Does PMI Cover Routine and Preventative Healthcare
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, we at WeCovr know the UK private medical insurance market inside and out. A common question we hear is whether these policies cover routine health checks and preventative screenings. The short answer is nuanced. While core PMI is for unexpected, acute conditions, the landscape is changing, with many providers now offering valuable wellness benefits.
This guide will demystify what's covered, what's not, and how providers compare.
How coverage for screenings, health checks, and regular diagnostics compares by provider
Private medical insurance (PMI) is primarily designed to cover the costs of diagnosis and treatment for new, short-term (acute) medical conditions that arise after you take out a policy. This core principle means that, traditionally, routine check-ups and preventative screenings have not been included.
However, the industry is evolving. Insurers now recognise that helping you stay healthy is good for everyone. It reduces the likelihood of expensive future claims and provides you with greater value. This has led to the rise of wellness programmes, health screening benefits, and other proactive health services.
Let's explore how the UK's leading providers approach this.
The Core Principle of UK PMI: Treating Acute Conditions
Before we dive into preventative care, it's crucial to understand the fundamental purpose of private medical insurance in the UK.
PMI is built to work alongside the NHS, not replace it entirely. Its primary function is to provide you with faster access to diagnosis and treatment for acute conditions.
- Acute Condition: An illness, injury, or disease that is likely to respond quickly to treatment and lead to a full recovery. Examples include joint replacements, cataract surgery, or treatment for a hernia.
- Chronic Condition: A long-term condition that cannot be cured, only managed. Examples include diabetes, asthma, and high blood pressure.
Crucial Point: Standard UK private health insurance policies do not cover pre-existing conditions (illnesses you had before your policy started) or the routine management of chronic conditions. The cover is for new, eligible medical problems that begin after your policy's start date.
Routine and preventative care falls outside this core "acute condition" model because it's not about treating an unexpected illness; it's about monitoring your general health or screening for potential future problems.
What Is Considered Routine and Preventative Care?
When insurers talk about excluding "routine" or "preventative" care from a core policy, they are generally referring to services that are part of primary care or national screening programmes, most of which are provided by the NHS.
These typically include:
- Routine GP consultations: For minor ailments like colds or general advice.
- Standard health checks: Such as routine blood pressure, cholesterol, or blood sugar tests without symptoms.
- Vaccinations: Both for travel and routine immunisations.
- Prescriptions: For ongoing medication, especially for chronic conditions.
- NHS Screening Programmes: Such as routine cervical screening, mammograms for specific age groups, and bowel cancer screening.
- Eye tests and dental check-ups: These are almost always excluded and require separate dental, optical, or cashback plans.
- Allergy testing: Unless it's to diagnose the cause of specific, new symptoms under a specialist's referral.
The reason for these exclusions is simple: PMI aims to complement the NHS by covering the things it struggles with most—long waiting lists for specialist consultations, diagnostics, and elective surgery. It doesn't aim to replace the comprehensive primary and preventative care the NHS already provides.
The Rise of Wellness Benefits: How Insurers Are Evolving
In recent years, the best PMI providers have shifted their focus. They've realised that a healthy customer is a happy customer—and one who is less likely to make a large claim. This has led to a boom in "wellness benefits" and "value-added services."
These benefits are often included with your policy at no extra cost and are designed to encourage a healthier lifestyle. They bridge the gap between traditional insurance (reacting to illness) and proactive health management (preventing illness).
These benefits can include:
- Discounts on gym memberships and fitness trackers.
- Access to mental health support and therapy sessions.
- Digital GP services for quick consultations.
- Rewards for hitting activity goals.
- And, most importantly for this topic, access to a certain number of health checks and screenings.
Comparing Provider Coverage for Health Checks and Screenings
While core policies are similar in excluding routine care, the "add-ons" and wellness benefits vary significantly between providers. This is where comparing policies becomes essential. An expert PMI broker like WeCovr can help you navigate these differences to find a plan that aligns with your health priorities.
Here’s a comparison of how the major UK providers handle preventative care in 2025.
| Provider | Core Policy on Routine Care | Health Screening & Diagnostic Benefits | Wellness Programme & Incentives | Digital GP Access |
|---|---|---|---|---|
| Bupa | Generally excluded. | Offers standalone health assessments. Some comprehensive plans include a health check benefit. | Bupa Touch app provides access to health information and rewards from partners. | Bupa Blua Health digital GP service is often included. |
| AXA Health | Generally excluded. | Some higher-tier plans may include a health check. Focus on guided access to diagnostics when symptoms are present. | 'ActivePlus' offers discounts on gym memberships and fitness gear. Access to health coaching. | Doctor at Hand service is a key feature, included in most plans. |
| Aviva | Generally excluded. | The Aviva DigiCare+ app (included with many policies) provides an annual health check. | Aviva DigiCare+ is the central hub, offering health support, gym discounts, and mental health services. | Included via the Aviva DigiCare+ app. |
| Vitality | Excluded, but incentivised. | Health checks are actively encouraged and rewarded with Vitality points, which can reduce future premiums. | The entire model is built on this. Earn points for activity, healthy eating, and health checks to get rewards (e.g., Apple Watch, cinema tickets). | Vitality GP is included, offering video consultations and referrals. |
| The Exeter | Generally excluded. | Focus is more on support during illness rather than preventative screenings. | The 'Healthwise' app provides remote GP access, second opinions, and mental health support. | Included via the Healthwise app. |
A Deeper Look at Each Provider
Vitality: The Pioneer of Proactive Health
Vitality's entire philosophy is built around rewarding you for being healthy. Their model doesn't just allow for preventative care; it actively incentivises it.
- How it works: You earn "Vitality Points" for activities like walking, going to the gym, eating healthily, and completing health checks.
- Health Checks: Completing a Vitality Healthcheck (measuring BMI, blood pressure, cholesterol, and glucose) earns you a significant number of points. You can also earn points for other screenings like dental checks and cervical screenings.
- Rewards: The more points you earn, the higher your "Vitality Status" (Bronze, Silver, Gold, Platinum). A higher status unlocks better rewards, including discounts on your policy renewal premium, a subsidised Apple Watch, free coffee, and cinema tickets.
For those who are motivated by rewards and want their insurance to be an active part of their health journey, Vitality is a compelling option.
Aviva: Integrated Digital Wellness
Aviva has consolidated its wellness offerings into the excellent Aviva DigiCare+ app. This service, provided by Square Health, is included with many of their PMI policies.
- Annual Health Check: A key feature is a yearly health check. This involves a simple finger-prick blood test that you do at home to check 20 different health markers for conditions like diabetes and high cholesterol. A follow-up consultation with a GP is included to discuss your results.
- Holistic Support: Beyond the health check, the app provides digital GP access, mental health support, nutritional advice, and second medical opinions, creating a comprehensive wellness ecosystem.
Aviva provides a strong, straightforward benefit that gives you a clear snapshot of your health each year.
Bupa: A Focus on Comprehensive Assessments
Bupa is one of the most recognised names in UK health. While their core insurance policies focus on acute care, they are a major provider of standalone Health Assessments.
- Standalone Service: You can book a Bupa health assessment without having Bupa insurance. They offer various levels, from a basic "Health Core" check to an advanced "Be.Reassured" assessment that includes more in-depth tests.
- Insurance Benefit: Some of Bupa’s more premium corporate or individual PMI policies may include a benefit that contributes towards the cost of one of these assessments.
- Digital GP: Most Bupa policies now come with access to the Bupa Blua Health service, allowing for 24/7 digital GP appointments, which is useful for getting quick advice and referrals.
AXA Health: Guided Care and Support
AXA Health's approach is focused on providing support and guidance when you need it. Their 'Doctor at Hand' digital GP service is central to this.
- Health Checks: More comprehensive plans may include a contribution towards a health check, but it's not a standard feature on all policies.
- Proactive Support: AXA's strengths lie in services like their 'Health at Hand' phone line staffed by nurses and counsellors, and their support for muscular-skeletal issues without needing a GP referral on some plans.
- ActivePlus: Through this scheme, members get access to discounted gym memberships and other fitness perks.
The Exeter: Member-Focused Support
The Exeter is a mutual society, meaning it's owned by its members. Their focus is often on providing excellent support and benefits when you're unwell.
- Healthwise App: Like Aviva, The Exeter provides a valuable app called 'Healthwise'. This service gives members access to a remote GP, second medical opinions, and mental health support.
- Preventative Focus: While the app doesn't typically include a free annual health screening, the access to medical professionals for advice can be seen as a form of preventative support, helping you address concerns before they become serious.
Are Advanced Diagnostics Ever Covered?
This is where a critical distinction must be made. While routine screening without symptoms is not covered by core PMI, diagnostic tests to investigate symptoms are a primary benefit of private medical insurance.
Here’s how it works:
- You develop a symptom. For example, persistent headaches, joint pain, or you find a lump.
- You see a GP. This can be your NHS GP or a private GP via your insurer's digital service.
- You get a referral. The GP determines that your symptoms require investigation and refers you to a specialist (e.g., a neurologist, orthopaedic surgeon, or oncologist).
- Specialist consultation and tests. Your PMI policy covers the cost of seeing that specialist privately. The specialist will then likely order diagnostic tests—such as an MRI scan, CT scan, ultrasound, or detailed blood tests—to find out the cause of your symptoms.
- Coverage: These diagnostic tests are fully covered by your PMI policy, subject to your outpatient limits.
Real-Life Example: A routine mammogram offered by the NHS to all women over 50 is a screening. A standard PMI policy won't cover you to have this done privately just for peace of mind. However, if you (at any age) discover a lump in your breast and your GP refers you to a specialist, the subsequent mammogram and any other tests needed to diagnose the lump are a core part of what your private health cover is for.
This is arguably the most valuable aspect of PMI: fast access to the advanced diagnostics needed to get a swift, accurate diagnosis. With NHS waiting times for some diagnostic tests stretching for months, this can provide immense peace of mind and lead to earlier, more effective treatment.
The Role of a PMI Broker Like WeCovr
The world of private medical insurance UK is complex. The differences in coverage for wellness and preventative care are a perfect example of why getting expert advice is so valuable.
- Navigating the Options: A policy that looks cheapest on paper might lack the wellness benefits you'd use most. A more expensive plan might include benefits that save you money elsewhere (like gym memberships or health checks).
- Personalised Advice: At WeCovr, we take the time to understand your priorities. Are you a fitness enthusiast who would benefit from the Vitality model? Or do you prefer the straightforward annual check-up offered by Aviva? We help you compare the market without the jargon.
- No Extra Cost: Our service is completely free to you. We are paid by the insurer you choose, so you get expert, impartial advice without it costing you a penny more.
- Extra Benefits: When you arrange a policy through us, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to support your health goals. Furthermore, customers who purchase PMI or life insurance often receive discounts on other types of cover.
Our high customer satisfaction ratings are a testament to our commitment to finding the right cover for every individual's needs.
Wellness and Lifestyle: Taking Control of Your Health
Insurance is a safety net, but the best way to stay well is through proactive lifestyle choices. The NHS and leading health organisations agree on a few key pillars of good health.
- A Balanced Diet: Following the principles of the NHS Eatwell Guide is a great start. Focus on plenty of fruits and vegetables, wholegrains, lean proteins, and healthy fats. Limiting processed foods, sugar, and saturated fats is crucial for preventing conditions like heart disease and type 2 diabetes.
- Regular Physical Activity: The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running or HIIT) per week. Strength-building exercises on two days a week are also recommended.
- Prioritising Sleep: Most adults need 7-9 hours of quality sleep per night. Poor sleep is linked to a higher risk of obesity, heart disease, and poor mental health.
- Managing Stress: Chronic stress can have a significant physical impact on your body. Techniques like mindfulness, meditation, yoga, or simply spending time in nature can help manage stress levels. Many PMI providers now offer access to mental health support apps and services.
- Sensible Alcohol Consumption: Sticking to the UK's low-risk drinking guidelines (no more than 14 units a week, spread over several days) can reduce your risk of a wide range of health problems.
The Financial Case for Preventative Care
Investing in your health isn't just about feeling good; it makes financial sense. According to the Department of Health and Social Care, a significant portion of the health service's burden in England is attributable to potentially preventable conditions. Early detection and healthy lifestyles can prevent or delay the onset of many serious and costly illnesses.
By using the wellness benefits included with your PMI, you can:
- Identify risk factors like high cholesterol or blood pressure early.
- Stay motivated to exercise with discounted gym memberships and trackers.
- Reduce your future insurance premiums with providers like Vitality.
- Catch serious conditions at an earlier, more treatable stage.
Ultimately, a private medical insurance policy with strong preventative benefits can be a powerful tool in your long-term health and financial planning.
Is a private health check worth it if I have PMI?
Does private medical insurance UK cover routine dental or optical appointments?
If a routine screening finds a problem, will my PMI cover the treatment?
Can I get a discount on my PMI for being healthy?
Ready to find a private health cover that truly matches your health goals? The market is more varied than ever, and the right policy for you is out there.
Get a free, no-obligation quote from WeCovr today. Our friendly experts will help you compare the UK's leading providers to find the perfect balance of comprehensive cover and valuable wellness benefits.
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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