TL;DR
As an FCA-authorised broker that has helped arrange over 900,000 policies of various types, WeCovr understands that getting a private medical insurance quote in the UK can feel complex. This definitive guide simplifies the process, giving you the confidence and knowledge to find the right cover for your needs. Everything you need before getting a PMI quote in the UK Navigating the world of Private Medical Insurance (PMI) can feel like learning a new language.
Key takeaways
- Chronic Conditions: These are long-term conditions that cannot be cured, only managed. Examples include diabetes, asthma, arthritis, and high blood pressure. While the initial diagnosis of a chronic condition might be covered, the ongoing, long-term management will not be.
- Pre-existing Conditions: This refers to any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy starts. How these are handled depends on your choice of underwriting, which we'll explore later.
- Emergency Services: If you have a medical emergency, like a heart attack or a serious accident, you must still call 999 and go to an NHS A&E department. PMI does not cover emergency treatment.
- Other Standard Exclusions: Common exclusions include cosmetic surgery (unless reconstructive), normal pregnancy and childbirth, and treatment for addiction.
- Full Name(s): For everyone you want to be covered on the policy.
As an FCA-authorised broker that has helped arrange over 900,000 policies of various types, WeCovr understands that getting a private medical insurance quote in the UK can feel complex. This definitive guide simplifies the process, giving you the confidence and knowledge to find the right cover for your needs.
Everything you need before getting a PMI quote in the UK
Navigating the world of Private Medical Insurance (PMI) can feel like learning a new language. With terms like 'moratorium', 'excess', and 'out-patient limits', it's easy to feel overwhelmed. But it doesn't have to be this way.
The key to getting the best private health cover is preparation. By gathering a few key pieces of information and understanding your options beforehand, you can approach the quote process with clarity, save time, and ultimately secure a policy that truly fits your life and budget.
This checklist is your step-by-step guide. We'll walk you through everything from basic personal details to the finer points of policy customisation, ensuring you're fully equipped to have a productive conversation with a broker or insurer.
Understanding the Basics: What is Private Medical Insurance (PMI)?
Before diving into the details, let's establish exactly what PMI is and what it is designed to do.
In the UK, we are incredibly fortunate to have the National Health Service (NHS). However, with increasing pressures, waiting times for certain treatments can be long. For instance, in late 2024, the NHS England waiting list for routine consultant-led treatment stood at over 7.5 million.
Private Medical Insurance is a policy you pay for that covers the cost of private healthcare for specific conditions. Its primary purpose is to provide faster access to diagnosis and treatment for acute conditions.
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 things like cataracts, joint replacements, or hernia repairs.
What PMI Does Not Cover
This is arguably the most important concept to understand. Standard UK private health insurance is not designed to cover:
- Chronic Conditions: These are long-term conditions that cannot be cured, only managed. Examples include diabetes, asthma, arthritis, and high blood pressure. While the initial diagnosis of a chronic condition might be covered, the ongoing, long-term management will not be.
- Pre-existing Conditions: This refers to any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy starts. How these are handled depends on your choice of underwriting, which we'll explore later.
- Emergency Services: If you have a medical emergency, like a heart attack or a serious accident, you must still call 999 and go to an NHS A&E department. PMI does not cover emergency treatment.
- Other Standard Exclusions: Common exclusions include cosmetic surgery (unless reconstructive), normal pregnancy and childbirth, and treatment for addiction.
Understanding this distinction between acute and chronic care is fundamental to setting the right expectations for your private health cover.
Your Personal and Family Details: The Foundation of Your Quote
Every quote starts with the basics. Insurers use this information to build a risk profile, which directly influences your premium (the monthly or annual cost of your policy).
Have these details ready:
- Full Name(s): For everyone you want to be covered on the policy.
- Date(s) of Birth: Age is one of the biggest factors in determining your premium. Statistically, the likelihood of needing medical treatment increases as we get older.
- Postcode: Where you live matters. Healthcare costs vary significantly across the UK. Treatment in central London, for example, is more expensive than in rural Scotland. Your postcode helps the insurer calculate the likely cost of treatment in your area.
- Smoking Status: You will need to declare if you and any other applicants have used tobacco or nicotine products (including vaping) within a certain timeframe, usually the last 12-24 months. Smokers are considered higher risk and will pay a higher premium.
Real-Life Example: Sarah, 45, from Manchester, and David, 45, from Marylebone, London, both request a quote for the exact same policy. David's premium will almost certainly be higher due to the higher average cost of private hospital care in central London.
Deciding Who to Cover: Individual, Couple, or Family Policies
Who needs cover? Your answer will shape the type of policy you choose.
- Individual Policy: Covers one person only. Simple and straightforward.
- Couple Policy: Covers you and your partner. This can sometimes be slightly cheaper than two separate individual policies. Most insurers define a 'couple' as two people living at the same address, regardless of marital status.
- Family Policy: Covers you, your partner, and your dependent children. Insurers often have special offers for families, such as 'free cover for your first child' or discounted rates for multiple children. Children can typically stay on a family policy until they are 21, or sometimes 25 if they are in full-time education.
Think about your future plans. If you're planning to start a family, ask how easy it is to add a newborn to the policy. Most insurers will allow you to add a new baby without any new medical underwriting, provided you do so within a few months of their birth.
Medical History: Honesty is the Best Policy
This is a critical part of your application. You will be asked questions about your medical history and the history of anyone else on the policy. It is vital that you are completely honest and accurate.
Failing to disclose a past condition, even if it seems minor, can have serious consequences. If you later make a claim for something related to that undisclosed condition, your insurer could refuse to pay for the treatment or even void your entire policy. This is known as 'non-disclosure'.
What you need to think about:
- Any consultations with doctors or specialists in the last 5 years.
- Any symptoms you've experienced, even if you didn't see a doctor.
- Any medication, treatment, or therapy you've received.
Don't worry, having a medical history doesn't automatically mean you can't get cover. It simply means the insurer needs to understand your health profile to offer the right terms. This leads us to one of the most important choices you'll make.
The Crucial Choice: Understanding Underwriting Options
'Underwriting' is the process an insurer uses to assess risk and decide whether to offer you a policy and on what terms. For PMI in the UK, you will typically be offered two main options.
-
Moratorium (MORI) Underwriting: This is the most common and simplest option. You won't have to fill out a detailed medical questionnaire upfront. Instead, the insurer applies a 'waiting period' (the moratorium) to pre-existing conditions.
- How it works: Any medical condition you've had symptoms, treatment, or advice for in the 5 years before the policy starts is excluded. However, if you then go for a continuous 2-year period after your policy begins without any symptoms, treatment, or advice for that specific condition, it may become eligible for cover.
- Pros: Quick and easy to set up. No lengthy forms.
- Cons: Less certainty. You may not know if a condition is covered until you make a claim.
-
Full Medical Underwriting (FMU): With this option, you provide a full declaration of your medical history by completing a detailed questionnaire when you apply.
- How it works: The insurer's underwriting team reviews your medical history and decides what they can and cannot cover. Any pre-existing conditions will be explicitly listed as exclusions on your policy documents.
- Pros: Complete clarity from day one. You know exactly what is and isn't covered. Can sometimes result in a lower premium if you have a clean bill of health.
- Cons: The application process takes longer. Can be more intrusive.
Comparing Underwriting Options
| Feature | Moratorium (MORI) Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Fast and simple, no medical forms | Slower, requires a detailed medical questionnaire |
| Clarity on Cover | Less certainty; cover for past issues is determined at the point of a claim | Full clarity from the start; exclusions are listed on your policy certificate |
| Cover for Pre-existing Conditions | May become eligible for cover after a 2-year trouble-free period | Usually excluded permanently, though some minor conditions may be accepted |
| Best For | People who want a quick start and have few or no recent medical issues | People who want absolute certainty about their cover, or those switching from another FMU policy |
A specialist broker, like the team at WeCovr, can explain these options in detail and help you decide which is the most suitable for your personal circumstances.
Customising Your Cover: Core Components and Optional Extras
Think of building a PMI policy like choosing the specifications for a new car. There's a standard model (core cover) and a list of optional extras you can add to tailor it to your needs and budget.
Core Cover: The Essentials
Almost every PMI policy in the UK includes the following as standard:
- In-patient Treatment: This covers you when you are admitted to a hospital and stay overnight. It includes the costs of surgery, hospital accommodation, nursing care, specialist fees, and diagnostics like MRI or CT scans while you are in hospital.
- Day-patient Treatment: This is for when you are admitted to a hospital for a planned procedure but do not stay overnight. Examples include arthroscopy or cataract surgery.
- Cancer Cover: This is a cornerstone of modern PMI. Most comprehensive policies offer extensive cancer cover, including surgery, chemotherapy, and radiotherapy. Some policies also include access to new and expensive drugs not yet available on the NHS. Always check the specifics of the cancer cover being offered.
Optional Extras: Tailoring Your Policy
This is where you can really control the breadth and cost of your cover.
| Optional Extra | What It Covers | Is It Worth It? |
|---|---|---|
| Out-patient Cover | Consultations with specialists and diagnostic tests that do not require hospital admission. This is key for getting a speedy diagnosis. | Highly recommended. Without it, you would need to rely on the NHS for your initial diagnosis before your PMI could cover the treatment. You can often choose a limit (e.g., £500, £1,000, or unlimited) to manage the cost. |
| Therapies Cover | Access to services like physiotherapy, osteopathy, and chiropractic treatment. | Very useful if you have a history of musculoskeletal issues or play sports. Limits on the number of sessions often apply. |
| Mental Health Cover | Covers consultations with psychiatrists and psychologists, and in-patient/day-patient psychiatric treatment. | Increasingly important. Mental health support on the NHS can have long waiting lists. This extra provides faster access to crucial support. |
| Dental & Optical Cover | Provides money back towards routine check-ups, dental treatments, and the cost of glasses or contact lenses. | This is more like a cashback plan than insurance for major unforeseen events. It can be cost-effective if you know you will use the full allowance each year. |
Deciding on these extras is a balance between comprehensive protection and your budget. The most common and valuable add-on is out-patient cover.
Setting Your Budget: How Excess and Hospital Lists Affect Your Premium
Two final levers allow you to fine-tune the cost of your policy.
1. The Policy Excess
An excess is a one-time payment you agree to make towards the cost of a claim each policy year. It's similar to the excess on a car or home insurance policy.
- How it works: If you have an excess of £250 and your first claim of the year costs £3,000, you would pay the first £250 and the insurer would pay the remaining £2,750. For any subsequent claims in that same policy year, you would pay nothing more.
- The trade-off: The higher the excess you choose, the lower your monthly premium will be.
- Common excess levels: £0, £100, £250, £500, £1,000.
Choosing a higher excess (e.g., £500) can be a smart way to make a comprehensive policy more affordable, as you are effectively self-insuring for smaller claims.
2. The Hospital List
Insurers have agreements with networks of private hospitals across the UK. They group these hospitals into lists or tiers, and the list you choose affects your premium.
- Tier 1: Local/Limited List: A selection of hospitals, often excluding those in major city centres like central London. This is the most budget-friendly option.
- Tier 2: Nationwide List: A comprehensive list of several hundred private hospitals across the UK, giving you plenty of choice. This is the most common option.
- Tier 3: Premium/London List: Includes all the hospitals on the nationwide list, plus the exclusive and expensive private hospitals in central London (e.g., The London Clinic, The Lister Hospital). This is the most expensive option.
Consider your location and willingness to travel. If you live outside of London and are happy to be treated locally, choosing a list that excludes the most expensive London hospitals is an easy way to reduce your premium without significantly impacting the quality of your care.
Lifestyle and Wellbeing: More Than Just Medical Cover
Modern private health cover is evolving. It's no longer just about being there when you're ill; it's also about helping you stay healthy.
When getting a quote, be prepared to answer questions about:
- BMI (Body Mass Index): Some insurers may ask for your height and weight to calculate your BMI. A very high BMI can sometimes lead to a higher premium.
- Alcohol Consumption: You may be asked about your average weekly unit consumption.
Insurers actively encourage healthy living by offering a range of wellness benefits. These can include:
- Discounted gym memberships.
- Wearable fitness tracker deals.
- Access to virtual GP services (24/7 phone or video consultations).
- Digital mental health support and therapy apps.
- Smoking cessation programmes.
- Discounts on health screenings.
At WeCovr, we enhance this further. Our clients who purchase Private Medical or Life Insurance receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping you maintain a healthy diet and lifestyle.
Why Use a Specialist Broker like WeCovr?
You could go directly to an insurer like Bupa, Aviva, or AXA. However, you would only get one price and one perspective. Using an independent, FCA-authorised broker offers several key advantages.
- Market-wide Comparison: A broker works with a panel of leading UK insurers. They can compare dozens of policies in one go to find the best private health cover for your specific needs and budget.
- Expert, Unbiased Advice: A good broker understands the market inside-out. They can explain the nuances of different policies, demystify the jargon, and guide you on crucial decisions like underwriting and excess levels. Their duty is to you, the client, not to any single insurer.
- No Extra Cost: Brokers are paid a commission by the insurer you choose to proceed with. This means their expert advice and support service is available to you at no extra cost. The premium is the same as if you went direct.
- Ongoing Support: Your relationship with a broker doesn't end once you buy the policy. They can assist you with renewals, help you review your cover, and even offer guidance if you run into any issues with a claim.
- Exclusive Benefits: Brokers can sometimes offer extra value. For example, WeCovr customers can benefit from discounts on other types of insurance when they purchase PMI, helping you save money across all your protection needs.
Your Step-by-Step Quote Preparation Checklist
Let's bring it all together. Before you pick up the phone or start filling in online forms, have this information ready.
-
Personal & Family Details:
- Full names of all applicants.
- Dates of birth for all applicants.
- Your home postcode.
- Smoking/vaping status for all adult applicants.
-
Cover Decisions:
- Who to cover: Yourself, you and a partner, or your family?
- Medical History: Make a mental note of any doctor's visits, treatments, or symptoms for all applicants over the last 5 years.
- Underwriting Preference: Have a think about whether you'd prefer the simplicity of a Moratorium or the clarity of Full Medical Underwriting.
-
Policy Customisation:
- Out-patient Cover: Do you want it, and if so, to what level (£500, £1,000, Full)?
- Other Extras: Are you interested in cover for Therapies, Mental Health, or Dental & Optical?
- Excess Level: What level of excess are you comfortable with (£100, £250, £500)? Remember, a higher excess lowers your premium.
- Hospital List: Do you need access to central London hospitals, or is a nationwide or local list sufficient?
-
Budget:
- Have a rough idea of what you are comfortable spending per month. This helps your broker find the best possible cover within your budget.
With this checklist completed, you are in the strongest possible position to find the right private medical insurance in the UK. You'll be able to have a clear, efficient conversation and compare quotes on a like-for-like basis, ensuring you get true value and peace of mind.
Do I need a medical exam to get private health insurance?
What is the difference between an acute and a chronic condition?
Does private health insurance cover cancer?
Can I add my family to my policy later on?
Ready to take the next step? The expert team at WeCovr is here to help. We'll take you through this checklist, provide a free, no-obligation comparison of the UK's leading insurers, and find the perfect policy for you. Get your personalised quote today.











