TL;DR
WeCovr answers the most common PMI questions for 2025 Navigating the world of private medical insurance (PMI) in the UK can feel complex. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we believe in making things simple. This guide answers your most pressing questions about private health cover for 2025, giving you the clarity to make confident decisions about your health.
Key takeaways
- Emergencies: For any life-threatening situation like a heart attack, stroke, or serious accident, you should always call 999 and use the NHS A&E services. PMI does not cover emergency treatment.
- Chronic Conditions: Standard PMI is designed for conditions that can be cured. It does not cover the long-term management of incurable, chronic illnesses like diabetes, asthma, or hypertension.
- Pre-existing Conditions: It generally will not cover any illness or injury you had symptoms of, or received treatment for, before your policy began.
- You feel unwell: You develop a new symptom, for example, persistent knee pain after an injury.
- Visit your NHS GP: Your first port of call is always your GP. They will assess your condition. If they feel you need to see a specialist, they will provide you with a referral letter. For PMI, it's best to ask for an 'open referral', which doesn't name a specific consultant.
WeCovr answers the most common PMI questions for 2025
Navigating the world of private medical insurance (PMI) in the UK can feel complex. At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we believe in making things simple. This guide answers your most pressing questions about private health cover for 2025, giving you the clarity to make confident decisions about your health.
What Exactly is Private Medical Insurance?
Think of Private Medical Insurance (PMI) as a health plan that runs alongside the NHS. You pay a monthly or annual premium to an insurance company. In return, if you develop a new, treatable medical condition, the policy covers the costs of diagnosis and treatment in a private hospital or facility.
The primary purpose of PMI in the UK is to help you bypass potential NHS waiting lists and gain faster access to specialist care for acute conditions.
Crucially, it's vital to understand what PMI is not for:
- Emergencies: For any life-threatening situation like a heart attack, stroke, or serious accident, you should always call 999 and use the NHS A&E services. PMI does not cover emergency treatment.
- Chronic Conditions: Standard PMI is designed for conditions that can be cured. It does not cover the long-term management of incurable, chronic illnesses like diabetes, asthma, or hypertension.
- Pre-existing Conditions: It generally will not cover any illness or injury you had symptoms of, or received treatment for, before your policy began.
The goal of PMI is to get you diagnosed, treated, and back to your normal life as quickly as possible for new, eligible health concerns.
How Does the PMI Process Work in Practice?
If you've never used private health cover before, the journey can seem unfamiliar. In reality, it's a straightforward process that works in partnership with your GP.
Here is a typical step-by-step example:
- You feel unwell: You develop a new symptom, for example, persistent knee pain after an injury.
- Visit your NHS GP: Your first port of call is always your GP. They will assess your condition. If they feel you need to see a specialist, they will provide you with a referral letter. For PMI, it's best to ask for an 'open referral', which doesn't name a specific consultant.
- Contact your insurer: You call your PMI provider's claims line with your referral details. You'll need your policy number and information about your symptoms.
- Get authorisation: The insurer checks that your condition is covered under your policy and authorises the claim. They will provide you with a pre-authorisation number.
- Choose your specialist: Your insurer will give you a list of approved specialists and private hospitals in your area. You have the freedom to choose who you see and where you are treated from this list.
- Receive treatment: You attend your private consultation, diagnostics (like an MRI scan), and any subsequent treatment, such as surgery.
- Bills are settled: The hospital and specialists send their invoices directly to your insurance provider. You don't have to handle any payments, apart from any excess you may have on your policy.
This seamless process means you can focus on your recovery without the stress of long waits or unexpected medical bills.
What Does Private Health Insurance Cover (and Not Cover)?
Understanding the scope of your cover is essential. While policies vary, most UK PMI plans are built around a core level of cover, with the option to add extra benefits.
Here’s a breakdown of what you can typically expect:
| Usually Covered (Core) | Optional Add-Ons | Almost Always Excluded |
|---|---|---|
| In-patient & Day-patient Treatment: Costs for surgery, hospital accommodation (often a private room), nursing care, and specialist fees when you're admitted to a hospital bed. | Out-patient Cover: Consultations and diagnostic tests that don't require a hospital bed. This is a very popular add-on. | Pre-existing Conditions: Any medical condition you had before taking out the policy. |
| Cancer Care: Comprehensive cover for chemotherapy, radiotherapy, and surgery is often a core feature, sometimes with access to experimental drugs not yet available on the NHS. | Mental Health Support: Cover for psychiatric treatment, therapy, or counselling sessions. | Chronic Conditions: Long-term illnesses like diabetes, arthritis, and high blood pressure that require ongoing management rather than a cure. |
| Diagnostic Scans: MRI, CT, and PET scans as part of in-patient or day-patient care. | Therapies: Physiotherapy, osteopathy, and chiropractic treatment. | A&E / Emergency Services: These are handled by the NHS. |
| Post-treatment Care: A set number of follow-up consultations or physiotherapy sessions after surgery. | Dental & Optical: Cover for routine check-ups, dental treatment, and the cost of glasses or contact lenses. | Uncomplicated Pregnancy & Childbirth: Routine maternity care is not covered. |
| Virtual GP Services: 24/7 access to a GP by phone or video call is now a common feature. | Travel Cover: Some policies allow you to add an international health insurance element. | Elective Cosmetic Surgery: Procedures chosen for aesthetic reasons. |
At WeCovr, our expert advisors can help you tailor a policy, ensuring you only pay for the benefits that matter to you.
The Critical Point: Acute vs. Chronic Conditions
This is the most common point of confusion, and it’s the bedrock of how PMI works in the UK. Insurers make a clear distinction between acute and chronic conditions.
- An Acute Condition is a disease, illness, or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in before it started.
- Examples: Cataracts, appendicitis, a hernia, a broken bone, a joint replacement.
- A Chronic Condition is a disease, illness, or injury that has one or more of the following characteristics: it needs long-term monitoring, it has no known cure, it is likely to recur, or it requires ongoing management.
- Examples: Asthma, diabetes, eczema, high blood pressure, arthritis.
Private medical insurance is designed to cover the diagnosis and treatment of new acute conditions that arise after you join. It is not designed for the ongoing management of chronic conditions, which remains the responsibility of the NHS.
How Your Medical History Affects Your Cover: Understanding Underwriting
When you apply for PMI, the insurer needs to know how to handle any medical conditions you've had in the past. This is done through a process called underwriting. There are two main types:
1. Moratorium Underwriting (Mori)
This is the most popular and straightforward option. You don't have to complete a detailed medical questionnaire when you apply. Instead, the policy automatically excludes treatment for any medical condition for which you have had symptoms, medication, or advice in the 5 years before your policy started.
However, if you then go for a continuous 2-year period after your policy starts without needing any treatment, tests, or advice for that condition, it may become eligible for cover in the future.
- Pros: Quick and easy application process.
- Cons: Less certainty. You only find out if a condition is covered when you make a claim.
2. Full Medical Underwriting (FMU)
With FMU, you provide your complete medical history by filling out a detailed questionnaire. The insurer's underwriting team reviews this information and may place specific, named exclusions on your policy for any pre-existing conditions.
- Pros: Complete clarity from day one. You know exactly what is and isn't covered.
- Cons: The application process is longer and more intrusive.
The right choice depends on your personal circumstances. A specialist PMI broker can advise you on which underwriting method is most suitable for you.
| Feature | Moratorium Underwriting (Mori) | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple, no medical forms. | Slower, requires a detailed medical questionnaire. |
| Clarity on Cover | Determined at the point of claim. | Clear from the start with named exclusions. |
| Pre-existing Conditions | Automatically excluded for a set period. May become eligible for cover after 2 years on the policy without symptoms or treatment. | Assessed individually and often permanently excluded. |
| Best For... | Those with no recent medical issues who want a fast start. | Those who want absolute certainty about their cover, even with a past medical history. |
How Much Does Private Health Insurance Cost in 2025?
The cost of private medical insurance UK varies widely based on several key factors. There's no one-size-fits-all price, but understanding these drivers will help you see how your premium is calculated.
- Age: This is the most significant factor. Premiums increase as you get older because the statistical likelihood of needing treatment rises.
- Location: Treatment costs vary across the UK, with central London being the most expensive. Some insurers use postcode-based pricing.
- Level of Cover: A basic policy covering only in-patient treatment will be cheaper than a comprehensive plan with out-patient, mental health, and dental cover.
- Excess (illustrative): This is the amount you agree to pay towards a claim. A higher excess (e.g., £500) will lower your monthly premium, whereas a £0 excess will increase it.
- Hospital List: Insurers have different tiers of hospital lists. A policy that gives you access to every private hospital in the UK will cost more than one with a more restricted local network.
- No Claims Discount: Similar to car insurance, many insurers reward you with a discount for every year you don't make a claim.
Illustrative Monthly Premiums (2025)
The table below provides an estimated monthly cost for a mid-range policy with £250 excess. These are for illustrative purposes only.
| Age | Non-Smoker, UK-wide (excl. Central London) |
|---|---|
| 30 | £45 – £65 |
| 40 | £60 – £85 |
| 50 | £80 – £120 |
| 60 | £120 – £180 |
The best way to get an accurate figure is to get a personalised quote. As an independent broker, WeCovr compares the market for you, finding the best PMI provider to match your budget and health needs at no extra cost.
Is Private Health Insurance Worth It? A Balanced Look
Deciding whether to invest in PMI is a personal choice that depends on your priorities, budget, and attitude to risk.
The NHS provides excellent care, particularly for emergencies and complex conditions. However, it is currently facing significant pressure. According to NHS England data, the waiting list for routine consultant-led treatment stood at over 7.5 million treatment pathways in mid-2024. For many, this is the driving force behind considering private options.
Arguments for PMI:
- Peace of Mind: Knowing you can access treatment quickly when you need it most.
- Speed: Drastically reduce the wait time for specialist consultations, diagnostic scans, and surgery.
- Choice: Select your preferred consultant and hospital from an approved list.
- Comfort: Recover in a private, en-suite room with more flexible visiting hours.
- Access: Gain eligibility for some newer drugs or treatments not yet universally available on the NHS.
Arguments Against PMI:
- Cost: The ongoing expense of monthly premiums can be significant.
- Exclusions: It doesn't cover everything, most notably chronic and pre-existing conditions.
- Duplication: You continue to fund the NHS through your National Insurance contributions regardless.
- Emergencies: It cannot replace NHS A&E services.
For many, the value lies in having a choice. It's a safety net that provides a fast-track option for treatable conditions, allowing you to get back to work, family, and life sooner.
The WeCovr Advantage: Holistic Health and Extra Value
We believe that supporting your health goes beyond just insurance policies. That's why we offer our PMI and Life Insurance clients exclusive benefits designed to promote a healthy lifestyle.
- Complimentary Access to CalorieHero: All our clients get free access to our AI-powered calorie and nutrition tracking app, CalorieHero. Taking control of your diet is a powerful step towards better long-term health, and we provide the tools to help you do it.
- Discounts on Other Cover: When you take out a PMI policy with us, you become eligible for discounts on other essential protection, such as life insurance or income protection, helping you build a comprehensive financial safety net for less.
- Expert, Impartial Advice: With high customer satisfaction ratings, our team is dedicated to providing clear, unbiased guidance. We're not tied to any single insurer; our only goal is to find the best private health cover for you.
We also believe in the power of prevention. Maintaining a healthy lifestyle through a balanced diet, regular physical activity, and adequate sleep can have a profound impact on your wellbeing and reduce your future need for medical treatment.
Do I need to declare my full medical history when applying for PMI?
Can I get private health insurance for a pre-existing condition?
Does PMI cover mental health?
What should I do in a medical emergency?
Ready to Find the Right Cover?
Choosing the right private medical insurance can feel like a big decision, but you don't have to do it alone. The friendly, expert team at WeCovr is here to cut through the jargon, compare leading UK providers, and build a quote that's perfectly tailored to your needs and budget.
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.
