TL;DR
At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we know private medical insurance in the UK can seem complex. This glossary decodes the jargon, making it simple for you to understand your health cover options and find the right policy for your needs. Your essential guide to understanding PMI terminology and jargon Private Medical Insurance (PMI) is designed to give you peace of mind and swift access to high-quality medical care when you need it most.
Key takeaways
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, appendicitis, or a broken bone. PMI is designed for these situations.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, requires palliative care, has no known cure, or is likely to recur. Examples include diabetes, asthma, high blood pressure, and arthritis. These are not covered by standard PMI policies.
- Acute Condition: As defined above, a short-term illness or injury that is curable with treatment. The cornerstone of what PMI covers.
- Add-on: Optional benefits you can add to a core policy to enhance your cover, such as dental, optical, or comprehensive out-patient cover.
- Benefit Limit: The maximum amount your insurer will pay out for a specific treatment, type of cover (e.g., out-patient), or in a policy year. Limits can be per condition, per year, or unlimited.
At WeCovr, an FCA-authorised broker that has helped arrange over 900,000 policies, we know private medical insurance in the UK can seem complex. This glossary decodes the jargon, making it simple for you to understand your health cover options and find the right policy for your needs.
Your essential guide to understanding PMI terminology and jargon
Private Medical Insurance (PMI) is designed to give you peace of mind and swift access to high-quality medical care when you need it most. However, the language used in policy documents can often feel like a barrier. From 'moratoriums' to 'excess' and 'out-patient limits', understanding these terms is crucial to selecting the right cover.
This comprehensive guide will walk you through every key term, concept, and acronym you're likely to encounter. We'll demystify the jargon, provide real-world examples, and empower you to make an informed decision about your health.
The Core Concepts: Understanding the PMI Landscape
Before diving into the A-Z glossary, let's establish the fundamental principles of how private health cover works in the UK.
What is Private Medical Insurance (PMI)?
Private Medical Insurance, also known as private health cover, is an insurance policy that covers the cost of private medical treatment for eligible conditions. It works alongside the NHS, offering you a choice in your healthcare journey.
The primary benefit is speed of access. With the NHS facing significant pressures—NHS England data from early 2025 shows millions on waiting lists for consultant-led elective care—PMI can help you bypass these queues for eligible treatments. This means faster diagnosis, quicker treatment, and a greater choice over where and when you are treated.
Acute vs. Chronic Conditions: The Golden Rule of PMI
This is the single most important concept to understand. Standard UK private medical insurance is designed to cover acute conditions, not chronic conditions.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a hernia, cataracts, appendicitis, or a broken bone. PMI is designed for these situations.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, requires palliative care, has no known cure, or is likely to recur. Examples include diabetes, asthma, high blood pressure, and arthritis. These are not covered by standard PMI policies.
Crucial Point: PMI also does not typically cover pre-existing conditions—any illness or injury you had before your policy start date. We'll explore this further in the 'Underwriting' section.
In-patient, Day-patient, and Out-patient Treatment Explained
Your PMI policy will specify which types of treatment are covered. Understanding the difference is key to knowing what your plan includes.
| Treatment Type | Description | Real-Life Example |
|---|---|---|
| In-patient | You are admitted to a hospital and occupy a bed overnight or longer for treatment. | A hip replacement surgery requiring a multi-day hospital stay. |
| Day-patient | You are admitted to a hospital or clinic for a planned procedure but do not stay overnight. | A cataract removal surgery where you go home the same day. |
| Out-patient | You visit a hospital or clinic for a consultation, diagnosis, or treatment without being formally admitted. | Seeing a specialist consultant about back pain, or having an MRI scan. |
Almost all PMI policies cover in-patient and day-patient treatment as standard. Out-patient cover is often an optional add-on that can significantly affect your premium.
Your Policy A to Z: Key Terminology Explained
Here is your alphabetical guide to the most common terms you'll find in your private medical insurance documents.
A
- Acute Condition: As defined above, a short-term illness or injury that is curable with treatment. The cornerstone of what PMI covers.
- Add-on: Optional benefits you can add to a core policy to enhance your cover, such as dental, optical, or comprehensive out-patient cover.
B
- Benefit Limit: The maximum amount your insurer will pay out for a specific treatment, type of cover (e.g., out-patient), or in a policy year. Limits can be per condition, per year, or unlimited.
C
- Claim: A request you make to your insurer to pay for your diagnosis or treatment under the terms of your policy.
- Chronic Condition: As defined above, a long-term condition that cannot be cured. These are standard exclusions on PMI policies.
- Comprehensive Cover: The highest level of private health cover, typically including extensive in-patient, day-patient, and out-patient benefits, along with therapies and other add-ons.
- Consultant: A senior hospital-based doctor who is a specialist in a particular field of medicine. A GP referral is usually required to see one.
- Cooling-Off Period: A statutory period, typically 14 days after your policy starts, during which you can cancel your policy and receive a full refund, provided you haven't made a claim.
D
- Day-patient: Treatment received at a hospital or clinic where you are admitted but do not stay overnight.
- Deferment Period: See 'Moratorium Period'.
- Dependant: A person, usually a partner or child, who is added to your main policy.
E
- Excess (or Deductible): A fixed amount you agree to pay towards the cost of a claim each policy year. For example, if your excess is £250 and your eligible claim is £2,000, you pay the first £250 and the insurer pays the remaining £1,750. A higher excess typically results in a lower premium.
- Exclusions: Specific conditions, treatments, or circumstances that are not covered by your policy. Standard exclusions always include pre-existing conditions, chronic conditions, cosmetic surgery, and emergency care.
F
- Financial Conduct Authority (FCA): The UK's financial services regulator. All reputable insurers and brokers, including WeCovr, must be authorised and regulated by the FCA.
- Full Medical Underwriting (FMU): A type of underwriting where you provide a detailed medical history when you apply. The insurer assesses this information and explicitly states any conditions that will be excluded from your cover from day one.
G
- GP Referral: A letter from your GP to a specialist consultant recommending you for further investigation or treatment. Most PMI policies require a GP referral before they will authorise a claim.
- Guided Consultant List (or Guided Option): Some policies offer a lower premium in exchange for you agreeing to choose a specialist from a shorter, insurer-approved list. This gives you less choice than a policy with an unrestricted list.
H
- Hospital List: A list of private hospitals and facilities where your policy will cover you for treatment. Insurers often have several tiers of hospital lists; a more extensive list (e.g., including central London hospitals) will usually mean a higher premium.
I
- In-patient: Treatment that requires you to be admitted to a hospital bed for one or more nights.
- Insurance Premium Tax (IPT): A tax charged on all general insurance premiums in the UK, including PMI. The current standard rate is 12% (as of 2025) and is included in the premium you are quoted.
M
- Moratorium Underwriting: The most common type of underwriting in the UK. You do not declare your full medical history upfront. Instead, the policy automatically excludes any condition you've had symptoms, treatment, or advice for in the 5 years before the policy start date. These exclusions can be lifted if you remain symptom-free and treatment-free for that condition for a continuous 2-year period after your policy begins.
- Moratorium Period: The continuous 2-year 'symptom-free' period required under moratorium underwriting before a pre-existing condition may become eligible for cover.
N
- No-Claims Discount (NCD): A discount on your premium that increases each year you don't make a claim, up to a maximum level. Making a claim will typically reduce or remove your NCD.
O
- Open Referral: A type of GP referral where your GP recommends you see a type of specialist (e.g., a cardiologist) rather than a named individual. This gives your insurer more flexibility to guide you to a consultant within their network.
- Out-patient: Medical care you receive at a hospital or clinic without being admitted, such as consultations, diagnostic tests, and scans. Cover for this is often limited or sold as an add-on.
P
- Policy Year: The 12-month period that your insurance contract covers.
- Pre-authorisation: The process of getting approval from your insurer before you undergo any tests or treatment. This is a crucial step in the claims process to ensure your costs will be covered.
- Pre-existing Condition: Any illness, disease, or injury for which you have experienced symptoms, received medication, or sought advice from a medical professional before your policy's start date. These are not covered by new PMI policies.
- Premium: The regular amount you pay (usually monthly or annually) to the insurer to keep your policy active.
- PMI Broker: An unbiased intermediary, like WeCovr, who can help you compare policies from different insurers to find the best private health cover for your needs and budget, at no extra cost to you.
S
- Six Week Option: An add-on that can reduce your premium. With this option, if the NHS can provide the in-patient treatment you need within six weeks of it being recommended, you agree to use the NHS. If the NHS waiting list is longer than six weeks, your PMI policy will cover the treatment privately.
U
- Underwriting: The process an insurer uses to assess your health and medical history to determine the terms of your policy, including what will be excluded. The two main types are Moratorium and Full Medical Underwriting.
Understanding Your Policy Options and Levels
Now that you know the language, let's look at how these elements combine to form your policy.
Choosing Your Level of Cover: Core, Mid-Range, and Comprehensive
Most insurers offer tiered policies to suit different budgets and needs.
| Level of Cover | What It Typically Includes | Best For |
|---|---|---|
| Core / Basic | In-patient and day-patient treatment, cancer cover. Limited or no out-patient cover. | Those on a budget who want peace of mind for major medical procedures, using the NHS for initial diagnostics. |
| Mid-Range | Everything in Core, plus a set limit for out-patient consultations and diagnostics (e.g., £1,000 per year). | A good balance of cover and cost, providing help with diagnosis as well as treatment. |
| Comprehensive | Everything in Mid-Range, but with full or very high limits for out-patient care, plus therapies (physio, osteopathy), and often mental health support. | Those who want the most complete cover available, with minimal need to rely on the NHS for any stage of the process. |
Underwriting Explained: Moratorium vs. Full Medical Underwriting (FMU)
This is one of the most significant choices you'll make when taking out a policy.
| Feature | Moratorium Underwriting | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and simple. No medical questionnaire. | Slower. Requires you to complete a full medical history declaration. |
| Exclusions | Blanket exclusion for any condition you've had in the last 5 years. | Specific, named exclusions based on your declaration. Certainty from day one. |
| Lifting Exclusions | A pre-existing condition may become eligible for cover after a 2-year continuous symptom-free period. | Exclusions are usually permanent unless you apply for a review. |
| Claims Process | Can be slower, as the insurer may need to investigate your medical history at the point of a claim to check if it's pre-existing. | Generally faster, as the exclusions are already clearly defined. |
| Best For | People who want a quick start and have a clean bill of health over the last 5 years. | People with a complex medical history who want absolute clarity on what is and isn't covered from the outset. |
For a detailed discussion on which might be right for you, see our guide on Moratorium vs. Full Medical Underwriting.
The Impact of Excess on Your Premium
Choosing an excess is a balancing act. A higher excess means you'll pay more out-of-pocket if you claim, but your monthly premium will be lower.
Example:
- Policy with £0 excess (illustrative): Premium might be £80/month.
- Policy with £250 excess (illustrative): Premium might be £65/month.
- Policy with £500 excess (illustrative): Premium might be £55/month.
Consider how much you could comfortably afford to pay in the event of a claim. For many, a small excess of £100-£250 offers a good compromise between premium savings and out-of-pocket costs. (illustrative estimate)
Beyond the Basics: Added Value and Wellness Benefits
The best private medical insurance UK providers now offer more than just cover for illness. They actively promote health and wellbeing.
Digital GP Services and Mental Health Support
Many policies now include 24/7 access to a digital GP service. This allows you to have a video consultation with a doctor at your convenience, often within hours, and get prescriptions or referrals. This is a hugely valuable benefit for busy individuals and families.
Mental health support is also increasingly a focus. Policies may include access to talking therapies, counselling sessions, or dedicated mental health helplines without affecting your main policy limits or your No-Claims Discount.
Wellness Programmes and Our Exclusive Benefits
Insurers often provide discounts on gym memberships, fitness trackers, and health screenings. They want to help you stay healthy, as it reduces the likelihood of claims.
At WeCovr, we enhance this further. When you arrange your PMI policy with us, you get complimentary access to CalorieHero, our exclusive AI-powered calorie and nutrition tracking app, helping you maintain a healthy diet and lifestyle. Furthermore, clients who purchase PMI or Life Insurance through us are eligible for discounts on other types of cover, helping you protect all aspects of your life for less. Our commitment to client value is one reason we enjoy consistently high customer satisfaction ratings.
How WeCovr Makes Choosing PMI Simple
Navigating the market and comparing dozens of policies, providers, and options can be overwhelming. This is where an expert PMI broker like WeCovr comes in.
As an independent, FCA-authorised broker, our role is to act on your behalf. We are not tied to any single insurer.
- We Listen: We take the time to understand your unique needs, health concerns, and budget.
- We Compare: We use our expertise and market knowledge to compare policies from the UK's leading insurers, including Aviva, Bupa, AXA Health, and Vitality.
- We Explain: We translate the jargon and clearly explain the pros and cons of each option, ensuring you understand exactly what you're buying.
- We Support: Our service doesn't end when you buy. We're here to help with policy queries and offer support for the lifetime of your cover.
Our advice comes at no cost to you. We are paid a commission by the insurer you choose, which doesn't affect the premium you pay.
Frequently Asked Questions (FAQ)
1. Does private medical insurance cover pre-existing conditions?
No, standard private medical insurance in the UK is designed for new, acute conditions that arise after your policy begins. All policies exclude pre-existing conditions you had before taking out cover. Some may become eligible for cover under a moratorium policy after a two-year symptom-free period, but this is not guaranteed.
2. Is private medical insurance worth it in the UK?
For many, the value lies in choice, speed, and peace of mind. It allows you to bypass potential NHS waiting lists for eligible treatments, choose your specialist and hospital, and often gain access to a private room. With NHS waiting lists remaining a significant challenge (according to NHS England data, 2025), PMI offers a valuable alternative for prompt medical care.
3. How much does private health insurance cost?
The cost of a policy varies widely based on several factors: your age, location, the level of cover you choose (especially out-patient limits), your chosen hospital list, and your excess. A basic policy for a young, healthy individual might start from £30-£40 per month, while a comprehensive policy for an older individual in London could be several hundred pounds per month.
4. What is the main difference between moratorium and full medical underwriting?
The key difference is how your medical history is handled. With Moratorium underwriting, you don't declare your history upfront, but anything you've had in the last 5 years is automatically excluded. With Full Medical Underwriting (FMU), you declare your full history, and the insurer gives you a clear list of permanent exclusions from the start. Moratorium is faster to set up; FMU provides more certainty.
Ready to Explore Your Options?
Understanding PMI is the first step. The next is finding a policy that fits you perfectly. Let WeCovr do the hard work for you. Our expert advisors can provide a free, no-obligation comparison of the UK's leading insurers, tailored to your personal needs.
Get your free, personalised quote today and take control of your health.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.
