TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside out. This guide demystifies how it works, giving you the confidence to protect your health and bypass NHS waiting lists for eligible treatments. From getting a quote to making a claim — WeCovr's step-by-step guide to private health insurance The UK is rightly proud of its National Health Service (NHS).
Key takeaways
- Speed: Bypass long NHS waiting lists for consultations, scans, and surgery.
- Choice: Select your specialist, consultant, and hospital from your insurer's approved list.
- Comfort: Access to private rooms, often with en-suite facilities, better food, and more flexible visiting hours.
- Access to Specialist Care: Quicker access to diagnostic tests like MRI and CT scans.
- Advanced Treatments: Some policies offer cover for drugs and treatments not yet available on the NHS due to cost or NICE (National Institute for Health and Care Excellence) approval delays.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands the UK private medical insurance market inside out. This guide demystifies how it works, giving you the confidence to protect your health and bypass NHS waiting lists for eligible treatments.
From getting a quote to making a claim — WeCovr's step-by-step guide to private health insurance
The UK is rightly proud of its National Health Service (NHS). It’s a world-class institution providing free healthcare at the point of need. However, with growing pressures and lengthening waiting lists, more people are turning to private medical insurance (PMI) for peace of mind and faster access to treatment.
But how does it all work? The world of insurance can seem complex, filled with jargon like 'moratoriums' and 'excesses'. This guide cuts through the noise. We'll walk you through the entire process, from figuring out what you need to making your first claim, step by simple step.
What is Private Medical Insurance (PMI)? A Health Safety Net
Think of private medical insurance as a health safety net running alongside the NHS. You pay a monthly or annual premium to an insurer. In return, if you develop a new, eligible medical condition after your policy starts, the insurer covers the costs of private diagnosis and treatment.
The Golden Rule of UK PMI: Private health insurance is designed to cover acute conditions. An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery.
This is the most crucial point to understand:
Standard private medical insurance in the UK does not cover pre-existing conditions or chronic conditions. A chronic condition is one that is long-lasting and often has no cure, such as diabetes, asthma, or high blood pressure. These will continue to be managed by the NHS.
The primary benefit of PMI is choice and speed. According to recent NHS England data, the waiting list for routine hospital treatment stood at around 7.5 million in 2024. With PMI, you can often see a specialist and receive treatment in a matter of weeks, not months or years.
Key reasons people buy private health cover:
- Speed: Bypass long NHS waiting lists for consultations, scans, and surgery.
- Choice: Select your specialist, consultant, and hospital from your insurer's approved list.
- Comfort: Access to private rooms, often with en-suite facilities, better food, and more flexible visiting hours.
- Access to Specialist Care: Quicker access to diagnostic tests like MRI and CT scans.
- Advanced Treatments: Some policies offer cover for drugs and treatments not yet available on the NHS due to cost or NICE (National Institute for Health and Care Excellence) approval delays.
Step 1: Getting Started – Understanding Your Needs
Before you even look at a quote, the first step is to think about what you actually need from a policy. A broker like WeCovr can guide you through this, but here are the key questions to ask yourself:
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Who needs cover?
- Individual: Just for you.
- Couple: For you and your partner.
- Family: For you, your partner, and your children (usually up to age 21, or 25 if in full-time education).
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What's your budget?
- PMI premiums can range from £30 a month for basic cover for a young person, to several hundred pounds for a comprehensive family policy. Be realistic about what you can comfortably afford each month.
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What level of cover do you want?
- Basic/Entry-Level: Primarily covers inpatient treatment (when you're admitted to a hospital bed overnight). It might have limits on outpatient diagnostics and consultations.
- Mid-Range: Offers more comprehensive inpatient cover and a decent allowance for outpatient services (e.g., £1,000-£1,500 for consultations and scans). This is the most popular level of cover.
- Comprehensive: Provides extensive cover for both inpatient and outpatient treatment, often with full cover for scans and tests. It may also include add-ons like dental, optical, and mental health support.
Think about what's most important to you. Is it just about covering the cost of surgery if needed? Or do you want peace of mind for the entire diagnostic journey, from the first specialist visit to the final follow-up?
Step 2: Getting a Quote – How Premiums are Calculated
Once you have an idea of your needs, it's time to get a quote. This is where you see how insurers translate your personal details and desired cover into a monthly price.
Several key factors determine your premium:
- Age: This is the single biggest factor. The older you are, the higher the statistical likelihood of needing medical treatment, so premiums increase with age.
- Location: Healthcare costs vary across the UK. Living in Central London, where hospital costs are highest, will result in a more expensive premium than living in rural Scotland.
- Lifestyle: Insurers will ask if you smoke or use nicotine products. Smokers pay significantly more due to the associated health risks.
- Level of Cover: As discussed, the more comprehensive your policy, the higher the cost.
- Excess: This is the amount you agree to pay towards a claim. For example, if you have a £250 excess and your treatment costs £3,000, you pay the first £250 and the insurer pays the remaining £2,750. A higher excess lowers your monthly premium.
- Hospital List: Insurers have tiered lists of hospitals. A policy that gives you access to every private hospital in the UK (including expensive Central London ones) will cost more than one with a more restricted regional list.
Example Monthly PMI Premiums (Illustrative)
To give you a clearer idea, here's a table showing estimated monthly costs for a mid-range policy with a £250 excess. These are for illustrative purposes only.
| Profile | Location | Smoker? | Estimated Monthly Premium |
|---|---|---|---|
| 30-year-old Individual | Manchester | No | £45 - £65 |
| 45-year-old Individual | Bristol | No | £70 - £95 |
| Couple (both aged 50) | Edinburgh | No | £150 - £200 |
| Family (Parents 40, two children <10) | Birmingham | No | £180 - £250 |
These are industry estimates for 2025. Your actual quote will depend on your specific circumstances and chosen insurer.
Step 3: Choosing Your Policy – Decoding the Jargon
This is where things can get confusing. Let's break down the most important terms and options you'll encounter when comparing policies.
Core Cover Options
- Inpatient & Day-patient Cover: This is the foundation of every PMI policy.
- Inpatient: Treatment that requires you to be admitted to a hospital bed overnight.
- Day-patient: Treatment that requires a hospital bed for the day, but you don't stay overnight (e.g., a minor surgical procedure).
- Outpatient Cover: This covers treatment where you aren't admitted to a hospital. It's often sold as an add-on or has a financial limit. It includes:
- Specialist consultations.
- Diagnostic tests and scans (MRI, CT, PET).
- Physiotherapy, osteopathy, etc.
Most buyers opt for a policy with some level of outpatient cover, as this is crucial for getting a diagnosis quickly.
Cancer Cover
This is one of the most valued components of any PMI policy. Insurers typically offer three levels:
- Included as Standard: All policies provide some level of cancer care, often covering surgery and radiotherapy/chemotherapy.
- Full Cancer Cover (Add-on): This is the most comprehensive option. It covers ongoing monitoring, palliative care, and often provides access to new and experimental drugs not yet funded by the NHS.
- NHS Cancer Support: A lower-cost option where if you are diagnosed with cancer, you would use the NHS for treatment. The policy might provide a one-off cash benefit or access to specific drugs the NHS won't fund.
Underwriting: The Health Questions Bit
Underwriting is how an insurer assesses your medical history to decide what they will and won't cover. There are two main types in the UK:
- Moratorium (Mori) Underwriting: This is the most common and simplest option. You don't have to provide a full medical history upfront. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the 5 years before your policy started.
- The 2-Year Rule: If you then go 2 continuous years without any symptoms, treatment, or advice for that condition after your policy begins, it may become eligible for cover.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire, declaring your full medical history. The insurer then reviews it and tells you exactly what is excluded from day one. This provides certainty but can be more time-consuming.
Comparing Underwriting Types
| Feature | Moratorium (Mori) Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Upfront Process | Quick and simple. No medical forms. | Requires a detailed health questionnaire. |
| Cover Certainty | Less certainty initially. Claims can be slower to process. | Complete clarity from day one on what is and isn't covered. |
| Pre-existing Conditions | Automatically excluded for a set period (usually 2 years). | Explicitly excluded in writing from the start. |
| Best For | People with no recent medical issues who want a fast application. | People with a complex medical history who want absolute clarity. |
Step 4: The Application Process – Going From Quote to Cover
You've chosen your provider and your cover level. What happens next?
- Finalise Your Quote: Confirm all details with your broker or insurer. Ensure the cover level, excess, and hospital list are exactly what you want.
- Complete the Application: You'll fill out a formal application with your personal details. If you chose FMU, this is where you'll complete the health questionnaire.
- Underwriting Review: The insurer's underwriting team will review your application. For moratorium, this is a quick check. For FMU, it's a more detailed review of your medical history.
- Policy Documents Issued: Once approved, you'll receive your policy documents, including your certificate of insurance, policy wording, and hospital list. Read these carefully!
- Cooling-Off Period: By law, you have a 14-day cooling-off period from the day you receive your documents. You can cancel the policy for any reason during this time and receive a full refund, provided you haven't made a claim.
A Word on Honesty: It is vital to be truthful during your application. Failing to disclose relevant medical information (known as 'non-disclosure') can lead to a claim being rejected or your policy being cancelled.
Step 5: Making a Claim – Your Journey to Private Treatment
This is the moment of truth – when you need to use your policy. The process is designed to be straightforward and is remarkably consistent across all major UK insurers.
The Step-by-Step Claim Process
Let's use a real-life example. Meet David, a 45-year-old policyholder who develops persistent knee pain.
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Visit Your GP: David's first stop is his local NHS GP. The GP examines his knee and agrees he needs to see an orthopaedic specialist. The GP provides an 'open referral' letter. This letter recommends specialist care but doesn't name a specific consultant, giving the insurer flexibility.
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Contact Your Insurer: Before booking anything, David calls his insurer's claims line. He provides his policy number and details of his symptoms and the open referral from his GP.
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Get Pre-Authorisation: The insurer checks his policy. They confirm that musculoskeletal issues are covered and that his outpatient limit is sufficient for a consultation and scan. They issue a pre-authorisation number for the claim. They also provide him with a list of 3-4 approved orthopaedic specialists in his area.
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Book Your Appointment: David chooses a specialist from the list at a time and hospital convenient for him. He gives the specialist's secretary his pre-authorisation number.
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Diagnosis and Treatment Plan: The specialist recommends an MRI scan to investigate further. David calls his insurer again with this information. The insurer approves the scan under the same claim number. The scan reveals a torn meniscus requiring keyhole surgery (an arthroscopy).
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Authorise Treatment: The insurer authorises the surgery, confirming the procedure code and the hospital.
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Receive Treatment & Settle the Bill (illustrative): David has the surgery in a private hospital. The hospital and the specialist send their invoices directly to the insurer. The insurer pays the bills in full, minus David's £250 policy excess, which he pays directly to the hospital. He is now on the road to recovery.
What Isn't Covered? Understanding the Exclusions
No insurance policy covers everything. It's just as important to know what's not covered to avoid any unwelcome surprises.
The main exclusions on virtually all UK PMI policies are:
- Pre-existing Conditions: Anything you had signs, symptoms, or treatment for before the policy began (subject to your underwriting type).
- Chronic Conditions: Long-term conditions that need ongoing management rather than a cure (e.g., diabetes, asthma, arthritis, hypertension). These remain under the care of the NHS.
- Emergencies: A&E visits, heart attacks, strokes. You should always call 999 and use the NHS in an emergency. PMI is for planned, non-emergency treatment.
- Routine Pregnancy & Childbirth: Normal maternity care is not covered, though some comprehensive policies may offer cover for complications.
- Cosmetic Surgery: Procedures that are not medically necessary.
- Self-Inflicted Injuries & Substance Abuse: Treatment for alcoholism, drug abuse, or injuries sustained while committing a crime.
- Routine Dental & Optical: Unless you have purchased a specific add-on for this.
Maximising Your Policy: More Than Just Claims
Modern health insurance is about more than just paying for hospital bills. Providers are increasingly focused on preventative care and wellness, offering a suite of benefits to help you stay healthy.
- Digital GP Services: Get a GP appointment via phone or video call, often 24/7. This is perfect for getting quick advice, prescriptions, or referrals without waiting for a face-to-face NHS appointment.
- Mental Health Support: Many policies now include access to telephone counselling lines or a set number of face-to-face therapy sessions for conditions like stress, anxiety, and depression.
- Wellness & Lifestyle Discounts: Providers like Vitality are famous for this, rewarding healthy behaviour (like hitting step counts) with cinema tickets, coffee, and discounts on gym memberships and wearable tech.
- Expert Health Information: Access to nurses and health experts via phone for non-urgent medical advice.
Exclusive WeCovr Member Benefits
At WeCovr, we believe in adding value beyond the policy itself. When you arrange your private medical insurance with us, you get:
- Complimentary Access to CalorieHero: Our intelligent AI-powered calorie and nutrition tracking app. Managing your weight and diet is a cornerstone of good health, and CalorieHero makes it simple and effective.
- Exclusive Discounts: As a valued WeCovr health insurance client, you'll receive preferential rates on our other insurance products, including life insurance, income protection, and home insurance.
Comparing Top UK PMI Providers
The UK private medical insurance market is mature and competitive, dominated by a few key players. While their core offerings are similar, they each have unique strengths.
| Provider | Known For | Key Differentiator |
|---|---|---|
| Bupa | A household name with a strong brand and a network of its own clinics. | Direct access services (no GP referral needed for some conditions). |
| AXA Health | Excellent customer service and a clear, modular policy structure. | Strong focus on mental health support and a flexible "Personal Health" plan. |
| Aviva | One of the UK's largest insurers, offering a solid all-round policy. | The "Expert Select" hospital option can significantly reduce premiums. |
| Vitality | An innovative approach focused on rewarding healthy living. | The Vitality Programme offers extensive discounts and wellness rewards. |
| The Exeter | A smaller, friendly society known for excellent service and flexibility. | Considers a wider range of health conditions and occupations. |
This is why working with an expert PMI broker is so valuable. At WeCovr, we compare policies from these leading providers and more, matching you with the one that best suits your needs and budget, saving you time and money. Our advice is completely free and impartial.
Do I still need the NHS if I have private health insurance?
What is the difference between moratorium and full medical underwriting?
Can I add my family to my health insurance policy?
How can I lower the cost of my private health insurance?
Take the Next Step Towards Peace of Mind
Understanding how private health insurance works is the first step to taking control of your healthcare choices. It provides a powerful alternative for prompt diagnosis and treatment, giving you and your family security when you need it most.
Ready to see how affordable private medical insurance can be?
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.











