
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr understands the UK private medical insurance market inside and out. This guide explains the significant benefits of employer-provided PMI for employees, demystifying how these increasingly popular schemes work and what they mean for your health.
Employer-provided Private Medical Insurance (PMI), often called a group or corporate health scheme, is a health insurance policy purchased by a company to provide private healthcare access for its employees. It acts as a highly valued employee benefit, sitting alongside pensions and other workplace perks.
So, why the recent surge in popularity? The answer lies in a combination of factors, most notably the unprecedented pressure on our cherished National Health Service (NHS).
According to the latest NHS England data, the referral to treatment (RTT) waiting list remains a significant concern, with millions of people waiting for routine consultant-led treatment. In mid-2024, this figure stood at around 7.5 million. This landscape has prompted employers to seek alternative ways to ensure their staff can access medical care quickly, minimising health-related anxiety and time off work.
For employees, this means a company-funded PMI scheme is no longer a 'nice-to-have' but a profoundly important benefit that offers peace of mind and tangible health advantages.
Understanding how your workplace health cover operates is the first step to making the most of it. It’s simpler than you might think.
Think of a group PMI policy as a single health insurance umbrella that covers a whole team of people – the employees of a company. Instead of each individual applying for and paying for their own policy, the employer handles the entire process.
The primary goal is to give you and your colleagues faster access to diagnosis and treatment for acute medical conditions that arise after you join the policy. An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery.
The process from feeling unwell to receiving private treatment is typically very straightforward:
Being a member of a group PMI scheme offers a wealth of advantages that directly impact your health, wellbeing, and finances.
This is arguably the most significant benefit. While the NHS provides excellent emergency care, waiting times for non-urgent diagnostics and surgery can be lengthy. Group PMI allows you to bypass these queues for eligible conditions.
Your health policy gives you a level of control that isn't always possible within the public system. You can often choose:
Private medical insurance can sometimes provide access to breakthrough drugs, treatments, or surgical techniques that are not yet approved by the National Institute for Health and Care Excellence (NICE) for widespread NHS use, often due to cost considerations. This can be particularly crucial in fields like oncology (cancer treatment).
Modern PMI policies place a huge emphasis on mental wellbeing. Most group schemes now include valuable mental health support as standard, such as:
This proactive support helps employees address mental health concerns early before they escalate.
Knowing you have a safety net in place for unexpected health issues provides immense peace of mind. You don't have to worry about the potential cost of private treatment, which can run into thousands or even tens of thousands of pounds. This reduces stress for both you and your family during an already difficult time.
It's vital to know the scope of your cover. While policies vary between insurers and the level chosen by your employer, most follow a similar structure.
Most comprehensive policies are built around "core cover" and may include optional extras selected by your employer.
| Coverage Type | Description |
|---|---|
| In-patient & Day-patient | Covers tests and treatment where you need to be admitted to a hospital bed, either overnight (in-patient) or for the day (day-patient). This includes surgery, hospital accommodation, and nursing care. |
| Out-patient Cover | Covers diagnostic tests and consultations with a specialist where you are not admitted to hospital. Policies usually have an annual limit for this, e.g., £1,000 per year. |
| Comprehensive Cancer Cover | This is a cornerstone of most policies. It typically covers the diagnosis and treatment of cancer, including surgery, chemotherapy, and radiotherapy, often with no financial or time limits. |
| Mental Health Support | As mentioned, this often includes access to counselling, therapy sessions (e.g., CBT), and psychiatric care, though the extent of cover can vary. |
| Digital GP | 24/7 access to a GP by phone or video app for consultations, advice, and prescriptions. |
This is the most important concept to understand about private medical insurance in the UK.
PMI is designed to cover new, short-term (acute) conditions that arise after your policy begins. It is generally NOT designed to cover long-term (chronic) or pre-existing conditions.
There is, however, a major exception to the pre-existing condition rule, which is a key benefit of larger group schemes. This relates to the type of "underwriting" used.
To enhance the core policy, employers can add other benefits. Check your policy documents to see if you have:
"Underwriting" is the process an insurer uses to assess risk and decide what it will and will not cover. For group schemes, the method used depends largely on the size of the company.
| Underwriting Type | How It Works | Best For... | Impact on Pre-existing Conditions |
|---|---|---|---|
| Medical History Disregarded (MHD) | The insurer disregards everyone's previous medical history. No medical questionnaires are required to join. | Larger companies (typically 20+ employees). | This is the gold standard. It can cover eligible pre-existing conditions, making it a hugely valuable benefit. |
| Moratorium (Mori) | No medical questions upfront. Any condition you've had in the 5 years before joining is excluded for the first 2 years of the policy. If you remain symptom-free for that condition for a continuous 2-year period after joining, it may become eligible for cover. | Small to medium-sized businesses. | Pre-existing conditions are initially excluded. Cover may be possible later, subject to the "2-year rule". |
| Full Medical Underwriting (FMU) | Each employee completes a full health questionnaire. The insurer then lists specific exclusions for each member based on their medical history. | Very small businesses (2-5 employees) or individuals. | Pre-existing conditions are explicitly and permanently excluded from the outset. |
If your company has MHD underwriting, it is a significant perk, as it's the only common way to get private medical cover for a condition you already have.
While your employer pays for the policy, there are some financial implications for you as an employee.
For the most part, yes. Your employer pays the monthly or annual premium for your cover. If you choose to add your family (a spouse, partner, or children), you will almost certainly have to pay the additional premium for them, though this is often at a discounted corporate rate.
Because your employer is paying for a personal benefit for you, HM Revenue & Customs (HMRC) considers it a 'Benefit in Kind' – a non-cash benefit that forms part of your total remuneration. As such, it is subject to income tax.
This small extra tax is a very low price for access to private healthcare that could otherwise cost thousands.
An 'excess' is a fixed amount you agree to pay towards the cost of a claim. For example, if your policy has a £100 excess and your treatment costs £3,000, you pay the first £100 and the insurer pays the remaining £2,900.
Employers choose an excess level to help manage the overall cost of the policy premium. A higher excess leads to a lower premium. The excess is usually applied either per claim or per policy year.
Modern private health cover has evolved far beyond simply paying for hospital stays. Insurers now provide a suite of tools and incentives to encourage a proactive approach to health and wellbeing.
The ability to speak to a doctor on a video call at 8pm on a Sunday is a game-changer for busy people. It saves time, reduces anxiety, and helps you get advice quickly without taking time off work to visit a surgery.
Many insurers partner with popular gym chains to offer discounted memberships. They also provide sophisticated wellness apps that reward you for healthy behaviour like hitting step counts, practising mindfulness, or getting enough sleep.
This is a philosophy we share at WeCovr. That's why we provide our health and life insurance clients with complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help them build and maintain healthy habits.
Some premium-level schemes include a budget for regular health screenings. These tests can help detect potential issues like high cholesterol, blood pressure, or certain cancer markers at an early stage, enabling preventative action.
Your PMI policy is a brilliant backstop, but the best strategy is always prevention. Small, consistent lifestyle choices make a huge difference:
While your employer makes the final decision on a policy, understanding the market is complex. This is where an independent and impartial PMI broker adds immense value to your employer.
A specialist broker like WeCovr works for the client (your employer), not the insurance companies. Our role is to:
Our service is provided at no direct cost to our clients, as we are compensated by a commission from the insurer that is chosen. Furthermore, clients who purchase PMI or life insurance through WeCovr can benefit from discounts on other types of cover, adding even more value. WeCovr's commitment to clear, expert advice has earned us consistently high satisfaction ratings from our clients.
Let's look at a few examples of how a company PMI scheme works in practice.
Scenario 1: Sarah, the Marketing Manager. Sarah develops persistent knee pain that makes her daily commute difficult. Her GP suspects a torn meniscus and refers her for an MRI and an orthopaedic consultation. The NHS waiting time is 8 months. Using her company PMI, Sarah gets an MRI scan the same week and sees a top surgeon the week after. She has keyhole surgery within three weeks and is back at work, pain-free, after a short recovery period supported by private physiotherapy sessions included in her cover.
Scenario 2: David, the Software Engineer. David finds himself feeling overwhelmed and anxious due to a heavy workload. He's struggling to sleep and concentrate. He feels hesitant to talk to his manager. He remembers his PMI scheme includes a 24/7 mental health helpline. He makes a confidential call and is referred for a course of six virtual Cognitive Behavioural Therapy (CBT) sessions. The therapy gives him practical tools to manage his anxiety, improving his wellbeing and productivity without him ever needing to take time off.
Scenario 3: Maria and her Family. Maria's employer offers the option to add family members to the PMI scheme, and she pays extra to include her husband and two children. Her youngest son, aged four, is suffering from recurrent ear infections, and a specialist recommends he has grommets fitted. The waiting list for the procedure at their local hospital is over a year. Through the family's PMI policy, the procedure is carried out at a private hospital a month later, resolving his discomfort and preventing potential long-term hearing issues.
A group private medical insurance policy is one of the most valuable and reassuring benefits an employer can offer. It provides a direct route to fast, high-quality healthcare, protecting both your physical and mental wellbeing.
If you are an employee wanting to understand your cover better, or an employer considering setting up a scheme, expert advice is essential.
Contact the friendly, expert team at WeCovr today for a free, no-obligation discussion and quote. We'll help you navigate the private medical insurance UK market to find the perfect solution.






