Private Health Insurance for Insurance Brokers in the UK
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr understands the UK insurance landscape. This expert guide on private medical insurance is designed for fellow brokers, providing the insights you need to advise clients confidently in a growing market where expert guidance is paramount.
WeCovr's guide to PMI for fellow insurance professionals
Welcome. As insurance professionals, we share a common goal: to provide our clients with the best possible protection and peace of mind. You might be a specialist in home, motor, or commercial liability, but your clients see you as their trusted insurance advisor for all their needs. Increasingly, one of those needs is private medical insurance (PMI).
The UK's health landscape is changing. With growing pressure on the NHS, more individuals and businesses are exploring private healthcare options than ever before. This presents a significant opportunity for you to deepen client relationships, add value, and expand your business.
This guide is written by brokers, for brokers. We'll cut through the jargon and provide a clear, comprehensive overview of the UK PMI market, empowering you to have informed conversations with your clients and help them navigate their options effectively.
Why Insurance Brokers Need a Solid Grasp of the UK PMI Market
Ignoring private health cover is no longer an option for the modern, client-focused broker. The demand is real, and the reasons are compelling.
According to the latest data from NHS England, the elective care waiting list remains a significant concern. In mid-2024, the list stood at over 7.5 million treatment pathways. For many people, the prospect of waiting months or even longer for diagnosis and treatment is a powerful motivator to seek private alternatives.
The Opportunity for You:
- Holistic Advice: Offering PMI demonstrates that you care about your client's overall wellbeing, not just their property or business. It positions you as a comprehensive risk advisor.
- Client Retention: When a client asks about health insurance, being able to provide immediate, knowledgeable guidance (or refer them to a specialist partner like WeCovr) strengthens their loyalty. Sending them elsewhere could mean losing them altogether.
- New Revenue Streams: PMI can be a lucrative addition to your portfolio, both through individual policies and, crucially, through group schemes for your commercial clients.
- Cross-Selling: A conversation about health naturally leads to discussions about other protection products, such as income protection and life insurance. At WeCovr, we often find that clients who purchase PMI are also interested in these related products, and we are happy to offer discounts on bundled policies.
For your clients, private medical insurance isn't a luxury; it's a practical tool for managing their health and getting back on their feet quickly. For you, it's a vital component of a modern insurance brokerage.
Understanding the Core Principles of Private Medical Insurance
Before advising clients, it's essential to grasp the fundamental principle of PMI in the UK. This is the single most important concept to communicate clearly to avoid future disappointment.
CRITICAL POINT: PMI is for Acute, Not Chronic or Pre-existing, Conditions.
Standard UK private medical insurance is designed to cover the diagnosis and treatment of 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. Examples include joint replacements, cataract surgery, hernia repairs, and treatment for many types of cancer.
- A chronic condition is an illness that cannot be cured, only managed. This includes conditions like diabetes, asthma, high blood pressure, and arthritis. PMI does not cover the routine management of chronic conditions.
- A pre-existing condition is any illness or injury for which you have experienced symptoms, received medication, or sought advice before the start of your policy. These are typically excluded from cover, at least initially.
How Underwriting Affects Cover for Pre-Existing Conditions
When a client applies for PMI, the insurer needs to understand their medical history to determine what they will and will not cover. There are two main ways they do this:
| Underwriting Type | How It Works | Best For |
|---|---|---|
| Moratorium (Mori) | This is the most common type. The client doesn't need to declare their full medical history upfront. Instead, the insurer automatically excludes any condition that existed in the 5 years prior to the policy start date. An exclusion can be lifted if the client serves a continuous 2-year period after their policy starts without having any symptoms, treatment, medication or advice for that condition. | Clients who want a quicker, less intrusive application process and haven't had significant medical issues in the past 5 years. |
| Full Medical Underwriting (FMU) | The client completes a detailed health questionnaire, declaring their medical history. The insurer then reviews this and states precisely what will be excluded from cover from day one. These exclusions are typically permanent. | Clients who want absolute clarity on what is and isn't covered from the outset, or those with a complex medical history. |
A third type, Continued Personal Medical Exclusions (CPME), is used when a client switches from one PMI provider to another, allowing them to carry over their existing underwriting terms.
Key Features and Jargon Demystified for Brokers
A PMI policy is built from a core foundation with optional layers. Understanding these building blocks is key to tailoring a policy to a client's specific needs and budget.
Core Cover: The Foundation
Nearly all UK PMI policies include the following as standard:
- In-patient Treatment: Covers costs when admitted to a hospital bed overnight, including surgery, accommodation, and specialist fees.
- Day-patient Treatment: Covers procedures where a hospital bed is required for the day but not overnight (e.g., an endoscopy).
- Cancer Cover: This is a major pillar of PMI. Most policies offer comprehensive cover for the diagnosis and treatment of cancer, including surgery, chemotherapy, and radiotherapy. The level of cover can vary, so it's a key area to compare.
Optional Extras: Tailoring the Policy
Clients can add extras to enhance their cover, though each will increase the premium.
- Out-patient Cover: This is the most common and valuable add-on. It covers diagnostic tests and consultations with a specialist that do not require a hospital bed. Without this, a client may still face a long NHS wait for an initial diagnosis, even if the subsequent treatment would be private. Cover is often limited to a set monetary amount per year (e.g., £500, £1,000, or unlimited).
- Therapies: Covers treatments like physiotherapy, osteopathy, and chiropractic care.
- Mental Health Cover: Provides access to psychiatrists, psychologists, and therapists. This is an increasingly sought-after benefit.
- Dental and Optical Cover: Helps with routine check-ups, treatments, and the cost of glasses or contact lenses.
Policy Levers: Managing the Premium
These are adjustments a client can make to control the cost of their policy.
| Policy Lever | How It Works | Impact on Premium |
|---|---|---|
| Excess | The amount the client agrees to pay towards the first claim they make in a policy year (e.g., £0, £100, £250, £500). | Higher excess = Lower premium. |
| Hospital List | Insurers group hospitals into tiers. A comprehensive list includes prime central London hospitals and is the most expensive. A reduced list, excluding these, will lower the cost. | More restricted list = Lower premium. |
| 6-Week Option | If the NHS can provide the required in-patient treatment within 6 weeks of it being recommended, the client agrees to use the NHS. If the wait is longer, the PMI policy kicks in. | Adding this option = Significant premium reduction. |
| Guided Options | Some insurers (like Aviva's 'Expert Select' or AXA's 'Guided' option) offer a lower premium in return for the client agreeing to use a specialist from a pre-approved list provided by the insurer. | Agreeing to a guided list = Lower premium. |
A specialist broker like WeCovr can model these different options in real-time, instantly showing clients how changing their excess or hospital list affects their monthly premium across multiple providers.
Navigating the UK's Leading PMI Providers
The UK PMI market is dominated by a handful of excellent providers, each with its own strengths and focus. As a broker, knowing their general market position is helpful.
| Provider | General Focus & Key Strengths |
|---|---|
| Bupa | One of the most recognised health brands in the UK. Known for its extensive network of hospitals and facilities and a strong focus on comprehensive cancer care. Often seen as a benchmark for quality. |
| AXA Health | A global insurance giant with a strong UK presence. Offers a wide range of flexible policies and is known for its excellent digital tools and member support, including a 24/7 virtual GP service. |
| Aviva | The UK's largest general insurer. Provides robust, straightforward PMI policies with clear terms. Their 'Expert Select' guided option is a popular way to manage costs. |
| Vitality | Unique in the market for its focus on wellness and prevention. The Vitality Programme rewards members with discounts and perks (e.g., cheap gym memberships, free coffee) for staying active and healthy. Appeals to younger, health-conscious clients. |
| The Exeter | A friendly society known for its flexible underwriting, particularly for clients with some pre-existing medical conditions. They have a strong reputation for excellent claims service and a human touch. |
This is not an exhaustive list, and other excellent providers operate in the market. The key takeaway is that "the best PMI provider" depends entirely on the client's individual circumstances, budget, and priorities. This is why impartial, whole-of-market advice is so critical.
How to Advise Clients: A Broker's Step-by-Step Guide
Approaching the PMI conversation can feel daunting, but following a structured process makes it simple and effective.
Step 1: The Fact-Find Start with open questions to understand their motivations and needs:
- "What has prompted you to think about private health insurance now?"
- "What is your main priority? Is it fast diagnosis, choice of hospital, or something else?"
- "Who needs to be covered on the policy – just you, or your partner and children too?"
- "What is a comfortable monthly budget for you to consider?"
- "Have you had any major health issues in the last five years?"
Step 2: Explain the Fundamentals Before you talk about products, set expectations. Clearly and simply explain the difference between acute and chronic conditions. Use an analogy: "Think of it like this: health insurance is like a fire extinguisher for your house. It's there for sudden, unexpected emergencies (an acute condition), not for general day-to-day maintenance (a chronic condition)."
Step 3: Match Needs to Features Based on their answers in Step 1, start building a picture of their ideal policy.
- Client says "I just want to be able to see a specialist quickly." -> Prioritise a good out-patient limit.
- Client says "My budget is tight." -> Discuss a higher excess and the 6-week option.
- Client says "I live in London and want the best hospitals." -> Ensure the quote includes a comprehensive central London hospital list.
Step 4: Compare the Market This is where you provide immense value. Instead of just showing them one option, explain that you can compare the market to find the best value. This is the perfect point to introduce a specialist partner. You could say: "To make sure you get the best possible cover for your budget, I work with a specialist team at WeCovr. They can compare policies from all the leading UK insurers for you, at no extra cost, and handle all the paperwork."
Step 5: Explain Underwriting Briefly explain the difference between Moratorium and Full Medical Underwriting. For most clients, Moratorium is simpler. However, if they have a history of minor issues and want certainty, FMU might be better.
The Business Case: Offering PMI for Small and Medium Enterprises (SMEs)
While individual PMI is a growing market, group PMI for businesses is where many brokers can find significant, untapped opportunities. Many of your existing commercial clients are prime candidates.
Benefits for the Business:
- Reduced Absenteeism: Getting an employee diagnosed and treated quickly means they are back at work faster, minimising disruption and lost productivity.
- Talent Attraction & Retention: In a competitive job market, a company health insurance scheme is a highly valued employee benefit that can set a business apart.
- Improved Morale: It shows a company cares for the health and wellbeing of its staff, fostering a positive and loyal company culture.
Key Differences for Group Schemes:
- Medical History Disregarded (MHD): For larger groups (typically 20+ employees, but sometimes fewer), insurers may offer MHD underwriting. This is the gold standard – it covers all eligible conditions, including pre-existing ones.
- Cost-Effective: The cost per employee on a group scheme is often significantly lower than for an individual policy.
- Administration: Setting up and managing a group scheme is a specialist task, making the expertise of a broker invaluable.
Start the conversation with your business clients. Ask them: "How much does it cost your business when a key member of staff is off sick for a month or more?" This simple question opens the door to a meaningful discussion about business PMI.
Beyond Insurance: The Rise of Wellness and Added-Value Benefits
Modern private health cover is evolving. It's no longer just a reactive product that you use when you're ill. The best PMI providers now include a wealth of proactive services designed to keep members healthy.
When discussing options with clients, highlight these valuable extras:
- Digital GP Services: Most insurers now offer 24/7 access to a virtual GP via phone or video call. This is incredibly convenient for getting quick advice, prescriptions, or referrals without waiting for a local GP appointment.
- Mental Health Support Lines: Many policies include access to confidential helplines and triage services for mental health concerns, offering immediate support when it's needed most.
- Wellness Programmes: Vitality leads the pack here, but other providers like Aviva and Bupa also offer apps and resources with health advice, gym discounts, and other perks to encourage a healthy lifestyle.
- Proactive Health Tips: Encourage clients to think about their all-round health. Small, consistent changes can make a huge difference.
- Diet: A balanced diet rich in fruits, vegetables, and whole grains can reduce the risk of many conditions.
- Activity: Aim for 150 minutes of moderate-intensity activity per week, like brisk walking or cycling.
- Sleep: Prioritise 7-9 hours of quality sleep per night to support mental and physical recovery.
At WeCovr, we champion this proactive approach. That's why every client who takes out a PMI or Life Insurance policy with us receives complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping them build healthy habits for life.
Common Pitfalls for Brokers to Avoid When Selling PMI
- Over-promising on Pre-existing Conditions: Never give a client the impression that a new PMI policy will cover their existing ailments. Be crystal clear about the acute vs. chronic and new vs. pre-existing rules.
- Not Explaining the Excess: Ensure the client understands their excess is payable per person, per policy year on their first claim. A £500 excess on a family policy can be a surprise if not explained properly.
- Ignoring Hospital Lists: A client living in Manchester doesn't need to pay for a policy that includes expensive central London hospitals. Tailor the list to their location and needs.
- Failing to Review: A client's needs and the market can change. Encourage an annual review to ensure their policy still represents the best value for them. Switching providers is often possible and can save them hundreds of pounds.
By being aware of these common mistakes, you can provide advice that is not only helpful but also compliant and transparent, protecting both your client and your professional reputation.
Why Partner with a Specialist PMI Broker like WeCovr?
As a general insurance broker, you are an expert in your field. By partnering with WeCovr, you gain an expert PMI team without any of the overheads. We are here to support you and your clients.
- Expertise on Tap: We live and breathe private medical insurance. We know the providers, the products, and the underwriting nuances inside out.
- Whole-of-Market Comparison: We use sophisticated technology to compare quotes from all the UK's leading insurers in minutes, ensuring your client always gets the best value.
- No Cost to the Client: Our service is completely free for the client. We are paid a commission by the insurer that the client chooses, which is already built into the premium. There is no price difference between coming to us and going direct.
- Seamless Service: We handle everything, from the initial advice and market comparison to the application and paperwork, making the process effortless for you and your client.
- High Customer Satisfaction: Our focus on clear, jargon-free advice and exceptional service has earned us high ratings on independent review sites. We treat your clients with the same care and professionalism that you do.
Do I pay more for using a specialist PMI broker like WeCovr?
How does moratorium underwriting work if I need to make a claim?
What is the '6-week option' and is it a good way to save money?
Is mental health treatment usually covered by private health insurance?
Ready to offer your clients market-leading private health insurance advice?
Empower your clients with choice and security. For a free, no-obligation quote that compares the UK's leading insurers, contact the friendly, expert team at WeCovr today. We're here to help you and your clients navigate the world of PMI with confidence.
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.
Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!