PMI for Families Pros, Cons, and Alternatives
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr specialises in helping UK families navigate the world of private medical insurance. This guide is designed to give you the clarity and confidence to decide if private health cover is the right choice for protecting your loved ones.
A family-focused guide to private health cover
When you have a family, their health and wellbeing become your number one priority. From scraped knees and winter colds to more serious concerns, you want to know they can get the best possible care, right when they need it. This is where many UK families start to consider private medical insurance (PMI).
But is it the right choice for you? With rising NHS waiting times, the appeal of private healthcare is undeniable. However, it's a significant financial commitment with complexities that need careful consideration.
This comprehensive guide will walk you through everything you need to know about family PMI in the UK. We'll break down the pros and cons, explore the costs, and look at the alternatives, giving you all the information you need to make a decision that feels right for your family's future.
What Exactly is Family Private Medical Insurance?
At its heart, private medical insurance is a policy you pay for that covers the cost of private healthcare for treatable, short-term medical conditions. For a family policy, this simply means that you, your partner, and your children are all covered under a single plan.
The core purpose of PMI is to complement the services offered by our brilliant NHS. It doesn't replace it. You'll still use your NHS GP, and for emergencies, you'll go to A&E. Where PMI steps in is for non-emergency situations, offering a route to faster diagnosis and treatment for specific conditions.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the single most important concept to understand about UK private medical insurance:
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of things like joint replacements, cataract surgery, or hernia repairs. PMI is designed to cover these.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, has no known cure, is likely to recur, or requires palliative care. Examples include diabetes, asthma, arthritis, and high blood pressure. Standard PMI policies do not cover the ongoing management of chronic conditions.
KEY TAKEAWAY: Private health cover is for new, treatable health issues that arise after you take out your policy. It is not for managing long-term illnesses or pre-existing conditions you already have.
The Pros: Why Should My Family Consider PMI?
For many, the benefits of private health cover offer invaluable peace of mind. Let's explore the main advantages for families.
1. Bypassing NHS Waiting Lists
This is often the primary motivator. While the NHS provides excellent care, it is under immense pressure. According to NHS England data, the elective care waiting list stood at around 7.54 million in Spring 2024. This can mean long, anxious waits for specialist appointments, diagnostic scans, and surgery.
- Real-Life Example: Imagine your 8-year-old son suffers from recurrent, painful ear infections and is recommended for grommet surgery. The NHS waiting list in your area could be 9-12 months. With PMI, he could potentially see a specialist within a week and have the procedure scheduled in a matter of weeks, preventing months of discomfort and missed school days.
2. Choice and Control
PMI gives you a level of control that isn't possible on the NHS. You can often choose:
- The specialist or consultant who treats you.
- The hospital where you receive treatment.
- The time of your appointments and surgery, fitting them around family and work commitments.
3. Private, Comfortable Facilities
Receiving treatment in a private hospital typically means a private, en-suite room with a TV, better food options, and more flexible visiting hours. For a child who is unwell and anxious, or for a parent recovering from surgery, this enhanced comfort can make a significant difference to their experience and recovery.
4. Access to Specialist Drugs and Treatments
Occasionally, a new drug or treatment that has been approved for use may not be available on the NHS due to funding decisions. Some comprehensive PMI policies may provide cover for these, giving you access to the very latest medical advancements.
5. Valuable Added Benefits
Modern PMI policies are no longer just about surgery. Many now come bundled with a host of wellness benefits that can be incredibly useful for a family:
- Virtual GP Services: 24/7 access to a GP via phone or video call. Invaluable for a parent worried about a child's fever at 2 am.
- Mental Health Support: Access to counselling or therapy sessions without a long wait, crucial for supporting the wellbeing of both parents and older children.
- Wellness Programmes: Discounts on gym memberships, fitness trackers, and health screenings to encourage a proactive approach to your family's health.
The Cons: What are the Downsides of Family PMI?
While the benefits are compelling, it's essential to have a clear-eyed view of the limitations and costs.
1. The Cost
Family health insurance is a significant monthly expense. Premiums can range from under £70 to over £300 per month, depending on a wide range of factors. This cost can increase each year as your family members get older and due to medical inflation (the rising cost of healthcare).
2. The Exclusions Are Non-Negotiable
This is where many people get caught out. It's vital to understand what is not covered:
| Commonly Excluded from PMI | Description |
|---|---|
| Pre-existing Conditions | Any illness or injury you had symptoms of, or received treatment for, before your policy started. |
| Chronic Conditions | Long-term conditions like diabetes, asthma, or high blood pressure are not covered for ongoing management. |
| Emergencies | You should always call 999 or go to A&E for emergencies like a suspected heart attack, stroke, or major accident. |
| Normal Pregnancy/Childbirth | Routine maternity care is not covered, though some policies may cover complications. |
| Cosmetic Surgery | Procedures that are not medically necessary. |
| Infertility Treatment | The diagnosis and treatment of infertility is usually excluded. |
3. Policy Complexity and Underwriting
PMI policies aren't always straightforward. A key area of complexity is underwriting—the method an insurer uses to decide what they will and won't cover based on your medical history.
- Moratorium Underwriting: This is the most common type. You don't declare your full medical history upfront. Instead, the insurer applies a blanket exclusion for any condition you've had in the past five years. This exclusion can be lifted, but only if you remain symptom-free and treatment-free for that condition for a continuous two-year period after your policy starts.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire. The insurer assesses it and tells you from day one exactly what is excluded from your policy. It's more work upfront but provides total clarity.
4. You Still Need the NHS
PMI is not a replacement for the NHS. You will rely on the NHS for GP services, A&E, and the management of any chronic conditions. It's a parallel system, not a substitute.
How Much Does Family Health Insurance Cost in the UK?
This is the million-dollar question, but the answer is: it depends. Insurers calculate your premium based on several key factors.
| Factor Influencing Cost | How it Affects Your Premium |
|---|---|
| Age | The older you are, the higher the premium. Children are usually cheaper to add to a policy than adults. |
| Location | The cost of private treatment varies across the UK. Living in London or the South East, where hospital costs are higher, will result in a higher premium. |
| Level of Cover | A basic policy covering only in-patient treatment will be much cheaper than a comprehensive one with full out-patient, dental, and therapy cover. |
| Policy Excess | This is the amount you agree to pay towards a claim. A higher excess (e.g., £500) will lower your monthly premium. |
| Hospital List | Insurers have different tiers of hospitals. Choosing a more restricted local list instead of a nationwide list (including central London hospitals) can save money. |
| Underwriting Type | Sometimes the choice of underwriting can have a small impact on the initial price. |
Illustrative Monthly Premiums for a Family of Four
To give you a rough idea, here are some sample costs. Please note: These are for illustration only and are not a quote. Your actual premium will depend on your specific circumstances.
Family Profile: Two adults (aged 35), two children (aged 5 & 8).
| Location | Basic Cover (Core only) | Mid-Range Cover (+ Out-patient) | Comprehensive Cover (+ Therapies) |
|---|---|---|---|
| Manchester | £80 - £120 | £130 - £180 | £190 - £250+ |
| Surrey | £100 - £150 | £160 - £220 | £240 - £320+ |
| Edinburgh | £75 - £115 | £125 - £170 | £180 - £240+ |
Estimates as of late 2024, subject to change. For an accurate price, you need a personalised quote.
Key Features to Look for in a Family PMI Policy
When comparing policies, it helps to understand the building blocks of cover.
- Core Cover (The Foundation): Almost all policies include this as standard. It covers costs when you are admitted to hospital, including surgery fees, consultant fees, and accommodation (in-patient), as well as procedures where you don't stay overnight (day-patient).
- Out-patient Cover (The Most Important Add-on): This is crucial. It covers the costs of diagnostic tests, consultations, and scans before you are admitted to hospital. Without it, you would have to pay for these yourself or go through the NHS, defeating the purpose of bypassing waiting lists. You can choose different levels, from a set monetary limit (e.g., £1,000 per year) to full cover.
- Cancer Cover (Peace of Mind): This is a standout feature of PMI. Most policies offer extensive cancer cover, including diagnosis, surgery, chemotherapy, and radiotherapy. It's important to check the level of cover, as some may have limits on advanced treatments.
- Therapies Cover: This add-on covers treatments like physiotherapy, osteopathy, and chiropractic care. It's very popular with active families.
- Mental Health Cover: An increasingly important option. This provides access to psychiatric treatment, counselling, and therapy, often with a set number of sessions or a financial limit.
- Dental & Optical Cover: Usually an optional extra that provides cashback for routine check-ups, glasses, and dental treatment. This often works more like a cash plan.
An expert broker, such as WeCovr, can help you mix and match these options to build a policy that fits your family's needs and budget perfectly.
Making Your Family Policy More Affordable
Worried about the cost? There are several effective ways to manage your premiums without sacrificing essential cover.
- Increase Your Excess: Agreeing to pay the first £250, £500, or even £1,000 of any claim can significantly reduce your monthly payments. It's a trade-off between a lower fixed cost and a higher potential one-off cost.
- Choose a "6-Week Wait" Option: This is a clever compromise. If the NHS can provide the treatment you need within six weeks, you agree to use the NHS. If the wait is longer than six weeks, your private policy kicks in. This can reduce premiums by 20-30%.
- Select a Guided Hospital List: Instead of having access to every private hospital in the UK, you can choose a more limited list curated by your insurer. This is often more than adequate and offers substantial savings.
- Pay Annually: If you can afford to, paying your premium in one annual lump sum often works out cheaper than paying monthly.
- Review Your Policy Annually: Don't just let your policy auto-renew. The best deal you got last year might not be the best one this year. Speaking to a broker annually ensures you're always on the most suitable and cost-effective plan.
A Family Wellness Hub: Beyond the Policy
A healthy family is a happy family. While insurance is there for when things go wrong, the best approach is always prevention. Many insurers actively encourage this, and here are some tips you can use today.
Nourishing Your Family
Good nutrition is the bedrock of good health.
- Eat the Rainbow: Encourage your children to eat a variety of colourful fruits and vegetables. Make it a game!
- Family Meals: Eating together at the dinner table, away from screens, fosters good habits and communication.
- Track Your Intake: Understanding nutrition can be empowering. As a WeCovr client, you get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help your family make smarter food choices.
Keeping Active Together
Regular exercise boosts immunity, improves mood, and strengthens bones.
- Weekend Adventures: Plan family bike rides, walks in the park, or a trip to a local swimming pool.
- Active Evenings: A simple 30-minute walk after dinner is a great way to bond and stay active.
- Make it Fun: Kicking a football around, dancing in the living room, or building a den in the garden all count!
The Power of Sleep
Good quality sleep is vital for growth, learning, and immune function.
- Consistent Bedtimes: Stick to a regular sleep schedule, even on weekends.
- Wind-Down Routine: An hour before bed, switch off screens and opt for reading, a warm bath, or quiet music.
What are the Alternatives to Private Medical Insurance?
PMI isn't the only option. It's important to know the other paths available to you.
1. Relying Solely on the NHS
This is the route most of the UK population takes.
- Pros: Free at the point of use, comprehensive care for all conditions (including chronic and emergency), staffed by world-class professionals.
- Cons: Potentially long waiting times for non-urgent care, limited choice over hospitals and specialists.
2. Self-Funding Private Treatment
If you have significant savings, you could choose to pay for private treatment on a case-by-case basis.
- Pros: Complete flexibility, no monthly premiums.
- Cons: Costs can be astronomical and unpredictable. A single knee replacement can cost £15,000+, while complex cancer treatment can run into the hundreds of thousands, wiping out savings.
3. Health Cash Plans
These are often confused with PMI but are very different. A cash plan helps with everyday healthcare costs. You pay a monthly premium, and in return, you can claim back a set amount of cash for things like dental check-ups, eye tests, physiotherapy, and prescriptions.
- Pros: Very affordable, helps budget for routine healthcare, easy to understand.
- Cons: It does not cover the cost of private surgery or major medical treatments. The cashback limits are usually a few hundred pounds per year.
Comparison of Healthcare Options
| Feature | NHS | Private Medical Insurance (PMI) | Self-Funding | Health Cash Plan |
|---|---|---|---|---|
| Covers Surgery & Treatment | Yes | Yes (for acute conditions) | Yes | No |
| Covers Routine Costs | No (for dental/optical) | No (usually an add-on) | Yes | Yes (up to a limit) |
| Cost | Free (via taxes) | Monthly Premium | Pay-as-you-go (can be very high) | Low Monthly Premium |
| Choice of Hospital | No | Yes | Yes | N/A |
| Waiting Times | Can be long | Short | Short | N/A |
| Best For | All care, especially emergencies | Faster access for acute conditions | Those with very large savings | Budgeting for routine healthcare |
How to Choose the Best PMI Provider for Your Family
With so many providers—including Aviva, Bupa, AXA Health, and Vitality—how do you choose?
- Don't Just Focus on Price: The cheapest policy is rarely the best. Look at the value and the details of the cover.
- Check the Hospital List: Ensure the hospitals included are convenient for you and have a good reputation.
- Read Customer Reviews: Check independent review sites to see how providers handle claims and treat their customers. WeCovr is proud of its high customer satisfaction ratings, which reflect our commitment to excellent service.
- Understand the Claims Process: Is it simple and digital, or complex and paper-based?
- Use an Independent Broker: This is the single most effective way to navigate the market. An expert, FCA-authorised broker like WeCovr works for you, not the insurers. We can:
- Compare policies from across the market to find the best fit.
- Explain the jargon and the fine print in plain English.
- Help you tailor a policy to your exact needs and budget.
- Assist you with the application process and at the point of claim.
- Our service is provided at no cost to you.
- Plus, if you take out a PMI or Life Insurance policy through us, you may be eligible for discounts on other types of cover you need.
Is private health insurance worth it for children?
Does family PMI cover pregnancy and childbirth?
Can I add a new baby to my existing family policy?
What happens to my family health insurance when my children become adults?
Ready to protect your family's health?
Making the right decision about your family's healthcare is one of the most important choices you'll make. We hope this guide has given you the clarity you need.
If you're ready to explore your options, the next step is a personalised, no-obligation quote. Our friendly experts at WeCovr can compare the UK's leading insurers in minutes to find a policy that protects your family and fits your budget.
[Get Your Free Family PMI Quote Today]
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
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