TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr understand the nuances of the private medical insurance market in the UK. This guide explores the complex question of whether private health cover can help with Polycystic Ovary Syndrome (PCOS), a condition affecting millions. Does PMI cover treatment for polycystic ovary syndrome?
Key takeaways
- PCOS is a chronic condition. UK health insurance is designed to cover acute conditions—illnesses or injuries that are short-term and can be resolved with treatment. Chronic conditions, which are long-lasting and require continuous management rather than a cure, are almost always excluded.
- PCOS is often a pre-existing condition. If you have been diagnosed with PCOS or have experienced symptoms before taking out a policy, it will be considered a pre-existing condition. Insurers will exclude cover for it and any related issues.
- Irregular or absent periods: This indicates your ovaries are not regularly releasing eggs (ovulation).
- Excess androgens: High levels of "male" hormones can lead to physical signs such as excess facial or body hair (hirsutism), oily skin, and acne.
- Polycystic ovaries: Your ovaries may become enlarged and contain numerous fluid-filled sacs (follicles) that surround the eggs. Despite the name, these are not true cysts.
As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr understand the nuances of the private medical insurance market in the UK. This guide explores the complex question of whether private health cover can help with Polycystic Ovary Syndrome (PCOS), a condition affecting millions.
Does PMI cover treatment for polycystic ovary syndrome?
The straightforward answer is that standard private medical insurance (PMI) in the UK does not typically cover the ongoing management of polycystic ovary syndrome (PCOS). This is for two primary reasons:
- PCOS is a chronic condition. UK health insurance is designed to cover acute conditions—illnesses or injuries that are short-term and can be resolved with treatment. Chronic conditions, which are long-lasting and require continuous management rather than a cure, are almost always excluded.
- PCOS is often a pre-existing condition. If you have been diagnosed with PCOS or have experienced symptoms before taking out a policy, it will be considered a pre-existing condition. Insurers will exclude cover for it and any related issues.
While this may seem disheartening, it's crucial to understand how PMI works to see where it can still provide immense value. For some individuals, PMI can play a vital role in the initial diagnostic stages of PCOS, offering a much faster route to getting answers.
This article will delve into the specifics, explaining the difference between chronic and acute care, how underwriting affects your cover, and what alternative support is available.
Understanding PCOS: A Quick Guide for UK Women
Polycystic Ovary Syndrome is a common endocrine (hormonal) disorder that affects how a woman's ovaries work. According to the NHS, it's thought to affect around 1 in 10 women in the UK, though many remain undiagnosed.
The exact cause is unknown, but it's related to abnormal hormone levels, including high levels of insulin and "male" hormones called androgens.
Key Signs and Symptoms of PCOS
PCOS presents differently in everyone, but the three main features are:
- Irregular or absent periods: This indicates your ovaries are not regularly releasing eggs (ovulation).
- Excess androgens: High levels of "male" hormones can lead to physical signs such as excess facial or body hair (hirsutism), oily skin, and acne.
- Polycystic ovaries: Your ovaries may become enlarged and contain numerous fluid-filled sacs (follicles) that surround the eggs. Despite the name, these are not true cysts.
To be diagnosed with PCOS, you typically need to have at least two of these three features.
Long-Term Health Implications
PCOS is more than just a reproductive issue; it's a metabolic condition that can increase the risk of other long-term health problems, including:
- Type 2 diabetes
- High cholesterol and high blood pressure
- Fertility problems
- Sleep apnoea
- Depression and anxiety
- A slightly increased risk of developing cancer of the womb lining (endometrial cancer) later in life.
Because of these associated risks, getting a timely diagnosis and managing the condition effectively is paramount for long-term health and wellbeing.
The Crucial Distinction: Chronic vs. Acute Conditions in UK Health Insurance
To understand why PCOS isn't covered for ongoing management, you must grasp the fundamental principle of UK private medical insurance: it's for acute conditions.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and return you to your previous state of health. Think of a cataract operation, a joint replacement, or treatment for an infection. The goal is to cure or resolve the issue.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics:
- It needs ongoing or long-term monitoring.
- It has no known cure.
- It's likely to come back or has already come back.
- It requires palliative care or management.
PCOS falls squarely into the chronic category. It requires lifelong management of symptoms and associated health risks.
| Feature | Acute Condition | Chronic Condition (like PCOS) |
|---|---|---|
| Duration | Short-term | Long-term or lifelong |
| Treatment Goal | To cure or fully resolve | To manage symptoms and prevent complications |
| PMI Coverage | Generally Covered | Generally Excluded |
| Examples | Broken arm, appendicitis, hernia repair | PCOS, diabetes, asthma, high blood pressure |
Insurers focus on acute conditions to keep private health cover affordable and sustainable. Covering the lifelong management costs of chronic conditions for every policyholder would make premiums prohibitively expensive for most people. The NHS is structured and funded to provide this excellent, long-term chronic care.
How Underwriting Affects PCOS Coverage
When you apply for private medical insurance, the insurer assesses your health and medical history in a process called underwriting. This determines what will and won't be covered. For someone with PCOS, the type of underwriting is critical.
There are two main types in the UK:
1. Full Medical Underwriting (FMU)
With FMU, you complete a detailed health questionnaire, declaring all your past and present medical conditions, including PCOS. The insurer reviews your history, and an underwriter will decide on the terms of your policy.
- Outcome for PCOS: The insurer will place a specific exclusion on your policy for PCOS and any conditions directly related to it. This is clear and transparent from day one. You know exactly where you stand.
2. Moratorium Underwriting
This is a simpler, faster way to get cover. You don't have to declare your medical history upfront. Instead, the policy automatically excludes cover for any condition for which you have had symptoms, medication, or advice in the five years before your policy start date.
-
The 'Two-Year Rule': A condition excluded under a moratorium can become eligible for cover, but only if you go for a continuous two-year period after your policy starts without experiencing any symptoms, needing treatment, medication, or medical advice for that condition.
-
Outcome for PCOS: Because PCOS is a chronic condition that often requires ongoing monitoring (even just a GP check-up), medication (like Metformin or the contraceptive pill), or produces persistent symptoms, it is extremely unlikely that you would ever satisfy the two-year symptom-free period. Any interaction with a healthcare professional regarding PCOS would reset the two-year clock. Therefore, PCOS will effectively remain permanently excluded.
Comparing Underwriting for Someone with PCOS
| Underwriting Type | How It Works | Impact on PCOS Coverage |
|---|---|---|
| Full Medical (FMU) | You declare PCOS on your application. | PCOS and related conditions are explicitly excluded from the start. It's clear and certain. |
| Moratorium | No initial health declaration. Auto-excludes conditions from the last 5 years. | PCOS is excluded. It is highly improbable it will ever become eligible for cover due to its chronic nature. |
An expert PMI broker like WeCovr can help you decide which underwriting method is best for your situation and ensure you understand the implications for your cover.
Are There Any Scenarios Where PMI Might Help with PCOS?
While ongoing management is excluded, private health cover can still be incredibly valuable in specific situations related to PCOS, primarily in getting a fast diagnosis.
The Golden Window: Initial Diagnosis
Imagine you're in your 20s, you have a new private health insurance policy, and you start experiencing symptoms like irregular periods and acne for the very first time. At this point, you don't have a diagnosis.
This is where PMI can be a game-changer.
Your journey could look like this:
- Digital GP Appointment: Most PMI policies include a 24/7 digital GP service. You can get an appointment within hours, discuss your symptoms, and get an open referral for a specialist.
- Fast-Track to a Specialist: Instead of waiting weeks or months for an NHS referral, your PMI policy can get you an appointment with a private gynaecologist or endocrinologist, often within a few days.
- Swift Diagnostics: The specialist may recommend tests to confirm a diagnosis. Your PMI policy would typically cover:
- Consultation fees.
- Blood tests to check hormone levels (testosterone, LH, FSH).
- A pelvic ultrasound scan to check for polycystic ovaries.
PMI covers these diagnostic steps because, at this stage, the condition is still an unknown, acute problem to be investigated. You could go from first symptoms to a confirmed diagnosis in a matter of weeks, rather than many months.
What happens after diagnosis? Once PCOS is confirmed, it becomes a diagnosed chronic condition. At this point, your private cover for it would cease, and the long-term management would transition back to the NHS or be self-funded. However, you've used your PMI for its greatest strength: speed.
Acute Complications
In some rare and specific cases, an acute condition that is a complication of PCOS might be covered. For example, if you developed a large ovarian cyst that ruptured and required emergency surgery, this is an acute surgical event. An insurer might cover the surgery, even though the underlying cause is PCOS.
Important Note: This is a grey area and highly dependent on your insurer and the specific wording of your policy. Coverage is never guaranteed in these situations, and the insurer might argue it's directly related to the excluded chronic condition.
Fertility Investigations
Most standard private health insurance UK policies explicitly exclude all forms of fertility treatment, including IVF. PCOS is a leading cause of infertility, so this is a significant exclusion.
However, some more comprehensive or high-end policies may offer limited benefits for investigating the cause of infertility. This could include some of the same diagnostic tests used for PCOS. Again, this is not standard, and you would need to check the policy details carefully. Cover for the actual treatment is almost unheard of on individual policies.
NHS vs. Private Care for PCOS: What's the Difference?
Both the NHS and the private sector have their strengths when it comes to managing PCOS.
The NHS Pathway
The NHS provides excellent, comprehensive, and evidence-based care for chronic conditions like PCOS. The typical pathway is:
- Visit your GP with your symptoms.
- Your GP may do initial blood tests.
- Referral to a specialist (gynaecologist or endocrinologist).
- Further tests and diagnosis.
- Development of a long-term management plan, which could involve lifestyle advice, medication (e.g., Metformin, Clomifene for fertility), and regular check-ups.
The main challenge with the NHS is waiting times. According to NHS England data, the median wait time for a first appointment in gynaecology can be several months. This waiting period can be a source of significant stress and anxiety.
The Private Pathway (via PMI for Diagnosis)
As discussed, PMI can bridge the waiting time gap for diagnosis.
| Feature | NHS Pathway | Private Pathway (via PMI) |
|---|---|---|
| Initial Appointment | GP appointment, then wait for specialist referral. | Digital GP (hours), specialist appointment (days/weeks). |
| Diagnostic Tests | Waiting lists for scans and follow-ups. | Scans and tests often done within a week. |
| Cost | Free at the point of use. | Covered by your PMI policy (subject to excess). |
| Long-Term Care | Provides full, ongoing management. | Does not cover ongoing management. |
| Best For... | Comprehensive, lifelong chronic disease management. | Rapid initial diagnosis and peace of mind. |
For many, the ideal approach is a hybrid one: using PMI to get a fast diagnosis and then using the excellent, free services of the NHS for the long-term management plan.
Maximising Your Health: Wellness and Lifestyle Management for PCOS
Since ongoing medical treatment for PCOS isn't covered by PMI, focusing on lifestyle and wellness is one of the most powerful things you can do. Many symptoms of PCOS can be significantly improved through diet, exercise, and stress management.
1. Nutrition and Diet
A key driver of PCOS symptoms is often insulin resistance. This is when your body's cells don't respond properly to insulin, leading your pancreas to produce more of it, which in turn can cause the ovaries to produce excess testosterone.
- Focus on Low-Glycaemic Index (GI) Foods: Choose whole grains, legumes, vegetables, and fruits over refined carbohydrates like white bread, sugary snacks, and white pasta. This helps to manage blood sugar and insulin levels.
- Balance Your Plate: Ensure each meal contains a good source of lean protein (chicken, fish, tofu), healthy fats (avocado, nuts, olive oil), and fibre-rich carbohydrates.
- Anti-Inflammatory Foods: Incorporate foods like fatty fish (salmon, mackerel), turmeric, ginger, and leafy greens to help combat the low-grade inflammation often associated with PCOS.
To help with this, WeCovr provides all its life and health insurance clients with complimentary access to CalorieHero, an AI-powered calorie and nutrition tracking app. This tool can be incredibly useful for planning meals and monitoring your intake to support your PCOS management goals.
2. Regular Physical Activity
Exercise is a cornerstone of PCOS management. It improves your body's sensitivity to insulin, can help with weight management, and boosts your mood.
- Cardiovascular Exercise: Aim for at least 150 minutes of moderate-intensity activity (like brisk walking, cycling, or swimming) per week.
- Resistance Training: Building muscle through weightlifting or bodyweight exercises is particularly effective at improving insulin sensitivity.
- Mind-Body Exercise: Activities like yoga and Pilates can help reduce stress levels, which is also beneficial for hormonal balance.
3. Sleep and Stress Management
Poor sleep and chronic stress can wreck your hormones, particularly cortisol. High cortisol levels can worsen insulin resistance and inflammation.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Create a relaxing bedtime routine and ensure your bedroom is dark, quiet, and cool.
- Practice Mindfulness: Techniques like meditation, deep breathing exercises, or simply spending time in nature can significantly lower stress levels. Many of the best PMI providers now include access to mindfulness apps like Headspace as part of their wellness benefits.
Choosing the Right Private Health Insurance Policy in the UK
Even though your policy won't cover PCOS management, it's still an incredibly valuable safety net for a vast range of other health issues, from cancer care and heart conditions to joint replacements and mental health support.
When choosing a policy, consider these key factors:
- Outpatient Cover: This covers specialist consultations and diagnostic tests. If you want cover for the initial diagnosis of new conditions, a good level of outpatient cover is essential.
- Hospital List: This dictates which private hospitals you can use. A national list gives you more choice than a local one.
- Excess (illustrative): This is the amount you pay towards a claim. A higher excess (£500 or £1,000) can significantly reduce your monthly premium.
- Added Benefits: Look for policies that include valuable extras like a 24/7 digital GP, mental health support lines, and wellness rewards or discounts.
Illustrative Monthly Premiums
Premiums vary widely based on age, location, cover level, and lifestyle. The table below gives a rough indication for a non-smoker.
| Age | Basic Cover (High Excess) | Comprehensive Cover (Low Excess) |
|---|---|---|
| 30 | £35 - £50 | £70 - £95 |
| 40 | £45 - £65 | £90 - £120 |
| 50 | £60 - £90 | £130 - £180 |
Disclaimer: These are illustrative estimates only. Your actual quote will depend on your individual circumstances.
Furthermore, if you purchase a private medical or life insurance policy through WeCovr, you may be eligible for discounts on other types of cover, such as home or travel insurance, providing even greater value.
The Role of a Specialist PMI Broker Like WeCovr
Navigating the private medical insurance market can be complex, especially with a pre-existing condition like PCOS. This is where an independent, FCA-authorised broker is invaluable.
Here’s how WeCovr can help:
- Expert Advice: We understand the market inside-out, including how each insurer treats chronic conditions. We can explain the fine print in plain English.
- Whole-of-Market Comparison: We compare policies from all the UK's leading insurers, including AXA Health, Bupa, Aviva, and Vitality, to find the one that best suits your needs and budget.
- Application Support: We guide you through the application process, ensuring you declare your medical history accurately under FMU to prevent any problems at the point of a claim.
- No Cost to You: Our service is completely free. We receive a commission from the insurer you choose, but this doesn't affect the premium you pay.
- High-Quality Service: We pride ourselves on our high customer satisfaction ratings, offering unbiased and expert guidance to thousands of clients across the UK.
Frequently Asked Questions (FAQs)
Do I need to declare PCOS when applying for private health insurance?
Can private health insurance help me get pregnant if I have PCOS?
If PCOS is excluded, is private medical insurance still worth it?
What is the difference between moratorium and full medical underwriting for someone with PCOS?
Take the Next Step
While private health insurance may not offer a direct solution for the long-term management of PCOS, it provides an invaluable safety net for other health concerns and can be instrumental in securing a rapid diagnosis for new conditions.
Understanding your options is the first step. At WeCovr, our expert advisors are here to provide clear, personalised advice tailored to your unique circumstances.
Contact WeCovr today for a free, no-obligation quote and let us help you find the right private health cover for your peace of mind.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.









