As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr provides expert guidance on private medical insurance in the UK. This article explores how salary sacrifice schemes can make comprehensive health cover more affordable for you and your employees.
WeCovr explains how salary sacrifice works with private health insurance
Salary sacrifice for private medical insurance (PMI) is a popular workplace benefit in the UK. It allows employees to access private healthcare at a potentially lower cost than buying a policy directly. But how does it actually work? Is it a genuine saving, and what are the tax implications?
This comprehensive guide breaks down everything you need to know. We’ll cover the benefits for both employees and employers, explain the tax rules in plain English, and walk you through the potential downsides to help you make an informed decision.
What Exactly is a Salary Sacrifice Scheme?
A salary sacrifice arrangement is a formal agreement between you and your employer. You agree to give up a portion of your gross (pre-tax) salary, and in return, your employer provides you with a non-cash benefit of a similar value.
Think of it like this: instead of your employer paying you £100 in cash, they use that £100 to pay for something else on your behalf, such as pension contributions, a cycle-to-work scheme, or in this case, a private health insurance policy.
Because you are "sacrificing" salary before tax and National Insurance (NI) are calculated, your total taxable income is lower. This is the key to how the scheme generates savings.
How Salary Sacrifice is Applied to Private Medical Insurance
When a company offers PMI through salary sacrifice, the process is straightforward:
- Agreement: You, the employee, agree to a formal change in your employment contract. This change reduces your cash salary by the exact amount of the health insurance premium.
- Payment: Your employer then uses the "sacrificed" portion of your salary to pay the monthly or annual premium for your private medical insurance policy directly to the insurer.
- Savings: You pay less in National Insurance contributions because your official salary is lower. Your employer also saves money on their employer's NI contributions.
- Tax: Private medical insurance is considered a 'Benefit in Kind' (BiK) by HMRC. This means you will still have to pay income tax on the value of the benefit, but the NI savings often make it worthwhile. We'll explore this in detail later.
This arrangement allows companies to offer a highly valued benefit without it necessarily increasing their overall payroll costs. For employees, it provides a convenient and cost-effective way to secure private health cover.
The Financial Benefits for Employees: A Real-Life Example
The main attraction of a salary sacrifice scheme is the potential for financial savings. The saving comes from reduced National Insurance Contributions (NICs).
Let's look at an example.
Scenario:
- Employee: Sarah, a basic rate taxpayer in England.
- Annual Salary: £40,000
- PMI Premium: £80 per month (£960 per year)
Table: Employee Savings with Salary Sacrifice PMI
| Metric | Without Salary Sacrifice | With Salary Sacrifice |
|---|
| Annual Gross Salary | £40,000 | £40,000 |
| Salary Sacrificed for PMI | £0 | £960 |
| Taxable Salary | £40,000 | £39,040 |
| Income Tax Paid (at 20%)* | £5,486 | £5,294 |
| NI Paid (at 8%)** | £2,194.40 | £2,115.20 |
| Net Annual Salary (after tax/NI) | £32,319.60 | £31,630.80 |
| PMI Premium Paid from Net Pay | £960 | £0 (paid by employer) |
| Final Take-Home after PMI | £31,359.60 | £31,630.80 |
| Benefit in Kind (BiK) Tax (20% of £960) | £0 | £192 |
| True Final Take-Home Position | £31,359.60 | £31,438.80 (£31,630.80 - £192) |
| Annual Saving | - | £79.20 |
Based on 2024/25 personal allowance of £12,570. Taxable income is Salary - Allowance.
*Based on 2024/25 Class 1 NI rates of 8% on earnings between £12,570 and £50,270.
Explanation:
By sacrificing £960 of her salary, Sarah reduces her NI contributions by £76.80 for the year. While she has to pay £192 in income tax on the benefit, her overall position is still better. The employer pays the premium, and the net effect is a saving for Sarah. The convenience of having it all managed by her employer is an added bonus.
For higher and additional rate taxpayers, the NI savings can be less significant due to the lower 2% rate on earnings above £50,270, but the scheme still offers a simple, managed way to get covered.
The Financial Benefits for Employers
It's not just employees who benefit. Employers also make savings on their National Insurance contributions.
Using our example of Sarah:
- PMI Premium: £960 per year
- Employer's NI Rate: 13.8% (on earnings above the secondary threshold)
The employer's NI saving is calculated on the sacrificed amount:
£960 x 13.8% = £132.48 per year
For every employee who joins the scheme, the company saves over £130 per year. Across a large workforce, these savings can be substantial. This money can be reinvested into the business, used to enhance the benefits package further, or even be shared with employees to make the scheme more attractive.
Understanding the 'Benefit in Kind' (BiK) Tax
This is the most misunderstood part of salary sacrifice for PMI.
What is a Benefit in Kind?
A Benefit in Kind (BiK) is any non-cash benefit that an employee receives which has a monetary value. Company cars and private health insurance are common examples. HMRC sees these as part of your overall earnings, so they are subject to income tax.
How is the Tax Handled?
- P11D Form: Your employer will declare the value of your health insurance benefit on a P11D form at the end of the tax year. The value is simply the total cost of the premium they paid for you.
- Tax Code Adjustment: HMRC will then adjust your tax code for the following tax year to collect the tax owed. This means you will pay the tax in small increments from your salary each month. You won't receive a separate bill.
Why is it Still Worth It?
Even though you pay income tax on the benefit, you do not pay National Insurance on it. As shown in our example, this NI saving is what makes the scheme financially advantageous.
Table: Net Cost of PMI - Salary Sacrifice vs. Personal Policy
| Method | Gross Cost of Policy | NI Saving | Income Tax Paid on Benefit | Effective Annual Cost to You |
|---|
| Personal Policy (paid from net salary) | £960 | £0 | £0 | £960 |
| Salary Sacrifice (basic rate taxpayer) | £960 | - £76.80 | + £192 | £883.20 |
This table clearly shows that despite the BiK tax, the net cost to the employee via salary sacrifice is lower than buying an identical policy with post-tax income.
Important Note: What UK Private Medical Insurance Covers
It is crucial to understand the purpose of private medical insurance in the UK. It is designed to provide quick 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 (e.g., joint pain needing a replacement, cataracts, hernias, most cancers).
Standard UK PMI policies, whether personal or through a business, do not cover:
- Pre-existing conditions: Any medical issue you had before your policy began.
- Chronic conditions: Long-term illnesses that cannot be cured, only managed (e.g., diabetes, asthma, high blood pressure).
While PMI doesn't cover the long-term management of chronic conditions, it can cover acute flare-ups. Always check the policy details carefully. As an expert PMI broker, WeCovr can help you and your employer understand the specific terms of any policy.
Setting Up a Salary Sacrifice Health Insurance Scheme
For Employers:
- Consult an Expert: Talk to a specialist broker like WeCovr. We can survey the market to find the best PMI provider that suits your budget and your employees' needs.
- Consult Employees: Gauge interest in the scheme. Explain the benefits, the BiK tax implications, and the impact on their contract.
- Amend Contracts: You must have a formal, written agreement with each participating employee to vary their terms and conditions of employment, reflecting the lower cash salary and the new non-cash benefit.
- Communicate Clearly: Provide clear documentation explaining how the scheme works, how to make a claim, and what happens if they leave the company.
For Employees:
- Understand the Offer: Read all the information from your employer carefully. Pay close attention to the policy details, the cost, and the tax implications.
- Consider the Downsides: Think about the impact of a lower official salary (we cover this next).
- Sign the Agreement: If you're happy to proceed, you'll sign a new contractual agreement with your employer.
Potential Downsides and Important Considerations
While attractive, salary sacrifice isn't without its drawbacks. You must consider the following:
- Lower 'Headline' Salary: Your official gross salary is reduced. This can affect:
- Mortgage Applications: Lenders often calculate affordability based on your basic salary. Some are familiar with salary sacrifice, but others may not be.
- Death-in-Service Benefits: If these are calculated as a multiple of your salary, the payout could be lower.
- Future Salary Increases: If pay rises are based on a percentage of your salary, the cash increase might be slightly smaller.
- Statutory Payments: Payments like Statutory Maternity Pay (SMP), Statutory Paternity Pay (SPP), and Statutory Sick Pay (SSP) are calculated based on your average earnings. A lower salary could lead to lower statutory payments. Many employers will have a policy to top these up to the pre-sacrifice level, but you should always check.
- What Happens if You Leave Your Job? Your health cover is tied to your employment. If you leave, the cover will cease. You may be able to continue the policy on a personal basis, but you would take on the full cost, and your pre-existing conditions from that point would not be covered if you switched to a new provider.
- Minimum Wage Rules: Your cash salary cannot fall below the National Minimum Wage or National Living Wage after the sacrifice.
How WeCovr Can Help You and Your Business
Navigating the world of company health insurance can be complex. At WeCovr, we simplify the process.
- Expert, Impartial Advice: As an FCA-authorised broker, we provide unbiased advice. We're not tied to any single insurer.
- Whole-of-Market Comparison: We compare policies from all the leading UK PMI providers, including Bupa, AXA Health, Aviva, and Vitality, to find the perfect fit for your company's needs and budget.
- No Cost to You: Our service is free for our clients. We receive a commission from the insurer you choose, which doesn't affect the price you pay.
- High Customer Satisfaction: We pride ourselves on our service, helping thousands of individuals and businesses make better decisions about their health and wellbeing.
Furthermore, WeCovr clients gain complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping you stay on top of your health goals. We also offer discounts on other types of insurance, such as life or income protection, when you arrange your PMI through us.
A Holistic Approach to Health and Wellbeing
Private medical insurance is a powerful tool for reactive healthcare, giving you peace of mind and fast access to treatment when you need it. But a truly healthy lifestyle is also about proactive, everyday choices.
- Nutrition: A balanced diet rich in fruits, vegetables, lean protein, and whole grains is the foundation of good health. Using an app like CalorieHero can help you understand your eating habits and make healthier choices.
- Sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep is linked to a range of health issues, including a weakened immune system and poor mental health.
- Activity: The NHS recommends at least 150 minutes of moderate-intensity activity a week. This could be brisk walking, cycling, or swimming. Find an activity you enjoy to make it a sustainable habit.
- Mental Health: Don't neglect your mental wellbeing. Many PMI policies now include access to mental health support, such as counselling sessions or digital therapy apps.
Combining a robust private medical insurance policy with healthy daily habits is the ultimate strategy for long-term health and wellbeing.
Do I have to pay tax on salary sacrifice health insurance?
Yes, you have to pay income tax on the value of the health insurance benefit. Private medical insurance is considered a 'Benefit in Kind' (BiK) by HMRC. Your employer will report this on a P11D form, and your tax code will be adjusted to collect the tax owed. However, you do not pay National Insurance on the benefit, which is how the scheme generates savings for you.
Can I add my family to my company's salary sacrifice PMI scheme?
Generally, yes. Most company health insurance schemes allow you to add your partner and/or children to the policy. The additional premium for your family members would also be taken via salary sacrifice, increasing the amount you sacrifice each month but also maximising your potential National Insurance savings. The entire premium, including the portion for your family, will be treated as a taxable Benefit in Kind.
What happens to my health insurance if I leave my job?
Your private medical insurance cover is tied to your employment and will end when you leave the company. However, most insurers offer a 'continuation' option. This allows you to switch the policy to a personal plan without needing new medical underwriting. This is a significant benefit, as it means any conditions that developed while you were covered by the company scheme will continue to be covered. You will, however, be responsible for paying the full premium yourself.
Is salary sacrifice for PMI better than a traditional 'benefit' policy?
It depends on the employer's offer. In a traditional scheme, the employer pays the premium and you pay the Benefit in Kind tax; it's a pure perk. In a salary sacrifice scheme, you effectively pay the premium but do so from your pre-tax salary, saving on National Insurance. A salary sacrifice scheme is often more cost-effective for an employer, making them more likely to offer it. For the employee, it's cheaper than buying a personal policy but not as good as having an employer pay for it entirely.
Ready to explore how private medical insurance can benefit you or your company? Get a free, no-obligation quote from WeCovr today and let our experts find the best cover for your needs.