TL;DR
As an FCA-authorised expert with over 900,000 policies issued, WeCovr has analysed the latest trends in the UK private medical insurance market. The data is clear: claims are surging as more people turn to private healthcare for prompt diagnosis and treatment, navigating a healthcare landscape under immense pressure. Study of claims data showing increased PMI utilisation, types of treatments covered, and implications for premiums and product design The last two years have marked a watershed moment for private medical insurance (PMI) in the United Kingdom.
Key takeaways
- Elective Surgery: Patients waiting for routine but life-impacting procedures like hip replacements, knee surgery, and hernia repairs face average waits that can stretch for many months, and in some cases, over a year.
- Diagnostics: The wait for crucial diagnostic tests such as MRI scans, CT scans, and endoscopies—essential for a quick and accurate diagnosis—can also be extensive.
- Addressing Delayed Care: Many people postponed seeking help for non-urgent issues during the pandemic. Now, those issues have become more pressing, contributing to the backlog.
- Mental Health Focus: The pandemic shone a harsh light on the importance of mental wellbeing. This has translated into a sharp rise in individuals seeking support for conditions like anxiety, depression, and stress, with many turning to the comprehensive mental health cover offered by PMI policies.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of conditions like appendicitis, a broken leg, a cataract, or a hernia. The treatment has a clear beginning and end.
As an FCA-authorised expert with over 900,000 policies issued, WeCovr has analysed the latest trends in the UK private medical insurance market. The data is clear: claims are surging as more people turn to private healthcare for prompt diagnosis and treatment, navigating a healthcare landscape under immense pressure.
Study of claims data showing increased PMI utilisation, types of treatments covered, and implications for premiums and product design
The last two years have marked a watershed moment for private medical insurance (PMI) in the United Kingdom. A combination of unprecedented strain on the NHS, growing health awareness post-pandemic, and a desire for faster access to care has fuelled a dramatic increase in the number of people both buying and using private health cover.
Analysis of claims data from across the industry reveals a clear and sustained trend: PMI utilisation is at an all-time high. According to the Association of British Insurers (ABI), health insurance providers paid out £7.7 million every day in 2023 to support the health of their members, funding vital treatments and diagnostics. This represents a significant uptick in claims volume compared to pre-pandemic levels, demonstrating that policyholders are not just holding policies for peace of mind—they are actively using them to bypass long waits and access the care they need, when they need it.
This surge has profound implications, not just for policyholders' wallets but also for the very design of the insurance products themselves.
What's Driving the Surge in PMI Claims?
Several powerful factors are converging to drive this unprecedented demand for private healthcare. Understanding these drivers is key to grasping the current state of the UK health insurance market.
1. Record NHS Waiting Lists
The single most significant driver is the immense pressure on the National Health Service. As of mid-2025, the number of treatments on the NHS waiting list in England remains stubbornly high, hovering around 7.5 million. This figure represents individual treatments, not unique patients, but it paints a stark picture of the delays people face.
- Elective Surgery: Patients waiting for routine but life-impacting procedures like hip replacements, knee surgery, and hernia repairs face average waits that can stretch for many months, and in some cases, over a year.
- Diagnostics: The wait for crucial diagnostic tests such as MRI scans, CT scans, and endoscopies—essential for a quick and accurate diagnosis—can also be extensive.
For many, waiting in pain or with uncertainty is not a viable option. Private medical insurance offers a direct route to bypass these queues, often reducing the wait for a consultation or scan from months to mere days or weeks.
2. Increased Health Awareness and Post-Pandemic Backlog
The COVID-19 pandemic fundamentally shifted our collective attitude towards health. There is a heightened awareness of vulnerability and a greater proactivity in seeking medical advice. This has led to:
- Addressing Delayed Care: Many people postponed seeking help for non-urgent issues during the pandemic. Now, those issues have become more pressing, contributing to the backlog.
- Mental Health Focus: The pandemic shone a harsh light on the importance of mental wellbeing. This has translated into a sharp rise in individuals seeking support for conditions like anxiety, depression, and stress, with many turning to the comprehensive mental health cover offered by PMI policies.
3. An Ageing and Evolving Population
UK demographics are shifting. The Office for National Statistics (ONS) projects that by 2030, roughly one in five people in the UK will be aged 65 or over. An older population naturally has more complex health needs, leading to greater demand for treatments like joint replacements, cataract surgery, and cardiac care—all areas where PMI excels.
4. The Rise of Employee Health Benefits
In a competitive job market, employers are increasingly using private medical insurance as a core part of their benefits package to attract and retain top talent. Offering health cover demonstrates a commitment to employee welfare and provides a tangible benefit that reduces absenteeism by ensuring staff get treated faster. The growth in these corporate schemes has significantly expanded the pool of insured individuals, naturally leading to a higher volume of claims.
Which Treatments Are Seeing the Highest Claims?
The claims data reveals specific areas of healthcare where PMI is having the most significant impact. These are typically specialties with long NHS waiting lists or where private care offers access to newer technologies and faster diagnostic pathways.
| Treatment Category | Common Procedures | Why People Claim |
|---|---|---|
| Orthopaedics | Hip replacement, knee replacement, arthroscopy, spinal surgery | To avoid long, painful waits for surgery that impacts mobility and quality of life. |
| Oncology (Cancer) | Chemotherapy, radiotherapy, targeted therapies, surgery | Fast-track diagnosis, access to drugs not yet on the NHS, choice of specialist. |
| Diagnostics | MRI, CT, PET scans, ultrasound, endoscopy, colonoscopy | To get a swift and accurate diagnosis, often within days, to enable treatment to start. |
| Mental Health | Counselling, psychotherapy (CBT), psychiatric consultations | To bypass long waits for NHS mental health services (IAPT/Talking Therapies). |
| Gastroenterology | Hernia repair, gallbladder removal, investigation of digestive issues | To resolve painful and uncomfortable conditions without a protracted wait. |
| Cardiology | Angiography, pacemaker insertion, consultations for heart conditions | Rapid access to specialist assessment and intervention for peace of mind and health. |
A real-life example: Imagine Sarah, a 45-year-old marketing manager, is suffering from severe knee pain. Her GP suspects a torn meniscus and refers her for an NHS MRI scan, with an estimated wait of 12 weeks, followed by a further wait of many months for surgery if needed. Unable to walk without pain, she uses her company PMI. She sees a specialist within a week, has an MRI two days later, and is booked for keyhole surgery the following week. This is the tangible benefit driving the claims surge.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the most important concept to understand about private medical insurance in the UK. Failure to grasp this distinction is the source of most customer confusion.
Standard UK PMI is designed to cover acute conditions that arise after you take out your policy.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of conditions like appendicitis, a broken leg, a cataract, or a hernia. The treatment has a clear beginning and end.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs long-term monitoring, it has no known cure, it is likely to recur, or it requires ongoing management. Examples include diabetes, asthma, high blood pressure, and arthritis.
PMI does not cover the routine management of chronic conditions. It may cover the initial diagnosis of a chronic condition, but the day-to-day monitoring, check-ups, and medication would then fall back to the NHS.
Equally important are pre-existing conditions. These are any illnesses or injuries you had, or sought advice for, before your policy began. These are almost always excluded from cover. Insurers do this using two main methods:
- Full Medical Underwriting: You declare your full medical history upfront, and the insurer explicitly lists any conditions that will be excluded.
- Moratorium Underwriting: You don't declare your history, but the policy automatically excludes any condition you've had symptoms of, or sought treatment for, in the five years before joining. However, if you then go two full years on the policy without any symptoms, medication, or advice for that condition, it may become eligible for cover.
What Does This Mean for Your PMI Premiums?
The inescapable consequence of more people claiming more often for more expensive treatments is that premiums are rising. Just like in car insurance, a higher number of claims across the board puts upward pressure on prices for everyone.
This is compounded by medical inflation, which consistently outpaces general inflation (the Consumer Price Index). Medical inflation is driven by:
- The high cost of new drugs and medical technologies.
- Increased energy and staffing costs for private hospitals.
- A growing demand for a finite number of specialists.
For 2025, many policyholders can expect to see their renewal premiums increase by a noticeable margin, reflecting these market-wide trends, in addition to any age-related increases or claims made on their policy.
Key Factors Influencing Your Premium
| Factor | Impact on Premium | How to Manage It |
|---|---|---|
| Age | Increases significantly as you get older. | Cannot be changed, but locking in a policy when younger is cheaper. |
| Location | More expensive in major cities like London. | Cannot be changed, but be aware of the impact. |
| Level of Cover | Comprehensive plans are more expensive. | Choose a modular plan and only pay for what you need. |
| Excess | A higher excess lowers your premium. | Select an excess you are comfortable paying (£250-£500 is common). |
| Hospital List | A limited list of hospitals is cheaper. | Check if your local private hospital is on the insurer's guided network. |
| Claims History | Making a claim can reduce your No-Claims Discount. | Consider if it's worth claiming for smaller expenses. |
Navigating these rising costs can be challenging. This is where an expert PMI broker like WeCovr becomes invaluable. We can compare the entire market to find a policy that provides the right cover without breaking the bank.
How Are Insurers Responding? Innovations in Product Design
Insurers are not just raising prices; they are also innovating to keep policies affordable and relevant. The modern PMI policy is far more flexible and customisable than its predecessors.
- Guided Pathways: Many insurers now offer "guided" or "expert-selected" consultant options. Instead of choosing any specialist, the insurer provides a shortlist of approved specialists known for high-quality, cost-effective care. This helps control costs and typically comes with a premium discount.
- The Six-Week Wait Option: This is an increasingly popular cost-saving measure. With this clause, your policy will only pay for in-patient treatment if the NHS waiting list for that specific procedure is longer than six weeks. If the NHS can treat you within six weeks, you use the NHS. It's a pragmatic compromise that can significantly reduce your premium.
- Digital Health Integration: This is a major area of growth. Insurers are transforming from simple payers of claims into proactive health partners. Policies now routinely include:
- 24/7 Virtual GP services: Speak to a GP via phone or video call, often within hours.
- Mental health support apps: Access to digital CBT, mindfulness resources, and counselling sessions.
- Wellness programmes and discounts: Incentives for gym memberships, fitness trackers, and healthy food to encourage a healthier lifestyle and prevent future claims.
At WeCovr, we go a step further by providing our PMI and Life Insurance clients with complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping you stay on top of your health goals.
- Modular "Build-Your-Own" Policies: The one-size-fits-all approach is gone. You can now start with a core policy covering essential in-patient care and then add modules like out-patient cover, mental health, or dental and optical benefits, tailoring the plan to your precise needs and budget.
Proactive Steps to Manage Your Health and Your Policy
In this changing landscape, being proactive is your best strategy. This applies to both your physical health and your financial planning.
Tips for Better Health
Preventing illness is always better than treating it. Small, consistent lifestyle changes can have a huge impact on your long-term health and reduce your reliance on medical services.
- A Balanced Diet: Focus on whole foods—fruits, vegetables, lean proteins, and whole grains. A healthy diet can lower your risk of heart disease, type 2 diabetes, and certain cancers.
- Regular Physical Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, swimming, or dancing. It's crucial for cardiovascular health, weight management, and mental wellbeing.
- Prioritise Sleep: Aim for 7-9 hours of quality sleep per night. Sleep is essential for physical repair, memory consolidation, and emotional regulation.
- Manage Stress: Chronic stress can wreak havoc on your body. Utilise the mental health resources in your PMI policy, practise mindfulness, or simply make time for hobbies you enjoy.
Tips for Managing Your PMI Policy
- Review Your Cover Annually: Don't just let your policy auto-renew. Your needs may have changed, and new, more competitive products may be available. A quick review could save you hundreds of pounds.
- Use an Independent Broker: An expert broker like WeCovr works for you, not the insurer. We compare policies from all the leading UK providers to find the best value. Our service is free to you, and we handle all the paperwork.
- Understand Your Policy Details: Before you need to claim, read your policy documents. Know your excess, your hospital list, and what is and isn't covered.
- Leverage Added Benefits: Make full use of the virtual GP, wellness apps, and health discounts included with your policy. They provide excellent value and can help you stay healthy.
- Bundle Your Insurance: When you purchase PMI or Life Insurance through WeCovr, you can often get discounts on other types of cover, such as home or travel insurance, providing even greater value.
WeCovr: Your Expert Guide in the UK PMI Market
The world of private medical insurance can seem complex, especially with the market evolving so rapidly. At WeCovr, our mission is to bring clarity and value to our clients. As an FCA-authorised broker with extensive experience and high customer satisfaction ratings, we provide impartial, expert advice tailored to you.
We don't just sell policies; we build relationships. We take the time to understand your health needs, your budget, and your priorities. Then, we search the market—from major names like Bupa and AXA to specialist providers—to find the perfect match. Our service costs you nothing, but our expertise can save you time, money, and stress.
Does private health insurance cover pre-existing conditions?
How much does private medical insurance cost in the UK?
Will making a claim increase my premium?
Can I get a discount on my PMI premium?
The surge in PMI claims is a direct response to the pressures on our healthcare system. If you're considering how private health cover could benefit you, or if you want to ensure your current policy still offers the best value, don't navigate the market alone.
