
TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands that navigating the world of private medical insurance in the UK can feel complex. Policy documents are often filled with jargon that can be confusing. That’s why we’ve created this definitive A-Z glossary.
Key takeaways
- Dental and optical cover
- Mental health cover
- Extended therapies cover (physiotherapy, osteopathy, etc.)
- Travel cover
- In-patient treatment: When you need to be admitted to a hospital bed overnight.
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr understands that navigating the world of private medical insurance in the UK can feel complex. Policy documents are often filled with jargon that can be confusing. That’s why we’ve created this definitive A-Z glossary.
WeCovr explains key PMI terms to help you understand policy wording with ease
This guide is designed to empower you. By understanding the language of private health insurance, you can make more informed decisions about your cover, compare quotes effectively, and feel confident you have the right policy for your needs.
Let's demystify the jargon together.
A is for...
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. Think of conditions like a broken bone, appendicitis, a cataract, or a hernia.
Why this matters: Private Medical Insurance (PMI) is specifically designed to cover the diagnosis and treatment of acute conditions that arise after your policy has started. It is not designed for long-term, incurable conditions (see Chronic Condition).
Add-ons (or Optional Extras)
These are additional benefits you can choose to add to a core health insurance policy for an increased premium. Common add-ons include:
- Dental and optical cover
- Mental health cover
- Extended therapies cover (physiotherapy, osteopathy, etc.)
- Travel cover
What this means for you: Add-ons allow you to tailor your policy to your specific needs. If you wear glasses and want help with dental check-ups, adding this benefit could be cost-effective. A PMI broker like WeCovr can help you weigh up the cost of add-ons against their potential benefits.
Annual Limit
This is the maximum amount your insurer will pay out for eligible claims in a single policy year. This limit can apply to the policy as a whole (e.g., an overall limit of £1 million) or to specific benefits (e.g., £1,000 for out-patient consultations). Most policies have very high or unlimited overall annual limits.
Appointed Representative
An Appointed Representative (AR) is a firm or person who acts as an agent for a company directly authorised by the Financial Conduct Authority (FCA). The authorised firm takes responsibility for the AR's compliance with FCA rules. WeCovr is a trading name of an FCA-authorised firm, ensuring we operate to the highest regulatory standards.
B is for...
Benefit
A benefit is a specific treatment, service, or cost that your private health insurance policy will pay for. Examples include consultations with a specialist, surgical procedures, hospital accommodation, and diagnostic tests.
Benefit Limit
This is the cap on how much your policy will pay for a specific benefit. For example, your policy might have a benefit limit of £1,500 per year for out-patient therapies. Once you've claimed up to this amount, you'll need to pay for any further therapy yourself for the rest of that policy year.
Broker (or Intermediary)
A broker is an independent expert who can help you compare policies from different insurance providers. A good broker understands the entire market and can offer impartial advice to find the best PMI provider and policy for your budget and needs.
How WeCovr helps: As a specialist PMI broker, we do the hard work for you. We compare leading UK insurers to find cover that fits you perfectly, at no extra cost to you. Our expert advice is completely free.
Bupa, Aviva, AXA Health, Vitality
These are some of the largest and most well-known private health insurance providers in the UK. Each offers a range of different policies with varying levels of cover, hospital lists, and unique benefits.
C is for...
Cancer Cover
This is one of the most valued components of a PMI policy. Cancer cover provides funding for the diagnosis and treatment of cancer, including chemotherapy, radiotherapy, surgery, and specialist consultations. The level of cover can vary significantly, from providing diagnostics only to comprehensive cover that includes the latest licensed drugs and treatments, some of which may not yet be available on the NHS.
A crucial detail: Always check the specifics of the cancer cover. Does it include palliative care? Are there limits on certain drugs? This is a key area where comparing policies is vital.
Chronic Condition
A chronic condition is an illness or disease that is long-lasting or recurrent and cannot be fully cured. It can be managed with treatment and medication, but it is not expected to go away. Examples include diabetes, asthma, arthritis, and high blood pressure.
CRITICAL POINT: Standard private medical insurance in the UK does not cover the management of chronic conditions. PMI is for acute conditions. If an acute flare-up of a chronic condition occurs, some policies may cover the treatment to return you to your previous state, but not the ongoing management.
Claim
The process of asking your insurer to pay for treatment covered by your policy. This usually involves getting a GP referral, contacting your insurer for pre-authorisation, and then receiving the treatment. The hospital or specialist typically bills the insurer directly.
Cooling-off Period
This is a legally mandated period, typically 14 days from when you receive your policy documents, during which you can cancel your policy and receive a full refund, provided you haven't made a claim.
Core Cover
This is the foundational level of cover provided by a PMI policy. It almost always includes:
- In-patient treatment: When you need to be admitted to a hospital bed overnight.
- Day-patient treatment: When you are admitted for a procedure but do not stay overnight.
- Comprehensive cancer cover.
You can then build on this core cover with optional add-ons.
D is for...
Day-patient
A patient who is admitted to a hospital or clinic for a planned medical procedure or test and is discharged on the same day. This includes minor surgeries, endoscopies, and some chemotherapy sessions.
Domiciliary Care
Medical care or support provided in your own home by healthcare professionals, such as a private nurse, following a hospital stay. Some comprehensive policies offer a limited benefit for this.
E is for...
Excess (or Deductible)
The amount of money you agree to pay towards a claim before the insurance company starts to pay. For example, if you have a £250 excess and receive treatment costing £2,000, you pay the first £250, and your insurer pays the remaining £1,750.
How it affects your premium: Choosing a higher excess will lower your monthly or annual premium. You can often choose an excess from £0 up to £1,000 or more. This is one of the most effective ways to make your private health cover more affordable.
Exclusions
These are specific conditions, treatments, or circumstances that your policy will not pay for. Every policy has them, and it's vital to read them carefully.
Common exclusions include:
- Pre-existing conditions (see below)
- Chronic conditions (see above)
- Emergency services (A&E visits)
- Cosmetic surgery (unless medically necessary)
- Normal pregnancy and childbirth
- Organ transplants
- Self-inflicted injuries
Expert Second Opinion
A service offered by some insurers where, if you are diagnosed with a serious condition, they can arrange for a world-leading expert to review your medical records and diagnosis to provide a second opinion on the best course of treatment. This can provide immense peace of mind during a stressful time.
F is for...
Fair and Reasonable Charges
Insurers often state that they will only cover costs that are 'fair and reasonable' or 'customary and reasonable'. This means they will pay the standard market rate for a particular treatment or consultation in a specific location. If a hospital or specialist charges significantly more than this, there might be a shortfall that you have to pay. This is rare with recognised providers but is an important safeguard for insurers.
FCA (Financial Conduct Authority)
The FCA is the UK's financial services regulator. Its role is to protect consumers, ensure the industry remains stable, and promote healthy competition. Any firm that sells, advises on, or arranges insurance in the UK must be authorised and regulated by the FCA. WeCovr and its partners are fully FCA-authorised, meaning we adhere to strict rules of conduct.
Full Medical Underwriting (FMU)
This is one of the two main ways an insurer assesses your medical history when you first take out a policy (the other is Moratorium Underwriting). With FMU, you are required to complete a detailed health questionnaire, providing full disclosure of your medical history and any previous conditions.
Key Features of Full Medical Underwriting:
- Clarity from Day One: You know exactly what is and isn't covered from the start.
- Potentially Better for Some Conditions: An insurer might agree to cover a past condition if it happened many years ago and is unlikely to recur.
- Time-Consuming: Requires you to gather medical information and fill out detailed forms.
Here is a simple comparison table:
| Feature | Full Medical Underwriting (FMU) | Moratorium Underwriting |
|---|---|---|
| Initial Process | Detailed health questionnaire | No initial medical questions |
| Clarity | High. You know what's excluded from the start. | Lower. Exclusions are based on recent history. |
| Speed | Slower application process. | Faster and simpler application. |
| Best For | People who want absolute certainty on cover. | People in good health with no recent issues. |
| Claim Process | Simpler, as underwriting is done upfront. | Can be slower, as insurer investigates medical history at the point of claim. |
G is for...
GP (General Practitioner)
Your family doctor, and the gatekeeper to most specialist care in the UK. For most PMI claims, you will need a referral from your GP (either NHS or private) before you can see a specialist.
Guided Option (or Open Referral)
This is a feature offered by some insurers that can reduce your premium. Instead of choosing any specialist you like from their approved list, the insurer provides a shortlist of 3-5 specialists for you to choose from when you need treatment. Because the insurer can direct you to consultants they have preferential fee arrangements with, they pass the savings on to you.
A tip for saving money: If you don't have a specific specialist in mind and are happy to be guided, choosing a 'guided option' can be a great way to lower your costs without compromising on the quality of care.
H is for...
Hospital List
An insurer's approved list of private hospitals, clinics, and medical facilities where you can receive treatment under your policy. These lists are usually tiered:
- Basic List: A limited number of hospitals, often excluding major city centres like London. This results in a lower premium.
- Standard List: A comprehensive list covering most of the UK.
- Premium/London List: Includes top-tier hospitals in Central London, which are typically more expensive. This option comes with the highest premium.
Choosing the right hospital list is crucial. If you live in rural Scotland, there's no point paying extra for a premium London list.
Health Screening
Preventative tests to check for early signs of disease before you have any symptoms. Some comprehensive PMI policies include a benefit for health screening, such as checks for cholesterol, blood pressure, or cancer risk. This aligns with the modern focus on proactive wellness rather than just reactive treatment.
Wellness Tip: Regular health screenings, a balanced diet, and consistent exercise are the cornerstones of long-term health. As a WeCovr client, you get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to help you stay on track with your wellness goals.
I is for...
In-patient
A person who is admitted to a hospital and stays overnight or longer for treatment. All core PMI policies cover in-patient care as standard.
Insurance Premium Tax (IPT)
A tax levied by the UK government on general insurance premiums, including private medical insurance. The current standard rate is 12% (as of early 2025). This is automatically included in the price of your premium.
M is for...
Medical History
Your personal record of past and present health conditions, treatments, and consultations. This is a key factor that insurers consider when you apply for a policy, particularly with Full Medical Underwriting.
Moratorium Underwriting
This is the most common type of underwriting for new PMI policies in the UK. It's simpler and quicker than Full Medical Underwriting because you don't have to declare your full medical history upfront.
Instead, the insurer applies a general exclusion for any pre-existing conditions you've had symptoms, advice, or treatment for in a set period before the policy starts (usually the last 5 years).
How it works: These conditions may become eligible for cover later on, but only if you serve a continuous period (usually 2 years) after your policy starts without experiencing any symptoms, or seeking advice or treatment for that condition.
What this means for you: It's a "deal now, ask questions later" approach. It's fast to set up, but there's less certainty at the start. When you make a claim, the insurer will investigate your medical history to see if it was a pre-existing condition.
Mental Health Cover
Cover for the diagnosis and treatment of mental health conditions like anxiety, depression, and stress. This is typically offered as an add-on to a core policy. Cover can range from a limited number of therapy sessions (e.g., CBT) to more comprehensive support, including psychiatric consultations and in-patient care.
With NHS waiting lists for mental health services growing, this is becoming an increasingly popular and valuable add-on. According to NHS Digital data, over 1.8 million people were in contact with mental health services at the end of 2023, with many more on waiting lists.
N is for...
No Claims Discount (NCD)
Similar to car insurance, a No Claims Discount rewards you for not making a claim on your policy. For every year you don't claim, you receive a discount on your renewal premium, up to a maximum level (e.g., 60-75%). If you do make a claim, your NCD will typically be reduced.
NHS Cash Benefit (or NHS Hospital Benefit)
If you choose to use the NHS for in-patient treatment that would have been covered by your policy, the insurer will pay you a fixed cash amount for each night you spend in an NHS hospital. This benefit acknowledges that you've saved the insurer money. It can be a useful perk, helping to cover incidental costs like parking or lost income while you're in hospital.
O is for...
Out-patient
This refers to any consultation, test, or treatment you receive at a hospital or clinic where you are not formally admitted and do not require a hospital bed. This is one of the most frequently used parts of a PMI policy.
Examples include:
- Initial consultations with a specialist.
- Diagnostic tests like MRI scans, CT scans, and X-rays.
- Therapies like physiotherapy.
- Minor procedures that don't require admission.
Out-patient cover is often sold with different annual limits (e.g., £500, £1,000, £1,500, or unlimited). Choosing a lower limit can reduce your premium.
Open Referral
See Guided Option. This is where your GP refers you to a type of specialist (e.g., a cardiologist) rather than a named individual, allowing your insurer to guide your choice.
P is for...
Policyholder
The person who owns the insurance policy and in whose name it is registered.
Pre-existing Condition
This is a cornerstone concept in UK PMI. A pre-existing condition is any illness, injury, or symptom for which you have sought advice, medication, or treatment before the start date of your policy.
THE GOLDEN RULE: Standard UK private medical insurance does not cover pre-existing conditions.
- With Moratorium Underwriting, they are automatically excluded for a set period.
- With Full Medical Underwriting, they are typically excluded permanently by name.
Trying to claim for a known pre-existing condition will result in the claim being rejected. Honesty and clarity from the outset are essential.
Premium
The amount of money you pay to the insurer in exchange for cover. This can be paid monthly or annually. Paying annually often comes with a small discount.
Private GP Services
An increasingly popular benefit, often accessible via a smartphone app. It gives you 24/7 access to a virtual GP consultation by phone or video call. This allows you to get medical advice, prescriptions, and referrals quickly, without waiting for an NHS GP appointment.
Provider
The insurance company that underwrites and provides the health insurance policy (e.g., Aviva, Bupa, Vitality).
Q is for...
Quote
An estimate of the premium you will pay for a specific health insurance policy. A quote is based on factors like your age, location, the level of cover you choose, your excess, and the underwriting type.
Get it right: Getting a quote from an expert broker like WeCovr ensures you're comparing like-for-like policies from across the market. We also offer discounts if you purchase multiple policies, such as life and health insurance together, and provide free access to our CalorieHero wellness app.
R is for...
Renewal
The process of continuing your health insurance policy for another year when your current term ends. Your insurer will send you a renewal invitation with the premium for the upcoming year. This premium may change due to your age, medical inflation, and any claims made. You are free to switch providers at renewal if you find a better deal elsewhere.
Referral
A formal recommendation from a doctor (usually your GP) for you to see a specialist or have further tests. A referral is nearly always required to start a PMI claim.
S is for...
Six-Week Option
This is a cost-saving feature that can significantly reduce your premium. If you add the six-week option to your policy, you agree to use the NHS for any in-patient treatment if the NHS waiting list for that procedure is less than six weeks. If the waiting list is longer than six weeks, your private cover kicks in immediately.
Given that the median waiting time for NHS consultant-led treatment was 15.2 weeks in early 2024 (according to NHS England data), the six-week option often means you will be eligible for private care. It's a calculated gamble that can pay off in lower premiums.
Specialist (or Consultant)
A doctor who has expert knowledge and training in a specific area of medicine, such as a cardiologist (heart), oncologist (cancer), or dermatologist (skin).
T is for...
Therapies Cover
Cover for treatment from recognised therapists to help with musculoskeletal issues. This typically includes:
- Physiotherapy
- Osteopathy
- Chiropractic
This is often an optional add-on or is included with a specific annual benefit limit.
U is for...
Underwriting
The process an insurer uses to evaluate your application and assess the risk of insuring you. They look at your age, lifestyle, medical history, and location to decide whether to offer you cover and at what price. The two main types are Moratorium and Full Medical Underwriting.
V is for...
Virtual GP
See Private GP Services. A digital service providing remote access to GP consultations via phone or video. This is a highly convenient benefit for getting quick advice and prescriptions.
W is for...
Waiting Period
A period at the beginning of your policy during which you cannot claim for certain benefits. For example, some policies may have a waiting period for maternity benefits or specific dental treatments. This does not usually apply to new, acute conditions that arise after you join.
Frequently Asked Questions (FAQs)
Does UK private health insurance cover pre-existing conditions?
What is the difference between in-patient and out-patient cover?
How can I reduce the cost of my private medical insurance?
- Increase your excess: Agreeing to pay a larger amount towards any claim (e.g., £500) will significantly lower your premium.
- Add a six-week option: Agreeing to use the NHS if the waiting list is under six weeks can offer large savings.
- Limit your hospital list: Choosing a list that excludes expensive city-centre hospitals will reduce the cost.
- Adjust your out-patient cover: Opting for a lower annual limit for out-patient care can make a big difference.
- Speak to a broker: An expert broker like WeCovr can compare the whole market to find the best value policy for your specific needs, completely free of charge.
Ready to Navigate Your Health with Confidence?
Understanding these terms is the first step towards finding the perfect private health cover. The next is getting expert, impartial advice.
At WeCovr, our friendly team of specialists is here to help you compare the UK's leading providers, tailor a policy to your needs and budget, and answer any questions you have—all at no cost to you.
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