As an FCA-authorised expert broker that has helped arrange over 800,000 policies, WeCovr understands that moving abroad requires meticulous planning. This guide to private medical insurance for British expats will help you navigate cross-border healthcare, ensuring you have the right protection for your new life outside the UK.
Dealing with local rules, finding cover, and what to expect when moving overseas
The dream of a new life abroad – whether for work, retirement, or adventure – is an exciting prospect. You've likely spent months, if not years, planning the logistics: sorting visas, finding a home, and arranging the move itself. Yet, one of the most critical aspects of this new chapter is often overlooked until the last minute: your health and healthcare.
Leaving the UK means leaving the comprehensive, free-at-the-point-of-use safety net of the NHS. The healthcare landscape in your new country could be drastically different, with its own rules, costs, and standards of care. Relying on a local state system may not be possible, practical, or desirable.
This is where understanding your cross-border healthcare options becomes paramount. This guide will walk you through everything you need to know, from your changing entitlement to NHS care to the specific type of private medical insurance designed for expatriates. We’ll demystify the jargon, explain the local rules in popular expat destinations, and help you find the right cover for your peace of mind.
Understanding the Healthcare Landscape When You Leave the UK
When you pack your bags and move overseas permanently, your relationship with the UK's healthcare system changes fundamentally. It's crucial to understand these changes to avoid being caught out by unexpected medical bills.
The End of Your NHS Entitlement
The core principle is simple: the NHS is a residence-based healthcare system. According to official UK government guidelines, once you are no longer considered 'ordinarily resident' in the UK, you lose your entitlement to free NHS hospital treatment.
What does 'ordinarily resident' mean? It means residing in the UK on a lawful and properly settled basis for the time being. If you move abroad to live permanently, you no longer meet this definition.
This means you cannot simply fly back to the UK for routine treatments, check-ups, or to see your old GP. While you will always receive emergency A&E treatment if you are visiting the UK, you may be charged for any subsequent hospital admission as an overseas visitor.
You might have heard about 'reciprocal healthcare' arrangements, particularly with countries in the EU, EEA, and Switzerland. These are managed through a document called an S1 form.
- Who is eligible? Primarily, those receiving a UK State Pension or certain other exportable benefits. Some posted workers may also qualify.
- What does it do? An S1 form, when registered with the health authorities in your new country of residence, entitles you to access their state-run healthcare on the same basis as a local citizen.
- What are the limitations? This is not a golden ticket to free healthcare. "On the same basis as a local" means you will have to pay the same mandatory contributions, co-payments (charges for appointments or prescriptions), and taxes as any other resident. Furthermore, the quality and accessibility of state healthcare can vary enormously from country to country. It may not cover private facilities, and waiting lists can be long.
Crucially, an S1 form is not a substitute for comprehensive private health cover. It's a valuable benefit if you qualify, but it often works best as a foundation, supplemented by a private plan for faster access and greater choice.
Is a GHIC Card Enough?
The Global Health Insurance Card (GHIC) has replaced the old EHIC card. It allows you to access state-provided emergency or medically necessary healthcare during a temporary stay in an EU country.
A GHIC is for tourists, not residents. It is designed for holidays and short trips. It is absolutely not valid for someone who has moved to live in another country and does not provide the comprehensive cover needed for residency. It also does not cover the cost of being returned to the UK (repatriation).
Why Standard UK PMI Isn't Enough for Expats
If you have a private medical insurance (PMI) policy in the UK, you might assume you can simply take it with you. Unfortunately, this is not the case. Standard UK PMI is designed for a specific purpose and geography, making it unsuitable for an expatriate lifestyle.
The Geographical Barrier
The most significant limitation is geographical. A UK PMI policy is designed to provide access to private healthcare within the United Kingdom. Its network of hospitals, specialists, and clinics is UK-based. While some policies offer a limited amount of 'emergency overseas cover', this is typically for short holidays and is not designed to cover you as a resident in another country. It will not be accepted for visa applications that require proof of health insurance.
The Critical Rule: Acute vs. Chronic Conditions
This is a fundamental principle of all private medical insurance, whether domestic or international.
- PMI covers acute conditions: These are diseases, illnesses, or injuries that are likely to respond quickly to treatment and lead to a full recovery. Think of things like joint replacements, cataract surgery, or treatment for a serious infection.
- PMI does NOT cover chronic conditions: These are long-term conditions that cannot be cured, only managed. Examples include diabetes, asthma, hypertension, and most types of heart disease.
- PMI does NOT cover pre-existing conditions: Any medical condition you had before you took out the policy will not be covered, at least not initially. Some conditions may become eligible for cover after a waiting period (see 'Moratorium Underwriting' below), but any ongoing or chronic issues will be permanently excluded.
A standard UK PMI policy is simply not structured to handle claims from international providers or navigate different medical systems and currencies. For life abroad, you need a specialised product.
International Private Medical Insurance (IPMI): Your Expat Healthcare Solution
For British citizens moving overseas, the correct solution is International Private Medical Insurance (IPMI). This is a specific class of insurance designed from the ground up to meet the needs of people living and working away from their home country.
IPMI provides comprehensive medical cover in your new country of residence and often across a wider region, or even globally. It gives you access to private healthcare, offering a choice of doctors and hospitals and helping you bypass potentially long waiting lists in local state systems.
Key Differences: UK PMI vs. International PMI (IPMI)
This table highlights the fundamental differences between the two types of policies.
| Feature | Standard UK PMI | International PMI (IPMI) |
|---|
| Area of Cover | United Kingdom only. | Regional or Global (often with options to include/exclude the USA). |
| Target User | UK residents seeking private care in the UK. | Expatriates, 'digital nomads', and global citizens. |
| Key Benefits | Fast access to UK private hospitals and specialists for acute conditions. | In-patient, out-patient, wellness, dental, optical, medical evacuation, repatriation. |
| Portability | Policy is not portable if you move abroad. | Designed to be fully portable as you move between countries. |
| Network | UK-based hospital lists. | Global network of hospitals with direct billing arrangements. |
| Currency | Premiums and claims in GBP (£). | Flexible premiums and claims in multiple currencies (e.g., EUR, USD, GBP). |
| Visa Compliance | Not suitable for visa applications. | Plans are designed to meet or exceed visa requirements for most countries. |
Who Needs International Health Insurance?
IPMI is essential for:
- Working Expats: Professionals and their families moving for a job.
- Retirees: Those choosing to spend their retirement in sunnier climes like Spain, Portugal, or France.
- Digital Nomads: Individuals who work remotely and travel frequently between different countries.
- Long-Term Students: Those studying abroad for one or more academic years.
Navigating Local Healthcare Rules and Regulations
Every country has a unique approach to healthcare, and as a new resident, you must comply with local laws. Many popular expat destinations now mandate private health insurance as a condition of residency.
Mandatory Insurance Requirements
Failing to secure compliant health insurance can lead to visa rejection or a refusal to renew your residency permit.
- Spain: To obtain a non-lucrative visa or residency as a retiree, you must have a private health insurance policy that provides cover equivalent to the Spanish state system. This means it must have no co-payments and no excess, and it must include repatriation cover.
- Dubai (UAE): Health insurance is compulsory for all residents. While employers must provide cover for their employees, this legal minimum may not extend to dependents (spouses and children) or be of a high standard. Many expats choose to purchase their own comprehensive family plan.
- France: Residents are required to join the French state system (PUMA). However, the state system only reimburses a percentage of healthcare costs (e.g., 70% for a GP visit). Almost all residents purchase a 'top-up' policy, known as a mutuelle, to cover the shortfall. A comprehensive IPMI plan can fulfil this role.
- Australia: While there's a Reciprocal Health Care Agreement with the UK, it provides only limited, medically necessary care. Most visa classes require you to hold adequate private health insurance for the duration of your stay.
- USA: There is no national healthcare system. Healthcare is phenomenally expensive, and insurance is essential. It is typically tied to employment, but if you're not covered by an employer, a robust IPMI policy with a specific USA cover add-on is non-negotiable.
Global Healthcare System Snapshots
This table gives a brief overview of what to expect in a few popular destinations.
| Country | State System Access for UK Expats | Private Cover Recommendation |
|---|
| Spain | Possible via S1 form (for state pensioners) or by paying into social security as a worker. | Essential. Required for many visas and highly recommended for faster access to English-speaking specialists. |
| France | Mandatory to join the state system (PUMA) after 3 months of stable residency. | Highly Recommended. A 'top-up' (mutuelle) policy is needed to cover costs not reimbursed by the state. |
| Australia | Limited access for essential care via Reciprocal Health Care Agreement. | Essential. Required for most visas and helps avoid the Medicare Levy Surcharge for higher earners. |
| Dubai (UAE) | No state system access for expats. | Mandatory. A legal requirement for all residents. Employer-provided plans may be basic. |
| USA | No state system access. | Absolutely Essential. Healthcare costs are the highest in the world. Cover must be specifically for the USA. |
How to Choose the Right International Health Insurance Plan
Choosing an IPMI policy can feel overwhelming due to the number of options available. Breaking it down into logical steps makes the process manageable. An expert broker like WeCovr can guide you through this process, comparing the market on your behalf at no extra cost.
Step 1: Assess Your Personal Needs
- Area of Cover: Where will you be living? Will you travel frequently to other countries? Plans are often priced by region. A 'Worldwide excluding USA' plan is a popular and cost-effective option, as including the USA significantly increases the premium.
- Lifestyle and Life Stage: Are you planning to start a family? You'll need maternity cover, which often has a 10-12 month waiting period. Are you a keen sportsperson? Check that your activities are covered.
- Budget: Be realistic about what you can afford. Premiums are a significant financial commitment.
Step 2: Understand Key Policy Components
- Levels of Cover:
- In-patient Only: The most basic level. Covers costs associated with a hospital stay (surgery, accommodation, tests).
- In-patient + Out-patient: A more comprehensive option that also covers things you don't need to be admitted to hospital for, such as GP visits, specialist consultations, diagnostic scans, and prescription drugs.
- Comprehensive: The top tier of cover, often including routine dental check-ups, optical care (glasses/lenses), and wellness benefits like health screenings.
- Deductible / Excess: This is the amount you agree to pay towards a claim before the insurer starts paying. For example, if you have a £500 excess, you pay the first £500 of a claim. Choosing a higher excess will lower your annual or monthly premium.
- Underwriting Options: This determines how the insurer treats your past medical history.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire, declaring all previous conditions. The insurer assesses your history and may place specific exclusions on your policy for those pre-existing conditions. It provides certainty from day one about what is and isn't covered.
- Moratorium Underwriting: You do not have to declare your medical history upfront. Instead, the policy automatically excludes any condition you've had symptoms of, or received treatment for, in the past 5 years. This exclusion lasts for a set 'moratorium period' (usually 24 months). If you go through that entire period without any symptoms, advice, or treatment for that condition, it may become eligible for cover. This is a simpler application process but can lead to uncertainty when you first claim.
Step 3: Compare Providers and Get Expert Advice
The international health insurance market is dominated by a few large, reputable providers, including Bupa Global, AXA Global Healthcare, Cigna Global, and Allianz Care. Each offers a range of plans with different strengths.
Trying to compare these complex policies alone is challenging. This is where a specialist PMI broker is invaluable.
- Expertise: They understand the complex terms and conditions.
- Market Access: They work with all the major insurers and can find the best fit for your specific needs and budget.
- No Cost to You: Brokers are paid a commission by the insurer you choose, so their advice and support service is free for you.
- Advocacy: They can assist with the application process and can even help you if you run into issues with a claim in the future.
What to Expect: Real-Life Scenarios for British Expats
Theory is helpful, but seeing how IPMI works in practice can make it clearer.
Scenario 1: The Young Family Moving to Spain
- The People: Tom and Jen, both 35, with a 4-year-old daughter, are moving to Valencia for Tom's job.
- The Challenge: Tom's employer doesn't offer a health plan. To get their residency visas, they need compliant private cover. They want good access to English-speaking paediatricians for their daughter.
- The Solution: They work with a broker like WeCovr who finds them a mid-range IPMI plan. It satisfies the visa rules (no excess, full cover), includes out-patient benefits for GP and specialist visits, and has a strong network of private hospitals in Valencia.
Scenario 2: The Retiree Couple in Portugal
- The People: Brian and Sandra, both 68, are retiring to the Algarve. Both receive UK state pensions.
- The Challenge: They register their S1 forms, giving them access to the Portuguese public health service. However, they're worried about waiting lists for things like a knee replacement and want the comfort of a private room if hospitalised.
- The Solution: They opt for a more basic IPMI plan that focuses on in-patient cover. This is more affordable and complements their state access. It acts as a safety net, giving them peace of mind that they can go private for serious issues without a huge bill.
Scenario 3: The Digital Nomad in Asia
- The Person: Chloe, 29, is a freelance graphic designer who plans to spend 4-6 months each in Thailand, Vietnam, and Indonesia.
- The Challenge: She needs a single, flexible policy that covers her across multiple countries, some of which have limited local healthcare facilities in rural areas.
- The Solution: She chooses an IPMI plan with a 'Worldwide excluding USA' area of cover. The most crucial benefit for her is medical evacuation, which ensures that if she has a serious accident in a remote location, the insurer will cover the cost of transporting her to the nearest centre of medical excellence (e.g., Bangkok or Singapore).
Beyond Insurance: Staying Healthy as an Expat
Your health is more than just an insurance policy. Moving abroad is a major life event that can impact your physical and mental wellbeing.
- Embrace a Healthy Lifestyle: Moving to a new country is a great opportunity to adopt new healthy habits. Explore local markets for fresh food and try new activities. To help you stay on track with your nutrition goals, WeCovr provides all our clients with complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app.
- Prioritise Mental Health: Culture shock, loneliness, and the stress of adapting to a new environment are real challenges. Many IPMI plans now include access to mental health support, virtual therapy sessions, and Employee Assistance Programmes (EAPs). Don't be afraid to use them.
- Build Your Support Network: Connect with other expats and locals. Joining clubs, taking language classes, and participating in community events can make a huge difference to your sense of belonging and overall happiness.
Furthermore, by arranging your health or life insurance through WeCovr, you can often benefit from discounts on other insurance products you may need, such as travel, home, or contents cover, helping you manage all your protection needs in one place.
What happens if I have a pre-existing medical condition?
This is a critical point to understand. Standard international private medical insurance does not cover pre-existing conditions, which are any medical issues you had before your policy began. It also does not cover chronic conditions (like diabetes or asthma) that require ongoing management. PMI is for new, acute conditions that arise after your policy starts. When you apply, you will either go through 'Full Medical Underwriting' (declaring your history) where the insurer will likely exclude those conditions, or 'Moratorium' underwriting, which automatically excludes recent conditions for a set period.
Can I keep my NHS GP if I move abroad permanently?
No. Once you move abroad and are no longer 'ordinarily resident' in the UK, you are no longer entitled to NHS care and should de-register from your GP practice. You should register with a doctor in your new country of residence. While you can still receive emergency A&E treatment when visiting the UK, any admitted hospital care may be chargeable.
Do I still need travel insurance if I have international health insurance?
Yes, they serve different purposes. Your International Private Medical Insurance (IPMI) covers your healthcare within your specified area of cover (your new country of residence and possibly a wider region). Travel insurance is for short trips *outside* that area of cover (e.g., a holiday from Spain to Morocco). It covers things that IPMI does not, such as trip cancellation, lost baggage, travel delays, and short-term emergency medical treatment for that specific trip.
Your Next Step to a Secure Life Abroad
Moving overseas is one of the most exciting journeys you can take. Ensuring your health and financial wellbeing are protected is the most important step in that journey. Standard UK private health cover won't protect you, and relying on unfamiliar state systems can be a gamble. A robust International Private Medical Insurance plan is the definitive solution.
Ready to explore your options? The expert, friendly advisors at WeCovr are here to help. We compare plans from the world's leading insurers to find the perfect fit for your needs and budget, all at no cost to you. Our high customer satisfaction ratings reflect our commitment to clear, impartial advice.
Get your free, no-obligation quote today and take the first step towards complete peace of mind for your new life abroad.