Considering private medical insurance in the UK? As an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, WeCovr knows it’s crucial to understand what people actually use their cover for. This guide breaks down the latest claims trends, revealing what you might need it for.
Breakdown of top claims categories and treatment types for 2025
Private Medical Insurance (PMI) is designed to cover the costs of diagnosis and treatment for acute medical conditions—that is, new illnesses or injuries that are likely to respond quickly to treatment. It acts as a partner to the NHS, offering faster access to specialists and a choice of leading private hospitals.
But what are policyholders actually claiming for? Based on the latest data from leading UK insurers and health organisations, we've analysed the key trends shaping the PMI landscape for 2025. Understanding these can help you choose the right policy for your potential needs.
A Critical Note on PMI Coverage: It's vital to remember that standard UK private health cover is for acute conditions that arise after your policy begins. It does not cover pre-existing conditions (ailments you had before taking out the policy) or chronic conditions (long-term illnesses like diabetes or asthma that require ongoing management rather than a cure).
1. Musculoskeletal (MSK) Conditions: The Perennial Leader
For years, issues with bones, joints, muscles, and ligaments have dominated PMI claims, and 2025 is no different. This category consistently accounts for the largest single portion of claims by both volume and value.
- Why is it so common? Our modern lifestyles, a combination of sedentary desk jobs and active hobbies, contribute heavily. From back pain caused by poor posture to sports injuries like torn ligaments, MSK problems affect people of all ages. Furthermore, NHS waiting times for orthopaedic treatment are among the longest, making private treatment a highly attractive option. According to NHS England data, the median wait for Trauma & Orthopaedic treatment can be many weeks, a period most find difficult to endure while in pain.
Common MSK Claims:
- Joint Pain: Especially knees, hips, and shoulders.
- Back and Neck Pain: Often leading to claims for physiotherapy and diagnostic scans.
- Sports Injuries: Including ACL (anterior cruciate ligament) tears and rotator cuff injuries.
- Arthritis: Specifically, claims for treatments like joint replacement surgery for osteoarthritis.
Typical Treatment Pathway:
- GP Referral: Your journey starts with a GP visit. Many PMI policies now include a digital GP service for quick consultations.
- Specialist Consultation: You'll be referred to an orthopaedic surgeon or rheumatologist.
- Diagnostics: An MRI or CT scan is often authorised to get a clear picture of the problem.
- Treatment: This could range from a course of physiotherapy to major surgery like a hip or knee replacement.
| MSK Treatment Type | Description | Why PMI is Valuable |
|---|
| Physiotherapy | A course of sessions to restore movement and function. | Quick access can prevent an acute problem from becoming chronic. |
| MRI/CT Scans | Detailed imaging to diagnose the source of pain. | Can be accessed privately within days, versus weeks or months on the NHS. |
| Joint Injections | Corticosteroid injections to reduce inflammation and pain. | Provides rapid relief, enabling you to continue with therapy or daily life. |
| Joint Replacement | Surgical replacement of a damaged hip, knee, or shoulder. | A primary reason people use PMI, bypassing extensive NHS waiting lists. |
2. Cancer Care: Comprehensive and Critical
Cancer care is arguably the most valued and comprehensive element of any good private medical insurance UK policy. While the NHS provides excellent cancer treatment, PMI offers additional benefits that provide peace of mind and control during an incredibly difficult time. Claims in this category are high-value and emotionally significant.
- What does PMI offer? The core benefits are faster access to diagnosis, consultations with leading oncologists, and access to treatments, including drugs and therapies that may not yet be available on the NHS due to funding decisions by the National Institute for Health and Care Excellence (NICE).
Key Features of Private Cancer Cover:
- Prompt Diagnosis: If you or your GP suspect cancer, PMI can get you the scans and biopsies needed for a diagnosis in days.
- Choice of Specialist: You can choose the oncologist and hospital where you receive your care.
- Advanced Treatments: Access to cutting-edge chemotherapy, radiotherapy, and biological therapies.
- Holistic Support: Many policies include benefits like wigs, prostheses, and mental health support during and after treatment.
A 2025 trend is the increasing use of 'at-home' chemotherapy, allowing patients to receive treatment in the comfort of their own homes, a service pioneered by private providers.
3. Mental Health Support: A Rapidly Growing Area of Claims
The stigma around mental health is thankfully diminishing, and this is clearly reflected in PMI claims. Over the past few years, mental health has become one of the fastest-growing claims categories. Insurers have responded by significantly enhancing their mental health cover, moving it from a niche add-on to a core component of many policies.
- Driving Factors: Increased societal stress, greater awareness, and long NHS waiting lists for talking therapies are fuelling this trend. The NHS IAPT (Improving Access to Psychological Therapies) programme, while world-leading, faces immense demand.
Common Mental Health Claims:
- Anxiety and Stress-Related Disorders: Often treated with talking therapies.
- Depression: Requiring psychiatric consultations and therapy.
- Cognitive Behavioural Therapy (CBT): A common, effective treatment for a range of conditions.
- In-patient/Day-patient Care: For more severe conditions requiring intensive support.
Most policies provide a set number of therapy sessions or a financial limit for outpatient treatment. It's crucial to check the level of mental health cover when you compare policies, as it can vary significantly. An expert PMI broker like WeCovr can help you find a policy with the right level of support for your needs.
4. Gastroenterology (Digestive Health)
Problems with the digestive system, from acid reflux to more serious conditions like Crohn's disease (although often classed as chronic, acute flare-ups can be covered), are another major claims area.
The pathway is similar to other conditions: a GP referral leads to a consultation with a gastroenterologist, followed by diagnostic tests.
Common Diagnostic Claims:
- Endoscopy/Colonoscopy: A camera is used to investigate the oesophagus, stomach, or bowel. These procedures are key for diagnosing conditions like ulcers, coeliac disease, and bowel cancer.
- Ultrasound Scans: To check organs like the gallbladder and liver.
Prompt investigation of digestive symptoms is vital, as it can provide peace of mind or lead to an early diagnosis of a serious condition.
5. Cardiology (Heart and Circulatory Conditions)
Claims related to heart health are common, particularly among older policyholders. While emergency events like a heart attack are handled by the NHS, PMI is crucial for the diagnostic and treatment phases for non-emergency heart conditions.
Typical Cardiology Claims:
- Diagnostic Tests: ECGs, echocardiograms, and angiograms to investigate symptoms like chest pain or palpitations.
- Surgical Procedures: Such as the fitting of a pacemaker or angioplasty (inserting a stent to open a blocked artery).
- Consultant Cardiologist Fees: For ongoing monitoring and treatment planning.
A Deeper Dive into Treatment Types: What's Being Claimed?
Beyond the broad categories, it's helpful to look at the specific types of treatments that generate the most claims.
Diagnostics: The Gateway to Treatment
Diagnostics are the detective work of healthcare. They are one of the most frequently claimed-for benefits, as a fast, accurate diagnosis is the first step to getting better.
| Diagnostic Test | What It's Used For | Typical Private Access Time |
|---|
| MRI Scan | Detailed images of soft tissues, joints, the brain, and spine. | 2-5 days |
| CT Scan | Cross-sectional images of bones, organs, and blood vessels. | 2-5 days |
| Ultrasound | Investigating organs, muscles, and blood flow. | 1-3 days |
| Endoscopy | Visually inspecting the digestive tract. | 1-2 weeks |
The ability to bypass long waiting lists for these scans is a primary driver for people taking out private health cover.
Surgical Procedures: From Minor to Major
Surgical procedures, both inpatient (requiring an overnight stay) and day-patient, represent the highest-value claims.
Top Claimed Surgical Procedures for 2025:
- Cataract Surgery: A very common and highly successful procedure to restore vision.
- Knee and Hip Replacements: Life-changing surgery for those with severe arthritis.
- Hernia Repair: A routine but necessary operation.
- Laparoscopy: Minimally invasive "keyhole" surgery for investigation or treatment (e.g., removing the gallbladder).
- Arthroscopy: Keyhole surgery on a joint, often the knee or shoulder, to repair cartilage or ligaments.
Therapies and Consultations
This broad category covers all non-surgical interventions and expert advice.
- Physiotherapy: Essential for MSK recovery.
- Psychological Therapies: CBT, counselling, and psychotherapy for mental health.
- Specialist Consultations: The fees for seeing a consultant privately are covered by PMI. This ensures you see an expert in their field quickly.
Understanding the "Why" Behind the 2025 Claims Trends
Several powerful factors are shaping what people claim for on their private medical insurance.
NHS Waiting Lists: A Key Driver
The single biggest driver for PMI claims remains the length of NHS waiting lists. As of mid-2024, the overall waiting list in England stood at several million, with many people waiting over a year for routine treatment.
This isn't a criticism of the hardworking staff in the NHS, but a reflection of the immense pressure the service is under. For individuals suffering from pain or anxiety, waiting months for treatment is not a viable option. PMI provides a direct route to bypass these queues.
An Ageing Population and Lifestyle Factors
As a nation, we are living longer, which naturally leads to a higher prevalence of age-related conditions like arthritis and cataracts. Furthermore, modern lifestyles—characterised by stress, poor posture, and diet—contribute to the high incidence of MSK, mental health, and digestive issues.
The Rise of Virtual and At-Home Care
The pandemic accelerated a trend that continues to grow: the delivery of healthcare outside of a traditional hospital setting.
- Digital GPs: Most PMI providers now offer a 24/7 virtual GP service. This is incredibly popular for its convenience, allowing you to get a consultation and referral from your own home.
- At-Home Treatment: For certain conditions, nurses can now administer treatments like chemotherapy at a patient's home, increasing comfort and reducing disruption.
- Remote Monitoring: Wearable tech and apps are increasingly being used to monitor conditions remotely, feeding data back to specialists.
Proactive Health: How to Reduce Your Need to Claim
While having a robust private health cover policy is reassuring, the best-case scenario is not having to use it at all. Taking proactive steps to manage your health can reduce your risk of developing the acute conditions that lead to claims.
Wellness Tips for a Healthier 2025:
- Stay Active: Aim for at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) a week, as recommended by the NHS. Regular exercise is proven to reduce the risk of heart disease, improve mental health, and strengthen your musculoskeletal system.
- Eat a Balanced Diet: A diet rich in fruits, vegetables, lean protein, and whole grains supports every system in your body. To help you manage your nutrition, WeCovr provides complimentary access to its AI-powered calorie and nutrition tracking app, CalorieHero, to all its PMI and life insurance customers.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep is linked to a weakened immune system, poor mental health, and an increased risk of chronic conditions.
- Manage Stress: Find healthy coping mechanisms for stress, whether it's mindfulness, yoga, spending time in nature, or a hobby you enjoy. Unmanaged stress is a major contributor to both mental and physical health problems.
- Don't Ignore Symptoms: Use the digital GP services included in your PMI policy for early advice on any worrying symptoms. Early intervention is key.
Choosing the Right UK Private Health Cover with WeCovr
Navigating the world of PMI can be complex, especially with so many providers and policy options. This is where an expert, independent PMI broker like WeCovr becomes an invaluable partner.
As an FCA-authorised firm with high customer satisfaction ratings, we specialise in helping individuals, families, and businesses find the best PMI provider for their unique circumstances.
Why Use WeCovr?
- Independent, Expert Advice: We are not tied to any single insurer. We compare policies from across the market to find the one that truly fits your needs and budget.
- No Cost to You: Our service is free. We receive a commission from the insurer you choose, so you get expert guidance without paying a penny extra.
- Policy Expertise: We understand the fine print. We can explain the differences in cancer cover, mental health limits, and outpatient options, ensuring you're not underinsured.
- Added Value: When you arrange a PMI or life insurance policy through us, you not only get access to CalorieHero but also benefit from discounts on other types of cover you might need, like home or travel insurance.
The claims trends for 2025 show that PMI is most valuable for providing fast access to diagnostics, surgery for musculoskeletal conditions, and comprehensive cancer and mental health care. By understanding these trends, you can make a more informed decision about the level of cover you need.
What is the most common claim on private medical insurance in the UK?
Based on all available data, the most common category for claims on private medical insurance is for musculoskeletal (MSK) conditions. This includes issues like back pain, knee and hip problems, and sports injuries, leading to treatments such as physiotherapy, MRI scans, and joint replacement surgery.
Does private health insurance cover pre-existing conditions?
No, standard UK private medical insurance does not cover pre-existing conditions, which are any diseases, illnesses, or injuries for which you have had symptoms, medication, or advice before your policy start date. It also does not cover chronic conditions (long-term illnesses requiring ongoing management). PMI is designed specifically for new, acute conditions that arise after you take out the cover.
Is mental health treatment typically included in UK PMI policies?
Mental health cover has become a much more common feature in UK PMI policies, reflecting growing demand. However, the level of cover varies significantly. Basic policies may offer limited outpatient therapy sessions, while more comprehensive plans can include psychiatric consultations and day-patient or in-patient care. It's crucial to check the details of the mental health benefits when comparing policies.
Ready to find a private health cover plan that protects you against the unexpected?
Get your free, no-obligation PMI quote from WeCovr today and let our experts guide you.