TL;DR
With NHS waiting lists remaining a significant concern for millions, many people in the UK are exploring their healthcare options. As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr know that understanding private medical insurance is the first step towards peace of mind. From sign-up to claims a guide to how UK PMI operates, including eligibility and common benefits Private Medical Insurance, often called PMI or private health cover, can seem complex.
Key takeaways
- Accident & Emergency (A&E) services
- Routine GP appointments
- Management of chronic conditions
- Acute Conditions (Covered): These are short-term, curable conditions. Examples include cataracts needing surgery, joint pain requiring a replacement, hernias, or appendicitis. PMI is designed to diagnose and treat these swiftly.
- Chronic Conditions (Not Covered): These are long-term conditions that require ongoing management but typically have no cure. Examples include diabetes, asthma, high blood pressure, and arthritis. The management of these conditions will almost always remain with your NHS GP and specialists.
With NHS waiting lists remaining a significant concern for millions, many people in the UK are exploring their healthcare options. As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr know that understanding private medical insurance is the first step towards peace of mind.
From sign-up to claims a guide to how UK PMI operates, including eligibility and common benefits
Private Medical Insurance, often called PMI or private health cover, can seem complex. But at its heart, it’s a straightforward contract. You pay a monthly or annual premium to an insurance company. In return, if you develop an eligible medical condition after your policy begins, the insurer covers the costs of private diagnosis and treatment.
This guide will demystify the entire process, from choosing a policy to making your first claim, empowering you to make an informed decision about your health.
What is Private Medical Insurance (PMI) and Why Consider It?
Private Medical Insurance is an insurance policy designed to cover the costs of private healthcare for acute conditions that arise after you take out the cover. An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery.
Think of it as a key to unlock faster access to specialist care, complementing the fantastic but stretched services of our National Health Service (NHS).
Crucially, PMI does not replace the NHS. You will still rely on the NHS for:
- Accident & Emergency (A&E) services
- Routine GP appointments
- Management of chronic conditions
The Critical Distinction: Acute vs. Chronic Conditions
This is the single most important concept to understand about UK private health cover:
- Acute Conditions (Covered): These are short-term, curable conditions. Examples include cataracts needing surgery, joint pain requiring a replacement, hernias, or appendicitis. PMI is designed to diagnose and treat these swiftly.
- Chronic Conditions (Not Covered): These are long-term conditions that require ongoing management but typically have no cure. Examples include diabetes, asthma, high blood pressure, and arthritis. The management of these conditions will almost always remain with your NHS GP and specialists.
- Pre-existing Conditions (Not Covered): Standard PMI policies also do not cover medical conditions for which you have experienced symptoms, received medication, or sought advice before your policy started.
Why Are People Turning to PMI?
The primary driver is the desire to bypass long waiting lists for diagnosis and non-urgent treatment. According to NHS England data, the referral-to-treatment waiting list stood at approximately 7.54 million in early 2024, with hundreds of thousands waiting over a year for planned procedures.
The core benefits of having a private medical insurance UK policy include:
- Speed of Access: Significantly reduce the wait for specialist consultations, diagnostic scans (like MRI and CT), and elective surgery.
- Choice and Control: You can often choose your specialist and the hospital where you receive treatment from a pre-approved list.
- Comfort and Privacy: Treatment is usually in a private hospital with a private room, ensuite facilities, and more flexible visiting hours.
- Access to Specialist Drugs and Treatments: Some policies provide access to new, licensed drugs or treatments that may not yet be available on the NHS due to cost or other considerations.
How to Get Private Medical Insurance: The Sign-Up Process Explained
Getting started with PMI is a structured process. Here’s a breakdown of the key stages.
Step 1: Assess Your Needs and Budget
Before you dive into quotes, ask yourself a few questions:
- Who needs cover? Is it just for you, you and a partner, or your whole family?
- What is your budget? Premiums can range from £40 to over £200 a month depending on various factors.
- What’s most important to you? Is it rapid cancer treatment, comprehensive mental health support, or simply fast access to diagnostics?
Step 2: Choose Your Underwriting Method
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.
| Underwriting Type | How It Works | Pros | Cons |
|---|---|---|---|
| Moratorium | You don't declare your full medical history upfront. The policy automatically excludes any condition you've had symptoms, treatment, or advice for in the 5 years before joining. | Quicker to set up; less initial paperwork. | Lack of certainty; a condition you thought was minor could be excluded at the point of claim. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire, declaring all previous medical conditions. The insurer then provides a list of specific exclusions from the start. | Complete clarity on what is and isn't covered from day one. | The application process is longer and more detailed. |
How a Moratorium Works in Practice: Imagine you had physiotherapy for a sore shoulder 3 years before taking out a moratorium policy. If your shoulder becomes painful again 1 year into your policy, the insurer will likely not cover it as it's a pre-existing condition from the last 5 years. However, if you remain symptom-free and require no treatment for that shoulder for 2 continuous years after your policy starts, it may become eligible for cover thereafter.
Step 3: Compare Policies and Providers
The UK PMI market is dominated by a few key providers, including Bupa, AXA Health, Aviva, and Vitality. Each has different strengths, hospital networks, and approaches to cover.
Trying to compare them all yourself can be overwhelming. This is where an independent PMI broker is invaluable. An expert broker like WeCovr does the hard work for you. We are authorised by the Financial Conduct Authority (FCA) and have access to policies from across the market. We can explain the fine print, tailor options to your budget, and help you find the best PMI provider for your specific circumstances—all at no cost to you.
Step 4: Customise Your Policy
PMI is not a one-size-fits-all product. You build your policy by starting with core cover and adding optional extras.
-
Core Cover (The Foundation): This is the mandatory part of any policy and almost always includes cover for in-patient and day-patient treatment. This means surgery, hospital stays, and procedures where a bed is required, even for just a few hours. Comprehensive cancer cover is also frequently included as standard.
-
Optional Extras (The Add-ons):
- Out-patient Cover: This is the most popular add-on. It covers costs incurred before a hospital admission, such as specialist consultations and diagnostic tests or scans. Without this, you would rely on the NHS for the diagnostic phase, which can involve long waits.
- Therapies: Covers treatments like physiotherapy, osteopathy, and chiropractic care.
- Mental Health Cover: Provides access to psychiatrists, psychologists, and therapy sessions.
- Dental and Optical: Can cover routine check-ups, accidents, and emergencies.
Step 5: Finalise and Pay
Once you’ve chosen your policy, you’ll receive your full policy documents. You have a 14-day "cooling-off period" during which you can cancel and receive a full refund, provided you haven't made a claim.
Understanding Your Policy: What's Covered and What's Not?
Clarity is key to avoiding disappointment at the point of a claim. While every policy differs, here's a general guide to what's typically included and excluded.
| Category | Typically Covered | Typically Not Covered |
|---|---|---|
| Hospital Treatment | In-patient & day-patient care, surgery, nursing fees, anaesthetist fees, hospital accommodation. | Treatment in a hospital not on your insurer's approved list. |
| Diagnostics | MRI, CT, and PET scans, X-rays, and blood tests if you have out-patient cover or they are part of in-patient treatment. | Scans or tests for conditions that are excluded from your policy. |
| Cancer Care | Surgery, chemotherapy, radiotherapy, specialist consultations. Many policies offer comprehensive cover. | Experimental treatments, ongoing monitoring after remission may be limited. |
| Mental Health | Psychiatric treatment, therapy sessions (if added as an option). | Pre-existing mental health conditions, dementia, learning difficulties. |
| Specific Conditions | Acute conditions like joint replacements, hernia repair, cataract surgery. | Chronic conditions like diabetes, asthma, hypertension, epilepsy. |
| Other Areas | - | Normal pregnancy & childbirth, cosmetic surgery, A&E visits, organ transplants, drug/alcohol abuse treatment. |
A crucial takeaway: Always read your policy documents carefully. If you are ever unsure whether something is covered, call your insurer or broker before proceeding with any treatment.
The Claims Process: A Step-by-Step Guide
So, you've developed a new symptom and need to use your policy. How does it work in practice?
Let's follow a real-world example:
Meet David, a 45-year-old policyholder with persistent knee pain.
-
Step 1: Visit Your GP. David's first port of call is his local NHS GP. He explains his symptoms. The GP agrees that the knee needs further investigation by an orthopaedic specialist.
-
Step 2: Get a GP Referral. The GP writes an "open referral" letter for David to see an orthopaedic consultant. This letter doesn't name a specific doctor, giving David and his insurer flexibility.
-
Step 3: Contact Your Insurer. Before booking anything, David calls his PMI provider's claims line. He provides his policy number and explains that he has a GP referral for his knee pain.
-
Step 4: Get Pre-authorisation. The insurer checks David's policy. They confirm that his out-patient cover is active and the condition (new-onset knee pain) is not pre-existing. They provide him with a pre-authorisation number for an initial consultation and a list of approved orthopaedic specialists in his area.
-
Step 5: Book the Appointment. David chooses a specialist from the list and books a private consultation for the following week. At the appointment, the specialist recommends an MRI scan to diagnose the problem. David calls his insurer again to get authorisation for the scan, which they approve.
-
Illustrative estimate: Step 6: Treatment and Payment. The MRI reveals a torn meniscus requiring keyhole surgery. The insurer authorises the surgery (an in-patient procedure) at a hospital on David's approved list. The hospital and specialist send their invoices directly to the insurer. David only has to pay the £250 excess on his policy directly to the hospital.
Within six weeks of his initial GP visit, David has had his consultation, scan, and surgery, and is starting his recovery.
How Much Does Private Medical Insurance Cost in the UK?
The price of your premium is highly personal and depends on several factors:
- Age: This is the most significant factor. Premiums increase as you get older because the statistical likelihood of needing treatment rises.
- Location: Living in areas with higher private treatment costs, like Central London, will result in higher premiums.
- Level of Cover: A basic policy covering only in-patient care will be much cheaper than a comprehensive one with full out-patient, therapies, and mental health cover.
- Excess (illustrative): This is the amount you agree to pay towards a claim. A higher excess (e.g., £500) will lower your monthly premium, while a lower excess (e.g., £100) will increase it.
- Hospital List: Insurers offer different hospital lists. A list restricted to local hospitals will be cheaper than a nationwide list that includes premium London hospitals.
- No-Claims Discount: Similar to car insurance, you can build up a discount for every year you don't make a claim.
Illustrative Monthly Premiums (2025 Estimates)
To give you an idea, here are some estimated monthly costs for a non-smoker living outside London.
| Age Group | Basic In-patient Cover (£500 Excess) | Comprehensive Cover (£250 Excess) |
|---|---|---|
| 30-year-old | £45 - £65 | £85 - £130 |
| 50-year-old | £80 - £110 | £160 - £260 |
| 65-year-old | £130 - £190 | £280 - £450+ |
Important: These are guide prices only. The only way to get an accurate figure is to get a personalised quote based on your unique needs. A broker like WeCovr can provide you with a detailed comparison of quotes from leading insurers in minutes.
Beyond Treatment: Wellness Benefits and Added Value
Modern private health cover is evolving. It's no longer just about reacting to illness; it's increasingly about promoting a healthy lifestyle to prevent it. Many leading policies now include a wealth of wellness benefits designed to keep you healthy.
These can include:
- 24/7 Digital GP: Speak to a GP via video call or phone, often within hours, and get prescriptions or referrals.
- Mental Health Support: Access to telephone counselling lines, mindfulness apps, and even face-to-face therapy sessions.
- Wellness Programmes: Some providers, like Vitality, reward you with discounts and perks (like free coffee or cinema tickets) for staying active, tracked via a smartwatch.
- Gym Discounts: Significant savings on memberships at major gym chains.
- Health Screenings: Access to preventative health checks to catch potential issues early.
At WeCovr, we enhance this focus on wellness. All our PMI and life insurance clients receive complimentary access to CalorieHero, our cutting-edge AI-powered calorie and nutrition tracking app. Furthermore, clients who purchase a PMI policy often qualify for discounts on other essential cover, such as life insurance or income protection, helping you protect your health and finances in one place.
Choosing the Right PMI Provider and Policy for You
Navigating the market to find the best private medical insurance can be a challenge, but you don't have to do it alone. Working with an experienced, FCA-authorised broker is the smartest way to approach it.
An independent broker:
- Understands the Market: We know the strengths and weaknesses of each insurer.
- Saves You Time: We gather the quotes and present them in an easy-to-understand format.
- Offers Impartial Advice: Our duty is to you, the client, not the insurer. We are focused on finding the right policy for your needs, backed by high customer satisfaction ratings.
- Costs You Nothing: We are paid a commission by the insurer you choose, so our expert service is free for you to use.
When you're ready to explore your options, here are the key questions to consider with your broker:
- What is my absolute maximum monthly budget?
- Is comprehensive out-patient cover essential for me?
- How important is mental health support?
- Do I have a specific hospital I want to be treated at?
- How much excess would I be comfortable paying if I needed to claim?
Answering these will help narrow down the options to find the perfect fit.
Can I get private health insurance for a pre-existing condition?
Do I still need to pay National Insurance if I have PMI?
What is the difference between moratorium and full medical underwriting?
Can my private health insurance premium go up?
Ready to take control of your healthcare journey? The path to faster treatment and peace of mind is clearer than you think.
Contact the friendly, FCA-authorised experts at WeCovr today. Get your free, no-obligation quote and let us compare the UK's leading insurers to find the perfect private health cover for you and your family.
Sources
- Department for Transport (DfT): Road safety and transport statistics.
- DVLA / DVSA: UK vehicle and driving regulatory guidance.
- Association of British Insurers (ABI): Motor insurance market and claims publications.
- Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.
