PMI Trends Based on Claims Data What People Actually Use Insurance For
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr provides expert insight into the UK’s private medical insurance market. This article dissects real claims data to reveal what people truly use their health cover for, helping you choose a policy that offers genuine value for your needs.
Real-world analysis of how policyholders use their health insurance, most claimed treatments, underutilized benefits, and optimizing policy value
Private Medical Insurance (PMI) can feel like a complex product. You pay a monthly premium for peace of mind, but what does that peace of mind look like in practice? What conditions, treatments, and services do policyholders in the UK actually claim for?
By analysing claims data from across the industry, we can move beyond marketing brochures and uncover the real-world value of private health cover. This data reveals the most common health challenges facing policyholders, the benefits they rely on most, and the valuable perks that often go unused. Understanding these trends is the key to choosing a policy that’s not just a safety net, but a practical tool for managing your health.
The Core Purpose of UK Private Medical Insurance: Acute vs. Chronic Conditions
Before diving into the data, it's crucial to understand the fundamental principle of private medical insurance in the UK.
PMI is designed to cover 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 things like a cataract, a hernia, or a broken bone. The goal of the treatment is to cure the condition and return you to your previous state of health.
Crucially, standard UK PMI policies do not cover pre-existing or chronic conditions.
- A pre-existing condition is any health issue you had before your policy started.
- A chronic condition is an illness that cannot be cured but can be managed with ongoing treatment, medication, or therapy. Examples include diabetes, asthma, hypertension (high blood pressure), and certain autoimmune disorders like Crohn's disease.
This distinction is the single most important concept to grasp. Your GP and the NHS remain your primary partners for managing long-term, chronic illnesses. PMI steps in to provide prompt diagnosis and treatment for new, curable health problems, helping you bypass NHS waiting lists and get back on your feet faster.
The Most Claimed Treatments: A Look at the UK's Top Health Concerns
Industry-wide claims data consistently points to a few key areas where private medical insurance provides the most support. These are not niche, rare diseases, but common conditions that can affect anyone.
H3: Musculoskeletal (MSK) Conditions: The Undisputed Number One
Year after year, issues with bones, joints, muscles, and ligaments represent the largest single category of claims. Data from major UK insurers regularly shows that MSK conditions account for roughly 30-40% of all claims by volume.
Why is this so common? Our modern lives contribute significantly. Sedentary office jobs lead to back and neck pain, while an increase in recreational sports results in injuries. As we age, natural wear and tear leads to conditions like osteoarthritis.
Most Common MSK Claims:
- Physiotherapy: The most frequent claim, used for everything from post-operative rehabilitation to treating back pain and sports injuries.
- Orthopaedic Surgery: Hip and knee replacements are leading procedures for older policyholders, dramatically improving quality of life.
- Diagnostics: MRI and CT scans to investigate joint pain or spinal issues are extremely common.
- Pain Management: Injections to relieve joint and back pain.
| MSK Treatment Pathway | Typical Use Case | Value of PMI |
|---|---|---|
| Initial Consultation | A patient develops persistent lower back pain. | See a specialist consultant within days or weeks, not months. |
| Diagnostics | The consultant refers for an MRI scan. | The scan is often completed within a week. |
| Treatment | The scan reveals a disc issue requiring physiotherapy. | A course of physiotherapy can begin immediately. |
| Surgery (if needed) | If physio is unsuccessful, surgery is recommended. | Surgery is scheduled at a convenient time in a private hospital. |
H3: Cancer Care: The Cornerstone of Comprehensive PMI
While not the most common claim by volume, cancer treatment is arguably the most valued benefit and a primary reason people invest in private health cover. A cancer diagnosis is a life-changing event, and PMI offers control, comfort, and access to cutting-edge care when it's needed most.
According to Cancer Research UK, there are around 375,000 new cancer cases in the UK every year. While the NHS provides excellent cancer care, the private sector can offer significant advantages.
How PMI Enhances Cancer Care:
- Speed of Diagnosis: Fast-tracks access to the initial consultations and scans needed to confirm a diagnosis.
- Choice of Specialist: Allows you to choose your oncologist and the hospital where you receive treatment.
- Access to New Treatments: Many comprehensive policies provide cover for breakthrough drugs, treatments, and therapies that may not yet be approved for widespread NHS use due to cost or other factors.
- Enhanced Comfort: Treatment is delivered in a private hospital, often with an en-suite room, better food, and more flexible visiting hours.
- Holistic Support: Policies often include benefits like specialist cancer nurses, nutritional advice, wigs, and therapy for the patient and their family.
H3: Mental Health Support: A Rapidly Growing Area of Claims
In recent years, claims for mental health have surged, reflecting a greater societal awareness and a willingness to seek help. NHS waiting lists for talking therapies can be notoriously long; according to NHS England data, while many are seen within weeks, a significant number wait over three months for treatment to begin.
PMI offers a vital alternative, providing prompt access to professional support.
Common Mental Health Claims:
- Psychiatric Assessments: Initial consultations to diagnose a condition and formulate a treatment plan.
- Talking Therapies: Courses of treatment with a psychologist or therapist, with Cognitive Behavioural Therapy (CBT) being one of the most common.
- In-patient/Day-patient Care: For more severe conditions requiring intensive support.
The ability to access therapy within a week or two, rather than waiting months, can make a profound difference in a person's recovery and ability to continue with work and family life.
H3: Other Significant Claim Areas
Beyond the "big three," a wide range of other specialist treatments feature prominently in claims data.
| Specialism | Common Conditions & Treatments Claimed For |
|---|---|
| Gastroenterology | Endoscopies and colonoscopies to investigate digestive issues like acid reflux, abdominal pain, or changes in bowel habits. |
| Cardiology | Consultations and investigations (e.g., ECGs, echocardiograms) for symptoms like chest pain or palpitations. |
| Dermatology | Removal of suspicious moles and treatment for skin conditions like severe eczema or psoriasis. |
| Gynaecology | Investigations for issues like heavy periods or pelvic pain, and procedures such as hysterectomies. |
| Ophthalmology | Cataract surgery is one of the most common and successful surgical procedures covered by PMI. |
Underutilised Benefits: Are You Getting the Full Value from Your Policy?
While people are quick to claim for surgery and specialist care, many policies are packed with valuable day-to-day benefits that go largely unused. Tapping into these can improve your overall health, prevent serious conditions from developing, and save you money—often without affecting your No Claims Discount.
H3: Digital GP and Virtual Services
This is perhaps the most powerful yet underused feature of modern PMI. Almost every policy now includes a 24/7 virtual GP service, accessible via an app or phone call.
Benefits:
- Incredible Convenience: Get a consultation from your home, office, or even while travelling.
- Speed: No need to wait days for a local GP appointment. You can often speak to a doctor within hours, or even minutes.
- Prescriptions & Referrals: Digital GPs can issue private prescriptions and, crucially, provide open referrals to a specialist, kick-starting your PMI claim process without needing to see your NHS GP first.
Using the virtual GP for minor queries or to get a referral doesn't count as a "claim" and won't impact your premium.
H3: Wellness Programmes and Preventative Health Perks
Leading insurers are increasingly focused on helping you stay healthy, not just treating you when you're ill. These wellness benefits are often included at no extra cost.
- Gym Discounts & Fitness Rewards: Many providers partner with major gym chains or offer rewards (like free coffee or cinema tickets) for hitting activity goals tracked on a wearable device.
- Health Screenings: Some policies offer access to discounted or included health screenings to catch potential problems early.
- Nutritional Support: As part of our commitment to wellness, WeCovr provides complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, helping you make informed decisions about your diet.
- Mental Health Helplines: Separate from full psychiatric cover, most policies include a 24/7 helpline for stress, anxiety, and bereavement support. This is a confidential service for you to talk through any worries.
H3: Second Medical Opinions
If you've received a complex diagnosis or been recommended major surgery, many policies allow you to get a second opinion from another leading expert, either in the UK or internationally. This provides invaluable reassurance and can sometimes open up alternative treatment paths. It’s a feature that sits quietly in your policy documents but offers immense peace of mind when you need it most.
| Underutilised Benefit | How to Use It | Why It's Valuable |
|---|---|---|
| Digital GP | Download the insurer's app. Use it for quick medical advice or specialist referrals. | Immediate access to a doctor, bypasses GP waiting times. |
| Wellness Rewards | Link your fitness tracker to the insurer's platform. | Get rewarded for staying active, which reduces your long-term health risks. |
| Mental Health Helpline | Find the dedicated phone number in your policy documents. | Confidential, immediate support for stress or anxiety. |
| Second Medical Opinion | Contact your insurer after receiving a diagnosis or treatment plan. | Confirmation and peace of mind from a world-leading expert. |
How to Optimise Your Policy Based on Real-world Usage
Understanding claims data empowers you to make smarter choices when buying or renewing your private health cover. Instead of guessing, you can tailor your policy to cover what you're most likely to need.
H3: Choosing the Right Level of Cover
- Basic/Entry-Level: These policies typically cover in-patient and day-patient treatment only. They are a cost-effective way to protect against the cost of major surgery but won't cover the initial consultations or diagnostics.
- Mid-Range: This is the most popular choice. It includes a level of outpatient cover, often with a financial limit (e.g., £1,000 per year). This is usually sufficient to cover the specialist consultations and scans needed to diagnose the most common conditions, like MSK issues.
- Comprehensive: Offers full outpatient cover with no annual limit, plus more extensive benefits for mental health and therapies. This is the best option for those wanting complete peace of mind.
H3: The Outpatient Cover Dilemma
As the data shows, a huge number of claims start with outpatient services (consultations and scans). Deciding on your level of outpatient cover is the biggest factor affecting your premium.
- Option 1: Full Cover. You pay a higher premium but know that every step of your diagnosis and treatment is covered.
- Option 2: Capped Cover. A limit of £1,000-£1,500 is often enough to cover the pathway for a typical MSK or gastroenterology claim. This strikes a great balance between cost and coverage.
- Option 3: No Outpatient Cover. You pay a much lower premium but must self-fund all consultations and diagnostics. This can be a false economy, as a single MRI scan can cost £400-£800.
An expert PMI broker like WeCovr can run quotes with different outpatient levels to help you find the sweet spot for your budget.
H3: Managing Your Excess and No Claims Discount
- Excess: This is the amount you agree to pay towards any claim. An excess of £250-£500 can significantly reduce your monthly premium. Given that you are unlikely to claim every year, this is often a sensible trade-off.
- No Claims Discount (NCD): Just like with car insurance, you are rewarded for not claiming. This can reduce your premium by up to 60-70% over time. Using benefits like the virtual GP, wellness apps, and helplines does not affect your NCD.
The Role of an Expert PMI Broker in Navigating the Market
The private medical insurance UK market can be confusing. Every provider has different terms, hospital lists, and benefit limits. This is where an independent, FCA-authorised broker is invaluable.
Unlike going direct to an insurer who can only sell you their own products, a broker like WeCovr provides a whole-of-market view.
Advantages of using WeCovr:
- Expert, Unbiased Advice: We know the market inside-out and can compare policies from all the leading providers to find the best fit for your specific needs and budget. Our high customer satisfaction ratings reflect our commitment to finding the right solution for every client.
- No Cost to You: Our service is free. We are paid a commission by the insurer you choose, which is already built into the price of the policy.
- Save Time and Hassle: We do the research and paperwork for you, presenting you with clear, easy-to-understand options.
- Exclusive Benefits: By arranging cover through us, you can also get discounts on other types of insurance, such as life or income protection, helping you build a complete financial safety net.
- Support at Claim Time: If you need to make a claim, we're here to offer guidance and support, helping you navigate the process smoothly.
The Future of PMI: What Do Emerging Trends Tell Us?
The health insurance landscape is constantly evolving, driven by technology and changing customer expectations.
- Preventative Health is Key: Insurers will invest even more in wellness, using data from wearables and apps to offer personalised health advice and reward healthy living.
- Care at Home: We will see a rise in "hospital at home" services, where post-operative care, IV infusions, and even chemotherapy can be delivered in the comfort of your own home.
- AI and Personalisation: Artificial intelligence will play a greater role in everything from streamlining the claims process to providing personalised health nudges via apps.
- Mental Health Parity: The gap between physical and mental health cover will continue to close, with more comprehensive and accessible support becoming standard.
Does private medical insurance cover pre-existing conditions?
Is it worth paying for outpatient cover on my PMI policy?
Can I use my private health cover for mental health treatment?
Ready to find a private medical insurance policy that reflects how people actually use it? The expert team at WeCovr is here to help. We provide free, impartial advice to help you compare the UK's leading providers and tailor a policy that offers real value for your health and your budget.
Get your free, no-obligation quote today and discover a smarter way to protect your health.
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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Who Are WeCovr?
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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