
As an FCA-authorised expert with over 800,000 policies of various kinds issued, WeCovr understands that navigating the world of private medical insurance in the UK can be confusing. Many people use the terms "health insurance" and "health cash plan" interchangeably, but they are fundamentally different products designed for very different needs.
This comprehensive guide will demystify these two popular forms of health cover. We’ll break down exactly what each one does, explore the costs and benefits, and provide real-life examples to help you decide which, if either, is the right choice for you and your family.
Private Medical Insurance, often called PMI or private health cover, is designed to be your safety net for significant, unforeseen medical issues. Its primary purpose is to cover the costs of private treatment for acute conditions that arise after you take out the policy.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of conditions like a joint injury requiring surgery, cataracts, or a hernia.
The Critical Distinction: Acute vs. Chronic and Pre-existing Conditions
This is the single most important concept to grasp about private medical insurance in the UK:
Standard PMI policies are designed for acute conditions only. They do not cover pre-existing conditions or chronic conditions.
PMI gives you peace of mind that if you are diagnosed with a new, curable condition, you can bypass NHS waiting lists and receive prompt, private care in a comfortable setting.
While policies vary, a comprehensive PMI plan usually covers:
Many providers also offer optional add-ons for an extra premium, such as dental and optical cover, though these are often limited.
Besides chronic and pre-existing conditions, PMI generally excludes:
A Health Cash Plan is a completely different beast. It is not insurance against a major medical catastrophe; instead, it's a simple, affordable way to manage and claim back money on your routine healthcare expenses.
Think of it as a health budgeting tool. You pay a small monthly premium, and in return, you can claim back a set amount of cash each year for specific, everyday treatments.
The process is straightforward:
For example, if your plan offers £150 for dental cover and your check-up and filling cost £110, you can claim the full £110 back. You would still have £40 remaining in your dental pot for that year.
Cash plans focus on routine, out-of-pocket expenses. Coverage is split into categories, each with its own annual limit.
To make the distinction crystal clear, let's compare the two products side-by-side.
| Feature | Private Medical Insurance (PMI) | Health Cash Plan |
|---|---|---|
| Primary Purpose | Covers high-cost, unexpected medical events and surgery for acute conditions. | Helps budget for and reclaim costs of routine, everyday healthcare. |
| Coverage Scope | In-depth cover for major treatments (e.g., surgery, cancer care). | Cashback for predictable costs (e.g., dental, optical, therapies). |
| Cost | Higher premiums (£40 - £200+ per month), based on age, health, and cover level. | Lower premiums (£10 - £40 per month), often tiered by benefit level. |
| Main Benefit | Avoids NHS waiting lists for eligible treatments and provides choice over specialists and hospitals. | Makes routine healthcare more affordable and encourages preventative care. |
| Claim Process | Pre-authorisation required. The insurer pays the hospital/specialist directly. | You pay upfront, then claim the cash back by submitting a receipt. |
| Pre-existing Conditions | Not covered. | Often covered after a qualifying period, or sometimes immediately. |
| Financial Limit | High annual limits, often £1 million or more. Some are unlimited. | Modest annual limits per benefit category (e.g., £150 for dental). |
Let's apply this to some common situations to see how each product performs.
Ahmed, a 45-year-old active man, injures his knee playing football. His GP refers him to an NHS specialist, but the waiting list for an initial consultation is four months, and the wait for potential surgery is over a year.
Conclusion: For serious, acute conditions requiring specialist treatment or surgery, PMI is the essential product.
The Taylor family consists of two parents and two children. They are all in good health but have regular check-ups.
Annual Costs without a Plan:
With a Health Cash Plan: The Taylors pay £25 a month (£300 per year) for a family cash plan.
Conclusion: For predictable, routine expenses, a Health Cash Plan is a highly effective budgeting tool.
For complete peace of mind, many people choose to have both.
This combination ensures you are covered for almost every eventuality, from a dental filling to major heart surgery, without facing significant out-of-pocket expenses.
The cost of these two products is determined by very different factors.
PMI pricing is complex and personalised. An expert PMI broker like WeCovr can help you find the best value by navigating these factors:
Illustrative Monthly PMI Premiums (2025)
These are for guidance only. Your quote will be specific to your circumstances.
| Age | Basic Cover (Mid-level Excess) | Comprehensive Cover (Low Excess) |
|---|---|---|
| 30 | £40 - £55 | £70 - £90 |
| 45 | £60 - £80 | £110 - £140 |
| 60 | £100 - £140 | £180 - £250+ |
Cash plan pricing is much simpler. It's usually based on pre-set levels of cover, and your age or medical history has little to no impact.
Illustrative Monthly Health Cash Plan Premiums (2025)
| Level | Monthly Cost (Individual) | Typical Annual Limits |
|---|---|---|
| Level 1 | £10 | £75 Dental, £75 Optical, £100 Therapies |
| Level 2 | £20 | £150 Dental, £150 Optical, £250 Therapies |
| Level 3 | £35 | £250 Dental, £250 Optical, £400 Therapies |
| Level 4 | £45 | £350 Dental, £350 Optical, £500+ Therapies |
Choosing the right cover can feel overwhelming. At WeCovr, we not only simplify the process but also add significant value. As an independent and FCA-authorised broker, we compare policies from the UK's leading insurers to find the one that best fits your needs and budget, at no extra cost to you.
We are proud of our high customer satisfaction ratings, which reflect our commitment to clear, honest advice. When you choose a policy through us, you also gain access to exclusive benefits:
Ask yourself these key questions:
What is my main worry? Is it the risk of a long NHS wait for surgery, or is it the rising cost of dental and optical care?
What is my monthly budget? If you have a limited budget but want some cover, a cash plan is a great starting point. If you can afford more and want comprehensive protection, PMI is the priority.
What is my health and lifestyle like? If you are very active and concerned about potential injuries, or have a family history of specific acute conditions, PMI might offer greater peace of mind.
Do I use routine services regularly? If you wear glasses, visit the dentist twice a year, and see a physio, a cash plan will almost certainly save you money.
Here are answers to some of the most common questions we receive.
1. Can I get private medical insurance if I have a pre-existing condition? Yes, you can still get a policy, but it will not cover your pre-existing conditions. Insurers use two main methods: "Moratorium underwriting" automatically excludes anything you've had symptoms or treatment for in the past 5 years. "Full medical underwriting" requires you to declare your medical history, and the insurer will list specific exclusions on your policy from the start.
2. Do I still need the NHS if I have private medical insurance? Absolutely. The NHS remains essential for everyone. PMI does not cover emergencies (like a heart attack or car accident), management of chronic conditions (like diabetes), or routine GP services. PMI and the NHS work in parallel; one does not replace the other.
3. Is a health cash plan worth the money? A health cash plan is worth it if you are disciplined enough to use the benefits. Before buying, add up your typical annual spending on dental, optical, and therapy treatments. If this amount is greater than the annual cost of the plan, it represents excellent value and will save you money.
4. How does an 'excess' work with private medical insurance? An excess is a fixed amount you agree to pay towards the cost of a claim each policy year. For example, if you have a £250 excess and your surgery costs £8,000, you would pay the first £250, and your insurer would pay the remaining £7,750. Choosing a higher excess is a popular way to make your monthly premium more affordable.
Deciding between private medical insurance and a health cash plan comes down to your priorities, budget, and what gives you the most peace of mind. One protects against the large, unexpected shocks, while the other helps you manage the small, predictable ones.
Ready to explore your options and find the right protection for you and your family?
The expert team at WeCovr is here to help. We provide free, no-obligation quotes and impartial advice to help you compare the UK's best PMI providers.






