How to Dispute a Health Insurance Premium Increase
Receiving your annual private medical insurance renewal notice only to find a significant price hike can be frustrating. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we understand your concerns. This guide explains why your private medical insurance in the UK might have increased and provides clear, actionable steps to dispute or lower the cost.
Action steps if you think your hike is unfair and how to appeal
Facing a premium increase doesn't mean you have to accept it without question. If you believe the rise is unjustified, you have a clear path to follow. Start by methodically reviewing the renewal offer, then gather your facts and prepare to negotiate. If that fails, a formal appeals process exists.
Here is your initial action plan:
- Review Your Renewal Letter: Don't just look at the final price. Compare it line-by-line with last year's policy. Have any benefits changed? Are your personal details correct?
- Understand the Reasons: Identify the likely causes. Is it your age? A recent claim? Or a general market trend?
- Contact Your Insurer or Broker: A phone call is often the most effective first step. Ask for a detailed explanation of the increase.
- Explore Your Options: Ask about ways to reduce the premium, such as increasing your excess or changing your hospital list.
- Consider Switching: Get a comparison quote from the wider market. A broker can do this for you.
- Lodge a Formal Complaint: If you're still unsatisfied, begin the insurer's official complaints procedure.
- Escalate to the Ombudsman: As a last resort, you can take your case to the Financial Ombudsman Service, free of charge.
Why Do Health Insurance Premiums Go Up? Understanding the Key Drivers
Before you can effectively challenge a price rise, it's vital to understand why premiums increase. It's rarely a single factor, but a combination of personal and market-wide forces.
1. Age: The Primary Factor
This is the most significant driver of premium increases. As we get older, the statistical likelihood of needing medical treatment rises. Insurers use age bands to price their policies, and crossing into a new band (e.g., turning 40, 50, or 65) often triggers a notable price jump, even if you haven't claimed.
Example of Age-Related Premium Increases
| Age Bracket | Typical Annual Premium | Reason for Increase |
|---|---|---|
| 30-39 | £700 | Baseline risk. |
| 40-49 | £950 | Increased risk of developing conditions. |
| 50-59 | £1,300 | Higher likelihood of needing joint replacements, cardiac care. |
| 60-69 | £1,850 | Substantially higher risk and cost of claims. |
| 70+ | £2,500+ | Highest risk category for complex and frequent treatment. |
Note: These are illustrative figures. Actual premiums vary widely based on insurer, location, and level of cover.
2. Your Claims History
If you've made a claim in the past policy year, your insurer may increase your premium at renewal. The size of the increase often depends on the value of the claim. Insurers do this because a past claim can indicate a higher likelihood of future claims. However, some policies offer a "no-claims discount protection," which can mitigate this for a small additional cost.
3. Medical Inflation
This is a crucial concept to grasp. The cost of private healthcare consistently rises faster than general inflation (the Consumer Price Index, or CPI). In the UK, medical inflation typically runs between 8% and 12% per year.
What fuels medical inflation?
- New Technologies & Treatments: Groundbreaking but expensive drugs, advanced diagnostic scanners (MRI, CT), and new surgical techniques increase the cost of care.
- Higher Staff Costs: The cost of paying skilled consultants, surgeons, and nurses rises.
- Increased Demand: An ageing population and pressures on the NHS lead more people to use private facilities, driving up prices.
4. Insurance Premium Tax (IPT)
IPT is a tax levied by the UK government on all general insurance policies, including private health cover. The standard rate is currently 12%. If the government raises the IPT rate, this cost is passed directly on to you, increasing your premium even if nothing else has changed.
5. Insurer's Overall Performance
Your premium also reflects the collective claims experience of everyone insured by your provider. If the insurer has had to pay out more in claims than anticipated across its entire customer base in a given year, it may raise premiums for all policyholders to rebalance its books and ensure it can cover future claims.
Your Step-by-Step Guide to Disputing a Premium Increase
Feeling empowered with knowledge, you can now take structured action. Follow these steps methodically.
Step 1: Scrutinise Your Renewal Notice
Your renewal pack is your first piece of evidence. Don't just glance at the new price. Take out a pen and compare it with last year's documents.
- Check the Premium Breakdown: Look at the base premium, the IPT, and any fees. Has the base cost risen, or is it a tax change?
- Verify Personal Details: Is your date of birth, address, and name correct? A simple error can lead to incorrect pricing.
- Review Your Cover Level: Has the insurer changed your benefits? Sometimes they might automatically "upgrade" you to a new plan with more features at a higher cost. Ensure you're comparing like-for-like.
- Note the Renewal Date: Be aware of the deadline. You typically have a window of 14-30 days before the renewal date to make changes or cancel.
Step 2: Prepare for the Conversation
Before you pick up the phone, gather your documents and talking points.
- Documents Needed:
- This year's renewal letter.
- Last year's policy schedule and renewal letter.
- A record of any claims you've made, including dates and treatments.
- Your original policy terms and conditions.
- Your Goal: To get a clear, specific reason for the increase and to negotiate a better price.
- Key Questions to Ask:
- "Could you please provide a detailed breakdown of why my premium has increased by X%?"
- "How much of this increase is due to my age, my claims history, and general medical inflation?"
- "Have there been any changes to my policy benefits that I wasn't aware of?"
- "What options are available to bring my premium down?"
Step 3: Contact Your Insurer or Broker
A direct conversation is often more productive than an email.
- If you bought direct: Call the insurer's customer service or renewals department. Be polite, patient, but firm. State the facts clearly.
- If you used a broker (like WeCovr): This is where a broker proves their worth. Your adviser can have this conversation on your behalf. They speak the insurer's language, understand the market, and can often negotiate more effectively. This service comes at no extra cost to you.
Step 4: Negotiate and Review Your Options
If the insurer won't reduce the price outright, they will almost certainly offer ways to adjust your policy to make it more affordable. This is your chance to tailor your cover to your current needs and budget.
Common Ways to Lower Your Private Health Cover Premium
| Option to Change | How it Reduces Your Premium | Things to Consider |
|---|---|---|
| Increase Your Excess | An excess is the amount you pay towards a claim. Increasing it from £100 to £500, for example, can significantly cut your premium. | Make sure you can comfortably afford the new excess amount if you need to make a claim. |
| Add a 6-Week Option | This popular option means you agree to use the NHS if it can provide the required treatment within 6 weeks of it being needed. If the NHS wait is longer, your PMI kicks in. | This offers a great balance of cost savings while still providing a safety net against long NHS waiting times. |
| Reduce Outpatient Cover | Limit the financial cover for consultations and diagnostics that don't require a hospital bed. You could reduce it from 'unlimited' to a set amount like £1,000. | This is a trade-off. You save money, but could face out-of-pocket costs if you need extensive diagnostic tests. |
| Change Hospital List | Insurers have tiered hospital lists. Opting for a list that excludes expensive central London hospitals can lead to substantial savings. | Check the revised list carefully to ensure it includes convenient, high-quality hospitals near you. |
| Co-payment Option | You agree to pay a percentage of each claim, for instance, 10% or 20%, in addition to any excess. | This can lower the premium but makes your potential costs less predictable if you do claim. |
An expert adviser at WeCovr can model these changes for you, showing you exactly how each tweak affects your premium and helping you find the perfect balance.
Step 5: Make a Formal Complaint
If your negotiations are unsuccessful and you still feel the premium increase is unfair or your insurer has not explained it properly, you can make a formal complaint.
- Write to the Insurer: Send a formal letter or email to their dedicated complaints department. Clearly title it "Formal Complaint."
- State Your Case: Outline the facts calmly and concisely. Explain why you believe the premium increase is unfair, what you have done to resolve it so far, and what you want as a resolution (e.g., a better explanation, a reduced premium).
- Await a Response: The Financial Conduct Authority (FCA) rules state that the firm must provide a final response within eight weeks.
Step 6: Escalate to the Financial Ombudsman Service (FOS)
If you receive a final response you're unhappy with, or if the eight weeks have passed with no resolution, you have the right to take your case to the Financial Ombudsman Service.
- Who they are: The FOS is a free, independent body that settles disputes between consumers and financial services firms.
- What they do: They will look at both sides of the story and decide what is fair and reasonable. Their decision is binding on the insurer if you accept it.
- When to go: You must contact the FOS within six months of the insurer's final response letter.
The FOS will not typically judge whether a premium is "too high" in isolation, but they will investigate if you were treated unfairly, if the terms were not transparent, or if the insurer made an error.
A Critical Reminder: Pre-existing and Chronic Conditions
It is absolutely essential to understand the fundamental purpose of private medical insurance in the UK. Standard policies are designed to cover acute conditions that arise after you take out your policy.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a broken bone, appendicitis, cataracts, or a hernia.
- Chronic Condition: A condition that is long-lasting and often has no known cure. It requires ongoing management rather than a one-off treatment. Standard PMI does not cover chronic conditions. Examples include diabetes, asthma, high blood pressure, and arthritis. You will still need to rely on the NHS for the routine management of these conditions.
- Pre-existing Condition: Any medical condition for which you have experienced symptoms, received advice, or had treatment before the start of your policy. These are typically excluded from cover, at least for an initial period (usually two years) under moratorium underwriting.
Understanding this distinction is key to managing your expectations and avoiding disappointment when it's time to claim.
When Switching Providers Is a Better Option
Sometimes, the most effective way to combat a premium rise is to vote with your feet. However, switching needs careful consideration, especially if you have developed new medical conditions since you first took out your cover.
The Importance of Underwriting
When you switch, your new insurer will underwrite you. This is the process they use to assess your health risk.
| Underwriting Type | How It Works | Best For |
|---|---|---|
| Moratorium (MORI) | The most common type. You don't declare your full history. Any condition you've had in the 5 years pre-policy is excluded. This exclusion is lifted if you go 2 full years on the new policy without symptoms, treatment, or advice for that condition. | People who are generally healthy and want a quick application process. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire. The insurer reviews your history and applies specific exclusions for pre-existing conditions, which are usually permanent. | People who want absolute certainty from day one about what is and isn't covered. |
| Continued Medical Exclusions (CME) | This is crucial for switchers. A specialist broker can arrange for your new insurer to carry over the same exclusions from your old policy. This means any new conditions you've developed while insured are covered by the new provider. | Anyone who has developed medical conditions since their original policy started and wants to switch without losing that cover. |
Working with an independent PMI broker like WeCovr is invaluable here. We can access CME switching terms that are not available to the public, ensuring you don't inadvertently lose important cover just to save a few pounds.
Proactive Steps to Manage Your Future Premiums
Don't just wait for the next renewal shock. You can take control of your health and your policy costs throughout the year.
- Engage with Wellness Programmes: Many top providers, like Vitality and Aviva, offer programmes that reward you for being healthy. By tracking your activity, getting health checks, and eating well, you can earn points that translate into direct premium discounts, cinema tickets, or coffee vouchers.
- Embrace a Healthy Lifestyle: This is the best long-term strategy. Regular exercise, a balanced diet, and good quality sleep reduce your risk of developing many of the acute conditions that lead to claims. As a WeCovr client, you get complimentary access to our CalorieHero AI calorie tracking app to help you on your journey.
- Conduct an Annual Policy Review: Never let your policy auto-renew without a review. Your needs change, the market changes, and new, more competitive products are always launching. A 15-minute call with your broker each year can save you hundreds of pounds.
- Bundle Your Insurance: When you arrange your private medical or life insurance through WeCovr, you can often get access to exclusive discounts on other types of cover, such as home or travel insurance, providing even greater value.
Dealing with a premium increase can be daunting, but by being informed and proactive, you hold more power than you think. Whether it's negotiating with your current provider or finding a better deal elsewhere, the key is to take action.
Can my insurer increase my premium if I haven't made a claim?
Is it worth complaining to the Financial Ombudsman Service (FOS)?
What is the biggest mistake people make when their private medical insurance premium goes up?
Will switching insurers mean I lose cover for conditions I've developed?
Don't just accept your renewal price. Take control.
Your renewal letter is not a final bill—it's the start of a conversation. Contact the award-winning team at WeCovr today for a free, no-obligation review of your policy. Our experts will compare the UK's leading insurers to see if you can get better cover for a lower price.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
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