TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr specialises in private medical insurance in the UK. Leaving work is a major life milestone, but it often means losing company health benefits. This guide explains how you can secure your health cover and maintain peace of mind in retirement.
Key takeaways
- It's an Employment Benefit: The policy is an agreement between your employer and the insurance provider. Your eligibility is directly tied to your status as an employee. Once you retire, you are no longer part of that group, and your cover under that specific agreement ends.
- Cost Dynamics: Employers secure favourable rates by insuring a group of people, which spreads the risk for the insurer. The group usually includes a mix of ages, with younger, healthier employees balancing the higher risk associated with older ones. A personal policy for a retiree is assessed on an individual basis, which naturally changes the cost.
- Administrative Simplicity: For an employer, managing a list of current employees is straightforward. Extending this to cover a growing number of retirees would create significant administrative and financial burdens.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire, declaring your full medical history. The insurer assesses this and tells you upfront what is covered and what is excluded. It provides clarity from day one.
- Moratorium Underwriting (Mori): You don't fill out a health questionnaire. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the past 5 years. This exclusion is typically for the first 2 years of the policy. If you remain symptom-free for that condition for a continuous 2-year period after your policy starts, the insurer may then cover it.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr specialises in private medical insurance in the UK. Leaving work is a major life milestone, but it often means losing company health benefits. This guide explains how you can secure your health cover and maintain peace of mind in retirement.
WeCovr explains how to maintain PMI standards after leaving an employer scheme
Retirement is often called the "golden years," a time for well-earned rest, travel, and hobbies. However, for many, the transition from employment brings an unwelcome surprise: the loss of company-sponsored private medical insurance (PMI). Suddenly, the safety net that provided fast access to specialists and private hospitals is gone, precisely when health concerns may become more prominent.
The good news is that you don't have to face a future of relying solely on an often-stretched NHS. With careful planning, you can transition seamlessly from a group scheme to a personal policy, often maintaining the level of cover you've become accustomed to.
This comprehensive guide will walk you through your options, explain the industry jargon in plain English, and empower you to make the best decision for your health and finances in retirement.
Why Does Company Health Insurance End at Retirement?
Understanding why your cover ceases is the first step to finding a solution. Company health insurance is typically offered as a "group scheme," which is a single policy that covers a group of employees.
Here’s why it ends when you leave your job:
- It's an Employment Benefit: The policy is an agreement between your employer and the insurance provider. Your eligibility is directly tied to your status as an employee. Once you retire, you are no longer part of that group, and your cover under that specific agreement ends.
- Cost Dynamics: Employers secure favourable rates by insuring a group of people, which spreads the risk for the insurer. The group usually includes a mix of ages, with younger, healthier employees balancing the higher risk associated with older ones. A personal policy for a retiree is assessed on an individual basis, which naturally changes the cost.
- Administrative Simplicity: For an employer, managing a list of current employees is straightforward. Extending this to cover a growing number of retirees would create significant administrative and financial burdens.
According to the Office for National Statistics (ONS), the population of those aged 65 and over is projected to grow significantly in the coming decades. This demographic shift underscores the importance of planning for healthcare needs post-employment, as public services face increasing demand.
Your Key Options for Private Health Cover After Leaving Work
When your company cover ends, you're faced with a critical choice. You essentially have three main paths to continue your private medical insurance journey. Each has distinct advantages and disadvantages, especially for retirees.
Option 1: The 'Continuation' or 'Group Leaver' Scheme
This is often the most straightforward option. Many company schemes have a "continuation" or "group leaver" clause that allows you to take your cover with you when you leave. You essentially convert your membership from the group policy to a personal one with the same insurer.
How it Works: You typically need to inform the insurer within a short window (e.g., 30-60 days) of leaving your job. You'll receive a quote for a personal policy, and if you accept, your cover continues without any new medical underwriting.
| Pros of a Continuation Scheme | Cons of a Continuation Scheme |
|---|---|
| ✅ No New Medical Underwriting: This is the biggest benefit. Any conditions that were covered under your company scheme will continue to be covered. | ❌ Potentially Higher Cost: You lose the group discount, so the personal premium can be significantly higher than what you (or your employer) paid before. |
| ✅ Seamless Cover: There are no gaps in your protection. You don't need to worry about the 2-year moratorium period that comes with some new policies. | ❌ Tied to One Insurer: You cannot shop around for a better deal. You are stuck with the benefits, hospital lists, and pricing of your previous insurer. |
| ✅ Simple and Fast: The process is usually very quick and requires minimal paperwork. | ❌ Limited Flexibility: You may not be able to change your level of cover easily. The policy might be a "one-size-fits-all" conversion. |
Real-Life Example: David, 66, has been treated for knee pain under his company PMI with Bupa. He retires and opts for Bupa's continuation scheme. Because there is no new underwriting, his future knee treatments (such as a potential hip replacement) remain covered. If he had started a new policy, his knee would have been classed as a pre-existing condition and excluded.
Option 2: Switching Your Policy with Continued Personal Medical Exclusions (CPME)
CPME is a savvy way to shop the market while protecting the cover you've built up. It's a "middle-ground" option that allows you to move to a new insurer while keeping the same underwriting terms you had on your old policy.
How it Works: With CPME, the new insurer agrees to take you on with the same medical exclusions you had before. Any condition that was covered by your old policy will be covered by the new one. Any condition that was excluded by the old policy will remain excluded.
| Pros of a CPME Switch | Cons of a CPME Switch |
|---|---|
| ✅ Access to the Whole Market: You can compare prices and benefits from multiple insurers to find a better deal or a policy that better suits your retirement needs. | ❌ More Complex: This requires more paperwork. You'll need your policy documents from your previous insurer to prove your underwriting terms. |
| ✅ Keep Your Continuous Cover: Like a continuation scheme, you avoid new medical underwriting for conditions that were already covered. | ❌ Not All Insurers Offer It: While common, not every insurer offers CPME terms, which might limit your choices slightly. |
| ✅ Potential for Big Savings: By switching, you could find a policy with similar benefits for a much lower premium. | ❌ Exclusions are Carried Over: If your old policy had a specific exclusion (e.g., for back problems), that exclusion will follow you to the new policy. |
Working with a specialist PMI broker like WeCovr is highly recommended for a CPME switch. We can handle the comparison and paperwork, ensuring the transition is smooth and that no cover is accidentally lost.
Option 3: Starting a New Policy with Fresh Underwriting
This means starting from scratch with a brand-new policy. This can be a good option if you are in excellent health and had no significant claims on your company policy. You will be subject to new medical underwriting.
There are two main types of underwriting for new policies:
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire, declaring your full medical history. The insurer assesses this and tells you upfront what is covered and what is excluded. It provides clarity from day one.
- Moratorium Underwriting (Mori): You don't fill out a health questionnaire. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the past 5 years. This exclusion is typically for the first 2 years of the policy. If you remain symptom-free for that condition for a continuous 2-year period after your policy starts, the insurer may then cover it.
| Full Medical Underwriting (FMU) | Moratorium (Mori) Underwriting |
|---|---|
| Process: You declare your medical history on a form. | Process: No initial health questions asked. |
| Clarity: You know exactly what is and isn't covered from the start. | Clarity: Can be ambiguous. A claim may be delayed or denied while the insurer investigates your 5-year history. |
| Best For: People who want certainty and have a clear medical history. | Best For: People in good health who want a quick start and don't want to fill out forms. |
| Exclusions: Exclusions are specific and permanent (unless successfully reviewed later). | Exclusions: Exclusions are general and may be temporary. |
Crucial Warning: With either FMU or Moratorium, any health issues you had before the new policy starts will be considered pre-existing conditions and will not be covered. This is the single biggest risk of starting a new policy in retirement.
The Crucial Role of Underwriting for Retirees
Underwriting is the process insurers use to assess risk and decide whether to offer you a policy and on what terms. For retirees, this is the most critical concept to grasp.
Acute vs. Chronic Conditions: The Golden Rule of PMI
UK private medical insurance is designed to cover acute conditions, not chronic conditions. Understanding this difference is essential.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, joint replacement, or treating an infection. PMI excels here, providing fast access to diagnosis and treatment.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, has no known cure, is likely to recur, or requires palliative care. Examples include diabetes, high blood pressure, asthma, and arthritis.
Standard UK PMI does not cover the routine, long-term management of chronic conditions. Your policy may cover the initial diagnosis of a chronic condition (the acute phase), but once it's diagnosed and a long-term management plan is in place, the care typically reverts to the NHS.
| What UK Private Medical Insurance Typically Covers | What UK Private Medical Insurance Typically Excludes |
|---|---|
| ✅ New, acute conditions that arise after your policy starts | ❌ Pre-existing conditions (from before your policy began) |
| ✅ Surgical procedures (e.g., hip/knee replacement, cataract surgery) | ❌ Management of long-term, chronic conditions (e.g., diabetes, asthma) |
| ✅ Consultations with specialists for new symptoms | ❌ Routine check-ups, screening, and preventative treatment |
| ✅ Advanced cancer treatment (drugs and therapies not always on the NHS) | ❌ Cosmetic surgery, unless reconstructive |
| ✅ Diagnostic tests and scans (MRI, CT, PET) for eligible conditions | ❌ A&E visits, drug and alcohol abuse treatment, fertility issues |
| ✅ In-patient and day-patient hospital stays | ❌ Unproven or experimental treatments |
How to Choose the Best PMI Provider for Your Retirement
With the market full of options, choosing the right provider can feel overwhelming. The "best" provider is the one that offers the right balance of benefits, hospital access, and price for your specific needs.
Key Factors to Compare
When evaluating policies, don't just look at the monthly premium. Dig deeper into these key features:
- Hospital List: Insurers offer different tiers of hospital access. A "national" list will include most private hospitals, while a "local" or "limited" list might exclude premium hospitals in central London to reduce costs. Check that your preferred local hospitals are on the list.
- Outpatient Cover: This covers consultations and diagnostics that don't require a hospital bed. Policies can range from no outpatient cover to a limited cash amount (£500, £1,000) or full cover. A good level of outpatient cover is crucial for getting a fast diagnosis.
- Cancer Cover: This is a cornerstone of modern PMI. Check the details carefully. Most top-tier policies offer comprehensive cover, including access to drugs and treatments not available on the NHS.
- Excess Level: This is the amount you agree to pay towards any claim. A higher excess (e.g., £250, £500, or £1,000) will significantly lower your premium. You can choose an excess "per claim" or "per year."
- No-Claims Discount (NCD): Similar to car insurance, your premium can be reduced each year you don't make a claim. Check the insurer's NCD scale to see how much you can save.
- Therapies Cover: Check the limits for treatments like physiotherapy, which can be vital for recovery from surgery or injury.
A Look at Major UK Health Insurers
Here is a brief overview of some of the leading providers in the UK market. An expert broker can provide a detailed comparison based on your needs.
| Provider | Key Feature / Focus | Example of a Common Benefit |
|---|---|---|
| Aviva | Strong all-around cover with a reputation for excellent customer service and comprehensive cancer care. | Often includes a "Six Week Option" which can lower premiums. |
| AXA Health | Known for flexible policies and a strong focus on mental health support and digital GP services. | Guided option where AXA helps choose the specialist can reduce costs. |
| Bupa | One of the most recognised names, offering extensive hospital networks and direct settlement with many facilities. | Offers comprehensive cancer cover with no time limits on eligible treatment. |
| Vitality | Unique approach that rewards healthy living with discounts and benefits, including lower premiums. | Active Rewards programme offers cinema tickets, coffee, and more for being active. |
| The Exeter | A Friendly Society known for its flexible underwriting and consideration of some pre-existing conditions on certain policies. | Often favoured by those with some prior medical history. |
Managing Costs: How to Make PMI Affordable in Retirement
The biggest concern for retirees is cost. With a fixed income, a high monthly premium can be a strain. Fortunately, there are many ways to tailor a policy to make it more affordable without sacrificing quality.
- Increase Your Excess: Choosing a higher excess is the most effective way to lower your premium. If you have some savings, you could opt for a £1,000 excess, knowing you'd only pay it if you need to make a claim.
- Opt for a 6-Week Wait Option: This is a popular cost-saving feature. With this option, your PMI will only kick in if the NHS waiting list for the in-patient treatment you need is longer than six weeks. If the NHS can treat you within six weeks, you use the NHS. This can reduce premiums by 20-30%.
- Choose a Limited Hospital List: Unless you need access to prime central London hospitals, choosing a more restricted list that covers excellent hospitals near you can generate significant savings.
- Review Your Outpatient Cover: While full outpatient cover is ideal, reducing it to a set amount (e.g., £1,000 per year) can be a good compromise. This is usually enough to cover the initial consultations and diagnostics to get the ball rolling.
- Talk to a Broker: An independent broker like WeCovr has access to the whole market. We can compare dozens of policies and use our expertise to find hidden discounts and build a policy that fits your budget perfectly, at no extra cost to you.
Beyond Insurance: A Proactive Approach to Health in Retirement
While having the right insurance is crucial, the best way to manage your health and keep premiums down is to stay healthy. Retirement offers a fantastic opportunity to focus on your wellbeing.
- Nourish Your Body: A balanced diet rich in fruit, vegetables, lean protein, and whole grains is vital. The NHS recommends aiming for at least five portions of fruit and veg a day. Staying hydrated is also key for energy and organ function.
- Stay Active: The NHS guidelines for adults aged 65 and over recommend at least 150 minutes of moderate-intensity activity a week (like brisk walking) or 75 minutes of vigorous-intensity activity (like jogging). Include activities that improve strength, balance, and flexibility.
- Prioritise Sleep: Good sleep is restorative for both mind and body. Aim for 7-9 hours per night and establish a regular sleep routine.
- Stay Socially Connected: Loneliness can have a significant negative impact on health. Make time for friends, family, local clubs, or volunteering to keep your mind sharp and spirits high.
- Travel Smart: If you plan to travel, check your PMI policy. Most UK policies only cover treatment in the UK. You will still need separate travel insurance for medical emergencies abroad.
As a WeCovr customer, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help you on your wellness journey. Furthermore, clients who purchase PMI or Life Insurance through us are often eligible for discounts on other types of cover, such as home or travel insurance.
The WeCovr Advantage: Why Use a Broker for Your Retirement PMI?
Navigating the transition from a company scheme to a personal policy can be complex. Using an independent, FCA-authorised broker like WeCovr simplifies the entire process and provides numerous benefits, especially for retirees.
- Expert, Impartial Advice: We are not tied to any single insurer. Our only goal is to find the best policy for you. We explain the pros and cons of every option.
- Market-Wide Comparison: We use our technology and expertise to compare policies from all the leading UK providers, saving you hours of research.
- No Cost to You: Our service is free. We are paid a commission by the insurer you choose, which is already built into the premium. You pay the same price as going direct, but you get our expert guidance included.
- Help with Applications: Whether you are choosing a Continuation, CPME, or a new policy, we help with the paperwork to ensure it's completed correctly.
- High Customer Satisfaction: We pride ourselves on clear communication and exceptional service, which is reflected in our high customer satisfaction ratings.
- Annual Reviews: At renewal, we don't just let your policy roll over. We will re-evaluate the market to ensure you are still on the best possible plan for your needs and budget.
Frequently Asked Questions (FAQs)
Do I need to have a medical examination to get health insurance in retirement?
Will my private medical insurance premiums increase every year?
- Age: As you get older, the statistical risk of needing medical treatment increases, so insurers adjust premiums accordingly on your birthday.
- Medical Inflation: The cost of new medical technologies, drugs, and hospital fees tends to rise faster than general inflation. This is passed on to the premiums.
- Claims History: If you have made a claim on your policy, it may affect your no-claims discount, leading to a higher premium at renewal.
What happens if I develop a chronic condition like diabetes after I've bought my policy?
Can I add my spouse or partner to my new individual health insurance policy?
Secure Your Health and Peace of Mind in Retirement
Leaving a company health scheme doesn't have to mean leaving quality healthcare behind. By understanding your options—Continuation, CPME, or a new policy—you can take control of your health cover for the years ahead. The right private medical insurance policy gives you the security of knowing that should you need eligible treatment, you can access it quickly, comfortably, and with a specialist of your choice.
Ready to explore your options and find the perfect private health cover for your retirement?
Contact WeCovr today for a free, no-obligation quote. Our expert advisors are ready to help you compare the market and secure your peace of mind.












