TL;DR
Navigating the world of private medical insurance in the UK can feel complex, but it doesn't have to be. As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr is here to demystify the process. This guide breaks down exactly how private health cover works.
Key takeaways
- Getting a Quote: The initial information-gathering phase.
- Underwriting: How insurers assess your health and set policy terms.
- Policy Customisation: Tailoring your cover to match your needs and budget.
- Making a Claim: The practical process of using your insurance.
- Annual Renewal: What happens when your policy year ends.
Navigating the world of private medical insurance in the UK can feel complex, but it doesn't have to be. As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr is here to demystify the process. This guide breaks down exactly how private health cover works.
Step-by-step from quotes and underwriting to claims and renewals
Private Medical Insurance (PMI) is a journey with several distinct stages. Think of it as a lifecycle: it begins with finding the right policy, continues through using its benefits if you need to, and concludes with an annual renewal where you reassess your needs. Understanding each step empowers you to make the best choices for your health and finances.
This comprehensive guide will walk you through:
- Getting a Quote: The initial information-gathering phase.
- Underwriting: How insurers assess your health and set policy terms.
- Policy Customisation: Tailoring your cover to match your needs and budget.
- Making a Claim: The practical process of using your insurance.
- Annual Renewal: What happens when your policy year ends.
What is Private Medical Insurance (PMI) and Why Consider It?
In simple terms, private medical insurance is a policy you pay for that covers the cost of private healthcare for specific conditions. It runs alongside the fantastic service provided by our National Health Service (NHS), offering an alternative route for diagnosis and treatment.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the most important concept to understand. UK private health insurance is designed to cover acute conditions.
- Acute Condition: 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, hernia repair, and cancer treatment.
- Chronic Condition: A long-term condition that cannot be cured, only managed. Examples include diabetes, asthma, high blood pressure, and arthritis.
Standard PMI policies do not cover the routine management of chronic conditions. They also typically exclude pre-existing conditions—any health issue you had before your policy began. The focus is on getting you back to your normal state of health after a new, unexpected illness or injury.
Why Do People Choose Private Health Cover?
While the NHS provides excellent care, it faces significant pressures. According to the latest NHS England data, the waiting list for routine hospital treatment stands at over 7 million. Many people turn to PMI for:
- Speed of Access: Bypassing long NHS waiting lists for consultations, scans, and surgery is the number one reason people buy PMI.
- Choice and Control: You can often choose your specialist and the hospital where you're treated, giving you more control over your healthcare journey.
- Comfort and Privacy: A key benefit is the likelihood of having a private en-suite room, rather than being on a general ward.
- Access to Specialist Treatments: Some policies provide access to drugs or treatments not yet available on the NHS due to funding decisions.
| Feature | NHS | Private Healthcare (with PMI) |
|---|---|---|
| Cost | Free at the point of use | Monthly/annual premium + excess |
| Waiting Times | Can be lengthy for non-urgent care | Significantly shorter |
| Choice of Hospital | Limited to your local NHS trust | Choice from an approved list |
| Choice of Specialist | Typically assigned a consultant | You can often choose your specialist |
| Accommodation | Usually a shared ward | Typically a private, en-suite room |
| Access to Drugs | Guided by NICE recommendations | May include drugs not yet on the NHS |
Step 1: Getting Your Private Health Insurance Quote
This is your starting point. To get an accurate quote, you'll need to provide some basic information. Insurers and brokers use this to calculate the risk and, therefore, the price (your premium).
Information You'll Need to Provide:
- Personal Details: Your date of birth, postcode, and whether you smoke. Age is the single biggest factor affecting cost.
- People to be Covered: Whether it's just for you, you and a partner, or your whole family.
- Level of Cover: What you want the policy to include (more on this below).
- Policy Levers: Your preferred excess and hospital list.
How to Get Your Quotes
- Direct from Insurers: You can approach providers like Bupa or AXA individually. This can be time-consuming and makes it hard to compare policies on a like-for-like basis.
- Comparison Websites: These can give you a quick overview of prices, but often lack the detail and expert guidance needed to understand the nuances of each policy.
- Using an Expert Broker: A specialist private medical insurance broker, like WeCovr, offers the best of both worlds. We do the hard work for you. Our service is free to you, as we are paid a commission by the insurer you choose.
The Broker Advantage:
- Whole-of-Market Advice: We compare policies from leading UK insurers to find the best fit.
- Expert Guidance: We explain the jargon and help you understand the differences in underwriting and cover.
- Personalised Recommendations: We tailor the options to your specific budget and health priorities.
Step 2: Understanding Underwriting – The Key to Your Cover
Underwriting is how an insurer assesses your medical history to determine what your policy will and won't cover. It's how they handle pre-existing conditions. In the UK, there are two main types.
1. Moratorium Underwriting
This is the most common type for individuals and families because it's quick and simple.
- How it works: You don't declare your full medical history when you apply. Instead, the policy automatically excludes any condition for which you have sought advice, had symptoms, or received treatment in the 5 years before the policy start date.
- The "rolling" part: An exclusion isn't necessarily permanent. If you then go for 2 continuous years after your policy starts without any symptoms, treatment, or advice for that condition, it may become eligible for cover.
Example: Sarah had physiotherapy for a bad back 3 years before taking out her policy. Under a moratorium, any back-related issues are automatically excluded for the first 2 years of her policy. If she has no back trouble at all during those 2 years, her back will then become eligible for cover.
| Pros | Cons |
|---|---|
| Quick and easy to set up | Lack of certainty at the start |
| No need for medical forms or GP reports | Claims process can be slower as checks are made then |
| Pre-existing conditions can become eligible for cover over time | Ambiguity over what constitutes "advice" or "symptoms" |
2. Full Medical Underwriting (FMU)
This method provides certainty from day one.
- How it works: You complete a detailed health questionnaire as part of your application. The insurer assesses your medical history and may write to your GP for more information. They then issue policy terms with a list of specific, named exclusions.
Example: With FMU, Sarah would declare her previous back problems on her application. The insurer would review the details and might state: "Exclusion: Any investigation or treatment related to the lumbar spine." This exclusion would be permanent unless she specifically asked for it to be reviewed later.
| Pros | Cons |
|---|---|
| You know exactly what is and isn't covered from day one | The application process is longer and more intrusive |
| Claims process is often faster as history is already known | Exclusions are usually permanent |
| Clear and transparent terms of cover | Requires you to remember and declare your full medical history |
A good broker can advise which underwriting type is best for your personal circumstances.
Step 3: Choosing Your Policy Options and Customising Your Cover
Private health insurance isn't one-size-fits-all. You can tailor your policy to balance the level of cover with the monthly premium.
Core Cover (Usually Included as Standard)
- In-patient Treatment: When you are admitted to a hospital bed overnight for treatment.
- Day-patient Treatment: When you are admitted to a hospital bed for a planned procedure but do not stay overnight.
- Cancer Cover: This is a cornerstone of modern PMI. Most policies offer comprehensive cancer cover, including surgery, chemotherapy, and radiotherapy.
Popular Optional Extras
- Out-patient Cover (illustrative): This is the most common add-on. It covers diagnostics and consultations that don't require a hospital bed. This includes specialist consultations, blood tests, X-rays, and MRI/CT scans. You can usually choose a limit (e.g., £500, £1,000, or unlimited) to control the cost.
- Therapies Cover: Covers treatments like physiotherapy, osteopathy, and chiropractic care.
- Mental Health Cover: Provides cover for consultations with psychiatrists and psychologists, and in-patient care for mental health conditions.
- Dental and Optical Cover: Usually a lower-value benefit that helps with the cost of routine check-ups, glasses, and dental treatment.
Key Levers to Control Your Premium
These are the main dials you can turn to make your policy more affordable.
| Lever | How It Works | Impact on Premium |
|---|---|---|
| Excess | The amount you agree to pay towards the cost of your first claim each policy year. Common levels are £0, £100, £250, £500, or £1,000. | Higher excess = Lower premium |
| Hospital List | Insurers have tiered hospital lists. A "local" list is cheaper than a "national" list that includes expensive central London hospitals. | More restricted list = Lower premium |
| 6-Week Wait | If the NHS can provide the in-patient treatment you need within 6 weeks of you being placed on a waiting list, you use the NHS. If the wait is longer, your private cover kicks in. | Adding this option = Significantly lower premium |
Step 4: The Claims Process – Using Your Private Health Insurance
So, the time has come when you need to use your policy. The process is designed to be straightforward.
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Visit Your GP: Your healthcare journey almost always starts with your NHS GP. If you have a symptom, see your GP first. They will assess you and, if necessary, provide you with an open referral to a specialist. An open referral means they recommend the type of specialist (e.g., a cardiologist) but not a specific person.
-
Contact Your Insurer: Call your insurer's claims helpline. Have your policy number ready. Explain the situation and provide the details from your GP referral.
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Get Authorisation: The insurer will check that the condition is covered by your policy. If it is, they will give you an authorisation number and advise you on which specialists and hospitals from their approved network you can use.
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Book Your Appointment: You can now contact the specialist's secretary or the hospital's private patient unit to book your consultation or treatment. You will need to provide them with your authorisation number.
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Receive Treatment & Settle Bills: After your treatment, the hospital and specialist will usually send their invoices directly to your insurance company. You are only responsible for paying the excess on your policy (if you have one). The insurer handles the rest.
Real-Life Example: John, 45, develops persistent knee pain.
- He sees his GP, who diagnoses a likely meniscus tear and provides an open referral to an orthopaedic surgeon.
- John calls his insurer. They confirm his out-patient cover is active and authorise a consultation and MRI scan.
- John books an appointment with an approved surgeon for the following week. The MRI confirms the tear.
- The surgeon recommends keyhole surgery. John calls his insurer again, who authorises the procedure.
- The surgery is scheduled for two weeks later. The hospital bills the insurer directly for £4,500. John pays his £250 excess, and the insurer pays the remaining £4,250.
Step 5: Renewing Your Policy – What Happens After Year One?
Your PMI policy is an annual contract. About a month before it ends, your insurer will send you a renewal notice with the premium for the upcoming year.
Why Do Premiums Increase at Renewal?
It's normal for your premium to increase each year. There are three main reasons for this:
- Age: As we get older, the statistical likelihood of us needing to claim increases. Most insurers have age-banded pricing, so your premium will rise on your birthday.
- Medical Inflation: The cost of private medical treatment, new drugs, and advanced technology rises faster than general inflation. This "medical inflation" typically runs at 8-10% per year and is factored into your renewal price.
- Your Claims History: If you have made a claim in the previous year, your renewal premium may see a larger increase compared to someone who hasn't.
Your Options at Renewal
You don't have to simply accept the new price. You have several options:
- Accept the Renewal: If you're happy with the price and cover, you can simply let the policy renew.
- Adjust Your Cover: Speak to your insurer or broker about ways to reduce the premium, such as increasing your excess or downgrading your hospital list.
- Switch Insurers: This is a powerful option. A broker like WeCovr can conduct a full market review to see if another insurer can offer you similar or better cover for a lower price. If you switch, it's vital to do so on a 'Continued Personal Medical Exclusions' (CPME) basis. This special type of underwriting allows you to carry over the cover from your old policy, ensuring any conditions that developed while you were insured remain covered by your new provider.
Enhancing Your Wellbeing with Your PMI Policy
Modern private health insurance is evolving. It's no longer just about reacting to illness; it's about proactively supporting your health and wellbeing. Many policies now include a fantastic range of added-value benefits at no extra cost.
Common Wellness Benefits:
- Digital GP: 24/7 access to a GP via phone or video call, often with the ability to get prescriptions delivered.
- Mental Health Support: Access to telephone counselling services or apps to support your mental wellbeing.
- Gym and Fitness Discounts: Money off gym memberships, fitness trackers, and sports clothing.
- Health and Wellness Apps: Access to apps for mindfulness, nutrition, and fitness coaching.
At WeCovr, we go a step further. When you arrange your health insurance with us, we provide complimentary access to our AI-powered nutrition app, CalorieHero, to help you manage your diet and health goals. Furthermore, our clients often receive discounts on other types of cover they may need, such as life or income protection insurance.
Staying active, eating a balanced diet, prioritising sleep, and managing stress are not only good for your health but can also contribute to a more stable insurance premium over the long term by reducing your risk of developing certain conditions.
Who are the Major Private Health Insurance Providers in the UK?
The UK market is served by a handful of excellent, well-established insurers. While they all provide high-quality cover, they have different strengths and areas of focus. An expert broker can help you navigate their offerings.
| Provider | Known For | Customer Satisfaction (Trustpilot) |
|---|---|---|
| Bupa | One of the oldest and largest providers, with a strong brand and its own network of clinics. | 4.1 / 5.0 |
| AXA Health | A global insurance giant known for comprehensive cover and strong customer service. | 4.3 / 5.0 |
| Aviva | The UK's largest general insurer, offering a well-regarded PMI product with a large hospital network. | 4.0 / 5.0 |
| Vitality | Unique approach that rewards healthy living with discounts, cashback, and other perks. | 4.2 / 5.0 |
| The Exeter | A friendly society (owned by its members) known for flexible underwriting and excellent service. | 4.7 / 5.0 |
| WPA | A not-for-profit insurer praised for its customer-centric approach and advanced cancer cover. | 4.7 / 5.0 |
Note: Trustpilot scores are as of early 2024 and are subject to change.
Does private health insurance cover pre-existing conditions?
Is private health insurance worth it in the UK?
How much does private health insurance cost per month?
Can I cancel my private health insurance at any time?
Take the Next Step with Confidence
Understanding how private health insurance works is the first step towards making a smart decision for your health. The next is getting advice tailored to you.
Ready to explore your options? The expert, friendly team at WeCovr is here to help. Get a free, no-obligation quote today and let us compare the market to find the perfect private health cover for you and your family.
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.
