TL;DR
As an FCA-authorised expert with over 900,000 policies of various kinds arranged, WeCovr offers a unique insight into the UK's private medical insurance landscape. This guide demystifies the most common claims, helping you understand the immense value that a private health cover policy provides for you and your family. What's most commonly claimed on private health insurance in 2025?
Key takeaways
- Rapid Diagnostics: Fast access to scans and consultations to confirm a diagnosis and stage the cancer.
- Choice of Specialist: You can choose your oncologist and hospital from the insurer's approved list.
- Comprehensive Treatment: Cover typically includes surgery, chemotherapy, and radiotherapy.
- Access to New Drugs: Many comprehensive policies cover breakthrough drugs and treatments that haven't been approved for widespread NHS use due to cost.
- Comfort and Privacy: Treatment is often provided in a private room, offering a more comfortable and less stressful environment.
As an FCA-authorised expert with over 900,000 policies of various kinds arranged, WeCovr offers a unique insight into the UK's private medical insurance landscape. This guide demystifies the most common claims, helping you understand the immense value that a private health cover policy provides for you and your family.
What's most commonly claimed on private health insurance in 2025?
Private medical insurance (PMI) in the UK is primarily used for the diagnosis and treatment of new, unexpected medical conditions. Based on the latest industry data and trends heading into 2025, the most common claims consistently fall into a few key categories.
Topping the list are musculoskeletal (MSK) conditions, such as back pain and joint problems, which account for the largest volume of claims. This is closely followed by cancer care, which, while less frequent, represents the highest value claims and is a primary reason many people invest in PMI. Other significant areas include diagnostics like MRI scans, mental health support, and digestive system (gastroenterology) issues.
These trends are driven by a combination of factors: our modern, often sedentary lifestyles, an ageing population, and a growing public awareness of both physical and mental health. Understanding these core claim areas is the first step to appreciating how a PMI policy can provide peace of mind and swift access to care when you need it most.
A Deep Dive into the Top PMI Claims Categories
Let's explore the conditions that most frequently lead to a claim on a private medical insurance policy in the UK. This gives you a clear picture of how your policy is most likely to be used.
Musculoskeletal (MSK) Conditions: The Undisputed Number One
Musculoskeletal conditions, affecting your bones, joints, and muscles, are by far the most common reason for a PMI claim. The NHS estimates that around 20 million people in the UK live with an MSK condition, making it a pervasive health issue.
These problems can arise from sports injuries, wear and tear over time, or even poor posture while working from home. They range from minor aches to debilitating pain that requires significant intervention. Private health cover offers a fast track to diagnosis and treatment, helping you get back on your feet sooner.
Common MSK Claims on Private Health Insurance
| Condition / Treatment | Description | Why It's Commonly Claimed |
|---|---|---|
| Physiotherapy | A course of physical therapy to restore movement and function. | The first line of treatment for back pain, sprains, and sports injuries. |
| Knee Arthroscopy | Keyhole surgery to diagnose and treat problems like torn cartilage. | A very common procedure for knee pain and injuries. |
| Hip Replacement | Surgical procedure to replace a damaged hip joint with an artificial one. | Often necessary for severe arthritis, significantly improving quality of life. |
| Spinal Injections | Corticosteroid injections to reduce inflammation and pain in the back. | A common, effective treatment for sciatica and slipped discs. |
| Cataract Surgery | A procedure to remove the cloudy lens of your eye and replace it with a clear artificial one. | While an eye condition, it's often grouped with high-volume surgical procedures like MSK. PMI bypasses long waits. |
Top Tip for MSK Health: Regular, gentle exercise is your best defence. Activities like swimming, yoga, and pilates strengthen your core muscles, support your joints, and improve flexibility. If you work at a desk, ensure your setup is ergonomic: your screen at eye level, your chair supporting your lower back, and your feet flat on the floor. Take a short break to stand and stretch every 30 minutes.
Cancer Care: The Most Valuable Benefit
While not the most frequent claim by volume, cancer cover is arguably the most valuable and life-changing benefit of private medical insurance. A cancer diagnosis is a deeply stressful experience, and PMI provides control, comfort, and access to cutting-edge treatments that might not yet be available on the NHS.
According to Cancer Research UK, there are around 375,000 new cancer cases in the UK every year. Private health cover ensures that from the moment of diagnosis, you have a dedicated care path.
How PMI Supports Cancer Treatment:
- Rapid Diagnostics: Fast access to scans and consultations to confirm a diagnosis and stage the cancer.
- Choice of Specialist: You can choose your oncologist and hospital from the insurer's approved list.
- Comprehensive Treatment: Cover typically includes surgery, chemotherapy, and radiotherapy.
- Access to New Drugs: Many comprehensive policies cover breakthrough drugs and treatments that haven't been approved for widespread NHS use due to cost.
- Comfort and Privacy: Treatment is often provided in a private room, offering a more comfortable and less stressful environment.
Common Cancer Types Covered by PMI
| Cancer Type | UK Incidence (Approx. Annual Cases) | PMI Support |
|---|---|---|
| Breast Cancer | 55,900 | Surgery (lumpectomy, mastectomy), chemotherapy, radiotherapy, hormone therapy. |
| Prostate Cancer | 52,300 | Surgery (prostatectomy), radiotherapy, advanced drug therapies. |
| Lung Cancer | 48,500 | Diagnostics, surgery, targeted therapies. |
| Bowel Cancer | 42,900 | Colonoscopy, surgery, chemotherapy. |
An expert PMI broker like WeCovr can help you understand the different levels of cancer cover available, from basic care to fully comprehensive options that include experimental treatments.
Mental Health Support: A Growing Area of Need
In recent years, insurers have significantly enhanced their mental health offerings in response to growing demand. The NHS reports that 1 in 4 adults in the UK experience a mental health problem each year. PMI can provide faster access to therapy and specialist consultations than is often possible through public services.
Modern policies no longer just cover traditional inpatient care. They now embrace a wide range of support options, including:
- Talking Therapies: Access to a set number of sessions with a psychologist or counsellor for treatments like Cognitive Behavioural Therapy (CBT).
- Psychiatric Consultations: Faster access to a psychiatrist for diagnosis and treatment plans for conditions like depression, anxiety, and OCD.
- Digital Mental Health Platforms: Many providers now include access to apps and online portals offering 24/7 support, self-help courses, and virtual therapy sessions.
This shift reflects an understanding that early and accessible intervention is key to managing mental wellbeing.
Diagnostics and Consultations: The Gateway to Treatment
Often, the first step in any health journey is figuring out what's wrong. Long waiting lists for diagnostic tests on the NHS are a major driver for people seeking private health cover. A PMI policy can reduce the wait for a crucial scan from months to just a few days.
A GP referral is almost always required to initiate this process. Once you have a referral, your insurer can authorise and arrange the necessary tests and specialist appointments.
Most Common Diagnostic Claims:
- MRI Scans (Magnetic Resonance Imaging): Essential for detailed images of soft tissues, joints, the brain, and spine.
- CT Scans (Computed Tomography): Used for detailed cross-sectional images of the body, often for chest or abdominal issues.
- Ultrasound: Used to view internal organs and, famously, in pregnancy.
- X-rays: The primary method for diagnosing fractures and some chest conditions.
- Specialist Consultations: Appointments with experts like cardiologists, dermatologists, or gastroenterologists.
By speeding up this initial phase, PMI not only provides peace of mind but also enables treatment to begin much sooner, often leading to better outcomes.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the single most important concept to understand about private medical insurance UK. Standard policies are designed to cover acute conditions, not chronic conditions.
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An Acute Condition: A disease, illness, or injury that is short-term and likely to respond quickly to treatment, leading to a full or near-full recovery.
- Examples: A broken arm, appendicitis, a hernia, a cataract, or a treatable infection.
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A Chronic Condition: A long-term condition that has no known cure and requires ongoing management.
- Examples: Diabetes, asthma, high blood pressure, Crohn's disease, or eczema.
Private medical insurance will pay for the initial diagnosis of a chronic condition. For instance, if you have symptoms, your PMI could cover the consultations and tests that lead to a diagnosis of diabetes. However, the day-to-day management of the diabetes (e.g., insulin, regular check-ups) would then be passed back to the NHS.
Similarly, pre-existing conditions – any health issue you knew about before taking out the policy – are typically excluded for a set period or permanently. This is why it's vital to be honest during your application and to discuss your medical history with an adviser.
How Do Demographics Influence PMI Claims?
Your age, gender, and lifestyle all have a significant impact on the type of health issues you're likely to face, and therefore, what you might claim for. Insurers use this data to calculate premiums.
| Age Group | Common Claims & Health Concerns | Preventative Health Tips |
|---|---|---|
| 20s-30s | - Sports injuries (e.g., torn ACL, sprained ankles) - Mental health support (anxiety, depression) - Maternity cash benefits (on some policies) | - Proper warm-ups and cool-downs for exercise. - Build a strong social support network. - Establish healthy sleep habits (7-9 hours). |
| 40s-50s | - Back and neck pain from posture - Investigative diagnostics (e.g., for digestive issues) - Early signs of arthritis - Hernia repair | - Focus on strength training to protect joints. - Eat a balanced, fibre-rich diet. - Attend regular health screenings. |
| 60s+ | - Joint replacements (hip, knee) - Cataract surgery - Cancer treatment (prostate, breast, bowel) - Heart conditions (cardiology consultations) | - Stay active with low-impact exercise like walking or swimming. - Maintain a healthy weight to reduce strain on joints. - Keep your mind active with puzzles or learning a new skill. |
Understanding these trends helps you anticipate your future health needs and choose a policy that provides the right level of cover for your stage in life.
The Financial Side: Understanding Claim Costs
One of the biggest benefits of PMI is protection against the high and often unpredictable costs of private healthcare. Medical inflation—the rising cost of new drugs, technology, and specialist fees—consistently outpaces general inflation.
Here is an illustrative table of typical costs for common private procedures in the UK. These are estimates and can vary significantly based on the hospital, specialist, and location.
Estimated Costs for Private Treatment in the UK (2025)
| Procedure / Treatment | Estimated Private Cost | Why It Costs This Much |
|---|---|---|
| MRI Scan | £400 - £1,500 | Cost of the machine, radiographer's time, and reporting by a consultant radiologist. |
| Hip Replacement Surgery | £12,000 - £15,000 | Includes surgeon & anaesthetist fees, hospital stay, the prosthesis, and initial physiotherapy. |
| Knee Arthroscopy | £4,000 - £6,000 | Surgeon & anaesthetist fees, theatre time, and a day-case hospital stay. |
| Cataract Surgery (per eye) | £2,500 - £4,000 | Surgeon's fee, cost of the artificial lens, and use of the operating theatre. |
| Chemotherapy (per cycle) | £2,000 - £20,000+ | Highly variable depending on the specific drugs used; newer drugs are extremely expensive. |
Your policy excess is a key part of managing your premium. This is the amount you agree to pay towards any claim. For example, if you have a £250 excess and the treatment costs £3,000, you pay the first £250 and your insurer pays the remaining £2,750. Choosing a higher excess will lower your monthly premium. An adviser at WeCovr can model these options for you to find the perfect balance.
Navigating the PMI Claims Process: A Simple Step-by-Step Guide
Making a claim on your private health insurance is designed to be a straightforward process. The golden rule is to always contact your insurer for authorisation before you arrange any treatment.
Here’s the typical journey:
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Visit Your GP: Your journey almost always starts with your NHS GP. You'll discuss your symptoms, and if they feel you need to see a specialist, they will provide you with an 'open referral' letter. This confirms you need further investigation but doesn't name a specific specialist.
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Contact Your Insurer: Call your PMI provider's dedicated claims line. Have your policy number and the details of your GP referral ready.
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Get Authorisation: The claims handler will check your policy to ensure the condition and proposed treatment are covered. They will give you an authorisation number for the consultation or tests.
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Book Your Appointment: Your insurer will provide you with a list of approved specialists and hospitals in your area. You can then call and book your appointment, providing your policy number and authorisation code.
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Treatment and Invoicing: After your consultation or treatment, the hospital or specialist will usually send the bill directly to your insurer. You only need to pay your excess (if applicable). The process is designed to be as seamless and stress-free as possible.
Beyond the Core Claims: The Rise of Value-Added Benefits
The best PMI providers now offer far more than just cover for when you are ill. Modern policies have evolved into holistic health and wellness packages, designed to help you stay healthy in the first place.
These value-added benefits often come as standard and can include:
- 24/7 Digital GP: Speak to a GP via video call or phone, often within a few hours. This is perfect for getting quick advice, prescriptions, or a referral without waiting for an NHS appointment.
- Fitness Discounts: Significant savings on gym memberships, fitness trackers, and workout apps to encourage an active lifestyle.
- Mental Health Helplines: Confidential phone lines staffed by trained counsellors, available day or night.
- Nutrition Consultations: Access to registered dietitians for personalised advice on healthy eating.
- Second Medical Opinions: The ability to have your diagnosis and treatment plan reviewed by a world-leading expert.
At WeCovr, we go a step further. All our PMI and Life Insurance clients receive complimentary access to CalorieHero, our exclusive AI-powered calorie and nutrition tracking app, to help you manage your diet effectively. Furthermore, when you take out a policy with us, you can access discounts on other types of cover, like home or travel insurance, saving you even more money.
Choosing the Right Policy with WeCovr
The UK private medical insurance market is complex, with dozens of providers and hundreds of policy variations. Trying to compare them all yourself can be overwhelming. This is where an independent, expert broker like WeCovr becomes your most valuable asset.
As an FCA-authorised firm with deep knowledge of the market, our job is to work for you, not the insurer. We take the time to understand your personal needs, health history, and budget. Then, we compare policies from the UK's leading insurers to find the one that offers the best possible value and protection.
Our service is provided at no cost to you. We receive a commission from the insurer you choose, which doesn't affect the price you pay. With high customer satisfaction ratings, our focus is entirely on providing clear, impartial advice to help you make a confident decision.
Does private health insurance cover pre-existing conditions?
How much does private medical insurance cost in the UK?
Do I need a GP referral to make a PMI claim?
What is an excess on a health insurance policy?
Ready to secure fast access to the best medical care? Get your free, no-obligation quote from WeCovr today. Our friendly experts will compare the market for you and find the perfect private health cover to protect you and your loved ones.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.











