TL;DR
As one of the UK's most experienced private medical insurance brokers, WeCovr has helped thousands of businesses navigate the complexities of employee health benefits. This guide explains everything UK employers and employees need to know about private health insurance, a cornerstone of a modern and competitive benefits package. How private medical insurance for employees works, including costs, benefits and tax implications Private medical insurance for employees, often called Group PMI or a company health insurance scheme, is a policy purchased by an employer to give their staff access to private healthcare.
Key takeaways
- Lower Premiums: The cost per person is typically lower than it would be for an equivalent individual policy.
- Simpler Set-up: For the employee, there's often less paperwork and no complex medical questionnaires, especially on larger schemes.
- Better Underwriting Terms: Many group schemes offer more generous cover, sometimes even including pre-existing conditions, which is extremely rare on individual plans.
- Fast-Tracked Medical Care: The primary benefit is bypassing potentially long NHS waiting lists for consultations, diagnostic scans (MRI, CT), and non-emergency surgery. According to recent NHS statistics, waiting lists remain a significant challenge, and PMI offers a direct route to faster treatment.
- Choice and Control: Employees gain more control over their healthcare. They can often choose their specialist or surgeon and select a hospital from the insurer's approved network, which may be closer to home or work.
As one of the UK's most experienced private medical insurance brokers, WeCovr has helped thousands of businesses navigate the complexities of employee health benefits. This guide explains everything UK employers and employees need to know about private health insurance, a cornerstone of a modern and competitive benefits package.
How private medical insurance for employees works, including costs, benefits and tax implications
Private medical insurance for employees, often called Group PMI or a company health insurance scheme, is a policy purchased by an employer to give their staff access to private healthcare. Instead of relying solely on the NHS, employees can receive eligible medical treatment more quickly, at a time and place that suits them.
Think of it as a subscription to private healthcare for your team. The company pays a monthly or annual premium to an insurer. In return, when a covered employee needs eligible medical care for an acute condition (a new illness or injury that can be cured), the policy covers the costs, subject to its terms.
This arrangement provides significant advantages for both the business and its people, from reducing sickness absence to making your company a more attractive place to work.
What is Employer Private Health Insurance (Group PMI)?
Employer Private Health Insurance is a single policy that covers a group of people—namely, the employees of a company. It functions under a master contract between the employer and the insurance provider (like Bupa, Aviva, or AXA Health).
This group approach is fundamentally different from an individual policy you might buy for yourself. Because the insurer is spreading its risk across multiple people, group schemes often come with distinct advantages:
- Lower Premiums: The cost per person is typically lower than it would be for an equivalent individual policy.
- Simpler Set-up: For the employee, there's often less paperwork and no complex medical questionnaires, especially on larger schemes.
- Better Underwriting Terms: Many group schemes offer more generous cover, sometimes even including pre-existing conditions, which is extremely rare on individual plans.
Schemes can be tailored to a company's budget and can cover as few as two employees, making them accessible even for small businesses and start-ups.
Key Benefits of Employer PMI: For Employees and Employers
Offering private health insurance is a strategic investment in your most valuable asset: your people. The return on this investment is felt by everyone.
Benefits for Employees
For staff, company-provided PMI is one of the most highly valued workplace perks.
- Fast-Tracked Medical Care: The primary benefit is bypassing potentially long NHS waiting lists for consultations, diagnostic scans (MRI, CT), and non-emergency surgery. According to recent NHS statistics, waiting lists remain a significant challenge, and PMI offers a direct route to faster treatment.
- Choice and Control: Employees gain more control over their healthcare. They can often choose their specialist or surgeon and select a hospital from the insurer's approved network, which may be closer to home or work.
- Access to Advanced Treatments: Private health insurance can provide access to certain cancer drugs, therapies, and treatments that may not be routinely available on the NHS due to funding or other guidelines.
- Comfort and Privacy: Treatment is typically provided in a private hospital with an en-suite room, offering a more comfortable and restful environment for recovery.
- Valuable Added Extras: Modern PMI policies are more than just hospital cover. They almost always include:
- 24/7 Virtual GP: Access to a GP via phone or video call, often with same-day appointments.
- Mental Health Support: Pathways to counselling, therapy, and psychiatric support are now a standard and vital component.
- Wellness Programmes: Many insurers, like Vitality, offer rewards for healthy living. As a WeCovr client, you also get complimentary access to our AI-powered calorie and nutrition tracker, CalorieHero, to support your wellbeing goals.
Benefits for Employers
For a business, the benefits are tangible and directly impact the bottom line.
- Attract & Retain Talent: In a competitive job market, a strong benefits package is crucial. Health insurance is consistently ranked as one of the most desired employee benefits, helping you stand out as an employer of choice.
- Reduce Sickness Absence: By giving employees faster access to diagnosis and treatment, you can significantly reduce the length of time they are off work sick. This boosts productivity and minimises disruption.
- Boost Morale and Loyalty: Providing health cover sends a powerful message that you care about your team's wellbeing. This fosters a positive company culture and increases employee loyalty.
- A Tax-Efficient Benefit: The premiums your company pays are generally considered an allowable business expense, which can be offset against your Corporation Tax liability.
How Much Does Group Health Insurance Cost?
The cost of a group health insurance policy is not one-size-fits-all. It is calculated based on a specific set of risk factors related to your company and the level of cover you choose.
Key factors that determine the premium include:
- Average Age of Employees: Older workforces generally have higher premiums as the risk of claims increases with age.
- Number of Employees: Larger groups can often secure a lower per-head cost.
- Location: Premiums are typically higher in Central London and the South East due to the higher cost of private medical treatment there.
- Industry: The type of work your employees do can influence risk and cost.
- Level of Cover: You can choose from basic, mid-range, or comprehensive plans. Adding options like out-patient cover, dental, and optical will increase the price.
- Policy Excess: This is the amount an employee pays towards their claim. A higher excess (e.g., £250) will lower the overall premium.
- Underwriting Type: The method used to assess pre-existing conditions has a major impact on cost.
Here is an illustrative table showing potential monthly costs per employee for a typical UK SME based outside London.
| Level of Cover | Average Monthly Cost Per Employee | Typical Inclusions |
|---|---|---|
| Basic | £30 - £50 | In-patient and day-patient treatment, comprehensive cancer cover, virtual GP. |
| Mid-Range | £55 - £80 | All of the above, plus limits on out-patient diagnostics and consultations. |
| Comprehensive | £85 - £130+ | All of the above, plus full out-patient cover, therapies, and often mental health. |
Note: These are illustrative figures as of early 2026. For an accurate quote tailored to your business, it's essential to speak with an expert broker like WeCovr.
Understanding Underwriting Options for Group PMI
"Underwriting" is the process an insurer uses to decide whether to offer cover and on what terms, particularly concerning pre-existing medical conditions. For group schemes, there are several options.
1. Moratorium (MORI) Underwriting
This is the most common type for small groups (2-19 employees).
- How it works: No medical declaration is needed upfront. The policy automatically excludes treatment for any pre-existing conditions an employee has had in the five years before joining.
- The 2-year rule: This exclusion can be lifted. If the employee goes for two continuous years on the policy without experiencing symptoms, needing treatment, or seeking advice for that condition, it may become eligible for cover.
- Pros: Quick and easy to set up.
- Cons: Lack of certainty. A claim might be rejected if the insurer finds it relates to a recent pre-existing condition.
2. Full Medical Underwriting (FMU)
- How it works: Each employee completes a full health questionnaire. The insurer reviews their medical history and lists specific conditions that will be permanently excluded from cover.
- Pros: Provides complete clarity from day one. Everyone knows exactly what is and isn't covered.
- Cons: More administration-heavy to set up.
3. Medical History Disregarded (MHD)
This is the gold standard of group underwriting, typically available to companies with 20+ employees.
- How it works: The insurer agrees to disregard most pre-existing conditions. This means employees can claim for eligible acute conditions, even if they had them before joining the policy.
- Critical Point: MHD is one of the single biggest advantages of a group scheme over an individual one. It offers cover that is simply unavailable to most individual buyers.
- Pros: The most comprehensive and inclusive cover. Hugely valuable for employees with a medical history.
- Cons: It is the most expensive underwriting option.
Working with an experienced broker like WeCovr is vital to select the right underwriting for your company's size, budget, and objectives. We can negotiate MHD terms for smaller groups than might otherwise be possible.
What Does Employer Health Insurance Typically Cover (and Not Cover)?
Clarity on coverage is essential. While policies vary, there is a standard framework. Private health insurance in the UK is designed to cover acute conditions that arise after you join a policy.
A Critical Distinction: Acute vs. Chronic
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples: joint replacement, cataract surgery, hernia repair. PMI covers these.
- Chronic Condition: An illness that cannot be cured but can be managed. Examples: diabetes, asthma, high blood pressure, arthritis. Standard UK PMI does not cover the long-term management of chronic conditions.
| What's Generally Covered | What's Generally Excluded |
|---|---|
| ✅ Hospital stays (in-patient/day-patient) | ❌ Management of chronic conditions |
| ✅ Specialist consultations & diagnostic tests | ❌ Pre-existing conditions (unless on MHD) |
| ✅ Surgical procedures | ❌ A&E and other emergency services |
| ✅ Comprehensive cancer care (a core benefit) | ❌ Normal pregnancy and childbirth |
| ✅ Mental health support (therapy, counselling) | ❌ Cosmetic surgery (unless for reconstruction) |
| ✅ Physiotherapy and other therapies | ❌ Self-inflicted injuries or substance abuse |
| ✅ 24/7 Virtual GP access | ❌ Experimental or unproven treatments |
Tax Implications of Private Health Insurance for Employees
The tax treatment of company health insurance is a common point of confusion. It's straightforward once broken down for the employer and the employee.
For the Employer
When a company pays for its employees' health insurance, the premiums are generally considered an allowable business expense. This means the cost can be deducted from your revenue when calculating your profit, thereby reducing your overall Corporation Tax bill.
However, the employer must also pay Class 1A National Insurance Contributions (NICs) on the value of the benefit provided to each employee.
For the Employee
For the employee, company-paid health insurance is a 'Benefit in Kind' (BIK). This is a non-cash benefit that has a monetary value.
- How it's taxed: The value of the annual premium is added to the employee's gross salary for tax purposes. The employee then pays income tax on this value at their marginal rate (e.g., 20% for basic rate taxpayers, 40% for higher rate).
- The P11D Form: The employer is responsible for reporting this benefit to HMRC for each employee using a P11D form at the end of the tax year.
Example of Benefit in Kind Tax:
- An employee is a basic rate (20%) taxpayer.
- Their employer pays an annual health insurance premium of £900 for them.
- This £900 is the BIK value.
- The employee's extra income tax liability for the year is: £900 x 20% = £180 (or £15 per month).
For a small monthly cost, the employee gains access to a benefit worth many times more, demonstrating its excellent value.
How to Set Up a Group PMI Scheme for Your Business
Setting up a group scheme is a simple, methodical process, especially when guided by an expert.
- Define Your Goals & Budget: Are you aiming to reduce absence, improve recruitment, or both? Determine a realistic monthly budget per employee.
- Gather Employee Data: For initial quotes, you only need anonymised data: a list of employees with their dates of birth and postcodes. No names are required at this stage.
- Speak to an Independent Broker: This is the most important step. A specialist broker like WeCovr works for you, not the insurer. We use our market knowledge to find the best policy for your specific needs and budget, at no extra cost to you. We are authorised and regulated by the Financial Conduct Authority (FCA).
- Compare Tailored Quotes: We will provide a clear comparison of quotes from the UK's leading insurers, explaining the differences in cover, hospital networks, and underwriting.
- Select Your Policy: Based on our advice and your preferences, you choose the plan that offers the best value for your business.
- Implement & Communicate: We handle the set-up with the insurer. Your final task is to communicate the new benefit to your team, explaining how it works and how they can make a claim.
Choosing the Best PMI Provider for Your Company
The "best" provider depends entirely on your priorities. Each of the major UK insurers has its own strengths.
| Provider | Known For & Key Strengths |
|---|---|
| Bupa | Extensive hospital network, trusted brand, and strong direct settlement arrangements. |
| AXA Health | Excellent mental health support, Doctor at Hand virtual GP, and a focus on clinical pathways. |
| Aviva | A major player with strong digital tools, a large hospital list, and well-regarded cancer cover. |
| Vitality | A unique wellness-focused model that rewards employees for healthy living with discounts and perks. |
| The Exeter | A friendly society known for its flexible underwriting and excellent service, particularly for smaller businesses. |
| WPA | A not-for-profit insurer with a reputation for customer service and flexible "shared responsibility" schemes. |
An independent broker is essential because they are not tied to any single provider. At WeCovr, we provide a whole-of-market analysis to ensure you get the right fit. Furthermore, clients who take out PMI or Life Insurance with us can often benefit from discounts on other insurance policies, providing even greater value.
Do employees have to pay tax on company health insurance?
Does employer health insurance cover pre-existing conditions?
Can a small business get group health insurance?
How do employees make a claim on a company policy?
Ready to Invest in Your Team's Health?
Providing private medical insurance is one of the most effective decisions a business can make to protect its people and its productivity. It’s a tax-efficient, high-value benefit that makes a real difference.
The market is complex, but the process doesn't have to be. The experts at WeCovr are here to provide clear, impartial advice. We'll compare the market for you and find a solution that fits your company and your budget perfectly.
Contact us today for a free, no-obligation quote and discover the best health insurance options for your business.
