TL;DR
Navigating the UK's private medical insurance market can feel overwhelming, but it doesn't have to be. As experienced brokers who have helped arrange cover for tens of thousands of individuals and businesses, WeCovr is here to provide the definitive guide on how to get private health insurance and choose the right policy for you. How to get private health insurance in the UK and choose the right level of cover Getting private health insurance is a significant decision that gives you more control over your healthcare.
Key takeaways
- Chronic Conditions: These are long-term illnesses that cannot be cured, only managed. Examples include diabetes, asthma, arthritis, and high blood pressure. While the initial diagnosis might be covered, the ongoing management is not.
- Pre-existing Conditions: Any illness or injury you had symptoms of, received advice for, or were treated for before the policy started. Some policies may cover them after a set period, which we'll explain in the underwriting section.
- Emergency Services: A&E visits and emergency treatment remain the responsibility of the NHS.
- Normal Pregnancy & Childbirth: Though complications are often covered.
- Cosmetic Surgery, Organ Transplants, and Self-inflicted Injuries.
Navigating the UK's private medical insurance market can feel overwhelming, but it doesn't have to be. As experienced brokers who have helped arrange cover for tens of thousands of individuals and businesses, WeCovr is here to provide the definitive guide on how to get private health insurance and choose the right policy for you.
How to get private health insurance in the UK and choose the right level of cover
Getting private health insurance is a significant decision that gives you more control over your healthcare. This comprehensive guide will walk you through every step, from understanding what a policy covers to comparing providers and selecting the perfect level of protection for your needs and budget. We'll demystify the jargon, highlight common pitfalls, and show you the smartest way to buy.
What is Private Medical Insurance (PMI)? A Clear Definition
Private Medical Insurance (PMI), also known as private health cover, is an insurance policy designed to cover the costs of private medical treatment for acute conditions that arise after your policy begins.
An acute condition is 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, or treatment for a hernia.
Crucially, standard UK PMI does not cover:
- Chronic Conditions: These are long-term illnesses that cannot be cured, only managed. Examples include diabetes, asthma, arthritis, and high blood pressure. While the initial diagnosis might be covered, the ongoing management is not.
- Pre-existing Conditions: Any illness or injury you had symptoms of, received advice for, or were treated for before the policy started. Some policies may cover them after a set period, which we'll explain in the underwriting section.
- Emergency Services: A&E visits and emergency treatment remain the responsibility of the NHS.
- Normal Pregnancy & Childbirth: Though complications are often covered.
- Cosmetic Surgery, Organ Transplants, and Self-inflicted Injuries.
Think of PMI as a way to bypass NHS waiting lists for eligible, non-emergency treatments, giving you fast access to specialists, comfortable private facilities, and greater choice over your care.
Do I Really Need Private Health Insurance in the UK?
The UK is fortunate to have the National Health Service (NHS), providing free healthcare to all residents. So, is PMI a necessity? For most, it's a choice, not a requirement. The decision often comes down to weighing the benefits against the cost.
According to the latest NHS England data, the median waiting time for consultant-led elective care is around 14 weeks, with hundreds of thousands of patients waiting over a year for treatment.
Reasons people choose to get private health insurance:
- Speed of Access: Avoid long NHS waiting lists for consultations, diagnostics, and surgery.
- Choice and Control: Choose your specialist, consultant, and hospital from an approved list.
- Comfort and Privacy: Access to a private room, often with an en-suite bathroom, better food, and more flexible visiting hours.
- Access to Specialist Drugs & Treatments: Some policies provide cover for drugs or treatments not yet available on the NHS due to cost or pending approval.
- Peace of Mind: Knowing you have a plan in place if you or your family fall ill.
| Benefit of PMI | NHS Provision |
|---|---|
| Speed | Long waiting lists for non-urgent care |
| Choice of Hospital | Treatment at a designated NHS hospital |
| Choice of Consultant | Assigned an NHS consultant |
| Accommodation | Typically a shared ward |
| Specialist Drugs | Limited to NICE-approved treatments |
For self-employed individuals or business owners, the ability to get back to work quickly without a long, debilitating wait can make PMI an essential business expense.
The 3 Ways to Get Private Health Insurance
There are three primary routes to securing private health cover in the UK.
- Through an Employer's Scheme: Many companies offer PMI as a valuable employee benefit. This is often the most cost-effective way to get cover, as premiums are spread across a large group. However, you have limited choice over the insurer and the level of cover.
- Directly from an Insurer: You can approach insurers like Bupa, AXA Health, or Aviva directly. While this seems straightforward, you will only see their products and prices. You won't know if a competitor offers better value or more suitable cover for your specific needs.
- Through an Independent Broker (Recommended): This is the most effective way for individuals and families to buy the right policy. A specialist PMI broker, like WeCovr, works on your behalf.
Why use a broker?
- Whole-of-Market Access: We compare policies from all leading UK insurers.
- Expert Advice: We explain the complex options in plain English, ensuring you don't overpay or under-insure.
- No Extra Cost: Our service is free to you. We are paid a commission by the insurer you choose, which is already built into the premium, whether you buy direct or through us.
- Personalised Recommendations: We tailor our search to your specific health needs, lifestyle, and budget.
An expert broker provides the market knowledge and impartial advice you can't get by going direct.
Step-by-Step Guide: How to Buy Your First PMI Policy
Follow these steps to find and secure the right private health insurance policy.
- Assess Your Needs: Think about why you want cover. Is it for fast access to surgery? Comprehensive cancer care? Mental health support? Who do you need to cover – just yourself, a partner, or your children?
- Set a Realistic Budget: Decide how much you can comfortably afford each month. Premiums can range from £30 to over £150 per person, depending on many factors. Knowing your budget helps narrow down the options.
- Speak to an Independent Broker: This is the most crucial step. Contact a specialist firm like WeCovr. Our advisers will conduct a fact-find to understand your requirements fully.
- Compare Personalised Quotes: Your broker will present you with a shortlist of suitable policies from different insurers. They will explain the differences in cover, hospital lists, and excesses.
- Choose Your Underwriting Method: Decide between Moratorium and Full Medical Underwriting (we explain this next). Your broker will advise on the best option based on your medical history.
- Review the Policy Documents: Carefully read the Key Facts document and the full policy wording. Pay close attention to the list of exclusions. Your broker will highlight the important sections for you.
- Complete the Application: Once you're happy, your broker will help you complete the application and set up your payment. Your cover will start on an agreed date.
Understanding Your Policy: Core Cover vs. Optional Extras
PMI policies are built in a modular way. You start with core cover and then add optional extras to create a policy that suits you.
Core Cover: Almost every UK PMI policy includes in-patient and day-patient treatment as standard.
- In-patient: Treatment that requires a stay in a hospital bed overnight.
- Day-patient: Treatment that requires a hospital bed for the day but not an overnight stay (e.g., a minor surgical procedure).
This core cover typically includes surgeons' and anaesthetists' fees, hospital charges, and specialist consultations while you are admitted to hospital. Comprehensive cancer cover is also often included as standard or as a mandatory upgrade.
Popular Optional Extras: This is where you tailor the policy to your needs and budget.
| Optional Extra | What It Covers | Who Is It For? |
|---|---|---|
| Out-patient Cover | Consultations, diagnostic tests (MRI, CT scans), and therapies that do not require a hospital bed. | Essential for speeding up diagnosis. Without it, you rely on the NHS to get a referral for private treatment. |
| Therapies Cover | Physiotherapy, osteopathy, chiropractic treatment, etc. | Ideal for those with active lifestyles or who want quick access to treatment for musculoskeletal issues. |
| Mental Health Cover | Access to psychiatrists, psychologists, and therapists for conditions like anxiety and depression. | Increasingly important for comprehensive wellbeing. Cover levels vary significantly between insurers. |
| Dental & Optical | Routine check-ups, fillings, eye tests, and contributions towards glasses or contact lenses. | A useful add-on for managing routine healthcare costs, but often has low annual limits. |
| Extended Hospital List | Access to premium hospitals, particularly in Central London (e.g., The Lister, The London Clinic). | For those who want maximum choice and access to top-tier facilities, but it significantly increases premiums. |
Adviser Tip: The most valuable add-on is out-patient cover. Without it, you must use the NHS for all your diagnostics and consultations, which can defeat the primary purpose of PMI: speed of access.
Choosing the Right Level of Cover: A Practical Framework
There's no "one-size-fits-all" policy. The right cover depends on your life stage, health, and priorities.
-
For a Young, Healthy Professional (Under 30):
- Focus: Protect against unexpected injuries or illnesses that could impact work.
- Recommended Cover: A mid-range policy with core cover, full out-patient cover, and perhaps therapies cover. A higher excess (£500) can keep costs down. A regional hospital list is usually sufficient.
-
For a Family with Young Children:
- Focus: Peace of mind for the whole family, ensuring children can be seen quickly.
- Recommended Cover: A comprehensive policy with full out-patient cover. Consider adding mental health support. Check if the policy offers benefits like a private GP helpline or virtual GP service.
-
For a Pre-Retiree or Retiree (55+):
- Focus: Comprehensive cover for age-related conditions like joint issues, cataracts, and heart conditions. Access to the best consultants is a priority.
- Recommended Cover: A comprehensive policy with full out-patient cover and a national hospital list. A lower excess might be preferable. Cancer cover is paramount.
When you speak to a WeCovr adviser, we help you build a policy based on these personal scenarios, ensuring you only pay for the cover you truly need.
How Underwriting Affects Your Cover and Price
Underwriting is how an insurer assesses your medical history to decide what they will and won't cover. This is one of the most critical parts of the application. There are two main types in the UK.
| Underwriting Type | How It Works | Pros | Cons |
|---|---|---|---|
| Moratorium (Mori) | You don't declare your full medical history upfront. Instead, the insurer automatically excludes any condition you've had symptoms of, or treatment for, in the 5 years before your policy started. However, if you then go 2 continuous years on the policy without any symptoms, treatment, or advice for that condition, the exclusion may be lifted. | Quick and easy to set up. Less intrusive paperwork. | Lack of certainty. A claim can be delayed or denied while the insurer investigates your history. "Rolling" moratoriums can be complex. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire, declaring your full medical history. The insurer assesses it and tells you upfront exactly what is and isn't covered via specific exclusions on your policy certificate. | Complete clarity from day one. You know exactly where you stand. Claims are often processed faster. | The application process takes longer. Pre-existing conditions will be permanently excluded unless specifically agreed. |
Which should you choose?
- Moratorium is popular for its simplicity. It's often suitable for those with a clean or simple medical history.
- Full Medical Underwriting is better for those who want absolute certainty or have a more complex medical history. It allows for a clear dialogue with the insurer.
A broker's guidance is invaluable here to prevent future disappointment at the point of claim.
The Real Cost of Private Health Insurance in 2026
The cost of a PMI policy is highly personal. Below are some illustrative examples of monthly premiums for a non-smoker on a mid-range policy (full out-patient cover, £250 excess).
| Age | Location (Postcode) | Indicative Monthly Premium |
|---|---|---|
| 30 | Manchester (M1) | £55 |
| 30 | Central London (SW1) | £75 |
| 45 | Bristol (BS1) | £80 |
| 45 | Central London (SW1) | £105 |
| 60 | Edinburgh (EH1) | £150 |
| 60 | Central London (SW1) | £200+ |
These are estimates for illustrative purposes only. Your actual premium will depend on the insurer and your specific circumstances.
As you can see, age and location are two of the biggest drivers of cost.
Key Factors That Influence Your PMI Premium
- Age: The single biggest factor. Premiums increase as you get older because the statistical risk of claiming increases.
- Location: Treatment costs vary across the UK. Living in or near Central London, where hospital costs are highest, will result in higher premiums.
- Level of Cover: The more optional extras you add (especially out-patient and therapies), the higher the cost.
- Excess: This is the amount you agree to pay towards a claim each year. A higher excess (£500 or £1,000) will lower your premium, while a lower excess (£100 or £0) will increase it.
- Hospital List: Insurers offer tiered hospital lists. A list that excludes expensive central city hospitals will be cheaper than a comprehensive national list.
- No-Claims Discount (NCD): Similar to car insurance, your premium will be discounted for every year you don't make a claim, often up to 60-75%.
- Underwriting: In some cases, FMU can be slightly cheaper than Moratorium as the insurer has a clearer picture of the risk they are taking on.
WeCovr helps you balance these factors to find a price point you are comfortable with without sacrificing essential cover. We also offer our clients discounts on other insurance products, like life or income protection, and complimentary access to our AI-powered calorie tracking app, CalorieHero, to support your health journey.
Comparing the UK's Leading Private Health Insurance Providers
The UK PMI market is dominated by a few key players, each with its own strengths.
| Provider | Known For | Key Feature/Focus |
|---|---|---|
| Bupa | The UK's largest and most well-known provider. | Strong hospital network and comprehensive cancer cover. Trusted brand. |
| AXA Health | A major global insurer with a strong UK presence. | Excellent digital tools (Doctor@Hand) and a focus on customer support. |
| Aviva | The UK's largest general insurer, with a strong PMI offering. | Often very competitive on price. Good value for money. The "Aviva Digital GP" app is highly rated. |
| Vitality | A unique approach focused on wellness and rewards. | The Vitality Programme rewards healthy living (gym visits, activity tracking) with premium discounts and other perks. |
| WPA | A not-for-profit insurer known for flexible policies. | Praised for customer service and offering unique benefits like shared responsibility, where you co-pay a percentage of each claim. |
A broker's job is not to favour one insurer, but to find the one whose product best matches your unique needs at the most competitive price.
Common Mistakes to Avoid When Buying PMI
- Focusing Only on Price: The cheapest policy is rarely the best. It may have a restrictive hospital list, no out-patient cover, or high penalties for claiming.
- Not Understanding Underwriting: Choosing the wrong underwriting can lead to claims being rejected for conditions you thought were covered.
- Ignoring the Hospital List: If your chosen policy doesn't include the hospitals in your area, your cover is of little use.
- Assuming Everything is Covered: All policies have exclusions. It's vital to read and understand them.
- Buying Direct without Comparing: You miss out on expert advice and the ability to see if a competitor offers a better deal for the same or less money.
How to Make a Claim on Your Private Health Insurance
Making a claim is more straightforward than many people think.
- Visit Your GP: The first step is always to see your NHS or private GP. They will assess your symptoms.
- Get an Open Referral: If they believe you need to see a specialist, ask for an 'open referral'. This gives your insurer the flexibility to help you choose a specialist from their approved network.
- Contact Your Insurer: Call your insurer's claims line with your policy number and the details of your referral.
- Authorisation: The insurer will check that your condition is covered and pre-authorise the consultation and any subsequent tests or treatment. They will give you an authorisation number.
- Book Your Appointment: You can now book your appointment with the authorised specialist. The hospital and specialist will usually bill the insurer directly.
Get Your Personalised PMI Quote with WeCovr
Choosing the right private medical insurance is one of the most important decisions you can make for your health and wellbeing. It provides security, choice, and fast access to care when you need it most.
The journey doesn't need to be complex. By partnering with an expert, independent broker like WeCovr, you gain a trusted adviser who will navigate the market on your behalf, ensuring you get the right cover from the right provider at the best possible price.
Our advice is completely free, and our team is ready to help you build a policy that gives you total peace of mind.
Ready to take control of your healthcare? Contact us today for your free, no-obligation comparison quote.
