Private Medical Insurance FAQs 50 Most Common Questions Answered

Navigating the world of private medical insurance in the UK can feel complex. That's why the experts at WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, have created this definitive guide to answer all your questions about private health cover.

Comprehensive FAQ covering eligibility, costs, claims, coverage, switching, cancellation, and every common query about private health insurance

Private Medical Insurance (PMI) offers a valuable alternative and supplement to NHS care, providing faster access to specialists, diagnosis, and treatment for acute medical conditions. But how does it work? Is it right for you? And what do you need to know before you buy?

This guide answers the 50 most common questions we hear every day.

Part 1: The Fundamentals of PMI

Let's start with the basics. What is private health insurance, and how does it fit into the UK's healthcare landscape?

1. What is Private Medical Insurance (PMI)?

Private Medical Insurance, often called private health insurance, is a policy you buy to cover the cost of private healthcare for specific medical conditions. Its primary purpose is to diagnose and treat acute conditions—illnesses or injuries that are curable and likely to respond quickly to treatment.

2. How does PMI work alongside the NHS?

PMI and the NHS work in partnership. PMI is not designed to replace the NHS. You will still rely on the NHS for accident and emergency services, GP appointments (unless your policy includes a private GP service), and the management of long-term chronic conditions. Where PMI excels is in bypassing NHS waiting lists for non-urgent consultations, diagnostic scans, and eligible surgical procedures.

3. Why should I consider buying private health insurance?

People in the UK choose PMI for several key reasons:

• Speed of Access: Avoid long NHS waiting lists for specialist appointments and treatments. According to NHS England data, the median waiting time for consultant-led elective care was 14.5 weeks as of mid-2024.
• Choice: You can often choose your specialist, consultant, and the hospital where you receive treatment from a list provided by your insurer.
• Comfort and Privacy: Private hospitals typically offer private en-suite rooms, more flexible visiting hours, and a quieter environment.
• Access to Specialist Drugs: Some policies provide access to drugs or treatments not yet available on the NHS due to funding decisions.

4. What's the difference between private health insurance and a health cash plan?

They are very different products:

• Private Health Insurance (PMI): Covers the cost of significant medical treatments for acute conditions, such as surgery, specialist consultations, and cancer care. It's for unexpected, curable health issues.
• Health Cash Plan: Helps you budget for everyday healthcare costs. You pay a monthly premium and can then claim back money for routine appointments like dental check-ups, eye tests, physiotherapy, and prescriptions, up to an annual limit.

5. Is PMI the same as critical illness cover?

No. PMI pays for the treatment of eligible medical conditions. Critical Illness Cover pays out a one-off, tax-free lump sum if you are diagnosed with a specific, serious illness defined in your policy (e.g., a heart attack, stroke, or certain types of cancer). You can spend the lump sum on anything you wish, from adapting your home to covering lost income.

6. Who are the main PMI providers in the UK?

The UK market is dominated by a few major players, each with different strengths and policy options. The main providers include:

• Bupa
• AXA Health
• Aviva
• Vitality
• WPA (Western Provident Association)

7. What is an insurance broker and why should I use one?

An insurance broker is an independent expert who can compare policies from multiple insurers to find the one that best suits your needs and budget. Unlike going direct to an insurer, who can only sell their own products, a broker offers impartial advice across the market.

8. What are the main benefits of using a broker like WeCovr?

Using an FCA-authorised PMI broker like WeCovr has significant advantages:

• Expert Advice: We understand the complex details of every policy.
• Market Comparison: We compare quotes from leading UK providers to find you the best value.
• No Extra Cost: Our service is free to you; we are paid a commission by the insurer you choose.
• Personalised Service: We help tailor your policy to cover what matters most to you, ensuring you don't pay for benefits you don't need.
• High Customer Satisfaction: We pride ourselves on clear, honest advice that puts our clients first.

Part 2: Understanding Your Coverage

Knowing what is and isn't covered is the most critical part of choosing a policy.

9. What does private medical insurance typically cover?

Most standard PMI policies cover the costs associated with treating acute conditions that arise after you take out the policy. This usually includes:

• Inpatient and day-patient treatment: Hospital fees, surgeon and anaesthetist fees, and specialist consultations while you are admitted to hospital.
• Diagnostic tests: MRI scans, CT scans, and X-rays.
• Outpatient consultations: Seeing a specialist without being admitted to hospital (this may have annual limits).
• Cancer cover: This is often a core part of a policy, covering diagnosis and treatment such as chemotherapy, radiotherapy, and surgery.

10. What is an 'acute' condition?

This is a fundamental concept in PMI. An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, joint pain requiring a replacement, or appendicitis. PMI is designed for these conditions.

11. What is a 'chronic' condition?

A chronic condition is a health problem that is long-lasting, has no known cure, and needs ongoing management rather than a one-off fix. Examples include diabetes, asthma, high blood pressure, and arthritis. Standard UK private medical insurance does not cover the routine management of chronic conditions.

12. Does PMI cover pre-existing conditions?

This is a critical point: No, standard PMI policies do not cover pre-existing conditions. A pre-existing condition is any illness, disease, or injury for which you have had symptoms, medication, advice, or treatment before your policy starts. How insurers handle this depends on the type of underwriting you choose (see questions 33 and 34).

13. What's the difference between inpatient and outpatient cover?

• Inpatient: You are admitted to a hospital and stay overnight. All core PMI policies cover this.
• Outpatient: You attend a hospital or clinic for a consultation or test but do not stay overnight. This is often an optional add-on or has a financial limit. A more comprehensive outpatient limit will increase your premium.

14. What is 'day-patient' treatment?

This is when you are admitted to a hospital for a procedure and occupy a bed but are discharged on the same day. An example would be a cataract operation or minor keyhole surgery. This is typically covered as standard, just like inpatient treatment.

15. Does PMI cover cancer treatment?

Yes, cancer cover is a cornerstone of most comprehensive PMI policies. It typically covers diagnosis, surgery, and treatments like chemotherapy, radiotherapy, and biological therapies. The level of cover can vary, so it's vital to check the details. Some policies may offer access to experimental drugs not available on the NHS.

16. Does PMI cover mental health conditions?

Coverage for mental health is becoming more common but varies significantly. Basic policies may offer no cover, while more comprehensive plans might cover a limited number of psychiatric or therapy sessions as an outpatient. Some top-tier plans offer more extensive inpatient and outpatient support for conditions like anxiety and depression.

17. Does PMI cover dental and optical care?

Routine dental check-ups, fillings, and eye tests are generally not covered by standard PMI. They are more suited to a health cash plan. However, major surgical dental work (e.g., removal of an impacted wisdom tooth in hospital) may be covered by some policies.

18. Are diagnostic tests like MRI and CT scans covered?

Yes, diagnostic tests are a core benefit of PMI. They are key to getting a swift diagnosis. Cover is usually included for both inpatient and outpatient settings, though outpatient cover may have a financial limit.

19. Does PMI cover physiotherapy and other therapies?

Most policies offer some cover for therapies like physiotherapy, osteopathy, and chiropractic treatment. This is usually available after a GP or specialist referral and is often limited to a set number of sessions or a financial cap per year.

20. What is generally not covered by PMI?

Besides pre-existing and chronic conditions, common exclusions include:

• Accident & Emergency treatment
• Cosmetic surgery (unless medically necessary for reconstruction)
• Fertility treatments (IVF)
• Normal pregnancy and childbirth
• Drug and alcohol abuse treatment
• Mobility aids and prosthetics (unless specified)
• Self-inflicted injuries

Part 3: Costs, Premiums, and Savings

How much does PMI cost, and what can you do to manage the price?

21. How much does private medical insurance cost in the UK?

The cost varies hugely. A basic policy for a young, healthy individual could be as little as £30-£40 per month. A comprehensive policy for someone in their 50s or 60s could be £150 per month or more.

Here is an illustrative table of potential monthly costs:

Note: These are estimates only. Your actual quote will depend on your specific circumstances.

22. What factors determine the cost of my premium?

Several key factors influence your premium:

• Age: The older you are, the higher the premium.
• Location: Treatment costs vary across the UK, with central London being the most expensive.
• Level of Cover: More comprehensive cover (e.g., high outpatient limits, mental health) costs more.
• Excess: A higher excess reduces your premium.
• Hospital List: A wider choice of hospitals, especially expensive London ones, increases the cost.
• Medical History & Smoker Status: Your personal health history can impact the price. Smokers pay more.

23. What is an 'excess' on a PMI policy?

An excess is the amount you agree to pay towards the cost of a claim. For example, if your excess is £250 and your treatment costs £3,000, you pay the first £250 and your insurer pays the remaining £2,750. The excess is usually payable once per policy year, per person.

24. How does choosing a higher excess affect my premium?

Opting for a higher excess is one of the most effective ways to lower your monthly premium. By agreeing to contribute more towards a claim, you reduce the insurer's financial risk, and they pass this saving on to you. Excess options typically range from £0 to £1,000.

25. What is a 'co-payment'?

A co-payment is different from an excess. It's a percentage of each claim that you agree to pay. For example, a 10% co-payment on a £5,000 claim would mean you pay £500. This is less common than a standard excess but is another way to manage premiums.

26. What is a 'hospital list' and how does it affect cost?

Insurers group UK private hospitals into bands or lists based on their costs. A basic policy might give you access to a local list of hospitals. A more expensive policy will include national hospitals and, at the top end, premium central London hospitals. Restricting your hospital list is a good way to save money if you don't live near London.

27. What is the 'six-week option' and can it save me money?

The 'six-week option' is a popular way to reduce your premium. If you add this to your policy, it means that if the NHS can provide the inpatient treatment you need within six weeks of it being recommended, you will use the NHS. If the NHS wait is longer than six weeks, your private cover kicks in. This effectively makes your PMI a safeguard against long NHS waits.

28. Are there any ways to get discounts on my PMI?

Yes. Besides choosing a higher excess or a reduced hospital list, you can get discounts by adding a partner or family to your policy. Furthermore, at WeCovr, if you purchase a PMI or Life Insurance policy, we offer discounts on other types of cover you might need, such as home or travel insurance.

29. Do premiums increase every year?

Yes, you should expect your premium to rise at renewal each year. This is due to two main factors:

1. Age: You will be a year older, which moves you into a higher risk bracket.
2. Medical Inflation: The cost of medical technology, drugs, and hospital fees rises faster than general inflation. This rate is often between 5% and 10% per year.

30. Can I pay for my PMI monthly or annually?

Yes, insurers offer both options. Paying annually is often slightly cheaper, as some insurers charge a small fee for spreading the cost monthly.

Part 4: Getting a Policy & Underwriting

Underwriting is how an insurer assesses your medical history to decide the terms of your policy.

31. How do I apply for private medical insurance?

The easiest way is to use a broker. They will ask you about your needs, budget, and medical history, then gather quotes on your behalf and explain the options. The alternative is to approach each insurer directly, which is more time-consuming.

32. What is 'underwriting'?

Underwriting is the process an insurer uses to determine what it will and will not cover, based on your medical history. For PMI, it's primarily focused on identifying any pre-existing conditions that will need to be excluded.

33. What is 'Moratorium' (MORI) underwriting?

This is the most common type of underwriting. You don't have to declare your full medical history upfront. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the last 5 years.

However, if you then go for a set period (usually 2 years) without any further symptoms, treatment, or advice for that condition after your policy has started, the exclusion may be lifted, and it could be covered in the future.

34. What is 'Full Medical Underwriting' (FMU)?

With FMU, you complete a detailed health questionnaire when you apply, declaring your full medical history. The insurer then assesses this and tells you exactly what is excluded from day one. These exclusions are usually permanent. The benefit is certainty—you know precisely where you stand from the start.

35. Which type of underwriting is right for me?

• Moratorium is quicker and less intrusive. It's a good choice if you have a clean bill of health or can't remember all the details of your medical history.
• Full Medical Underwriting is better if you have had past health issues and want certainty about what is covered before you buy. It can sometimes lead to better terms if the condition was minor.

An expert broker can help you decide which is more suitable for you.

36. Do I need a medical exam to get PMI?

No, you almost never need to have a medical examination to take out a private health insurance policy in the UK. The underwriting is based on the information you provide on your application form.

Part 5: Making a Claim

You have a policy and need to use it. What's the process?

37. How do I make a claim on my health insurance?

The process is straightforward:

1. Visit your GP: You experience a symptom and see your NHS GP (or a private GP if your policy includes it).
2. Get a Referral: Your GP suspects an issue that needs further investigation and gives you an 'open referral' to a specialist.
3. Contact Your Insurer: You call your insurer's claims line with your referral details.
4. Get Pre-authorisation: The insurer checks your cover, confirms the condition is eligible for a claim, and provides you with a pre-authorisation number. They will also give you a list of approved specialists and hospitals.
5. Book Your Appointment: You book your consultation or treatment with the authorised specialist. Your insurer usually settles the bill directly with the hospital.

38. Do I always need a GP referral to use my PMI?

Generally, yes. A GP referral is the standard pathway to start a claim. It ensures that the use of specialist care is medically appropriate. Some modern policies offer 'self-referral' for certain conditions like physiotherapy or mental health support, and many now include a virtual GP service you can use for a referral.

39. What is 'pre-authorisation'?

Pre-authorisation is the most important step in the claims process. It is your insurer's official confirmation that your proposed consultation or treatment is covered under your policy. Never proceed with any private treatment without getting pre-authorisation first, or you risk having to pay the bill yourself.

40. Can my insurer refuse a claim?

Yes, an insurer can refuse a claim if:

• The condition is a policy exclusion (e.g., a chronic or pre-existing condition).
• You haven't obtained pre-authorisation.
• You have reached the financial or session limit for that benefit on your policy.
• You failed to disclose relevant information when you took out the policy.

41. What happens if my treatment costs more than my policy limit?

If your policy has an annual financial limit on a particular benefit (e.g., £1,000 for outpatient cover) and your treatment costs exceed this, you will be responsible for paying the difference. This is why it's important to choose your cover levels carefully.

Part 6: Managing, Switching, and Cancelling Your Policy

Your policy is not set in stone. Here's how to manage it over time.

42. Can I add my partner or children to my policy?

Yes, you can usually add close family members to your policy, either when you first take it out or at your annual renewal. This often results in a small discount compared to buying separate individual policies.

43. Can I switch my private medical insurance provider?

Yes, you are free to switch providers at your renewal date, especially if you receive a large premium increase. A broker can help you compare the market to see if you can get a better deal elsewhere.

44. What happens to my underwriting if I switch?

When switching, it's crucial to protect the cover you've already built up. You can do this by switching on a 'Continued Medical Exclusions' (CME) or 'Continued Personal Medical Exclusions' (CPME) basis. This means your new insurer agrees to match the underwriting terms of your old policy, so you won't have to start a new moratorium period for conditions that were already covered.

45. How do I cancel my private health insurance policy?

You can cancel your policy at any time by contacting your insurer. If you cancel mid-term and have not made a claim, you may be entitled to a pro-rata refund. If you have claimed, you will likely have to pay the full year's premium.

46. Is there a 'cooling-off' period?

Yes. By law, you have a 14-day cooling-off period from the date you receive your policy documents. If you change your mind within this time, you can cancel and receive a full refund, provided you have not made a claim.

47. What should I do if my circumstances change (e.g., move house, change job)?

You should inform your insurer or broker of any significant life changes. Moving house could affect your premium if you move to a more or less expensive area for healthcare. Changing jobs is important if you are moving to or from a role that includes company health insurance.

Part 7: Company Policies & Other Questions

Finally, let's look at employer-provided PMI and the extra perks that come with modern policies.

48. What is company private medical insurance?

This is a group policy taken out by an employer for its staff. It's a highly valued employee benefit that can help with recruitment and retention. Cover can be offered to all staff or just to certain management levels.

49. Is company health insurance a taxable benefit-in-kind?

Yes. If your employer pays the premium for your private health cover, HMRC considers this a 'benefit-in-kind'. This means you will have to pay income tax on the value of the premium. Your employer will report this to HMRC on a P11D form.

50. What extra wellness benefits come with modern PMI policies?

Insurers are increasingly focused on prevention and wellbeing. Many policies now include a range of valuable perks at no extra cost, such as:

• Virtual GP services: 24/7 access to a GP via phone or video call.
• Health and wellness apps: Tools to help you track fitness, nutrition, and mental wellbeing.
• Discounts: Money off gym memberships, fitness trackers, and healthy food.
• Second opinion services: Access to a world-leading expert to review your diagnosis.

As a WeCovr client, you also get complimentary access to our AI-powered nutrition app, CalorieHero, to help you stay on top of your health goals.

Ready to Find the Right Cover?

Feeling more confident about private medical insurance? The next step is to find a policy that fits you perfectly.

At WeCovr, our expert advisors provide free, impartial advice to help you compare the UK's leading insurers. We'll demystify the options and tailor a policy to your exact needs and budget.

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