHS GP appointment.
2. Wellness Programmes and Rewards
This is where insurers like Vitality, Bupa, and AXA really shine. Their wellness programmes actively reward you for living a healthier life. These benefits are particularly powerful for individuals managing Type 2 diabetes.
- Discounts on Gym Memberships: Get up to 50% off memberships at chains like Nuffield Health, PureGym, and Virgin Active.
- Wearable Tech Deals: Get a subsidised Apple Watch or Fitbit to track your activity levels.
- Healthy Food Savings: Receive discounts or cashback on healthy food ranges at supermarkets like Waitrose and Ocado.
- Activity Points: Earn points for walking, running, or cycling, which can be redeemed for free coffee, cinema tickets, and other rewards.
These programmes provide powerful financial incentives to exercise regularly and eat well—two of the most important factors in managing blood sugar levels.
3. WeCovr's Exclusive Benefits
At WeCovr, we believe in providing tangible value beyond just finding you the right policy. That's why our health and life insurance clients receive:
- Complimentary access to CalorieHero: Our proprietary AI-powered app for tracking calories, macronutrients, and water intake. For anyone managing their diet for diabetes, this is an invaluable tool to help you stay on track with your nutritional goals.
- Discounts on other insurance: When you arrange your PMI through us, you become eligible for discounts on other products, such as life insurance or income protection.
4. Proactive Mental Health Support
Living with and managing a long-term condition can be mentally taxing. The stress and anxiety can affect your physical health. Recognising this, most PMI providers have built robust mental health support pathways into their plans. This often includes:
- Access to a set number of counselling or CBT (Cognitive Behavioural Therapy) sessions without needing a GP referral.
- Digital mental health tools and apps.
- Support for a wide range of conditions, from stress and anxiety to depression.
Accessing this support privately means you can often start therapy in days, rather than waiting months for NHS services.
Practical Health Tips for Living Well with Diabetes
While your PMI policy supports your acute healthcare needs, managing your diabetes day-to-day relies on lifestyle. Always follow the advice of your NHS healthcare team, but these general tips are universally recommended.
- Know Your Carbs: Understanding how carbohydrates affect your blood sugar is key. Focus on complex carbs (whole grains, vegetables) over simple ones (sugary drinks, white bread). Your NHS dietitian can provide personalised advice.
- Stay Active: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be 30 minutes of brisk walking five days a week. Activity helps your body use insulin more effectively.
- Prioritise Sleep: Poor sleep can negatively affect blood sugar levels and insulin sensitivity. Aim for 7-9 hours of quality sleep per night.
- Don't Skip Your Checks: Attend all your annual NHS checks for your eyes, feet, and kidneys. Early detection of complications is vital.
- Plan for Travel: If you travel, ensure you have more than enough medication. Carry a doctor's letter explaining your condition and the need for supplies like needles or an insulin pump. Remember, PMI is not travel insurance—you need a separate travel policy that specifically covers your pre-existing diabetes for medical emergencies abroad.
Comparing UK PMI Providers
While the core principle on chronic conditions is consistent across the market, providers differ in their hospital lists, cancer cover details, and wellness benefits.
Here’s a simplified overview of what some leading providers offer.
| Feature Area | AXA Health | Bupa | Vitality |
|---|---|---|---|
| Overall Approach | Focus on traditional, comprehensive health cover with strong diagnostic pathways. | A market leader with a huge network of facilities and a strong focus on clinical excellence. | Unique model focused on rewarding healthy behaviour with extensive wellness benefits. |
| Cancer Cover | Comprehensive cancer cover as standard, with options to enhance it. | Full cover for eligible cancer treatment on all policies. No time or financial limits. | 'Advanced Cancer Cover' promises to cover all eligible costs, including experimental drugs. |
| Mental Health | Strong mental health pathway, often providing access to therapists without a GP referral. | Extensive mental health cover, including support for addiction and self-harm. | Integrated approach linking mental and physical wellness. Access to therapy and online tools. |
| Wellness Programme | 'Health Gateway' portal with health information and some gym discounts. | 'Bupa LiveWell' offers health assessments and coaching but is less reward-focused than Vitality. | The market-leading 'Vitality Programme' rewards daily activity with discounts and perks. |
| Digital GP | 'Doctor at Hand' app. | 'Digital GP' powered by Babylon. | 'Vitality GP' with integrated referrals. |
How do you choose?
Comparing these policies can be overwhelming. The best PMI provider for you depends on your priorities. Do you want the most comprehensive hospital list? The most engaging wellness programme? Or the most affordable core cover?
This is where a specialist broker adds a lot of value. At WeCovr, we do the hard work for you. We are independent and work with all the leading insurers. Our expert advisors will listen to your needs, explain the key differences in plain English, and provide you with quotes tailored to you and your budget. Our service is completely free for you to use.
Frequently Asked Questions (FAQs)
Do I have to declare my diabetes when I apply for private medical insurance?
Will my PMI premiums be higher because I have diabetes?
What happens if I develop diabetes after my PMI policy has started?
Can I use PMI to see a private endocrinologist for my diabetes?
Take the Next Step with WeCovr
Understanding the nuances of private medical insurance UK can feel complex, but it doesn't have to be. For people with diabetes, PMI offers a powerful way to secure peace of mind and fast access to treatment for a wide range of other health concerns, all while continuing to benefit from the excellent chronic care provided by the NHS.
The expert team at WeCovr is ready to help you navigate your options. We'll compare policies from across the market to find a plan that fits your personal needs and budget, ensuring you have clarity and confidence in your cover.
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.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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