
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 800,000 policies of various kinds, have created this definitive guide to answer all your questions about private health cover.
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.
Let's start with the basics. What is private health insurance, and how does it fit into the UK's healthcare landscape?
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.
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.
People in the UK choose PMI for several key reasons:
They are very different products:
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.
The UK market is dominated by a few major players, each with different strengths and policy options. The main providers include:
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.
Using an FCA-authorised PMI broker like WeCovr has significant advantages:
Knowing what is and isn't covered is the most critical part of choosing a policy.
Most standard PMI policies cover the costs associated with treating acute conditions that arise after you take out the policy. This usually includes:
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.
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.
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).
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.
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.
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.
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.
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.
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.
Besides pre-existing and chronic conditions, common exclusions include:
How much does PMI cost, and what can you do to manage the price?
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:
| Age | Basic Cover (High Excess) | Comprehensive Cover (Low Excess) |
|---|---|---|
| 30 | £35 - £50 | £70 - £100 |
| 45 | £55 - £80 | £110 - £160 |
| 60 | £100 - £150 | £200 - £300+ |
Note: These are estimates only. Your actual quote will depend on your specific circumstances.
Several key factors influence your premium:
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.
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.
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.
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.
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.
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.
Yes, you should expect your premium to rise at renewal each year. This is due to two main factors:
Yes, insurers offer both options. Paying annually is often slightly cheaper, as some insurers charge a small fee for spreading the cost monthly.
Underwriting is how an insurer assesses your medical history to decide the terms of your policy.
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.
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.
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.
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.
An expert broker can help you decide which is more suitable for you.
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.
You have a policy and need to use it. What's the process?
The process is straightforward:
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.
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.
Yes, an insurer can refuse a claim if:
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.
Your policy is not set in stone. Here's how to manage it over time.
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.
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.
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.
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.
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.
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.
Finally, let's look at employer-provided PMI and the extra perks that come with modern policies.
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.
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.
Insurers are increasingly focused on prevention and wellbeing. Many policies now include a range of valuable perks at no extra cost, such as:
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.
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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