TL;DR
With NHS waiting lists in the UK remaining a significant concern, more people are exploring private medical insurance (PMI) for peace of mind. Here at WeCovr, where our expert team has helped arrange over 900,000 policies of various kinds, we know the biggest question is often about cost. But what does a "low-cost" or "basic" policy really get you?
Key takeaways
- 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 conditions like hernias, joint replacements, or cataracts.
- A chronic condition is a long-term illness that cannot be cured but can be managed. PMI does not cover the ongoing management of chronic conditions like diabetes, asthma, or high blood pressure.
- In-Patient and Day-Patient Treatment: This is the cornerstone of all PMI policies. It covers costs when you are admitted to a hospital for treatment and require a bed, either overnight (in-patient) or just for the day (day-patient). This includes surgery, hospital accommodation, nursing care, and specialist fees.
- Comprehensive Cancer Cover: This is a huge reason people buy PMI. Most basic policies provide extensive cancer cover, including surgery, chemotherapy, and radiotherapy. It can also provide access to cutting-edge drugs and treatments that may not yet be available on the NHS. The level of cover can vary, so it's vital to check the details.
- Virtual GP Services: Now a standard feature on most plans. This gives you 24/7 access to a GP via phone or video call, often with the ability to get prescriptions or referrals quickly. This alone can be worth the policy's cost for busy individuals and families.
With NHS waiting lists in the UK remaining a significant concern, more people are exploring private medical insurance (PMI) for peace of mind. Here at WeCovr, where our expert team has helped arrange over 900,000 policies of various kinds, we know the biggest question is often about cost. But what does a "low-cost" or "basic" policy really get you?
This guide cuts through the marketing jargon to give you a realistic, no-nonsense look at what you can expect from an entry-level private health insurance plan.
A realistic look at low-cost and basic private health insurance policies
First, let's be crystal clear about the fundamental purpose of private medical insurance in the UK. PMI is designed to cover the costs of treatment for acute conditions that arise after you take out your 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 conditions like hernias, joint replacements, or cataracts.
- A chronic condition is a long-term illness that cannot be cured but can be managed. PMI does not cover the ongoing management of chronic conditions like diabetes, asthma, or high blood pressure.
A low-cost policy is not an "all-you-can-eat" healthcare buffet. It is a strategic financial tool designed to provide a crucial safety net. It gives you access to prompt diagnosis and private treatment for specific, eligible conditions, helping you bypass long NHS queues for surgery and specialist care. It's about getting you back on your feet faster when you need it most.
What Does 'Low-Cost' or 'Basic' Health Insurance Actually Mean?
"Low-cost" doesn't mean poor quality. It means the policy has been structured with specific limitations to make the premium affordable. Insurers achieve this by letting you adjust several key components of your cover.
Think of it like building a car. The engine (in-patient cover) is standard. But do you want the leather seats (full out-patient cover), the premium sound system (mental health cover), or the satellite navigation (therapy cover)? Each extra adds to the price. A basic policy focuses purely on the essential "engine" of health insurance.
Here are the main levers used to control the cost of a policy:
| Cost-Saving Lever | How it Reduces Your Premium | What it Means for You |
|---|---|---|
| Higher Excess | You agree to pay a larger portion of the first claim each year. | A lower monthly premium, but a higher one-off cost if you need to claim. |
| Limited Hospital List | You choose a list that excludes premium central London or other high-cost hospitals. | You may have to travel further for treatment, but you save significantly on your premium. |
| No/Limited Out-patient Cover | Your cover for diagnostics (scans, tests) and consultations before a hospital admission is removed or capped. | You would rely on the NHS for initial diagnosis or pay for it yourself. The policy only kicks in for the treatment itself. |
| The '6-Week Wait' Option | Your private cover only activates if the NHS waiting list for your required treatment is longer than six weeks. | A major cost-saver, but you lose the guarantee of immediate private treatment if the NHS is quick. |
Understanding these trade-offs is the key to building a policy that fits your budget without leaving you exposed. An expert broker at WeCovr can walk you through these options to find the perfect balance for your needs.
Core Inclusions: What You Can Expect from a Basic PMI Policy
Even the most basic policies provide a powerful level of core protection. They are designed to cover the most expensive aspects of private healthcare.
Here’s what is almost always included:
- In-Patient and Day-Patient Treatment: This is the cornerstone of all PMI policies. It covers costs when you are admitted to a hospital for treatment and require a bed, either overnight (in-patient) or just for the day (day-patient). This includes surgery, hospital accommodation, nursing care, and specialist fees.
- Comprehensive Cancer Cover: This is a huge reason people buy PMI. Most basic policies provide extensive cancer cover, including surgery, chemotherapy, and radiotherapy. It can also provide access to cutting-edge drugs and treatments that may not yet be available on the NHS. The level of cover can vary, so it's vital to check the details.
- Virtual GP Services: Now a standard feature on most plans. This gives you 24/7 access to a GP via phone or video call, often with the ability to get prescriptions or referrals quickly. This alone can be worth the policy's cost for busy individuals and families.
- Basic Mental Health Support: While comprehensive therapy is usually an add-on, most basic policies include access to a mental health support line or a limited number of counselling sessions.
In short, a basic policy focuses on paying for the big, scary, and expensive events, ensuring you get treated quickly when it matters most.
The Big Exclusions: What You Definitely Won't Get
Managing your expectations is vital. A low-cost policy has clear boundaries. Understanding them prevents disappointment when you need to make a claim.
You should not expect a basic private medical insurance policy to cover:
- Chronic Conditions: As stated earlier, PMI does not cover the routine management of long-term conditions like diabetes, Crohn's disease, epilepsy, or high blood pressure. The NHS remains the primary provider for this type of care.
- Pre-existing Conditions: This is the single most important exclusion to understand. Any medical condition for which you have had symptoms, medication, or advice in the 5 years before your policy starts will be excluded, at least initially. Under 'moratorium' underwriting, these conditions may become eligible for cover after you complete a 2-year period on the policy without any related issues.
- A&E and Emergencies: All emergency services are handled by the NHS. If you have a heart attack or are in a serious accident, you go to A&E. PMI is for planned, non-emergency treatment.
- Routine Maternity & Fertility: Standard pregnancy and childbirth are not covered. Complications of pregnancy may be, but you must check the policy wording. IVF and other fertility treatments are also excluded.
- Most Out-patient Diagnostics: This is a key difference. A basic policy often has no out-patient cover. This means consultations with specialists and diagnostic tests (like MRI or CT scans) done before you are admitted to hospital are not covered. You would either use the NHS for this diagnostic journey or pay for it yourself.
- Cosmetic Surgery: Any surgery that is purely for aesthetic reasons is excluded.
- Dental and Optical: Routine check-ups and treatments are not included unless you purchase a specific add-on or have a separate cash plan.
How Insurers Reduce Premiums: Understanding the Trade-Offs
Let's dive deeper into the four main ways you can tailor a policy to make it more affordable.
1. The Excess
The excess is the amount you agree to pay towards a claim. It's usually paid once per policy year.
- Example: You have a policy with a £250 excess. You need a knee operation costing £8,000. You pay the first £250, and your insurer pays the remaining £7,750.
- Impact on Premium: Choosing a higher excess of £500 or £1,000 can reduce your monthly premium by 20-40%. It's a direct trade-off between your monthly cost and your potential out-of-pocket expense if you claim.
2. The Hospital List
Insurers group UK private hospitals into tiers based on their costs. Central London hospitals are the most expensive.
- National List: Includes all hospitals, including the top-tier London ones. Highest premium.
- Regional/Standard List: Excludes the most expensive hospitals. A good middle-ground.
- Local/Trust List: Uses a network of local private wings in NHS Trust hospitals. Most affordable option.
Insider Adviser Tip: Unless you live in central London and are adamant about being treated there, choosing a standard or even a local list is one of the easiest ways to slash your premium without significantly impacting the quality of your care.
3. Out-patient Cover Limits
This is arguably the most significant cost control lever after the excess.
| Out-patient Level | What It Covers | Impact on Premium |
|---|---|---|
| None | No cover for specialist consultations or diagnostic scans before hospital admission. | Lowest Premium. Ideal if you're happy to use the NHS for diagnostics. |
| Limited | Cover is capped at a set amount per year (e.g., £500 or £1,000). | Mid-range Premium. A good compromise that covers the cost of a few consultations and scans. |
| Full | All eligible out-patient costs are covered in full. | Highest Premium. Provides complete end-to-end private care. |
4. The 'Six-Week Wait' Option
This option tells your insurer that you're happy to use the NHS if it can provide the required in-patient or day-patient treatment within six weeks of it being recommended. If the NHS wait is longer, your private cover kicks in.
This can reduce premiums by up to 25% because it removes the risk for the insurer for a large number of common procedures where NHS waits are shorter. It's a gamble on NHS performance, but a financially savvy one for many.
Comparing a Basic Policy to a Comprehensive Policy
This table clearly illustrates the trade-offs you make when choosing a lower-cost plan.
| Feature | Basic 'Core' Policy | Comprehensive Policy |
|---|---|---|
| In-patient & Day-patient Care | ✅ Covered in full | ✅ Covered in full |
| Cancer Cover | ✅ Core cover included | ✅ Advanced options (e.g., more drug choices) |
| Virtual GP | ✅ Usually included | ✅ Usually included |
| Out-patient Consultations & Scans | ❌ Not covered, or capped at ~£500 | ✅ Covered in full |
| Therapies (Physio, Osteo, Chiro) | ❌ Not covered | ✅ Covered up to a limit |
| Mental Health Treatment | ❌ Limited to a helpline or a few sessions | ✅ Extensive cover for therapy & psychiatry |
| Hospital List | 🔒 Usually a restricted list | 🌍 Full national list available |
| Dental & Optical Cover | ❌ Not included | ➕ Optional add-on |
Is a Low-Cost Private Health Insurance Policy Worth It? A Broker's View
Absolutely, for the right person with the right expectations.
A low-cost policy is not for someone who wants private cover for every minor ache and pain. It's for the person who wants to ensure that if they are diagnosed with a serious, acute condition requiring surgery or specialist treatment—like cancer, a heart condition, or a joint replacement—they will not have to endure a long and anxious wait on the NHS.
A basic policy is an excellent fit for:
- The Self-Employed: For whom extended time off work due to NHS waiting lists could be financially catastrophic.
- Budget-Conscious Families: Who want a safety net for major health events without the high cost of a comprehensive plan.
- Older Individuals: Who are primarily concerned about access to prompt surgery for age-related conditions like cataracts or joint problems.
By focusing on core in-patient and cancer cover, you are protecting yourself against the most disruptive and expensive health scenarios. The peace of mind this provides is invaluable and, with the right structure, can be surprisingly affordable.
The UK's Leading PMI Providers for Basic Cover
The UK private medical insurance market is competitive, with several excellent providers offering strong entry-level options. While the "best" provider depends entirely on your personal circumstances, here are the main names you'll see:
- Aviva: Known for its strong core product and a clear, well-regarded 'Expert Select' hospital option.
- AXA Health: Offers a modular approach, allowing you to build a policy from the ground up, making it easy to create a budget-friendly plan.
- Bupa: A household name with a vast network and a trusted reputation. Their 'Bupa By You' product is highly flexible.
- Vitality: Unique for its focus on rewarding healthy living. You can earn discounts and rewards for being active, which can help offset the cost of the premium.
- The Exeter: A friendly society known for excellent service and a straightforward approach, often popular with older applicants.
Comparing these providers and their countless options can be overwhelming. This is where using an independent broker like WeCovr is essential. We do the work for you, comparing the entire market to find a policy that matches your exact needs and budget, at no extra cost to you.
Beyond the Policy: Added Value in Low-Cost Plans
Don't underestimate the "freebies" that come with modern PMI policies. These often provide significant day-to-day value.
- Digital GP: Instant access to a doctor for advice, diagnosis, and prescriptions is a game-changer for convenience.
- Wellness Apps and Discounts: Many insurers offer apps to support your health. At WeCovr, we go a step further. All our health and life insurance clients receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help you stay on top of your health goals.
- Member Discounts: Taking out a PMI policy can often unlock savings on other insurance products. WeCovr clients, for example, can receive discounts on other types of cover, like life insurance, when they purchase a health plan.
How to Get the Best Value from Your Health Insurance
- Use a Broker: The single most effective way to get the best value is to use an unbiased broker like WeCovr. We have a complete view of the market and can explain the nuances of each policy. We are not tied to any one insurer and our service is free to you.
- Review Annually: Never simply auto-renew. Premiums increase with age and medical inflation. A quick market comparison each year can save you hundreds of pounds.
- Choose the Right Underwriting: Discuss with an adviser whether 'Moratorium' or 'Full Medical Underwriting' is best for your personal history.
- Be Honest About Your Needs: Don't pay for features you won't use. If you only want cover for major surgery, say so. A good adviser will build the policy around that specific need.
Can I get health insurance with a pre-existing condition?
Is private health insurance tax-deductible in the UK?
What's the difference between health insurance and a health cash plan?
Take the Next Step
A low-cost private health insurance policy is a powerful tool for safeguarding your health and finances against the uncertainty of NHS waiting lists. It provides a vital safety net for serious conditions, giving you choice, speed, and peace of mind when you need it most.
Ready to see how affordable your peace of mind could be?
Contact WeCovr today for a free, no-obligation quote. Our expert, friendly advisers will compare the UK's top insurers to find the right cover for you, at the right price.
