TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr is your expert guide to private medical insurance in the UK. This comprehensive 2026 update explains how PMI works, from choosing a policy to making your first claim, giving you the clarity to make the best choice for your health. From getting a quote to making a claim — WeCovr's updated step-by-step guide to PMI Navigating the world of private medical insurance (PMI) can feel complex, but it doesn't have to be.
Key takeaways
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of things like hernias, joint replacements, or cataract surgery.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, is incurable, or is likely to come back. Examples include diabetes, asthma, and high blood pressure.
- Speed of Access: Bypass long NHS waiting times for specialist consultations, diagnostic scans (like MRI and CT), and elective surgery.
- Choice and Control: You can often choose your specialist or surgeon and select a hospital that is convenient for you.
- Comfort and Privacy: Treatment is typically in a private hospital with your own en-suite room, more flexible visiting hours, and better food.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr is your expert guide to private medical insurance in the UK. This comprehensive 2026 update explains how PMI works, from choosing a policy to making your first claim, giving you the clarity to make the best choice for your health.
From getting a quote to making a claim — WeCovr's updated step-by-step guide to PMI
Navigating the world of private medical insurance (PMI) can feel complex, but it doesn't have to be. At its core, PMI is a policy you buy to cover the cost of private healthcare for new, treatable medical conditions. It works alongside the NHS, not as a replacement, giving you more choice, speed, and comfort when you need it most.
With NHS waiting lists in England remaining a significant concern—affecting an estimated 7.5 million people in late 2025 according to NHS England data—more people than ever are considering private health cover.
This guide breaks down the entire process into simple, manageable steps.
Step 1: Understanding Why You Might Want PMI
Before you even think about getting a quote, it's vital to understand what private medical insurance is for and whether it aligns with your needs.
The Key Purpose of PMI: To cover the costs of diagnosis and treatment for acute conditions that arise after your policy begins.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of things like hernias, joint replacements, or cataract surgery.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, is incurable, or is likely to come back. Examples include diabetes, asthma, and high blood pressure.
Crucially, standard UK private medical insurance does not cover chronic conditions or pre-existing conditions. The NHS remains your port of call for these, as well as for accident and emergency (A&E) services.
So, why do people choose PMI?
- Speed of Access: Bypass long NHS waiting times for specialist consultations, diagnostic scans (like MRI and CT), and elective surgery.
- Choice and Control: You can often choose your specialist or surgeon and select a hospital that is convenient for you.
- Comfort and Privacy: Treatment is typically in a private hospital with your own en-suite room, more flexible visiting hours, and better food.
- Access to Specialist Drugs and Treatments: Some policies provide cover for drugs or treatments that may not be available on the NHS due to cost or other reasons.
Think of it as a partnership: the NHS is there for emergencies, chronic care, and your GP. PMI is there to speed up planned, non-emergency treatment for new health problems.
Step 2: Getting Your Personalised Health Insurance Quote
Once you've decided PMI is right for you, the next step is to see what your options look like and how much they cost. This is where using a specialist PMI broker like WeCovr can save you time and money.
Information You'll Need to Provide
To generate an accurate quote, insurers and brokers need some basic information:
- Personal Details: Your name, date of birth, and postcode. Age is the single biggest factor in pricing, and your location matters because hospital costs vary across the country (London is typically the most expensive).
- People to be Covered: Will it be just you, you and a partner, or your whole family?
- Your Medical History (Underwriting): You'll need to choose how you want the insurer to assess your medical history. This is a key decision.
- Level of Cover: Do you want a basic plan that just covers essential surgery, or a comprehensive one with extras like therapy and dental cover?
Understanding Underwriting: Moratorium vs. Full Medical
This is perhaps the most technical part of getting a policy, but it's simple when broken down. Underwriting is the process an insurer uses to decide what they will and won't cover based on your past health.
| Underwriting Type | How It Works | Pros | Cons |
|---|---|---|---|
| Moratorium (Most Popular) | You don't declare your full medical history upfront. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the last 5 years. This exclusion can be lifted if you go a continuous 2-year period after your policy starts without any issues related to that condition. | Quicker to set up. Less paperwork. | Can create uncertainty. A claim might be investigated to see if it relates to a pre-existing condition, which can cause delays. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire, declaring your entire medical history. The insurer then tells you upfront exactly what is excluded from your policy. | Complete clarity from day one. You know exactly what isn't covered. Faster claims process as history is already known. | Takes longer to set up. Requires you to remember and declare your full medical history. Exclusions are often permanent. |
An expert adviser at WeCovr can help you decide which underwriting option is best for your personal circumstances, ensuring there are no surprises down the line.
Step 3: Customising Your Policy to Fit Your Budget
A common myth is that private health insurance is prohibitively expensive. In reality, modern policies are highly customisable, allowing you to balance the level of cover with the monthly premium.
Core Cover: The Essentials
Almost every PMI policy in the UK includes in-patient and day-patient treatment as standard.
- In-patient: Treatment where you are admitted to a hospital and stay overnight.
- Day-patient: Treatment where you are admitted and discharged on the same day (e.g., a minor surgical procedure).
This core cover typically includes hospital fees, specialist fees, and anaesthetist fees.
Optional Extras: Building Your Perfect Plan
Here's where you can tailor the policy. Common add-ons include:
- Out-patient Cover: This is the most important add-on. It covers diagnostic tests and consultations that don't require a hospital admission. Without it, you would have to pay for your initial specialist consultation and scans (like MRI/CT) yourself, or wait for them on the NHS. Most people choose some level of out-patient cover.
- Therapies Cover: Includes treatments like physiotherapy, osteopathy, and chiropractic care, often up to a set number of sessions per year.
- Mental Health Cover: Provides support for acute mental health conditions, including access to psychiatrists and therapists.
- Dental and Optical Cover: Contributes towards routine check-ups, treatments, and glasses/contact lenses.
| Feature | Basic Policy | Comprehensive Policy |
|---|---|---|
| In-patient/Day-patient | ✅ Included | ✅ Included |
| Out-patient Cover | ❌ Not included (or very limited) | ✅ Included (often up to a set limit or in full) |
| Therapies | ❌ Not included | ✅ Included (e.g., up to 8 sessions) |
| Mental Health | ❌ Not included | ✅ Often included as a valuable add-on |
| Cancer Cover | ✅ Included (often comprehensive) | ✅ Included (often enhanced with access to more drugs) |
Controlling the Cost: Your Levers
Beyond the level of cover, you have three main ways to adjust your premium:
- Excess: This is the amount you agree to pay towards the cost of your first claim each year. 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 (£500, £1,000) will significantly lower your monthly premium.
- Hospital List: Insurers group private hospitals into tiers based on cost. Choosing a list that excludes the most expensive central London hospitals can reduce your premium. If you don't live near London, this is an easy way to save money.
- Six-Week Option: This is a popular cost-saving measure. If you add a six-week option, your PMI will only cover your treatment if the NHS waiting list for that specific procedure is longer than six weeks. If it's shorter, you use the NHS. This can reduce your premium by 20-30%.
Example Monthly PMI Costs (2026 Estimates)
The following table provides illustrative monthly premiums. Your actual quote will depend on your specific circumstances.
| Age / Profile | Location | Level of Cover | Estimated Monthly Premium |
|---|---|---|---|
| 30-year-old, non-smoker | Manchester | Mid-range, £250 excess | £45 - £60 |
| 45-year-old, non-smoker | Bristol | Comprehensive, £100 excess | £80 - £110 |
| 55-year-old couple, non-smokers | London | Mid-range, £500 excess | £180 - £250 |
| Family of 4 (ages 40, 38, 10, 8) | Edinburgh | Comprehensive, £250 excess | £220 - £300 |
Disclaimer: These are estimates for illustrative purposes only. For an accurate quote, speak to an adviser.
Step 4: Your Policy is Live – What Happens Next?
Congratulations, you've chosen your policy and your cover is active! Here’s what to expect.
Your Policy Documents
You will receive a policy pack, either digitally or by post. This contains:
- Your policy schedule, confirming your cover details.
- Your policy booklet, explaining the terms and conditions in full.
- Your membership card with your policy number and the claims helpline.
Keep these documents safe!
Initial Waiting Periods
Most policies have an initial waiting period (often 14-30 days) at the very start, during which you cannot make a claim. This prevents people from buying a policy only when they know they immediately need treatment.
Making the Most of Wellness and Value-Added Benefits
Modern private medical insurance isn't just for when you're ill. The best PMI providers now include a wealth of benefits designed to keep you healthy. These can include:
- Digital GP: 24/7 access to a GP via phone or video call, often bookable within hours.
- Health and Wellness Apps: Access to apps for mental wellbeing, fitness programmes, and nutritional advice.
- Member Discounts: Reduced gym memberships, fitness trackers, and other health-related products.
When you arrange your policy through WeCovr, you also get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, helping you stay on top of your diet and fitness goals. Furthermore, customers who purchase PMI or life insurance with us may be eligible for discounts on other types of cover, adding even more value.
Step 5: The Claims Process – Your Step-by-Step Guide
This is the moment of truth—when you need to use your policy. The process is designed to be straightforward.
Here is the typical journey from feeling unwell to receiving private treatment:
Step 1: Visit Your NHS GP
Your health journey almost always starts with your GP. They will assess your symptoms. Your PMI does not cover GP visits, so you use the NHS as normal.
Step 2: Get an Open Referral
If your GP believes you need to see a specialist, they will write you a referral letter. Ask for an "open referral". This means they recommend you see a specialist (e.g., a cardiologist) but don't name a specific individual. This gives your insurer the flexibility to help you choose from their approved list of specialists.
Step 3: Call Your Insurer's Claims Line
With your referral letter in hand, call the claims number on your membership card. You'll need to provide:
- Your policy number.
- Details of your symptoms and the GP's recommendation.
Step 4: Get Authorisation
The insurer will check that your condition is covered under your policy. If it is, they will give you an authorisation number. They will also provide you with a list of approved specialists and hospitals you can use.
This is a critical step. Do not proceed with any consultations or treatment without getting authorisation first, or your insurer may not pay.
Step 5: Book Your Consultation and Treatment
You can now contact the specialist's secretary to book your first appointment. Let them know you are using private medical insurance and give them your authorisation number and policy details. If the specialist recommends a test (like an MRI) or a procedure, you will need to call your insurer again to get this next stage of treatment authorised.
Step 6: The Insurer Settles the Bill
The best part about the process is that you rarely have to handle any money yourself (other than your excess). The hospital and specialists will usually send their invoices directly to your insurance provider for settlement. If you paid an excess, the insurer will deduct this from the final payment to the hospital.
Step 6: After Your Claim – Policy Management
Once your treatment is complete and the bills are settled, your claim is closed.
Impact on Your No-Claims Discount (NCD)
Much like car insurance, many PMI policies feature a No-Claims Discount. If you don't make a claim during a policy year, your discount increases at renewal, helping to offset age-related price rises. If you do make a claim, your NCD level will typically be reduced.
Annual Renewal
Your policy will run for 12 months, after which you will be invited to renew. Your renewal premium will be based on:
- Your age (premiums rise as you get older).
- Medical inflation (the rising cost of healthcare).
- Your claims history (your NCD level).
At renewal, it’s always a good idea to review the market. A broker like WeCovr can re-compare prices from all the leading insurers to ensure you are still on the best possible plan for your needs and budget, at no extra cost to you.
Your Health is Your Wealth: Proactive Wellness Tips
Whilst having a great health insurance policy provides peace of mind, the best strategy is to stay healthy in the first place. Here are some simple, effective tips:
- Balanced Diet: Focus on whole foods—fruits, vegetables, lean proteins, and whole grains. Use an app like WeCovr's CalorieHero to track your intake and ensure you're getting the right balance of nutrients.
- Consistent Sleep: Aim for 7-9 hours of quality sleep per night. According to the Sleep Foundation, consistent sleep is crucial for immune function, mental clarity, and managing stress.
- Regular Movement: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be a brisk walk, a bike ride, or a swim. Find something you enjoy to make it a sustainable habit.
- Mindful Stress Management: Chronic stress can negatively impact your health. Practices like mindfulness, meditation, or even just taking 10 minutes a day for a quiet cup of tea can make a huge difference.
By combining a proactive approach to your own wellness with the safety net of a robust health insurance policy, you are taking the ultimate step in securing your long-term health and wellbeing.
Is private medical insurance worth it in the UK?
Does health insurance cover conditions I already have?
What is the difference between Moratorium and Full Medical Underwriting?
How can I reduce the cost of my private health insurance?
- Increase your excess: Agreeing to pay more towards your first claim of the year (e.g., £500 instead of £100) will lower your monthly premium.
- Choose a guided hospital list: Opting for a list that gives you a choice from a select panel of high-quality hospitals, rather than any hospital, can reduce costs.
- Add a 6-week option: This means you'll use the NHS if the waiting list for your treatment is less than 6 weeks, which can offer a significant discount.
- Compare the market: Using an independent broker to compare policies from multiple insurers ensures you get the best price for the cover you need.
Ready to Take the Next Step?
Understanding how private health insurance works is the first step towards protecting your health and gaining peace of mind. The next is finding the right policy for you.
At WeCovr, our expert, experienced advisers are here to help. We'll compare policies from the UK's leading insurers, explain your options in plain English, and build a plan that fits your needs and budget perfectly—all at no cost to you.
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.
