TL;DR
Navigating the UK's private medical insurance (PMI) market can feel like a daunting task. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, we believe knowledge is power. Asking a broker the right questions is the crucial first step toward securing the perfect health cover for you and your family.
Key takeaways
- Moratorium (Mori) Underwriting: This is the most common type. You don't declare your full medical history upfront. Instead, the insurer applies a general rule: any medical condition you've had symptoms, treatment, or advice for in the 5 years before your policy starts is automatically excluded for an initial period (usually the first 2 years of the policy). If you then remain completely trouble-free from that condition for a continuous 2-year period after your policy starts, it may become eligible for cover.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire when you apply. The insurer reviews your medical history and provides a definitive list of any specific exclusions from day one.
- Basic/Entry-Level: Primarily covers in-patient and day-patient treatment (i.e., when you need a hospital bed). It often has limited or no cover for out-patient diagnostics and consultations. This is a good option for those on a tight budget who are most concerned about covering the costs of major surgery.
- Mid-Range: The most popular choice. It includes full in-patient cover plus a specified limit for out-patient services (e.g., up to £1,000-£1,500 per year). This covers the specialist consultations and diagnostic scans needed before you are admitted to hospital.
- Comprehensive: Offers full cover for in-patient treatment and either unlimited or very high limits for out-patient care. These policies often include more extensive cover for mental health, therapies, and alternative treatments, alongside generous wellness benefits.
Navigating the UK's private medical insurance (PMI) market can feel like a daunting task. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, we believe knowledge is power. Asking a broker the right questions is the crucial first step toward securing the perfect health cover for you and your family.
This guide is designed to arm you with those essential questions. A good broker won't just sell you a policy; they will act as your expert guide, helping you understand the intricacies of cover, claims, and costs.
Key questions and the best answers brokers should provide on policies and claims
Choosing a private medical insurance policy is a significant decision. Your broker's role is to provide clarity and confidence. Below are the critical areas to explore with them, along with the detailed, transparent answers you should expect to receive.
Part 1: Understanding You and Your Needs
Before a broker even mentions an insurer or a policy, they should first seek to understand you. A quality broker’s initial questions should revolve around your personal circumstances, expectations, and budget. If they launch straight into a sales pitch, it’s a red flag.
Question: "What do you need to know about me to find the right policy?"
A great broker will want to build a complete picture of your needs. They should ask you about:
- Your Health & Lifestyle: Are you a smoker? What are your general activity levels? While they cannot ask for your full medical history at this stage, they need a sense of your overall health profile.
- Who to Cover: Is the policy just for you, or for your partner and children too? The needs of a 25-year-old individual are very different from those of a family of four.
- Your Budget: What is a comfortable monthly premium for you? An honest conversation about budget prevents them from recommending policies that are unaffordable.
- Your Expectations: Why are you considering PMI? Is it primarily to bypass NHS waiting lists for surgery? Or are you looking for comprehensive cover that includes mental health support, therapies, and extensive wellness benefits?
- Your Location: Where you live in the UK affects which hospitals are available and can influence your premium.
The Best Answer a Broker Should Give: "To find the best policy, I first need to understand what 'best' means for you. We'll discuss your budget, who needs cover, and what's most important to you—whether that's fast access to treatment, comprehensive cancer care, or mental health support. We'll then match your unique needs to the insurers and policies that are the best fit, explaining the pros and cons of each."
Part 2: De-mystifying the Policy Details
Once your broker understands your needs, the conversation can turn to the specifics of the policies available. This is where detail is everything.
Critical Question: "What exactly is and isn't covered?"
This is the single most important question you can ask. Misunderstanding the scope of cover is the primary source of frustration for policyholders.
The Golden Rule: Acute vs. Chronic Conditions
A good broker must explain this fundamental principle of UK private medical insurance from the outset:
- Acute Condition: 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 repair, and treatment for infections. PMI is designed to cover acute conditions.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs long-term monitoring, has no known cure, is likely to recur, or requires ongoing management. Examples include diabetes, asthma, high blood pressure, and Crohn's disease. Standard UK PMI does not cover the routine management of chronic conditions.
Your broker should provide a clear table of common inclusions and exclusions.
| Common Inclusions (for Acute Conditions) | Common Exclusions |
|---|---|
| In-patient and day-patient surgery & treatment | Pre-existing conditions (see underwriting section below) |
| Consultations with specialists | Management of chronic conditions (e.g., diabetes, asthma) |
| Diagnostic tests (MRI, CT, PET scans) | Routine GP services and A&E visits |
| Cancer treatment (chemotherapy, radiotherapy) | Normal pregnancy and childbirth |
| Hospital accommodation and nursing care | Cosmetic surgery (unless medically necessary) |
| Out-patient therapies (e.g., physiotherapy) | Experimental or unproven treatments |
| Mental health support (varies by policy) | Alcohol or substance abuse treatment |
The Best Answer a Broker Should Give: "Your policy is designed to get you diagnosed and treated quickly for new, acute medical conditions that arise after your policy starts. It covers things like surgery, consultations, and cancer care. It's important to understand it doesn't cover pre-existing conditions or the day-to-day management of long-term chronic illnesses like diabetes. Let's walk through some specific examples so you're completely clear on what you're protected for."
Question: "How do you handle pre-existing conditions? What is 'underwriting'?"
This follows directly from the previous question. Underwriting is the process an insurer uses to assess your medical history and decide which conditions, if any, to exclude from your cover.
Your broker must explain the two main types of underwriting in the UK:
- Moratorium (Mori) Underwriting: This is the most common type. You don't declare your full medical history upfront. Instead, the insurer applies a general rule: any medical condition you've had symptoms, treatment, or advice for in the 5 years before your policy starts is automatically excluded for an initial period (usually the first 2 years of the policy). If you then remain completely trouble-free from that condition for a continuous 2-year period after your policy starts, it may become eligible for cover.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire when you apply. The insurer reviews your medical history and provides a definitive list of any specific exclusions from day one.
| Feature | Moratorium (Mori) Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple. No health forms. | Slower. Requires a detailed health questionnaire. |
| Clarity on Cover | Can be grey areas. An insurer may need to check your medical history at the point of a claim. | Fully transparent. You know exactly what is excluded from the start. |
| Best For | People with few or no recent health issues who want a fast application. | People with a complex medical history who want certainty about what's covered. |
| Claim Process | Potentially slower as the insurer may need to investigate if a condition is pre-existing. | Generally faster as exclusions are already defined. |
The Best Answer a Broker Should Give: "We have two main options for underwriting. With 'Moratorium', it's quick to set up as there are no health forms, but any condition you've had in the last five years is automatically excluded for the first two years of your policy. With 'Full Medical Underwriting', you fill out a health form, and the insurer tells you upfront exactly what is excluded. We can discuss your medical history in confidence to help you decide which path gives you the most peace of mind."
Question: "What are the different levels of cover available?"
PMI is not a one-size-fits-all product. Policies are typically structured in tiers, allowing you to balance the level of cover with the cost of the premium.
Your broker should explain the three main levels:
- Basic/Entry-Level: Primarily covers in-patient and day-patient treatment (i.e., when you need a hospital bed). It often has limited or no cover for out-patient diagnostics and consultations. This is a good option for those on a tight budget who are most concerned about covering the costs of major surgery.
- Mid-Range: The most popular choice. It includes full in-patient cover plus a specified limit for out-patient services (e.g., up to £1,000-£1,500 per year). This covers the specialist consultations and diagnostic scans needed before you are admitted to hospital.
- Comprehensive: Offers full cover for in-patient treatment and either unlimited or very high limits for out-patient care. These policies often include more extensive cover for mental health, therapies, and alternative treatments, alongside generous wellness benefits.
| Feature | Basic Cover | Mid-Range Cover | Comprehensive Cover |
|---|---|---|---|
| In-patient & Day-patient | ✅ | ✅ | ✅ |
| Cancer Cover | Core treatment is usually standard. | Enhanced options available (e.g., choice of drugs). | Full, advanced cover often included. |
| Out-patient Limits | Often excluded or very low (e.g., £0-£500). | Capped limit (e.g., £1,000-£1,500). | Full cover or very high limits (e.g., £2,000+). |
| Therapies (Physio etc.) | Usually excluded. | Often included with limits. | Included with higher limits. |
| Mental Health Support | Limited or excluded. | Can be added as an option. | More extensive cover usually included. |
The Best Answer a Broker Should Give: "We can tailor the level of cover to your priorities. A 'Basic' policy focuses on covering the big costs like surgery. A 'Mid-Range' policy adds cover for the consultations and scans you'd need beforehand, which is what most clients choose. A 'Comprehensive' plan provides the most extensive protection, including higher limits for therapies and mental health. Let's look at the price difference between these to see what offers you the best value."
Question: "How can I customise my policy to make it more affordable?"
A key advantage of using a broker is their ability to fine-tune a policy to fit your budget. They should proactively suggest ways to manage your premium without sacrificing the cover that matters most to you.
Key customisation options include:
- Excess: This is the amount you agree to pay towards a claim each year. A higher excess (e.g., £500) will significantly lower your monthly premium compared to a lower excess (e.g., £100).
- Hospital List: Insurers have different tiers of hospital lists. Choosing a more restricted list that covers excellent local hospitals but excludes the most expensive central London facilities can reduce your premium.
- Six-Week Option: This is a popular cost-saving measure. If the NHS can provide the in-patient treatment you need within six weeks of it being recommended, you would use the NHS. If the waiting list is longer than six weeks, your private cover kicks in. This can reduce premiums by 20-30%.
- No-Claims Discount (NCD): Similar to car insurance, you build up a discount for every year you don't claim, which helps keep future premiums down. Your broker should explain how each insurer's NCD works.
The Best Answer a Broker Should Give: "There are several ways we can make your policy more affordable. The most effective is adjusting the 'excess'—the amount you pay per claim. We can also look at the 'hospital list' to ensure you're not paying for access to hospitals you'd never use. Finally, the 'six-week option' is a fantastic way to lower costs, leveraging the NHS for quicker treatments while still having private cover as a safety net for longer waits."
Part 3: The Broker and the Insurers
It's not just the policy you need to question, but also the person and the companies behind it.
Question: "Why should I use you as a broker? What makes you different?"
You need to feel confident in the broker's expertise and impartiality.
The Best Answer a Broker Should Give: "As an FCA-authorised broker, our primary duty is to you, not the insurance company. We are independent and have access to a wide panel of leading UK insurers, so we're not tied to just one provider. Our service is provided at no cost to you, as we are paid a commission by the insurer you choose. Our role is to use our market expertise to find you the best possible cover for your budget and support you throughout the life of your policy, including helping you if you ever need to make a claim. At WeCovr, we pride ourselves on our high customer satisfaction and our ability to make the complex simple for our clients."
Question: "Which insurers do you recommend and why?"
A good broker won't have a single "best" insurer. The best insurer is the one that best matches your specific needs.
The Best Answer a Broker Should Give: "There is no single 'best' provider—it all depends on what you're looking for. For example:
- Bupa and AXA Health are known for their extensive hospital networks and strong brand reputation.
- Vitality is a great choice if you're active and want to be rewarded for a healthy lifestyle, as their wellness programme is market-leading.
- Aviva offers very flexible and competitively priced policies.
My job is to explain the strengths of each and recommend the one whose underwriting, claims philosophy, and pricing aligns best with the needs we've already discussed."
Part 4: The Claims Process and Long-Term Value
A policy is only as good as its ability to pay out when you need it.
Question: "Can you walk me through the claims process step-by-step?"
Understanding the process in advance removes stress and uncertainty when you're unwell.
The Best Answer a Broker Should Give: "The process is designed to be straightforward. Let's use an example: you develop persistent knee pain.
- GP Referral: You visit your NHS GP. They examine you and agree you need to see a specialist, giving you an 'open referral'.
- Contact Your Insurer: You call your insurer's claims line with your policy number and the referral details.
- Get Authorisation: The insurer checks your cover and authorises a consultation with a specialist from their approved network. They will give you an authorisation code.
- Book and Attend Appointment: You book your appointment with the specialist, giving them your authorisation code.
- Treatment Authorisation & Delivery: If the specialist recommends a scan or surgery, you call the insurer again for authorisation before proceeding.
- Bills are Settled: The hospital and specialist bill the insurer directly. You only have to pay your excess if it applies."
Question: "What happens if there's a problem with a claim? What is a 'shortfall'?"
This tests the broker's commitment to you after the sale.
The Best Answer a Broker Should Give: "If you run into any issues, you should call us. As your broker, we can speak to the insurer on your behalf to help resolve any confusion. A 'shortfall' can sometimes happen if a specialist charges more than the insurer's published fee guidelines. The best way to avoid this is to always use a specialist from the insurer's approved list and to get full authorisation before any treatment. We always guide our clients on how to do this correctly."
Question: "What additional benefits and wellness rewards are available?"
Modern PMI is evolving beyond just paying for treatment. Many policies now include proactive health and wellness benefits.
The Best Answer a Broker Should Give: "Many top-tier policies now include fantastic wellness benefits to help you stay healthy. These can include:
- Discounted gym memberships.
- Wearable tech offers (like Apple Watch or Garmin).
- Points and rewards for healthy activities.
- Digital GP services for 24/7 access to a doctor.
- Mental health support lines and apps.
For instance, at WeCovr, all our health and life insurance clients receive complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to support their health goals. Furthermore, when you take out a PMI policy with us, we can often provide you with discounts on other crucial cover like life insurance or income protection, helping you build a comprehensive financial safety net."
Question: "How will my premium change over the years?"
It's vital to understand that your premium will not stay the same forever. A transparent broker will explain the factors that cause increases.
The Best Answer a Broker Should Give: "Your premium is likely to increase each year for three main reasons:
- Age: As we get older, the statistical risk of needing medical treatment increases, so your age-related price will rise at each renewal.
- Medical Inflation: The cost of medical technology, drugs, and hospital services generally rises faster than standard inflation. This is usually around 8-10% per year.
- Claims: If you make a claim, it will likely reduce your No-Claims Discount, leading to a higher premium the following year.
Our job is to review your cover each year to ensure it still represents good value. If your renewal price is too high, we can re-broke the market for you to see if another insurer can offer better terms."
Final Checks Before You Commit
Before signing on the dotted line, run through this final checklist with your broker:
- Confirm the exact monthly premium.
- Re-read the policy summary, paying close attention to the list of exclusions.
- Understand the cooling-off period (usually 14 days), during which you can cancel without penalty.
- Ask for the claims line number and save it in your phone.
Choosing private medical insurance is a partnership between you, your broker, and the insurer. By asking these questions, you empower yourself to make an informed choice, ensuring the policy you buy is the one that will truly be there for you when you need it most.
Can I get health insurance to cover a pre-existing condition?
Is private medical insurance worth it in the UK?
Do I always need a GP referral to use my private health insurance?
Ready to find the right private health cover for your needs? The expert team at WeCovr is here to provide free, impartial advice and compare leading UK insurers for you.
[Get Your Free, No-Obligation Quote Today and let us demystify the world of PMI for you.]
Sources
- NHS England: Waiting times and referral-to-treatment statistics.
- Office for National Statistics (ONS): Health, mortality, and workforce data.
- NICE: Clinical guidance and technology appraisals.
- Care Quality Commission (CQC): Provider quality and inspection reports.
- UK Health Security Agency (UKHSA): Public health surveillance reports.
- Association of British Insurers (ABI): Health and protection market publications.











