TL;DR
WeCovr explains key PMI terms to help you understand policy wording with ease Navigating the world of private medical insurance (PMI) in the UK can feel like learning a new language. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr knows that understanding the jargon is the first step to finding the perfect private health cover for you and your family. This definitive glossary breaks down every key term, from 'Acute Condition' to 'Wellness Programme', into simple, plain English.
Key takeaways
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of things like a broken bone, appendicitis, cataracts, or a joint replacement. Your PMI policy is designed to get you diagnosed and treated for these conditions swiftly.
- Chronic Condition: 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."
WeCovr explains key PMI terms to help you understand policy wording with ease
Navigating the world of private medical insurance (PMI) in the UK can feel like learning a new language. As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr knows that understanding the jargon is the first step to finding the perfect private health cover for you and your family.
This definitive glossary breaks down every key term, from 'Acute Condition' to 'Wellness Programme', into simple, plain English. We'll demystify policy documents and empower you to compare quotes with confidence, ensuring you get the protection you need without any surprises.
The Crucial Difference: Acute vs. Chronic Conditions
Before we dive into the A-Z, it's vital to understand the single most important principle of UK private medical insurance: PMI is designed to cover acute conditions, not chronic conditions.
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Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of things like a broken bone, appendicitis, cataracts, or a joint replacement. Your PMI policy is designed to get you diagnosed and treated for these conditions swiftly.
-
Chronic Condition: 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 comes back or is likely to come back.
Examples of chronic conditions include diabetes, asthma, high blood pressure, and arthritis. Standard PMI policies do not cover the ongoing management of these conditions.
In a nutshell: PMI is for getting you back on your feet from a new, treatable condition. It is not a replacement for the NHS's excellent work in managing long-term illnesses.
Understanding Your Underwriting Options
When you apply for a policy, the insurer needs to know about your medical history. This process is called underwriting, and there are two main types. Choosing the right one is a key decision.
| Underwriting Type | How It Works | Pros | Cons |
|---|---|---|---|
| Moratorium (Mori) | You don't declare your full medical history upfront. Instead, the insurer applies a "waiting period" (usually two years). If you remain symptom-free and need no treatment, advice, or medication for a pre-existing condition during this period, it may become eligible for cover. | Quicker to set up. Less paperwork. | Claims can be slower as the insurer will investigate your history at that point. Less certainty about what's covered from day one. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire, disclosing your medical history. The insurer then tells you from the start exactly what is and isn't covered. | Complete clarity from day one. Faster claims process as underwriting is done upfront. | The application process takes longer. You must be very thorough with your disclosures. |
An expert PMI broker, like WeCovr, can help you decide which underwriting method is best for your personal circumstances.
Your A-Z Guide to Private Medical Insurance Terms
Let's break down the language of PMI, one letter at a time.
A
- Acute Condition: As explained above, a short-term illness or injury that can be cured with treatment. This is what PMI is for.
- Annual Limit: The maximum amount, in pounds sterling (£), that your insurer will pay out for eligible claims in a single policy year. Some policies have a limit per condition, while others have an overall annual limit. Comprehensive plans often offer unlimited cover.
- A&E (Accident & Emergency): Private health insurance does not cover A&E visits. This is an area where the NHS provides immediate, essential care for everyone in the UK.
- Aviva: One of the UK's largest and most well-known private medical insurance providers.
B
- Benefit: A specific treatment, service, or cost that is covered by your policy. For example, 'out-patient consultations' or 'cancer cover' are benefits.
- Broker (or Intermediary): A specialist, FCA-regulated firm like WeCovr that helps you compare policies from different insurers. A good broker doesn't charge you a fee; they are paid a commission by the insurer you choose. Their job is to find the best PMI provider and policy for your needs and budget.
- Bupa: A leading health and care company in the UK, offering a wide range of private medical insurance plans.
C
- Cancer Cover: A core and highly valued benefit of most PMI policies. It provides access to specialist consultants, diagnostic tests, and treatments like chemotherapy, radiotherapy, and surgery that may not be available on the NHS, or have long waiting times.
- Chronic Condition: A long-term condition that cannot be cured, such as diabetes or asthma. Standard PMI does not cover chronic conditions.
- Claims: The process of asking your insurer to pay for eligible treatment covered under your policy. This usually starts with a GP referral.
- Comprehensive Cover: The highest level of private health cover, typically including extensive in-patient, day-patient, and out-patient benefits with high or unlimited annual limits.
- Cooling-off Period: A statutory period (usually 14 days) after you purchase your policy during which you can cancel and receive a full refund, provided you haven't made a claim.
D
- Day-patient: Someone who is admitted to a hospital or clinic for a medical procedure but does not need to stay overnight. Many minor surgical procedures are performed on a day-patient basis.
- Dental & Optical Cover: Not usually included as standard. This is an optional add-on that provides cover for routine check-ups, dental treatments, and the cost of glasses or contact lenses.
- Domiciliary Care: Medical care provided in your own home by a nurse or other healthcare professional. This is sometimes included as a benefit, especially for post-operative care.
E
- Excess (or Deductible): A fixed amount you agree to pay towards the cost of your first claim (or sometimes each claim) in a policy year. For example, if you have a £250 excess and your eligible treatment costs £3,000, you pay the first £250 and your insurer pays the remaining £2,750. Choosing a higher excess is a common way to lower your monthly premium.
- Exclusions: Specific conditions, treatments, or circumstances that are not covered by your policy. These are always listed in your policy documents and commonly include pre-existing conditions, chronic conditions, cosmetic surgery, and A&E visits.
- Emergency Cover: As mentioned, true emergencies are handled by the NHS. Private hospitals in the UK are not equipped with A&E departments.
F
- FCA (Financial Conduct Authority): The UK's financial services regulator. All reputable insurers and brokers, including WeCovr, must be authorised and regulated by the FCA. This ensures they meet strict standards of conduct and fairness.
- Full Medical Underwriting (FMU): One of the two main types of underwriting, where you provide your complete medical history at the start. See the detailed table above.
G
- GP (General Practitioner): Your local NHS doctor. In almost all cases, you will need a referral from your GP to see a private specialist and make a claim on your insurance.
- Guided Option (or Open Referral): A feature where, instead of choosing any specialist you wish, your insurer provides a shortlist of 2-3 approved specialists for you to choose from. Opting for a guided plan can significantly reduce your premiums.
H
- Hospital List: A list of private hospitals and clinics where you can receive treatment under your policy. Insurers group hospitals into tiers or bands. A more restrictive list (e.g., local hospitals only) will result in a lower premium, while a comprehensive list including prime central London hospitals will be more expensive.
- Health Screening: A preventative check-up to look for early signs of disease. Some policies include a limited health screen as a benefit, allowing you to be proactive about your wellbeing.
I
- In-patient: Someone who is admitted to hospital and stays overnight for one or more nights for treatment.
- Insurance Premium Tax (IPT): A tax charged by the government on all general insurance premiums, including PMI. As of late 2025, the standard rate is 12%. This is automatically included in the price you are quoted.
L
- Level of Cover: The range and monetary value of benefits included in your policy. Levels typically range from basic (covering in-patient and day-patient care only) to intermediate and comprehensive (which also include out-patient cover, therapies, and more).
M
- Moratorium Underwriting: The most common type of underwriting in the UK. It's quicker to set up as you don't declare your medical history, but it involves a two-year waiting period for pre-existing conditions. See the detailed table above.
- Mental Health Cover: An increasingly important benefit. This can be an add-on or included in comprehensive plans. It provides cover for specialist consultations, counselling, and psychiatric treatment. Demand for these services has risen, with NHS data showing around 1 in 5 adults experienced some form of depression in early 2021.
- MRI, CT, and PET Scans: Advanced diagnostic scans used to get a detailed picture of the inside of your body. Access to these scans is a key benefit of PMI, as NHS waiting times can be lengthy.
N
- 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 pays you a fixed cash amount for each night you spend in an NHS hospital. This acknowledges that you are saving the insurer money.
- No-Claims Discount (NCD): Similar to car insurance, many PMI policies feature an NCD. For every year you don't make a claim, you receive a discount on your renewal premium, up to a maximum level (often 60-75%).
O
- Out-patient: A person who visits a hospital or clinic for a consultation, test, or treatment but does not need to be admitted. This could be a visit to see a specialist or for a blood test or X-ray. Out-patient cover is a crucial part of a comprehensive policy and often has its own annual limit.
- Open Referral: See 'Guided Option'. Your GP refers you for a type of specialist (e.g., a cardiologist) rather than a named individual, and your insurer provides a list of approved options.
P
- Pre-existing Condition: Any illness, disease, or injury for which you have experienced symptoms, received medication, or sought advice before the start date of your policy. These are generally excluded from cover, either permanently (with FMU) or for an initial period (with Moratorium).
- Premium: The regular amount you pay (usually monthly or annually) to keep your insurance policy active.
- Policyholder: The person who owns the insurance policy.
- Provider: The insurance company that underwrites and provides the health cover (e.g., Bupa, Aviva, AXA Health, Vitality).
R
- Referral: A recommendation from your GP to see a specialist for diagnosis or treatment. This is the starting point for most PMI claims.
- Renewal: The point at which your annual policy ends and you are invited to continue it for another year. Your premium will be recalculated based on your age, your claims history, and medical inflation.
S
- Self-insurance: The practice of setting aside your own money to pay for potential private medical treatment, rather than paying premiums to an insurer. This can be risky as major procedures like cancer treatment can cost tens or even hundreds of thousands of pounds.
- Specialist (or Consultant): A senior doctor who has expert knowledge in a particular area of medicine, such as a cardiologist (heart), oncologist (cancer), or orthopaedic surgeon (bones and joints).
- Six-Week Option: A popular cost-saving option. If you add this 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, you can use your private cover. This can significantly lower your premium.
T
- Therapies: Treatments such as physiotherapy, osteopathy, and chiropractic care. These are often included as an out-patient benefit or as an optional add-on to help with recovery from injury or surgery.
U
- Underwriting: The process an insurer uses to assess risk and decide whether to offer you cover, and on what terms. The two main types are Moratorium and Full Medical Underwriting.
V
- Vitality: A major UK health insurance provider known for its innovative 'Wellness Programme', which rewards members with discounts and benefits for staying active and healthy.
W
- Waiting Period: A period of time at the start of the policy during which you cannot claim for certain benefits. This is different from a moratorium period. For example, some policies have a short waiting period for benefits like maternity cash.
- Wellness Programme: An increasingly common feature of modern private health cover. These programmes, offered by providers like Vitality, encourage healthy living through discounted gym memberships, fitness trackers, and other rewards. At WeCovr, we support this by offering complimentary access to our AI-powered nutrition app, CalorieHero, to all our health and life insurance clients.
Your Health, Your Choice
Understanding these terms is the key to unlocking the value of private medical insurance. It allows you to compare quotes accurately and build a policy that fits your exact needs and budget. Whether you prioritise rapid access to diagnostics, comprehensive cancer care, or a plan that rewards a healthy lifestyle, there's a solution out there for you.
Remember, a specialist broker like WeCovr can guide you through all these options at no cost to you, ensuring you make an informed decision. Plus, when you take out a policy through us, you may also be eligible for discounts on other types of cover, like life or income protection insurance.
Do I need to declare pre-existing conditions when I apply for PMI?
It depends on the type of underwriting you choose. With 'Full Medical Underwriting' (FMU), you must declare your entire medical history. With 'Moratorium' underwriting, you don't declare conditions upfront, but anything you've had symptoms or treatment for in the five years before your policy starts will be excluded for at least the first two years of your cover. Honesty and accuracy are always the best policy.
Can I use my private medical insurance for a chronic condition like diabetes or asthma?
No, standard UK private health insurance is designed to cover 'acute' conditions (new, short-term, and curable). It does not cover the routine management, monitoring, or treatment of long-term 'chronic' conditions like diabetes, asthma, or high blood pressure. However, some policies may cover an acute flare-up of a chronic condition.
What is the difference between an in-patient and an out-patient?
An 'in-patient' is someone who is admitted to a hospital and stays overnight for treatment. A 'day-patient' is also admitted for a procedure but goes home the same day. An 'out-patient' visits a hospital or clinic for a consultation or test but is not formally admitted. Your policy will have separate benefit limits for each type of care.
Why should I use a PMI broker like WeCovr instead of going directly to an insurer?
A specialist broker like WeCovr offers impartial, expert advice across the entire market. We can compare policies from multiple leading insurers to find the best private health cover for your specific needs and budget. This service is free for you, as we are paid by the insurer you choose. We handle the paperwork and can help you make sense of complex options like underwriting and hospital lists, saving you time and potentially a lot of money.
Get Your Free, No-Obligation PMI Quote Today
Ready to take the next step? Don't let confusing jargon hold you back from getting the peace of mind that private medical insurance provides. The expert team at WeCovr is here to provide clear, friendly advice and a personalised quote that matches your needs.
Contact WeCovr today for a free, no-obligation quote and find the perfect private health insurance UK policy for you.
