TL;DR
Navigating the world of health-related insurance can feel complex. At WeCovr, an FCA-authorised broker in the UK, we've helped arrange over 900,000 policies of various kinds. We're here to clarify exactly how private medical insurance (PMI) differs from critical illness cover and income protection, helping you choose the right protection for your needs.
Key takeaways
- Private Medical Insurance (PMI) pays for the cost of your medical treatment.
- Critical Illness Cover pays you a lump sum of money if you're diagnosed with a specific serious illness.
- Income Protection pays you a regular monthly income if you can't work due to illness or injury.
- Consultations: Seeing a specialist consultant privately.
- Diagnostic Tests: MRI, CT, and PET scans, blood tests, and X-rays without the long wait.
Navigating the world of health-related insurance can feel complex. At WeCovr, an FCA-authorised broker in the UK, we've helped arrange over 900,000 policies of various kinds. We're here to clarify exactly how private medical insurance (PMI) differs from critical illness cover and income protection, helping you choose the right protection for your needs.
Understanding these differences is not just a financial exercise; it's about securing peace of mind for you and your family. Each policy serves a unique purpose, and knowing what they do—and what they don't do—is the first step towards building a robust safety net.
PMI compared to other health-related insurance—what each actually does
Think of health and financial protection as a three-legged stool. Each leg provides a different kind of support when you face a health challenge. If one leg is missing, the stool becomes unstable. Private Medical Insurance (PMI), Critical Illness Cover, and Income Protection are those three legs.
- Private Medical Insurance (PMI) pays for the cost of your medical treatment.
- Critical Illness Cover pays you a lump sum of money if you're diagnosed with a specific serious illness.
- Income Protection pays you a regular monthly income if you can't work due to illness or injury.
They are not in competition with each other; in fact, they work best together. Let's break down each one in detail.
What is Private Medical Insurance (PMI)? The Key to Faster Treatment
Private Medical Insurance, often called private health cover, is designed to cover the costs of private medical treatment for acute conditions that arise after your policy begins. Its primary purpose is to help you bypass NHS waiting lists and get prompt access to specialists, diagnostic tests, and high-quality hospital care.
With NHS waiting lists in England hovering around 7.5 million cases in 2024, PMI offers a valuable alternative for those seeking quicker diagnosis and treatment.
What Does PMI Actually Cover?
PMI is focused on getting you back to your usual state of health. It typically covers:
- Consultations: Seeing a specialist consultant privately.
- Diagnostic Tests: MRI, CT, and PET scans, blood tests, and X-rays without the long wait.
- Hospital Stays: A private room in a private hospital or a private wing of an NHS hospital.
- Surgery: In-patient and day-patient surgical procedures.
- Cancer Care: Comprehensive cancer treatment, including chemotherapy, radiotherapy, and access to drugs not always available on the NHS.
- Therapies: Post-operative physiotherapy or other therapies to aid recovery.
- Mental Health Support: Many modern policies offer significant cover for mental health consultations and therapy.
Example in Action:
Imagine you develop persistent knee pain. With the NHS, you might wait several weeks for a GP appointment, followed by a months-long wait to see an orthopaedic specialist, and then another long wait for an MRI scan. With PMI, you could get a GP referral, see a specialist within days, have an MRI the same week, and be scheduled for surgery shortly after.
The Critical Exclusion: Pre-existing and Chronic Conditions
This is the most important point to understand about private medical insurance in the UK:
Standard PMI policies DO NOT cover pre-existing conditions or chronic conditions.
- Pre-existing Condition: Any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy started.
- Chronic Condition: A condition that is long-lasting, has no known cure, and needs ongoing management. Examples include diabetes, asthma, arthritis, and high blood pressure.
PMI is for acute conditions—illnesses that are curable and have a foreseeable end, like a hernia, cataracts, or a joint replacement. The NHS remains your port of call for managing long-term chronic illnesses.
What is Critical Illness Cover? Financial Support When You Need It Most
Critical Illness Cover is a different beast entirely. It’s not about paying for medical bills. Instead, it pays out a one-off, tax-free lump sum if you are diagnosed with one of the specific life-threatening or life-altering conditions listed in your policy.
According to Cancer Research UK, 1 in 2 people in the UK will be diagnosed with some form of cancer during their lifetime. A critical illness diagnosis can have a devastating financial impact, and this is the problem this cover aims to solve. (illustrative estimate)
What Is the Money For?
The lump sum is yours to use however you see fit. People often use it for:
- Paying off a mortgage or rent: Removing the biggest financial burden while you recover.
- Covering lost income: For you or a partner who takes time off work to care for you.
- Adapting your home: Installing a stairlift or a wet room if your mobility is affected.
- Paying for private medical treatment: You could use the money to pay for treatments not covered by PMI or the NHS.
- Reducing financial stress: Allowing you to focus entirely on your recovery without worrying about bills.
What Conditions Are Covered?
Policies vary, but most will cover the "big three":
- Cancer (of a specified severity)
- Heart Attack
- Stroke
Comprehensive policies can cover 50 or even more conditions, including multiple sclerosis, kidney failure, major organ transplant, and Parkinson's disease. The key is that the condition must meet the exact definition stated in the policy document.
Example in Action:
Suppose you have a £50,000 Critical Illness policy. You suffer a severe heart attack that meets your policy's definition. After a short 'survival period' (usually 14-30 days), the insurer pays you £50,000, tax-free. You could use this to clear your credit card debt, take six months off work unpaid, and focus completely on your cardiac rehabilitation programme. (illustrative estimate)
What is Income Protection Insurance? Your Salary's Safety Net
Income Protection is arguably the foundation of any financial protection plan. It's designed to replace a portion of your monthly income if you are unable to work due to any illness or injury.
Think of it as your own personal sick pay scheme. This is particularly vital for the self-employed or those in jobs with limited sick pay benefits. With the Office for National Statistics (ONS) reporting a record 185.6 million working days lost to sickness in 2022, the risk of being unable to earn is very real.
How Does Income Protection Work?
- You choose a percentage of your income to cover: Usually between 50% and 70% of your gross monthly salary. The payments you receive are tax-free.
- You choose a "deferment period": This is the waiting period between when you stop work and when the policy starts paying out. It can be anywhere from 4 weeks to 12 months. The longer the deferment period, the lower your premium. You would typically align this with any sick pay you receive from your employer.
- You make a claim: If you're signed off work by a doctor for a reason covered by the policy, you start your claim.
- You receive monthly payments: Once your deferment period ends, the policy pays you a regular monthly income until you can return to work, the policy term ends, or you retire, whichever comes first.
The Importance of "Own Occupation" Cover
When choosing an Income Protection policy, the definition of incapacity is crucial. The best policies offer an "own occupation" definition. This means the policy will pay out if you are unable to do your specific job. Other, less comprehensive definitions might only pay out if you are unable to do any job, which is a much stricter test.
Example in Action:
You are a self-employed electrician earning £4,000 per month. You have an Income Protection policy set to pay out £2,500 per month after a 3-month deferment period. You fall from a ladder and break your back, leaving you unable to work for 18 months. After the first 3 months (the deferment period), your policy starts paying you £2,500 every month, allowing you to cover your mortgage and bills while you undergo extensive physiotherapy. (illustrative estimate)
Key Differences at a Glance: PMI vs. Critical Illness vs. Income Protection
To make it crystal clear, here’s a simple table comparing the three types of cover.
| Feature | Private Medical Insurance (PMI) | Critical Illness Cover | Income Protection Insurance |
|---|---|---|---|
| What it Does | Pays for the cost of private medical diagnosis and treatment. | Provides a one-off, tax-free lump sum payment. | Provides a regular, tax-free monthly income. |
| How it Pays Out | Directly to the hospital, clinic, or specialist. | Directly to you. | Directly to you. |
| What Triggers a Claim | The need for treatment for an eligible acute medical condition. | Diagnosis of a specific serious illness listed in the policy. | Being unable to work due to any illness or injury. |
| Main Purpose | To get faster medical care and bypass NHS waiting lists. | To handle the major financial impact of a serious illness (e.g., pay off mortgage). | To replace your lost salary and cover day-to-day living costs. |
| Duration of Payout | For the duration of your eligible treatment. | A single lump sum payment. | Monthly payments until you return to work or the policy ends. |
| Typical Use Case | Getting a hip replacement in a private hospital within weeks. | Receiving £100,000 after a cancer diagnosis to clear debts. | Receiving £2,000 a month after an accident prevents you from working. |
Do I Need All Three? Building Your Protection Portfolio
The ideal answer for many people is yes. The three policies provide a comprehensive safety net that protects your health, your wealth, and your income. They are not mutually exclusive; they are complementary.
- PMI looks after your physical recovery.
- Critical Illness Cover protects your major assets and financial stability.
- Income Protection protects your monthly lifestyle.
Let's see how they work together:
Chris, a 40-year-old marketing manager, is diagnosed with bowel cancer.
- His PMI policy immediately kicks in. He sees a top oncologist privately within 48 hours, has surgery the following week in a private hospital, and starts a course of advanced chemotherapy not yet available on the NHS.
- Because cancer is a specified condition on his Critical Illness Cover, he receives a £75,000 lump sum. He uses this to pay off his car loan and credit cards, and his wife reduces her working hours to support him, all without financial worry.
- The treatment is gruelling, and he's signed off work for nine months. After his three-month deferment period, his Income Protection policy starts paying him £2,800 a month, ensuring his mortgage and household bills are paid without fail.
In this scenario, Chris can focus 100% on getting better, free from worries about NHS waiting lists, mounting bills, or his family's daily expenses.
An expert PMI broker like WeCovr can help you assess your individual circumstances—your job, family, finances, and health—to recommend a tailored package of protection that fits your budget.
Wellness Benefits & Added Value from Modern Insurers
Insurers are no longer just about claims. The best PMI providers and life insurers now offer a suite of wellness services designed to help you stay healthy.
These can include:
- 24/7 Digital GP: Video consultations with a GP at any time of day or night.
- Mental Health Support: Access to therapy sessions, counselling hotlines, and mindfulness apps.
- Fitness Discounts: Reduced-price gym memberships or discounts on fitness trackers.
- Health and Nutrition Advice: Access to expert guidance on diet and lifestyle.
At WeCovr, we go a step further. When you arrange your PMI or Life Insurance through us, we provide complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help you stay on top of your health goals. Furthermore, clients who purchase PMI or Life Insurance often receive discounts on other types of cover, making it more affordable to build that complete protection portfolio.
How to Choose the Right Private Health Cover with WeCovr
Choosing the right policy from the hundreds available can be overwhelming. This is where an independent, FCA-authorised broker like WeCovr becomes invaluable.
- We Listen: We take the time to understand your needs, budget, and priorities. There's no one-size-fits-all solution.
- We Compare: We use our expertise and technology to search the market, comparing policies from a wide range of leading UK insurers. We explain the differences in cover, not just the price.
- We Advise: We make a professional recommendation based on our findings and your needs. Our advice comes at no cost to you.
- We Support: Our service doesn't stop once the policy is in place. We're here to help you with any questions or issues you may have in the future, including at claim time.
Our high customer satisfaction ratings are a testament to our commitment to providing clear, impartial, and helpful advice. We demystify the jargon and empower you to make an informed decision.
Can I get PMI if I have a pre-existing medical condition?
Is the payout from Critical Illness Cover or Income Protection taxable?
Do these policies mean I don't need the NHS anymore?
Which policy is the most important one to have?
Ready to explore your options and find the right protection for you and your family?
Get a free, no-obligation quote from WeCovr today. Our expert advisors will compare the top UK providers to find the perfect cover for your needs and budget.
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.








