TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr know that understanding private medical insurance (PMI) in the UK can feel like learning a new language. Policy documents are filled with specific terms that can be confusing. This guide is here to change that.
Key takeaways
- Example: A knee injury from playing football, gallstones requiring surgery, or a throat infection that needs specialist investigation are all acute conditions. The goal of the treatment is to return you to your previous state of health.
- It needs ongoing or long-term monitoring.
- It requires management through check-ups, medication, or tests.
- It has no known "cure."
- It is likely to come back.
As an FCA-authorised broker that has helped arrange over 900,000 policies, we at WeCovr know that understanding private medical insurance (PMI) in the UK can feel like learning a new language. Policy documents are filled with specific terms that can be confusing. This guide is here to change that.
We've created the definitive glossary for 2026 to demystify the jargon, helping you compare quotes and choose your private health cover with total confidence.
WeCovr explains key PMI terms to help you understand policy wording with ease
Navigating the world of private health insurance is much simpler once you grasp the key concepts. Think of this glossary as your personal translator. We'll break down everything from the fundamental principles of cover to the specifics of making a claim, using simple language and real-world examples.
The Foundations: Core Private Health Insurance Concepts
These are the building blocks of every PMI policy. Understanding them is the first step to becoming an informed buyer.
Acute Condition
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Private medical insurance in the UK is specifically designed to cover acute conditions that arise after you take out your policy.
- Example: A knee injury from playing football, gallstones requiring surgery, or a throat infection that needs specialist investigation are all acute conditions. The goal of the treatment is to return you to your previous state of health.
Chronic Condition
A chronic condition is a disease, illness, or injury that has one or more of the following characteristics:
- It needs ongoing or long-term monitoring.
- It requires management through check-ups, medication, or tests.
- It has no known "cure."
- It is likely to come back.
Crucially, standard UK private health insurance does not cover the management of chronic conditions. This is the single most important exclusion to understand.
- Examples: Diabetes, asthma, high blood pressure, arthritis, and eczema are all chronic conditions. While PMI might cover the initial diagnosis of a chronic condition (an 'acute flare-up'), the long-term management will be passed back to the NHS.
Pre-existing Condition
This refers to any illness, disease, or injury for which you have experienced symptoms, received medication, or sought advice from a medical professional before the start date of your policy. This applies whether you received a formal diagnosis or not.
- Example: If you had physiotherapy for back pain in the year before you bought a policy, that back pain would be considered a pre-existing condition and would be excluded from cover, at least initially.
Private Medical Insurance (PMI)
Also known as 'private health insurance' or 'private health cover', PMI is an insurance policy that pays for the costs of private medical treatment for eligible acute conditions. Its primary purpose is to help you bypass NHS waiting lists and give you more choice over your care, such as choosing your specialist and hospital.
According to data from late 2025, NHS waiting lists in England continue to present a significant challenge, with millions of treatment pathways awaiting commencement. This pressure on the public system is a key reason why over 11% of the UK population opts for private medical insurance.
Policyholder
The person who owns the insurance policy and is responsible for paying the premiums. This may also be your employer if you are covered under a company scheme.
Dependant
A person added to the main policyholder's plan, typically a spouse, partner, or children. Each dependant will be covered under the same policy terms, but adding them will increase the premium.
Premium
The regular amount of money you pay to the insurer to keep your policy active. You can usually choose to pay this monthly or annually. Paying annually often comes with a small discount.
Underwriting Explained: How Insurers Assess Your Health
Underwriting is the process an insurer uses to assess your risk and decide on the terms of your policy, including what will be excluded. There are two main types for new policies.
Moratorium Underwriting (Mori)
This is the most common and simplest type of underwriting. You don't need to provide a detailed medical history upfront. Instead, the insurer applies a blanket exclusion for any pre-existing conditions you've had in the last 5 years.
Here’s the key part: if you then go for a set period (usually 2 years) after your policy starts without having any symptoms, treatment, or advice for that condition, the insurer may automatically start covering it.
- Best for: People who are generally healthy, have had no recent medical issues, and want a quick and easy application process.
Full Medical Underwriting (FMU)
With FMU, you complete a detailed health questionnaire as part of your application. You must disclose your full medical history. The insurer's underwriting team will then review this information and may decide to apply specific, permanent exclusions to your policy from day one.
- Best for: People who want certainty about what is and isn't covered from the outset, or those who have pre-existing conditions from more than 5 years ago that might be covered under FMU but excluded under a moratorium.
Comparing Underwriting Options
| Feature | Moratorium (Mori) Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple, no medical forms. | Longer, requires a full health questionnaire. |
| Pre-existing Conditions | Automatically excluded for a set period (usually 5 years). | Declared upfront and assessed individually. |
| Clarity on Cover | Can be uncertainty at the point of claim. | You know exactly what is excluded from day one. |
| Cover for Old Conditions | May become eligible for cover after 2 claim-free years. | Exclusions are often permanent. |
| Claims Process | Can be slower as the insurer may need to investigate your medical history. | Often faster as exclusions are already defined. |
An expert PMI broker like WeCovr can talk you through these options and advise which is most suitable for your personal circumstances, ensuring there are no surprises down the line.
Continued Personal Medical Exclusions (CPME)
If you already have a PMI policy and want to switch to a new insurer, CPME underwriting allows you to carry over your existing medical exclusions. This is beneficial because it means you won't have to start a new moratorium period, and conditions that were already covered by your old policy will continue to be covered by the new one.
Decoding Your Policy Cover: What's Included?
A PMI policy is built from core cover and optional extras. Understanding the difference is key to tailoring a policy that fits your needs and budget.
In-patient and Day-patient Treatment
This is the core of almost every private medical insurance policy in the UK.
- In-patient: Treatment that requires admission to a hospital for at least one night. This includes the cost of the bed, nursing care, surgery, and consultant fees.
- Day-patient: Treatment that requires a hospital bed for the day but does not require an overnight stay (e.g., a minor surgical procedure like an endoscopy).
All PMI policies cover in-patient and day-patient treatment as standard.
Out-patient Treatment
This covers medical care that does not require a hospital bed. This is one of the most important optional extras to consider.
- What it includes: Specialist consultations, diagnostic tests (like blood tests and X-rays), and scans.
- Why it's important: Without out-patient cover, you would need to use the NHS to get a diagnosis before your PMI could step in for in-patient treatment. With it, the entire patient journey can be private, from initial consultation to recovery.
Most insurers offer different levels of out-patient cover, from a set monetary value (e.g., £500, £1,000) to fully comprehensive cover.
Cancer Cover
This is a vital component of modern PMI. While all policies include a level of cancer cover, the comprehensiveness can vary significantly. Key things to look for include:
- Chemotherapy and Radiotherapy: Covered as standard.
- Surgery and Consultations: Included.
- Advanced/Experimental Drugs: Access to drugs that may not yet be available on the NHS.
- Monitoring and Check-ups: Cover for follow-up care after initial treatment.
Given the sensitivity of this cover, it's crucial to compare what different providers offer.
Mental Health Cover
Increasingly recognised as essential, mental health cover provides funding for the treatment of acute mental health conditions.
- Typical Cover: Access to psychiatrists, psychologists, and therapists. It usually covers in-patient or day-patient treatment for a limited period.
- Limitations: Chronic mental health conditions are not covered, and there is often an annual limit on the financial benefit or number of therapy sessions.
Therapies Cover
Often an optional add-on, this covers treatments designed to aid recovery from an acute condition. It typically includes:
- Physiotherapy
- Osteopathy
- Chiropractic treatment
There is usually an annual limit on the number of sessions you can claim for.
Understanding Policy Limits, Exclusions, and Costs
These terms define the financial boundaries of your policy and what it will not pay for.
Excess
The excess is a fixed amount you agree to pay towards a claim. For example, if you have a £250 excess and make a claim for a £3,000 procedure, you would pay the first £250, and the insurer would pay the remaining £2,750.
- How it works: You can choose your excess level (e.g., £0, £100, £250, £500). A higher excess will result in a lower monthly premium.
- Per claim vs. Per year: Some policies apply the excess per claim, while others apply it just once per policy year, regardless of how many claims you make.
Annual Benefit Limit
This is the maximum total amount your insurer will pay out for all your claims in a single policy year. Many comprehensive policies now offer an 'unlimited' benefit limit, but cheaper policies may cap this at a certain level (e.g., £20,000).
Standard Exclusions
Every policy has a list of standard exclusions—treatments and conditions that are never covered. It's vital to read these.
| Commonly Excluded Treatments & Conditions |
|---|
| Pre-existing and Chronic Conditions |
| Normal Pregnancy and Childbirth |
| Cosmetic Surgery (unless for reconstruction after an accident/cancer) |
| Fertility Treatment (IVF) |
| Organ Transplants |
| Emergency/A&E services (these are handled by the NHS) |
| Drug and Alcohol Abuse Treatment |
| Self-inflicted injuries |
Hospital List (or Hospital Network)
Insurers have agreements with networks of private hospitals. The list of hospitals you can use is determined by your policy choice. This has a major impact on your premium.
- Local/Trust Network: A smaller list of hospitals, often excluding central London, leading to the lowest premiums.
- National Network: A comprehensive list of hospitals across the UK, offering wide choice.
- Premium Network: Includes all national hospitals plus the most expensive private facilities in central London.
No-Claims Discount (NCD)
Similar to car insurance, most PMI providers operate a No-Claims Discount scheme. For every year you don't make a claim, you get a discount on your premium at renewal, up to a maximum level (e.g., 70%). If you do make a claim, your NCD level will likely be reduced, increasing your future premiums.
6-Week Option
This is a popular cost-saving feature. If you add the 6-week option to your policy, you agree to use the NHS for in-patient treatment if the NHS waiting list for that procedure is less than six weeks. If the wait is longer than six weeks, your private cover kicks in. This can significantly reduce your premium because you are sharing some of the risk with the NHS.
Navigating the Claims and Treatment Process
Knowing the steps to take when you need to use your insurance is essential.
- GP Referral: For most conditions, the journey starts with your NHS or private GP. If they feel you need to see a specialist, they will write you a referral letter.
- Open Referral: Your GP refers you for a type of specialism (e.g., 'a cardiologist') without naming a specific doctor. This gives your insurer the flexibility to recommend a fee-assured specialist from their network, which is often the quickest route.
- Pre-authorisation: Before you have any consultation or treatment, you must call your insurer to get the claim authorised. You will provide them with your referral details, and they will confirm that the condition and treatment are covered by your policy. They will issue you with a pre-authorisation number. Failure to get pre-authorisation can result in your claim being denied.
- See a Consultant / Specialist: Once authorised, you can book an appointment with the specialist.
- Fee-Assured Specialist: This is a consultant who agrees to charge within the fee guidelines set by your insurer. By using a fee-assured specialist, you ensure there will be no shortfall in payment. Your insurer will provide a list of them.
- Shortfall: This is a gap between what your specialist charges and what your insurer is willing to pay. It can occur if you choose a consultant who is not fee-assured by your provider. You would be responsible for paying this difference yourself.
Beyond the Basics: Added Value and Wellness Benefits
The best PMI providers now offer more than just medical cover. These benefits are designed to support your day-to-day health and wellbeing.
- Digital GP / Virtual GP: 24/7 access to a GP via phone or video call. This is incredibly convenient for getting quick advice, prescriptions, or referrals without waiting for a face-to-face appointment.
- Wellness Programmes: Many insurers incentivise healthy living. This can include discounted gym memberships, free coffees, cinema tickets, or money off fitness trackers for reaching activity goals.
- Mental Health Support Lines: Confidential helplines offering support for stress, anxiety, and other concerns, often available to you even if you don't have full mental health cover.
Here at WeCovr, we enhance this value further. All our health and life insurance clients receive complimentary access to our AI-powered nutrition app, CalorieHero, to help them stay on top of their health goals. We also offer discounts on other types of cover, like life insurance or income protection, when you purchase a PMI policy through us.
How a PMI Broker Like WeCovr Can Help
With so many providers, policy options, and terms to consider, choosing the right private medical insurance in the UK can be overwhelming. This is where an independent broker is invaluable.
As a leading FCA-authorised PMI broker, WeCovr works for you, not the insurers. Our service is provided at no cost to you.
- We Compare the Market: We compare policies from all the major UK insurers to find the best fit for you.
- We Offer Expert Advice: Our trained advisors explain all the jargon and help you tailor a policy to your specific needs and budget.
- We Simplify the Process: From application to claim, we are here to help, ensuring you get the most value from your cover. Our clients consistently give us high satisfaction ratings for our clear, friendly, and professional service.
Does private health insurance cover pre-existing conditions?
Is it worth getting private medical insurance in the UK?
How much does private health insurance cost?
- Age: Premiums increase as you get older.
- Location: Living in areas with higher hospital costs, like London, increases the price.
- Level of Cover: A comprehensive policy with full out-patient and therapy cover will cost more than a basic in-patient only plan.
- Excess: Choosing a higher excess will lower your premium.
- Hospital List: A more extensive hospital list costs more.
What is the difference between moratorium and full medical underwriting?
Ready to make sense of it all and find the right protection for you and your family?
