TL;DR
As an FCA-authorised expert with over 900,000 policies arranged, WeCovr helps UK consumers navigate the complex world of private medical insurance. This guide explores a smart, affordable strategy: blending private health cover with a health cash plan to create a powerful, well-rounded safety net for you and your family. How to create affordable, well-rounded protection using cash and medical insurance plans In today's healthcare landscape, many of us are looking for ways to gain more control over our health and wellbeing.
Key takeaways
- Speed: Bypassing long NHS queues for consultations, scans, and procedures.
- Choice: Greater control over where you are treated, the specialist you see, and when your treatment takes place.
- Pre-existing Conditions: Any illness, disease, or injury you have sought advice or treatment for in the years before your policy starts (typically the last 5 years).
- Chronic Conditions: Illnesses that cannot be cured and require long-term management, such as diabetes, asthma, high blood pressure, or Crohn's disease. These conditions will continue to be managed by your NHS GP and specialists.
- Dental: Claim back money for check-ups, hygienist visits, fillings, crowns, and even braces.
As an FCA-authorised expert with over 900,000 policies arranged, WeCovr helps UK consumers navigate the complex world of private medical insurance. This guide explores a smart, affordable strategy: blending private health cover with a health cash plan to create a powerful, well-rounded safety net for you and your family.
How to create affordable, well-rounded protection using cash and medical insurance plans
In today's healthcare landscape, many of us are looking for ways to gain more control over our health and wellbeing. While the NHS remains a cherished national institution, record waiting lists and stretched services mean that accessing timely care can be a challenge. This has led a growing number of people to explore private options.
The two main players in the private health market are Private Medical Insurance (PMI) and Health Cash Plans. For years, consumers have treated them as an either/or choice. But what if the smartest move isn't choosing one over the other, but combining them?
This is the "hybrid" approach: using a tailored PMI policy for the big, unexpected health crises, and a cost-effective cash plan to cover your day-to-day, routine medical expenses. This guide will show you exactly how to build this affordable, comprehensive solution.
The Current UK Healthcare Landscape: Why People Are Looking for Alternatives
The National Health Service (NHS) provides exceptional care to millions, free at the point of use. However, it is currently facing unprecedented pressure.
According to NHS England data, the referral to treatment (RTT) waiting list stood at approximately 7.54 million in August 2024. This figure represents the number of people waiting for consultant-led elective care, and while services are working incredibly hard, these numbers highlight the potential for long waits for diagnosis and treatment.
This reality has made private healthcare an increasingly attractive option for those who can afford it, offering two key benefits:
- Speed: Bypassing long NHS queues for consultations, scans, and procedures.
- Choice: Greater control over where you are treated, the specialist you see, and when your treatment takes place.
This is where private health plans come in, but understanding the difference between the main types is crucial.
Deconstructing the Options: What is Private Medical Insurance (PMI)?
Private Medical Insurance (PMI), often called 'private health cover', is a type of insurance policy designed to cover the costs of private medical treatment for acute conditions that arise after you take out the policy.
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 things like hernias, cataracts, joint replacements, or appendicitis.
The Golden Rule of PMI: What It Does Not Cover
It is absolutely vital to understand that standard private medical insurance in the UK does not cover pre-existing conditions or chronic conditions.
- Pre-existing Conditions: Any illness, disease, or injury you have sought advice or treatment for in the years before your policy starts (typically the last 5 years).
- Chronic Conditions: Illnesses that cannot be cured and require long-term management, such as diabetes, asthma, high blood pressure, or Crohn's disease. These conditions will continue to be managed by your NHS GP and specialists.
PMI is for the new and unexpected, not for ongoing management of existing health issues.
What Does a Typical PMI Policy Cover?
PMI policies are modular, meaning you can build them to suit your needs and budget. Core cover is almost always included, with optional extras available.
| Coverage Type | Description | Is it Usually Included? |
|---|
| In-patient & Day-patient Treatment | Covers costs when you are admitted to hospital and require a bed, either overnight (in-patient) or for the day (day-patient). This includes surgery, hospital fees, specialist fees, and nursing care. | Core Cover |
| Cancer Care | Comprehensive cover for the diagnosis and treatment of cancer, including chemotherapy, radiotherapy, surgery, and specialist consultations. Often one of the most valued benefits. | Core Cover (though levels can vary) |
| Out-patient Treatment | Covers diagnostic tests and consultations with a specialist where you are not admitted to hospital. This can be limited or unlimited depending on the policy. | Optional Extra |
| Mental Health Support | Cover for therapy sessions, psychiatric consultations, and sometimes in-patient treatment for mental health conditions. | Optional Extra (increasingly included in core) |
| Therapies | Cover for treatments like physiotherapy, osteopathy, and chiropractic care, often up to a set number of sessions per year. | Optional Extra |
| Digital GP Services | 24/7 access to a GP via phone or video call, allowing you to get medical advice and prescriptions quickly without leaving home. | Often included as a standard benefit. |
Understanding the Other Side: What is a Health Cash Plan?
A Health Cash Plan is a much simpler, more affordable type of health policy. It is not insurance for major medical events. Instead, it helps you budget for and reclaim costs associated with your everyday, routine healthcare.
Think of it as a piggy bank for your health. You pay a small monthly premium, and in return, you can claim cash back on a variety of treatments, up to an annual limit for each category.
What Does a Health Cash Plan Typically Cover?
Benefits are straightforward and focus on routine care that PMI often excludes.
- Dental: Claim back money for check-ups, hygienist visits, fillings, crowns, and even braces.
- Optical: Get cash back towards the cost of eye tests, glasses, and contact lenses.
- Therapies: Includes physiotherapy, osteopathy, chiropractic, and sometimes acupuncture or podiatry.
- Specialist Consultations: A contribution towards the cost of seeing a specialist privately.
- Prescription Charges: Reclaim the cost of NHS prescriptions.
- Health Screenings: Money back for preventative health checks.
- Maternity/Paternity/Adoption Grant: A one-off cash payment upon the birth or adoption of a child.
How it Works: A Simple Example
- You have a health cash plan that costs £15 per month.
- It gives you an annual benefit of £120 for routine dental treatment.
- You visit the dentist for a check-up and a filling, which costs £95.
- You pay the dentist, get a receipt, and submit a claim to your cash plan provider.
- They transfer the £95 directly into your bank account.
- You still have £25 left in your dental 'pot' for the rest of the policy year.
The Protection Gap: Why Neither Plan is Perfect on Its Own
While both PMI and cash plans are valuable, they each have significant gaps when used as a standalone solution. This creates a "protection gap," leaving you exposed in certain areas.
Let's compare them side-by-side:
| Feature | Private Medical Insurance (PMI) | Health Cash Plan |
|---|
| Purpose | Covers major, expensive, acute medical events (e.g., surgery, cancer). | Covers routine, everyday healthcare costs (e.g., dental, optical). |
| Key Strength | Peace of mind for serious illness; fast access to high-cost private treatment. | Makes everyday healthcare more affordable and predictable. |
| Key Weakness | Does not cover routine dental, optical, or pre-existing/chronic conditions. | Does not cover major surgery, hospital stays, or expensive treatments like cancer care. |
| How it Pays | Insurer pays the hospital/specialist directly (you may pay an excess). | You pay for treatment first, then claim the cash back from the provider. |
| Cost | More expensive. Premiums range from £40 to £150+ per month, depending on age, cover, and health. | Highly affordable. Premiums typically range from £10 to £40 per month. |
| Best For... | Someone whose main concern is bypassing long waits for major surgery or getting comprehensive cancer care. | Someone who wants help budgeting for predictable costs like dental check-ups and new glasses. |
As you can see, they are two sides of the same coin. PMI protects you from the budget-destroying, high-cost events. A cash plan helps you manage the predictable, lower-cost expenses that add up over a year.
The Hybrid Solution: The Best of Both Worlds
The hybrid strategy is about intelligently combining a modified PMI policy with a health cash plan. The goal is to get comprehensive protection without paying for a top-tier, all-inclusive PMI plan.
The Strategy:
- Lower your PMI Premium: You choose a PMI policy but customise it to reduce the cost. You keep the essential cover for major events like surgery and cancer but scale back on the "extras."
- Add a Cash Plan: You use the money you've saved on your PMI premium to buy a separate health cash plan.
- Fill the Gaps: The cash plan now covers the routine treatments (dental, optical, physio) that you removed from your PMI policy, often more effectively and at a lower cost.
Real-Life Example: Meet David, a 42-Year-Old Marketing Manager
David wants private health cover for his family but is conscious of the monthly cost. A fully comprehensive PMI policy for him and his partner is quoted at £130 per month. It includes full out-patient cover, therapies, and a low excess.
Instead, he works with a PMI broker like WeCovr to build a hybrid plan:
-
Customise the PMI:
- He increases the policy excess (the amount he pays towards a claim) from £250 to £1,000.
- He removes the optional therapies cover (physiotherapy, etc.).
- He opts for a limited out-patient cover of £500, enough for initial consultations and diagnostics but not extensive follow-ups.
- Result: His new PMI premium is just £65 per month. He is still fully covered for cancer and any in-patient surgery.
-
Add a Cash Plan:
- He takes out a family health cash plan for £25 per month.
- This plan provides:
- £200 per person for dental.
- £150 per person for optical.
- £300 per person for physiotherapy and other therapies.
- 24/7 Digital GP access.
The Final Calculation:
- Comprehensive PMI Only: £130 / month
- Hybrid Plan (PMI + Cash Plan): £65 + £25 = £90 / month
By adopting the hybrid approach, David saves £40 per month (£480 per year) while arguably having better cover for his family's day-to-day needs. His cash plan provides generous, predictable benefits for dental and optical care that the original PMI policy didn't cover as effectively. He retains the crucial safety net for serious illness while making routine healthcare more manageable.
How to Build Your Perfect Hybrid Health Plan: A Step-by-Step Guide
Ready to create your own affordable and robust health protection? Follow these steps.
1. Assess Your Personal Needs and Budget
Start by asking yourself a few key questions:
- What is my main priority? Is it fast access to surgery, comprehensive cancer care, or help with routine costs?
- What is my monthly budget? Be realistic about what you can comfortably afford.
- Do I have any specific health concerns? While PMI won't cover pre-existing conditions, you might want a plan with strong mental health support or a good network of hospitals known for orthopaedics, for example.
- Am I covering just myself, or a partner and family?
2. Customise Your PMI Policy to Control Costs
This is where you make your PMI policy lean and focused. A good PMI broker can be invaluable here, guiding you through the options that give you the biggest savings without compromising on core protection.
- Increase Your Excess: This is the fastest way to lower your premium. Choosing a £500 or £1,000 excess means you agree to pay that amount towards your first claim in a policy year. You're essentially self-insuring for smaller issues, leaving the policy to cover the major costs.
- The 6-Week Option: This popular option can reduce your premium by up to 25%. It means that if the NHS can treat you within six weeks for a specific condition, you will use the NHS. If the wait is longer, your private cover kicks in. It’s a pragmatic compromise.
- Limit Out-patient Cover: Comprehensive out-patient cover can be expensive. You can choose to limit it (e.g., to £500 or £1,000 per year) or remove it entirely, relying on the NHS for initial diagnostics. Your cash plan can also provide a small benefit towards specialist consultations.
- Choose a Guided Hospital List: Instead of having access to every private hospital in the UK, you can agree to use a curated list of high-quality hospitals selected by the insurer. This helps them manage costs and passes the savings on to you.
3. Select a Complementary Health Cash Plan
Once you've tailored your PMI policy, find a cash plan that plugs the gaps you've created.
- Look at Therapy Limits: If you've removed therapies from your PMI, ensure your cash plan has a generous allowance for physiotherapy, osteopathy, etc.
- Check Dental and Optical Benefits: These are the bread and butter of a cash plan. Look for plans with high enough annual limits to cover your expected costs for check-ups and glasses/lenses.
- Consider Per-Child Benefits: If you have a family, check if the annual limits apply per person or are shared across the policy.
4. Work With an Independent Broker
Navigating the hundreds of policy combinations from the UK's best PMI providers can be overwhelming. This is where an independent, FCA-authorised broker like WeCovr provides immense value.
An expert broker will:
- Take the time to understand your unique needs and budget.
- Compare the entire market to find the right PMI and cash plan providers for you.
- Help you customise the policies to create the perfect hybrid blend.
- Do all the legwork for you, at no cost to you. Their commission is paid by the insurer you choose.
Beyond Insurance: Wellness Benefits and Added Value
Modern health plans are no longer just about paying for treatment. Insurers are increasingly focused on prevention and helping you stay healthy. When choosing your plans, look out for these valuable extras:
- Digital GP Services: 24/7 access to a GP is now a standard feature and is incredibly convenient.
- Mental Health Support: Many plans offer access to counselling helplines or a set number of therapy sessions without needing a GP referral.
- Gym Discounts and Fitness Rewards: Some providers partner with major gym chains or offer rewards for hitting activity goals.
- Wellness Apps: Insurers often provide access to apps for mindfulness, nutrition, and fitness tracking.
As a WeCovr client, you also get complimentary access to our proprietary AI-powered calorie and nutrition tracking app, CalorieHero, helping you take proactive control of your diet and health. Furthermore, clients who purchase PMI or Life Insurance through us may be eligible for discounts on other types of cover, creating even more value.
Who Benefits Most from a Hybrid Health Plan?
This flexible approach is ideal for a wide range of people:
- The Self-Employed and Freelancers: Who need a robust but affordable safety net without the benefit of a company scheme.
- Young Families: Who want comprehensive cover for their children's routine needs (dental, optical) as well as protection against serious illness, all within a tight budget.
- Employees with Basic Corporate PMI: Many company plans are basic. A personal cash plan is a cheap and effective way to 'top up' your cover with dental, optical, and therapy benefits.
- The Budget-Conscious Individual: Anyone who recognises the value of private medical insurance UK but finds the cost of a comprehensive policy prohibitive.
A hybrid plan democratises private healthcare, making it accessible to more people than ever before.
Can I use my health cash plan to pay for my PMI policy excess?
This is a clever use of the hybrid model, but it depends on the cash plan's terms. Some cash plans offer a "hospital benefit" or a cash payout for each night spent in hospital. You could potentially use this payout to contribute towards your PMI excess. However, cash plans will not typically pay an excess directly. It's essential to check the policy wording of your specific cash plan to see what is covered under their in-patient benefits.
Are pre-existing conditions ever covered by private medical insurance?
Generally, standard UK private health cover does not include pre-existing conditions. However, the way this is applied depends on your underwriting. With 'moratorium underwriting', an insurer may agree to cover a past condition if you remain completely symptom-free and have not needed any treatment, medication, or advice for it for a continuous period (usually two years) after your policy starts. Chronic conditions are never covered. It is vital to be transparent about your medical history when applying.
How does a broker like WeCovr help me save money?
An expert broker saves you money in several ways. Firstly, we have access to the whole market and understand the pricing and features of every provider, ensuring you don't overpay. Secondly, we are experts at tailoring policies – we know which benefits to adjust (like excess or out-patient limits) to significantly lower your premium without sacrificing the core protection you need. Finally, our service is free to you, so you get expert, unbiased advice without any extra cost, preventing you from buying an unsuitable or overpriced policy.
Is a hybrid plan always better than a comprehensive PMI policy?
Not necessarily. A hybrid plan is an excellent strategy for achieving cost-effective, well-rounded cover. However, for individuals who want the absolute highest level of convenience and simplicity, a top-tier comprehensive PMI plan with unlimited out-patient cover and zero excess may be preferable, provided they are comfortable with the higher premium. The "best" solution always depends on your personal priorities, budget, and attitude to risk.
Take the Next Step to Affordable, Smarter Health Cover
Creating a hybrid health plan is a powerful way to get the peace of mind of private medical insurance and the practical benefits of a cash plan, all for an affordable monthly price. You get a safety net for the big worries and a helping hand with the everyday costs.
Ready to design your perfect hybrid health plan? The expert, friendly team at WeCovr can help you compare policies from across the UK market, ensuring you get the right cover at the best price. Our advice is independent and comes at no cost to you.
Get your free, no-obligation quote today and build the protection you and your family deserve.