TL;DR
Deciding how to protect your health and finances can feel like navigating a maze of acronyms and policies. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we simplify complex choices. This guide demystifies two key products: Private Medical Insurance (PMI) and Critical Illness (CI) cover in the UK.
Key takeaways
- Emergency and A&E visits (these are handled by the NHS)
- Cosmetic surgery (unless medically necessary)
- Normal pregnancy and childbirth
- Mobility aids, such as wheelchairs
- Drug and alcohol abuse treatment
Deciding how to protect your health and finances can feel like navigating a maze of acronyms and policies. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we simplify complex choices. This guide demystifies two key products: Private Medical Insurance (PMI) and Critical Illness (CI) cover in the UK.
How PMI premiums compare with CI policies
Private Medical Insurance (PMI) and Critical Illness (CI) cover are often discussed together, but they serve fundamentally different purposes and, as a result, have very different cost structures. PMI premiums pay for access to private medical treatment for acute conditions, whereas CI premiums pay for a policy that provides a one-off, tax-free lump sum if you are diagnosed with a specific serious illness.
Generally speaking, for a similar level of "perceived" protection, PMI premiums are often higher and increase more steeply with age than CI premiums. This is because PMI covers a wide range of potential treatments, from minor procedures to major surgeries, and the likelihood of needing medical care increases significantly as we get older.
CI cover, while protecting against life-altering events, is statistically less likely to be claimed on than PMI. A CI policy only pays out for a defined list of serious conditions, not for general diagnostics or smaller treatments.
Let's break down exactly what each policy is, what it covers, and how their costs are calculated.
What is Private Medical Insurance (PMI)? Unpacking the Cover
Private Medical Insurance, often called private health cover, is designed to cover the costs of private medical treatment for acute conditions that arise after your policy has started. 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 it as a way to bypass NHS waiting lists for eligible treatments, get a private room in a hospital, and have more choice over your consultant and when you are treated.
Critical Constraint: It is vital to understand that standard UK private medical insurance does not cover pre-existing conditions (ailments you had before taking out the policy) or chronic conditions (long-term illnesses that cannot be cured, like diabetes, asthma, or high blood pressure). PMI is for new, curable health issues.
What Does a Typical PMI Policy Cover?
Cover levels vary, but most policies are structured in tiers, from basic to comprehensive.
| Feature | Basic Cover | Mid-Range Cover | Comprehensive Cover |
|---|---|---|---|
| In-patient Treatment | ✅ Yes (tests & surgery while in a hospital bed) | ✅ Yes | ✅ Yes |
| Day-patient Treatment | ✅ Yes (procedures where you don't stay overnight) | ✅ Yes | ✅ Yes |
| Cancer Cover | ✅ Yes (often comprehensive, including drugs not on the NHS) | ✅ Yes | ✅ Yes |
| Out-patient Diagnostics | ❌ No, or capped (£0 - £500) | ✅ Yes (capped, e.g., £1,000 - £1,500) | ✅ Yes (often unlimited) |
| Therapies | ❌ No | ✅ Yes (limited sessions of physio, osteopathy etc.) | ✅ Yes (more sessions) |
| Mental Health Support | ❌ No, or very limited | ✅ Yes (often includes some psychiatric cover) | ✅ Yes (more extensive cover) |
| Dental & Optical | ❌ No (usually an add-on) | ❌ No (usually an add-on) | ✅ Yes (can be included or added) |
Key Exclusions in Private Health Insurance
Besides pre-existing and chronic conditions, PMI typically excludes:
- Emergency and A&E visits (these are handled by the NHS)
- Cosmetic surgery (unless medically necessary)
- Normal pregnancy and childbirth
- Mobility aids, such as wheelchairs
- Drug and alcohol abuse treatment
What is Critical Illness Cover (CI)? A Deep Dive
Critical Illness Cover is a different type of protection altogether. It is a form of life insurance that pays out a tax-free lump sum if you are diagnosed with one of a list of specific, serious, and often life-changing illnesses or medical conditions defined in your policy.
You choose the amount of cover (the "sum assured") and the policy term when you take out the policy. If you make a successful claim, you can use the money for anything you want.
Common uses for a CI payout include:
- Paying off your mortgage or rent
- Covering lost income if you can't work
- Adapting your home (e.g., installing a ramp)
- Paying for private medical treatment not covered by PMI or the NHS
- Reducing financial stress for you and your family
What Conditions Does Critical Illness Cover Include?
The number and definition of illnesses covered vary between insurers, but most policies cover the "big three":
- Cancer (of a specified severity)
- Heart Attack (of a specified severity)
- Stroke (resulting in permanent symptoms)
According to the Association of British Insurers (ABI), these three conditions account for the vast majority of claims. More comprehensive policies can cover over 100 conditions, including:
- Multiple sclerosis
- Kidney failure
- Major organ transplant
- Parkinson's disease
- Motor neurone disease
- Loss of limbs or sight
It's crucial to read the policy's Key Features Document to understand the exact definitions. For example, some early-stage cancers might not be covered, or a heart attack may need to be of a certain severity to trigger a payout.
PMI vs. CI Cover: A Head-to-Head Comparison
To make the distinction crystal clear, here’s a direct comparison of the two types of cover.
| Feature | Private Medical Insurance (PMI) | Critical Illness (CI) Cover |
|---|---|---|
| Purpose | To pay for the cost of private medical treatment. | To provide a financial cushion after a serious diagnosis. |
| How it Pays Out | Insurer pays the hospital/consultant directly for treatment costs. | Pays a one-off, tax-free lump sum directly to you. |
| What it Covers | Treatment for acute medical conditions (e.g., hip replacement, hernia repair, cataract surgery). | A defined list of serious illnesses (e.g., cancer, stroke, heart attack). |
| When it Pays | When you need eligible medical treatment. You can claim multiple times. | Once, upon diagnosis of a specified critical illness. The policy then ends. |
| Chronic Conditions | Not covered. PMI is for curable (acute) conditions. | Can be claimed for if the chronic condition meets the policy definition (e.g., Multiple Sclerosis). |
| Premiums | Paid monthly or annually. Increase with age and claims history. | Paid monthly or annually. Usually fixed for the policy term ('guaranteed premiums'). |
| Typical Use | Bypassing NHS waiting lists, getting a private room, choosing your specialist. | Paying off a mortgage, replacing lost income, adapting your home. |
Cost Breakdown: Factors Influencing Your Premiums
The cost of both PMI and CI cover is highly personal. Let's explore the specific factors that insurers use to calculate your monthly premium.
Factors Affecting Private Health Insurance (PMI) Costs
PMI premiums are dynamic and can change each year at renewal.
- Age: This is the single biggest factor. The older you are, the higher the statistical likelihood of needing treatment.
- Location: Treatment costs vary across the UK. Living in Central London, where hospital costs are highest, will result in much higher premiums than living in a rural area.
- Level of Cover: A basic, in-patient-only plan is far cheaper than a comprehensive plan with unlimited out-patient cover and therapies.
- Excess (illustrative): This is the amount you agree to pay towards a claim. A higher excess (£500 or £1,000) will significantly lower your premium compared to a zero excess.
- Hospital List: Insurers have tiered hospital lists. Choosing a list that excludes expensive central London hospitals can reduce your premium by 20-30%.
- Underwriting:
- Moratorium: You don't declare your full medical history upfront. The insurer automatically excludes any condition you've had symptoms of or treatment for in the last 5 years. It's simpler but can lead to uncertainty at the point of a claim.
- Full Medical Underwriting (FMU): You complete a full health questionnaire. The insurer gives you a clear list of exclusions from the start.
- No Claims Discount (NCD): Similar to car insurance, if you don't claim, you build up a discount on your premium, which can be as high as 70-75%. Making a claim will reduce your NCD and increase your renewal premium.
- Lifestyle: Smoking and a high BMI can increase your premium, though this is a less direct factor than with CI cover.
Factors Affecting Critical Illness (CI) Cover Costs
CI premiums are typically fixed for the life of the policy if you choose 'guaranteed' premiums. 'Reviewable' premiums are cheaper initially but can increase over time.
- Age: As with PMI, the older you are when you take out the policy, the higher the premium, as the risk of illness increases.
- Sum Assured (illustrative): This is the size of the lump sum payout you want. A £250,000 policy will cost significantly more than a £50,000 policy.
- Policy Term: The length of time you want to be covered for. A policy that runs until age 70 will be more expensive than one that runs until age 50.
- Smoker Status: This is a huge factor. Smokers can expect to pay 50-100% more than non-smokers for the same level of cover due to the massively increased risk of cancer, heart attacks, and strokes.
- Health & Medical History: Your personal health, BMI, and any significant family history of conditions like heart disease or cancer will be assessed.
- Occupation: A high-risk job (e.g., construction worker) may lead to a higher premium than a low-risk office job.
- Guaranteed vs. Reviewable Premiums: Guaranteed premiums are fixed for the term. Reviewable premiums are reassessed by the insurer every 5-10 years and can increase.
Real-Life Cost Examples: PMI vs. CI in 2025
To put this into context, let's look at some illustrative monthly premium examples. These are estimates for non-smokers in a mid-cost UK region (e.g., the Midlands) and are for guidance only. Actual quotes will vary.
An expert broker like WeCovr can provide personalised quotes from across the market to find the best value for your specific circumstances.
Scenario 1: Healthy 30-Year-Old Individual
- Goal: General health protection and a financial safety net.
- PMI Details: Mid-range cover, £250 excess, standard hospital list.
- CI Details (illustrative): £100,000 of cover until age 65, guaranteed premiums.
| Policy Type | Illustrative Monthly Premium | Notes |
|---|---|---|
| Private Medical Insurance (PMI) | £45 - £65 | Covers treatment costs. Premium will rise with age. |
| Critical Illness (CI) Cover | £12 - £20 | Provides a £100k lump sum. Premium is fixed. |
Insight: For a young, healthy individual, CI cover is significantly cheaper. However, they are protecting against different risks. The PMI policy might be used for a knee surgery worth £5,000, while the CI policy would only pay out for a major event like cancer. (illustrative estimate)
Scenario 2: A 45-Year-Old Couple
- Goal: Protect their family and mortgage. One person is a non-smoker, one is a smoker.
- PMI Details (illustrative): Comprehensive family cover, £500 excess.
- CI Details (illustrative): £200,000 joint-life policy until age 65, guaranteed premiums.
| Policy Type | Illustrative Monthly Premium | Notes |
|---|---|---|
| Private Medical Insurance (PMI) | £150 - £220 (for both) | Covers family treatment. Premium will rise significantly with age. |
| Critical Illness (CI) Cover | £90 - £140 (for both) | Smoker status dramatically increases the cost. Provides a £200k lump sum. |
Insight: The gap in cost narrows with age, as PMI premiums increase steeply. The impact of smoking on the CI premium is very clear. A joint CI policy often pays out on the first person's diagnosis and then ends.
Scenario 3: Family of Four (Parents age 40, Children 8 & 10)
- Goal: Ensure fast access to treatment for the whole family and secure finances.
- PMI Details: Family PMI plan, mid-range cover, £250 excess.
- CI Details (illustrative): Two separate CI policies for the parents, £150,000 each.
| Policy Type | Illustrative Monthly Premium | Notes |
|---|---|---|
| Private Medical Insurance (PMI) | £140 - £200 (for the family) | Children are relatively cheap to add to a PMI policy. |
| Critical Illness (CI) Cover | £60 - £95 (total for parents only) | Children can often be added for free with a smaller benefit (£25k). |
Insight: Family PMI is a single, convenient policy. While CI is cheaper, it only protects the parents' income and financial stability; it doesn't provide medical treatment for a child's broken arm or need for grommets.
Do I Need Both? Making an Informed Decision
This isn't an "either/or" question. PMI and CI cover are not rivals; they are complementary products that protect you in different ways.
- PMI is for your HEALTH. It pays for treatment to get you back on your feet.
- CI is for your WEALTH. It pays you a lump sum to protect your finances while you recover.
Consider this scenario: You are diagnosed with a type of cancer covered by both policies.
- Your PMI policy would pay for the private consultations, scans, surgery, and chemotherapy, potentially giving you access to drugs not yet available on the NHS.
- Your CI policy would pay you a £150,000 lump sum. You could use this to pay your mortgage for two years while you take time off work to recover, without worrying about bills.
Ideally, having both offers the most comprehensive protection. However, budgets are a real-world constraint. The right choice depends on your priorities:
- If your main worry is NHS waiting lists... PMI might be your priority.
- If your main worry is paying your mortgage if you get seriously ill... CI cover might be your priority.
A consultation with an independent PMI broker can help you assess your personal risks and budget to find a solution that works for you, whether it's one policy, the other, or a combination of both.
How WeCovr Helps You Find the Right Cover at the Right Price
Navigating the UK private health insurance market alone can be overwhelming. As an FCA-authorised specialist broker, WeCovr provides expert, impartial advice at no cost to you. Our service is paid for by the insurer you choose, so you get the benefit of our expertise for free.
Here’s how we help:
- We Listen: We take the time to understand your unique needs, budget, and health priorities.
- We Compare: We search the market, comparing policies from the UK's best PMI providers like Aviva, Bupa, AXA Health, and Vitality to find the most suitable cover.
- We Explain: We break down the jargon and clearly explain the differences in cost, cover, and exclusions, so you can make a confident decision.
- We Add Value: We offer our clients complimentary access to our AI-powered diet and calorie tracking app, CalorieHero, to support their wellness goals. Furthermore, customers who purchase PMI or Life Insurance through us can receive discounts on other insurance products. Our high customer satisfaction ratings reflect our commitment to exceptional service.
Beyond Insurance: Embracing a Healthier Lifestyle
While insurance provides a crucial safety net, the best strategy is always to invest in your health. A healthier lifestyle can reduce your risk of needing to claim and, in the long term, can help manage your insurance premiums.
- Balanced Diet: Focus on whole foods, fruits, vegetables, lean proteins, and healthy fats. Limiting processed foods, sugar, and excessive salt can dramatically reduce your risk of chronic diseases.
- Regular Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, or swimming. It's great for your heart, weight, and mental health.
- Quality Sleep: Aim for 7-9 hours of quality sleep per night. Good sleep is essential for immune function, mental clarity, and physical recovery.
- Stress Management: Chronic stress can impact your physical health. Practices like mindfulness, yoga, or even just spending time in nature can make a big difference.
Using tools like the CalorieHero app, which WeCovr provides to clients, can make tracking your nutrition simple and effective, empowering you to take control of your health.
Can I get private medical insurance if I have a pre-existing condition?
Does Critical Illness Cover pay out for any serious illness?
Can I use the lump sum from a Critical Illness payout to pay for private medical treatment?
Ready to explore your options and find the right protection for you and your family?
Sources
- Department for Transport (DfT): Road safety and transport statistics.
- DVLA / DVSA: UK vehicle and driving regulatory guidance.
- Association of British Insurers (ABI): Motor insurance market and claims publications.
- Financial Conduct Authority (FCA): Insurance conduct and consumer information guidance.







