TL;DR
As an FCA-authorised expert that has helped arrange over 900,000 policies, WeCovr understands that navigating the world of private medical insurance (PMI) in the UK can feel complex. A primary concern for many is ensuring they have robust protection against cancer, a condition that will affect one in two people in the UK. WeCovr explains how cancer care is included in PMI policies A cancer diagnosis is a life-changing event, bringing with it immense emotional and physical challenges.
Key takeaways
- You notice a symptom: You might discover a lump, experience unexplained pain, or have other worrying symptoms. Your first port of call is always your NHS GP.
- GP Referral: If your GP shares your concerns, they will refer you to a specialist. With PMI, you can ask for an 'open referral'. This allows you to choose a specialist from your insurer's approved list.
- Authorisation from your Insurer: You call your PMI provider with the referral details. They will check your cover and authorise the next steps, giving you an authorisation number for your claim.
- Private Consultation & Diagnostics: You book an appointment with a private specialist, often within a few days. If they recommend diagnostic tests like an MRI, CT, or PET scan, your insurance will cover this, and it can usually be arranged very quickly.
- Diagnosis and Treatment Plan: If a diagnosis of cancer is confirmed, your private consultant (oncologist) will work with a multidisciplinary team to create a personal treatment plan.
As an FCA-authorised expert that has helped arrange over 900,000 policies, WeCovr understands that navigating the world of private medical insurance (PMI) in the UK can feel complex. A primary concern for many is ensuring they have robust protection against cancer, a condition that will affect one in two people in the UK.
WeCovr explains how cancer care is included in PMI policies
A cancer diagnosis is a life-changing event, bringing with it immense emotional and physical challenges. While the NHS provides excellent cancer care, many people seek the additional benefits offered by private health insurance. These can include faster access to specialists, a wider choice of treatments, and a more comfortable care environment.
In this comprehensive guide, we'll break down everything you need to know about cancer cover within a private medical insurance policy, helping you make an informed decision for your health and peace of mind.
What is Cancer Cover and Why is it So Important?
Cancer cover is a fundamental component of most private medical insurance policies in the UK. It is designed to pay for the diagnosis, treatment, and aftercare of cancerous conditions that arise after you take out your policy.
The importance of this cover is underscored by UK health statistics. According to Cancer Research UK, there are around 375,000 new cancer cases in the UK every year. While survival rates are improving, the journey from diagnosis to recovery can be long and demanding.
Private vs. NHS Cancer Care
The NHS has a world-class reputation for cancer treatment, and it's a service the nation is rightly proud of. So, why consider private cover? The key differences lie in access, choice, and environment.
| Feature | NHS Cancer Care | Private Cancer Care (with PMI) |
|---|---|---|
| Speed of Diagnosis | Aims for a 28-day target from urgent GP referral to diagnosis. Waiting lists can cause delays. | Typically much faster. See a specialist and have diagnostic scans (MRI, CT) often within days. |
| Choice of Specialist | You are usually treated by the team at your local NHS hospital. | You can often choose your consultant and hospital from a list provided by your insurer. |
| Treatment Access | Provides treatments approved by the National Institute for Health and Care Excellence (NICE). | May offer access to newer, innovative drugs or therapies not yet available or funded on the NHS. |
| Environment | Treatment is often in a shared ward or busy outpatient department. | Care is usually in a private hospital with an en-suite room, offering more comfort and privacy. |
| Support Services | Support is available but can be stretched. | Often includes dedicated cancer nurses, mental health support, and other therapies as standard. |
Having private medical insurance doesn't mean you forsake the NHS. It simply gives you an alternative route for your care, allowing you to bypass potential waiting lists and access a different range of options.
Understanding How Cancer Cover Works in a PMI Policy
When you have a PMI policy with cancer cover, it provides a clear pathway from your first symptoms to your final recovery check-up. Let's walk through a typical patient journey.
- You notice a symptom: You might discover a lump, experience unexplained pain, or have other worrying symptoms. Your first port of call is always your NHS GP.
- GP Referral: If your GP shares your concerns, they will refer you to a specialist. With PMI, you can ask for an 'open referral'. This allows you to choose a specialist from your insurer's approved list.
- Authorisation from your Insurer: You call your PMI provider with the referral details. They will check your cover and authorise the next steps, giving you an authorisation number for your claim.
- Private Consultation & Diagnostics: You book an appointment with a private specialist, often within a few days. If they recommend diagnostic tests like an MRI, CT, or PET scan, your insurance will cover this, and it can usually be arranged very quickly.
- Diagnosis and Treatment Plan: If a diagnosis of cancer is confirmed, your private consultant (oncologist) will work with a multidisciplinary team to create a personal treatment plan.
- Treatment Begins: Your treatment—whether it's surgery, chemotherapy, radiotherapy, or another therapy—will take place in a private hospital or clinic chosen from your hospital list.
- Ongoing Care and Monitoring: Your policy will cover follow-up consultations, monitoring scans, and potentially palliative care if required.
The Critical Rule: Pre-existing and Chronic Conditions
It is vital to understand a core principle of private medical insurance in the UK: PMI is designed to cover acute conditions that arise after your policy begins.
- Pre-existing Condition: This is any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before taking out the policy. Standard PMI policies will not cover pre-existing cancer or symptoms that could lead to a cancer diagnosis.
- Chronic Condition: This is a condition that is long-lasting and can be managed but not cured, such as diabetes or asthma. PMI does not cover the routine management of chronic conditions.
Fortunately, insurers typically classify cancer as an acute condition, because the treatments (like surgery or chemotherapy) aim to cure it and put you into remission.
What Does a Typical Cancer Cover Policy Include?
While policies vary between insurers, comprehensive cancer cover will generally include a wide range of benefits designed to support you at every stage.
Core Inclusions:
- Consultant and Specialist Fees: Covers the cost of your oncologist, surgeon, and other experts.
- Diagnostic Tests and Scans: Pays for MRI, CT, and PET scans, as well as biopsies and other laboratory tests to diagnose and stage the cancer.
- Hospital Stays: Includes the cost of a private room, usually with an en-suite bathroom.
- Surgery: Covers the cost of tumour removal and may include reconstructive surgery (e.g., after a mastectomy).
- Cancer Therapies:
- Chemotherapy: The use of cytotoxic drugs to destroy cancer cells.
- Radiotherapy: Using high-energy rays to target and kill cancer cells.
- Hormone Therapy & Immunotherapy: More targeted treatments that are becoming increasingly common.
- Follow-up Consultations: Monitoring your recovery after treatment is complete.
Advanced and Supportive Inclusions:
- Advanced Therapies: Some comprehensive plans cover cutting-edge treatments like proton beam therapy or stereotactic radiotherapy.
- Experimental Drugs: A major benefit of some top-tier policies is cover for drugs that have been licensed but are not yet approved by NICE for NHS use due to cost or other factors. This can open up life-extending treatment options.
- Chemotherapy at Home: Many insurers now offer the option for a qualified nurse to administer chemotherapy in the comfort of your own home.
- Wigs and Prostheses: Provides a financial contribution towards the cost of a wig if you lose your hair, or for external prostheses if needed after surgery.
- Mental Health Support: Access to counselling or therapy to help you and sometimes your family cope with the emotional impact of a diagnosis.
- Palliative Care: Covers care focused on providing relief from the symptoms and stress of a serious illness to improve quality of life.
Levels of Cancer Cover: Finding the Right Option for You
Insurers know that one size doesn't fit all. They typically offer different tiers of cancer cover, allowing you to balance the level of protection with your budget. As an expert PMI broker, WeCovr can help you compare these options side-by-side.
| Level of Cover | What's Typically Included | Who It's Best For |
|---|---|---|
| Comprehensive Cancer Cover | The most extensive option. Includes all standard treatments plus access to advanced therapies and unlicensed drugs. Usually has no financial or time limits on treatment. | Those who want the absolute best protection available, with no compromises on treatment options. |
| Core Cancer Cover | Included as standard on most policies. Covers surgery, radiotherapy, and chemotherapy. It may have financial or time limits and may not include the latest experimental drugs. | A solid, affordable choice for people who want robust cover for standard cancer treatments. |
| NHS Cancer Cover Pathway | A budget-friendly option. Your PMI covers the initial private diagnosis (fast access to specialists and scans). If cancer is diagnosed, you then move to the NHS for your treatment. | Individuals on a tighter budget who value a quick diagnosis but are happy to rely on the excellent treatment provided by the NHS. |
Some insurers also allow you to remove cancer cover entirely for a significantly lower premium, but this is a major decision that leaves you fully reliant on the NHS for all aspects of cancer care.
Key Terms in Cancer Cover Explained
The world of insurance can be full of jargon. Here are a few key terms explained in plain English:
- Underwriting: This is how an insurer assesses your health risk.
- Moratorium: You don't declare your full medical history. The insurer automatically excludes anything you've had symptoms or treatment for in the last 5 years. This exclusion can be lifted if you remain symptom-free for a continuous 2-year period after your policy starts.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire. The insurer then tells you exactly what is and isn't covered from the start.
- Benefit Limits (illustrative): This is the maximum amount your insurer will pay out. For cancer cover, this is often 'unlimited', but cheaper policies might have an annual financial cap (e.g., £100,000) or a time limit.
- Excess (illustrative): The amount you agree to pay towards the cost of a claim. A higher excess (e.g., £500) will lower your monthly premium, while a lower excess (£100) will increase it.
- Hospital List: Your policy will come with a list of approved hospitals. A more limited list (e.g., your local private hospitals) is cheaper than a nationwide list that includes premium central London hospitals.
How Much Does Private Health Insurance with Cancer Cover Cost?
The cost of a PMI policy is highly personal and depends on several factors:
- Age: This is the single biggest factor. Premiums increase as you get older.
- Location: Premiums are typically higher in London and the South East.
- Level of Cover: Comprehensive cover costs more than a basic policy.
- Excess: A higher excess reduces your premium.
- Lifestyle: Smokers will pay significantly more than non-smokers.
To give you an idea, here are some illustrative monthly costs for a non-smoker with a £250 excess seeking a comprehensive policy.
| Age | Location | Estimated Monthly Cost |
|---|---|---|
| 30 | Leeds | £45 - £70 |
| 45 | Birmingham | £75 - £100 |
| 60 | London | £130 - £190 |
Please note: These are examples only. The best way to get an accurate price is to get a personalised quote.
Beyond Treatment: Wellness, Prevention, and Added Benefits
Modern private medical insurance is about more than just treating illness; it's also about promoting a healthy lifestyle.
Tips for a Healthier Lifestyle
While no one can guarantee they'll never get cancer, a healthy lifestyle can significantly reduce your risk for many types.
- Balanced Diet: Focus on a diet rich in fruits, vegetables, whole grains, and lean proteins. Limiting processed foods, red meat, and alcohol is also recommended.
- Stay Active: The UK's Chief Medical Officers recommend adults get at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous activity (like running) each week.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Good sleep is essential for a strong immune system.
- Attend Screenings: Always attend your NHS screening invitations for breast, bowel, and cervical cancer. Early detection saves lives.
Added Value from Your PMI Policy
Many insurers now bundle valuable wellness benefits into their policies to encourage healthy living, which can include:
- Discounted gym memberships.
- Rewards for hitting activity goals.
- Access to digital GP services.
- Mental health support apps and phone lines.
At WeCovr, we go a step further. When you take out a private medical insurance policy with us, we provide complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to support your health goals. Furthermore, our clients often receive discounts on other insurance products, such as life or critical illness cover.
A Real-Life Example: How PMI Helped David
David, a 52-year-old architect from Manchester, noticed he was feeling unusually tired and was having trouble swallowing. His GP referred him for an urgent endoscopy on the NHS, with a potential 4-week wait.
Worried, David called his private medical insurer. They authorised an immediate private consultation.
- Day 3: David saw a private gastroenterologist.
- Day 5: He had an endoscopy and a biopsy taken in a private clinic.
- Day 10: The results confirmed early-stage oesophageal cancer.
- Week 3 (illustrative): David had minimally invasive surgery in a private hospital. His policy covered the entire £18,000 cost, minus his £250 excess.
- Follow-up: His policy also covered six sessions with a psychologist to help him process the diagnosis.
David was able to bypass the waiting list, receive treatment quickly, and focus on his recovery in a comfortable, private environment.
Is cancer cover standard in private health insurance?
Can I get private health insurance if I have had cancer before?
What is the main advantage of private cancer care over the NHS?
Do I have to pay for my cancer treatment if I have PMI?
Take the Next Step with WeCovr
Choosing the right private medical insurance is one of the most important decisions you can make for your future health. The peace of mind that comes from knowing you have fast access to high-quality care is invaluable.
The expert team at WeCovr is here to make the process simple. As an independent, FCA-authorised broker, we compare policies from all the leading UK insurers to find the right protection for you. We'll explain the options in clear, simple terms and help you find a policy that fits your needs and budget perfectly.
Get your free, no-obligation quote today and secure your health for tomorrow.
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.
