Private health insurance

What is private health insurance?

What does private health insurance cover?

It normally covers non-routine tests and treatment for acute medical conditions. These are serious, curable, and usually short-term issues that start after your policy begins.

Basic plans usually cover essential treatments, while comprehensive health policies can also include specialist therapies or medicines.

Typically covered:

• Inpatient treatment: surgery, hospital accommodation, and nursing care

• Outpatient consultations, tests and scans

• Specialist therapies (such as physio – often capped)

• Some drugs unavailable on the NHS

• Short-term musculoskeletal conditions (such as back pain)

• Digestive system conditions (such as gastroenteritis)

• Heart and circulatory diseases (such as coronary heart disease)

• Eye and ear conditions (such as an inner-ear infection)

Typically NOT covered:

• Chronic conditions (such as diabetes, asthma, and arthritis)

• Pre-existing conditions (unless agreed when taking out the policy)

• Routine pregnancy care, labour and IVF

• A&E and emergency treatment (NHS only)

• Cosmetic procedures

If your tests lead to a diagnosis of a chronic condition, the initial tests are usually covered by the insurer, but the long-term treatment and ongoing management aren't.

For example, if you developed symptoms of diabetes and your GP referred you to a specialist to diagnose the issue, your policy should cover this. However, if you were then diagnosed with diabetes, any treatment, medication, or check-ups would no longer be covered and would instead pass to the NHS. 

Cancer cover varies by provider

Many take out PMI for cancer cover, but what’s included differs by policy and provider, so always check.

Usually covered: Specialist consultations, diagnostic scans (MRI/CT/PET), surgery, radiotherapy, chemotherapy, and some drugs not funded by the NHS.

Possible limits: Annual or lifetime caps, restricted follow-up monitoring, no experimental drugs, limited palliative or end-of-life care.

Mental health cover also varies

If you're looking for mental health cover, make sure you check your policy, as this also differs by provider and plan.

May include: Counselling, psychiatrist or psychologist sessions, inpatient psychiatric care.

Possible restrictions: Annual session caps, no long-term treatment, no addiction treatment, limits on inpatient days.

Should I get private health insurance?

Private medical insurance is completely optional. Some people value faster treatment and wider choice, while others are happy to just stick with the NHS. So you'll need to weigh up whether the monthly cost is worth it for you.

Here are some key points to consider:

The NHS may be sufficient depending on your needs

Consider self-insuring

Instead of paying an insurer monthly, you could put that money into a top savings account. If you need treatment, dip into your 'insurance fund' and pay it yourself from there. If you don’t need any treatment, you keep the cash.

But it takes time to build savings, and treatment can be costly. For example:

• Carpal tunnel release on one wrist: about £2,000

• Cataract surgery (one eye): about £3,000

• Hip/knee replacement: from £10,000

You could combine self-insuring with a high-excess policy. That way, you pay less for the policy, yet you're covered for the more expensive major procedures. 

Check if you're already covered by your employer

Some employers offer private medical insurance as a perk (though taxable) or a paid option. Firms’ bulk-buying power often means they can negotiate big discounts, so compare it with the cheapest plans that meet your needs.

But beware: If you claim and later leave, you may lose cover for existing conditions or face huge premiums.

Why do you need private health insurance if we have the NHS?

What to look for when picking a PMI policy

If you think private medical insurance is right for you, there are a few choices you need to make when taking out a policy.

1. Underwriting: how the insurer decides what’s covered

How you apply affects whether past conditions are covered and the speed of claiming.

Moratorium underwriting (usually cheapest and quickest to buy)

The insurer won’t ask for your full medical history upfront, so conditions you’ve had in the last five years are usually excluded at first (but may become covered after you’ve been symptom-free for two years on the policy).

Claiming is usually slower, as you’ll often need to prove you haven’t had the condition before if you claim within the first two years (or longer for some conditions). This can mean waiting for a GP to confirm, and sometimes there’s a cost involved.

Full medical underwriting (FMU)

This is the belt-and-braces option where you provide your full medical history via a questionnaire when you take out a policy. The insurer may also ask to contact your GP for more details.

It may seem intrusive, but you’ll know upfront if a pre-existing condition can be covered and what’s excluded. It also means claims are usually much quicker.

Continued personal medical exclusions (CPME)

This is for anyone switching provider who’s already on FMU or CPME. Your new insurer transfers your health insurance across with existing exclusions still in place, often at a cheaper price. The risk is they may add more exclusions.

Medical history disregarded

If you buy private medical cover via work (as part of a group policy or employee benefit), you may get this option. You don’t need to declare pre-existing conditions, and the policy usually covers them – but always check.

2. Choosing a higher excess can cut £100s off the cost – but claims could be costly

As with most insurance, you usually pay an excess (an amount towards the claim). The bigger the excess, the cheaper the premium. For example, a £450/year policy with no excess dropped to almost £300/year with a £500 excess.

Think about what you want cover for. Everything? Or just big medical issues such as a hip replacement? If the latter, consider a high excess to cut costs.

You’ll also need to choose how the excess works (unlike most insurance):

• Each claim: Pay the excess for every new claim. So if you have a policy excess of £200 and you have to make two claims, the excess is £400.

• First claim only: Pay the excess once per policy year. Premiums are higher, and not all insurers offer this. If treatment runs into the next year, you’ll pay again.

• Percentage of claim: For example, insurer WPA's Complete Health plan uses ‘shared responsibility’ – you pay 25% of each claim up to a set annual limit. If you pick this, make sure you’ve enough set aside to cover your share.

One strategy: combine a high-excess policy (£1,000+) with self-insuring – putting cash in savings for smaller treatments, but keeping cover for big bills.

3. Check which hospitals you can use – wider choice = higher cost

Your policy will include a list of hospitals where you can be treated. The broader the list, the higher the premium.

• Standard lists: cheapest, fewer hospitals.

• Extended lists: broader national choice.

• London lists: most expensive, reflecting higher fees in the capital.

Check whether your local private hospitals are included. Paying for a wide hospital network isn't worth it if you wouldn’t use it.

4. What treatments do you want to cover?

Make sure the policy includes the areas that matter to you most. These vary a lot by insurer and plan level, so don't assume everything is included.

Options can include improved cover for cancer and mental health. Consider what you'd be happy to use the NHS for, and what you'd want to be private for.

You can also cut the cost by restricting when you use the policy. Several insurers will lower your premium if you choose what's called a 'six-week option'. This means if the waiting time with the NHS is six weeks or under, you'll be treated with the NHS. If it's more, you'll qualify for private healthcare.

All treatments must be approved by the insurer first. If you do choose to have a consultation with a specialist or other practitioner who is not on an approved list, the insurer may not reimburse you the costs, or will only pay up to the limits it would usually pay.

How much is private health insurance?

The key is making sure it meets your needs. Like-for-like quotes are tricky as there are so many variables. Some policies include certain cover as standard, others make it an optional extra.

What affects the cost of a policy?

Like motor or home insurance, insurers need your info to work out your risk and price. Age is one of the biggest factors, along with the level of cover you choose, your medical history, the excess you’re willing to pay (which all determines how the policy is underwritten).

The table below shows how quotes can vary by age and cover level. Your own price will differ as it’s based on your circumstances

How to buy private health insurance

You should always compare quotes from multiple providers. And if you can afford it, paying upfront for an annual policy can be cheaper than monthly payments, as some insurers offer discounts.

Remember, only choose a policy that genuinely meets your needs, no matter how good the deal is.

Step 1. Use comparison sites to compare private health insurance quotes

Comparison sites work well if you broadly know what you want and don’t need detailed guidance (see how to find a broker if you need more help).

There may look like there are loads of big-name sites offering private medical insurance, but most are actually ‘white labels’ of a few specialist engines. They’re branded differently, but behind the scenes the comparison is usually powered by ActiveQuote or Howden (who are also brokers).

So we’ve focused on getting you the best perks added on top for each one, plus the new third comparison which is also a broker, isn’t white-labelled anywhere else.

These engines share a lot of the same policies, but prices can still differ. So CHECK AT LEAST TWO…

Annoyance alert: These comparisons want you to put your phone number in, and may try to contact you by phone or email to discuss your quote. There's no way to opt out. It would of course be terrible if you accidentally put in a non-working phone number.

Check other insurer perks too

Vitality is not the only provider offering perks such as discounted gym membership, so we've listed some examples below, but never choose an insurance product based solely on freebies and sweeteners – make sure it also has the coverage you need for a price you can afford.

• Aviva's 'Healthier Solutions' insurance includes a scheme called 'My Health Counts'. This lets you save up to 15% on your renewal costs in the second year if you sign up, complete a health questionnaire, and follow its recommended actions to improve your lifestyle. You'll also need to log back in to retake the questionnaire between six and nine months into your policy.

•  Bupa also offers discounts on gym membership and health assessments.

While we've included links here for you to find out more, it's always better for you to go via the comparison sites above, rather than applying direct, so you get the cashback or voucher too.

Step 2. For specialist advice and more options, contact a broker 

If you're not sure which policy to get, or have conditions making it difficult to find the right one, do contact a broker for a more thorough search. It usually takes a bit longer, but you should receive a much more bespoke quotation, with any exclusions clearly explained. Brokers often have connections with various insurers, so may also be able to offer you a special deal.

To find a broker, use the Association of Medical Insurers and Intermediaries, a trade association for independent medical insurance advisers. It has a list of members to choose from. Alternatively, you can still try the comparison sites via a phone call.

Good brokers can answer questions about cover, particular insurers' records, rules and more. Most are free to you, because they take commission from insurers if you get a policy. Though, of course, check how and if they'll charge before you get the advice.

Comparing PMI and healthcare cash plans

PMI and healthcare cash plans are often confused, but they work very differently. PMI covers the big, expensive stuff – planned operations, specialist consultations, scans and treatments you might otherwise wait for on the NHS.

Healthcare cash plans, on the other hand, don’t cover major treatment or let you skip NHS waiting lists. Instead, they reimburse small, fixed amounts for everyday costs such as dental check-ups, eye tests, glasses, physio and complementary therapies. You pay first, then claim back up to a limit.

They’re far cheaper, but won’t cover operations, cancer care, private hospital stays or anything serious – think of them as help with routine bills, not a cheap replacement for PMI.

How the PMI claims process works

If you need to seek medical help and want to start the process of submitting a health insurance claim, here is a breakdown of each step to help you avoid delays.

1. Get a GP referral. Start by seeing a GP – either your own or the insurer’s virtual GP service. You’ll usually need a referral explaining your symptoms and the type of specialist or investigation required. Some insurers require an open referral, meaning the GP names the specialty rather than a specific consultant.
   

2. Contact your insurer for pre-authorisation. Before you book anything, contact your insurer’s claims team. You’ll be asked about your symptoms and referral, and they’ll confirm whether the treatment is covered. Some insurers let you do this online; others require a call. How your policy was underwritten when you signed up affects how fast this happens:
   
   - Full medical underwriting: decisions are usually quick because your medical history is already on file.
   - Moratorium underwriting: the insurer may need to check GP records to confirm the condition isn’t pre-existing, or you may need the GP to fill out a form to prove it is a new issue, which can slow things down.
   
   Once authorised, the insurer will confirm approved consultants, hospitals, and any limits or excess you must pay.
   

3. Attend treatment. After approval, you can book your appointment with the insurer-approved specialist or hospital. The provider normally bills the insurer directly, so you don’t pay the full cost upfront.
   

4. Pay your excess (if needed). If your policy has an excess, the insurer will confirm how much you owe and whether it’s charged per claim or per policy year. You’ll either pay the excess directly to the treatment provider or settle it with the insurer after treatment, depending on how your policy works.

Already got PMI? Many can slash costs (but take care switching if you've had past treatment)

PMI prices usually rise each year at renewal. And the 'existing customers can't be charged more than new customers going via the same channel' rule for car and home insurance does not apply to PMI. So, no surprise, that PMI costs can escalate quickly. But there are ways you can slash those costs.

A comparison will often reveal big savings, which is great if you've never claimed. If that's the case, switch away!

Yet if you've had treatments on the policy within the last five years, and the issue reoccurs within two years, a new provider will likely exclude treating it, as it's a pre-existing condition (some even say more than two years, so do check policy details). If that's an issue, you may effectively be locked in to your current provider as long as you want treatment on those issues.

We've also heard providers may offer to switch you to another of their own brands at a much lower cost (do let us know if that happens). 

Get paid £50 just by checking if a switch would save you cash

The Confused.com Switch and Save* service (quotes are provided by Howden Life and Health) does a comparison and asks for your existing policy details. If it can't find you a better deal than your current policy, you'll get £50.

However, as part of this, you are effectively agreeing that Howden will become your broker (even if you don't accept the quote), which means it'll handle any future queries, changes, or renewals. It's not a bad thing, but decide whether you want it before doing anything.

We've also heard providers may offer to switch you to another of their own brands at a much lower cost (do let us know if that happens). 

How to complain about your insurance provider

The insurance industry doesn't always have the best reputation for customer service. Plus, while a provider may be good for some, it can be hell for others.

Common problems include claims either not being paid out on time or at all, unfair charges, or exclusions being hidden in small print.

It's always worth trying to call your provider first, but, if not, then you can use free complaints tool Resolver. It helps you manage your complaint, and if the company doesn't play ball, it also helps you escalate your complaint to the free Financial Ombudsman Service.

Private health insurance FAQs