What is private medical insurance?

Private medical insurance coverage

PMI coverage typically includes a mix of inpatient and outpatient services, specialist consultations, diagnostic tests, and more. Some common examples include:

Private GP sessions: Some policies include access to private General Practitioner (GP) consultations, allowing you to see a doctor quickly and conveniently.

Virtual GP sessions: With the growing use of technology, some policies offer virtual GP consultations, enabling you to get medical advice from the comfort of your home.

Facility costs: These are expenses related to hospital stays and treatments, including room charges and nursing care.

Diagnostic tests: Coverage often includes essential diagnostic tests like MRI and CT scans, which can help in the early detection and treatment of various conditions.

Surgical costs: PMI can cover the costs of minor or major surgeries, with the aim of providing you with timely and appropriate surgical care.

Inpatient cover: This typically includes treatments that require an overnight stay in a hospital, covering room and board as well as medical treatments received during the stay.

Outpatient cover: This covers treatments and procedures that do not require an overnight stay, such as consultations, diagnostic tests, and minor surgeries.

Mental health: Many PMI policies provide coverage for mental health services, including consultations with specialists, therapy sessions, and inpatient mental health care if needed.

Complementary therapies: Some policies extend to cover alternative treatments that complement traditional medicine, such as osteopathy, chiropractic, podiatry, homoeopathy and physiotherapy.

Dental and optical: Some comprehensive policies may include cover for dental treatments and eye care, such as routine check-ups, fillings, glasses, and contact lenses.

What isn’t included?

You should also be aware of common exclusions that may apply to your health insurance policy. These vary from provider to provider, and some may be personal to your circumstances: 

• Pre-existing conditions: Conditions you had symptoms of, was diagnosed or treated before the start of the policy.
• Chronic illnesses: Long-term illnesses such as diabetes and asthma.
• Cosmetic surgery: Elective procedures that are not medically necessary.
• Routine pregnancy and childbirth: Normal pregnancy and childbirth-related expenses.
• Fertility treatments: Treatments such as IVF and other assisted reproductive technologies.
• Experimental treatments: Procedures and medications that are not widely accepted or approved.
• Elective procedures: Non-essential surgeries and treatments chosen by the patient.
• Self-inflicted injuries: Injuries resulting from self-harm or suicide attempts.
• Alcohol and drug rehabilitation: Treatments for substance abuse and addiction.
• Preventative treatments: Routine health checks and vaccinations.
• War and terrorism: Injuries or illnesses resulting from war, acts of terrorism, or nuclear incidents.
• Sports injuries: Injuries sustained from participating in professional or extreme sports.

PMI policy types

What you’re covered for is defined by your policy. There are many options available across different providers, but the most common to choose from will be basic, comprehensive, or flexible policies that allow you to tailor your cover.

Basic policy coverage

Basic policy coverage in PMI provides essential protection and access to private healthcare services. These policies are designed to cover the most fundamental medical needs, offering a cost-effective solution for those seeking private medical cover. Typically, a basic policy will include:

Inpatient cover: Coverage for treatments and procedures that require an overnight hospital stay, including surgeries, nursing care, and hospital accommodation.

Limited outpatient cover: While the primary focus is on inpatient care, some basic policies may include a restricted amount of outpatient services, such as initial consultations and follow-up visits after hospitalisation.

Diagnostic tests: Essential tests like X-rays, blood tests, and basic scans to diagnose and monitor health conditions.

Surgical procedures: Coverage for necessary surgeries, aiming to provide timely and efficient treatment for various medical conditions.

Basic policies are ideal for those who want peace of mind knowing that they have access to private healthcare for major medical events without a significant financial burden. These policies offer essential coverage at a generally more affordable price, making them a popular choice for many individuals, families and SMEs.

Comprehensive policy coverage

Comprehensive policy coverage offers a broader range of benefits, offering extensive protection and access to a wide array of private healthcare services. These policies are designed for those who want the highest level of coverage and are willing to pay a higher premium for the peace of mind that comes with comprehensive care. A typical comprehensive policy may include:

Inpatient and outpatient cover: Full coverage for both inpatient treatments and outpatient services, including consultations, diagnostic tests, and follow-up appointments.

Advanced diagnostic tests: Access to sophisticated diagnostic tools such as MRI, CT scans, and advanced imaging techniques.

Specialist consultations: Cover for specialist consultations, with the aim of getting you to see the right specialist for your needs.

Mental health services: Coverage for mental health treatments, including therapy sessions, psychiatric consultations, and inpatient mental health care if necessary.

‍Complementary therapies: Inclusion of alternative treatments like acupuncture, physiotherapy, chiropractic care, and other holistic therapies.

Dental and optical cover: Benefits for routine and advanced dental treatments as well as vision care, including eye exams, glasses, and contact lenses.

Flexible cover

For those who desire more control and flexibility in their health insurance, some providers allow you to build a policy based on the cover you want included. This type of policy allows individuals to select the exact benefits they want, ensuring they only pay for what they need. Key features of this customisable approach include:

Modular benefits: Choose from various modules such as inpatient cover, outpatient cover, mental health services, and complementary therapies. Each module can be added or excluded based on personal requirements.

Flexible limits: Set coverage limits that align with your budget and healthcare needs. For instance, you can choose higher or lower limits for outpatient services

Optional add-ons: Enhance your policy with additional benefits like dental and optical cover, overseas medical treatment, or advanced cancer care.

Excess levels: Adjust the level of excess (the amount you pay out-of-pocket before the insurance kicks in) to balance between premium costs and coverage.

This policy type is perfect for those who want maximum flexibility and control over their health insurance, allowing them to create a policy that fits their lifestyle, budget, and specific health requirements. This option ensures that you only pay for the coverage you need, providing a personalised and cost-effective solution for private healthcare.

Who provides health insurance in the UK?

A variety of companies offer health insurance in the UK, each providing different plans and coverage options to suit individual, family, and business needs. Below are some of the key health insurance providers in the UK, each with unique offerings designed to meet diverse healthcare requirements.

1. AXA Health
2. Bupa
3. Vitality
4. The Exeter
5. Aviva
6. WPA
7. Freedom Health Insurance

Benefits and drawbacks of private medical insurance

PMI offers an alternative to the NHS by providing access to private healthcare services. While it can bring many benefits, it's essential to weigh these against the potential drawbacks. Below, we explore the pros and cons of PMI in the UK to help you make an informed decision about whether this type of coverage is right for you.

Pros of private medical insurance

• Short waiting times: Access to private medical treatment may mean prompt access to consultations, diagnostic tests, and surgeries.
• Choice of specialists and hospitals: Choice of specialists and hospitals: PMI often allows you to choose from a wide range of specialists and hospitals, potentially giving you a large degree of control over your healthcare.
• Comfort and privacy: Private hospitals often offer comfortable accommodation with a large emphasis on privacy during hospital stays.
• Fast diagnosis: With coverage for various diagnostic tests, PMI may lead to quick diagnosis and treatment of medical conditions.
• Comprehensive coverage: Depending on the policy, PMI can cover a wide range of services, including outpatient care, mental health services, complementary therapies, and more.
• Specialist referrals: You can ask your GP to refer you to an expert or a specialist working privately to get a second opinion or specialist treatment subject to your chosen policy.
• Access to scans: If the NHS delays a scan or won’t approve one, you may be able to use your cover to pay for it.
• Reduced waiting time: For 6 week wait policies, use your insurance to reduce the time you spend waiting for NHS treatment if your wait time exceeds six weeks.
• Choice of surgeon and hospital: Subject to your chosen policy, you can choose a surgeon and hospital that fit your schedule and location, which isn’t always possible on the NHS.
• Private room: You’re more likely to get a private room rather than stay in a potentially open, mixed-sex ward.
• Specialist drugs and treatments: Access may be available to new or experimental drugs and treatments dependent on the policy terms.
• Quick access to physiotherapy: Insurance may provide fast access to physiotherapy sessions.

Cons of private medical insurance

• Cost: Private medical insurance can be expensive, with premiums varying significantly. Premiums will rise each year and with age.
• NHS may offer better care for serious conditions: NHS may offer better care for serious conditions: For serious illnesses such as cancer, heart disease, or stroke, the NHS provides priority treatment, and NHS hospitals may be as good as, or better than, private hospitals.
• Exclusions and limitations: Chronic illnesses, such as diabetes and asthma, are usually not covered. Most policies also do not cover pre-existing medical conditions.
• Complexity: Understanding the details of what is covered and navigating claims can be complex and time-consuming.
• Premium increases: As you age and are more likely to need hospital treatment, the cost of premiums will increase, potentially becoming unaffordable when you need it most.

Would you benefit from private medical insurance?

Deciding whether to purchase health insurance can depend on various factors, including your healthcare preferences, financial situation, and existing coverage. Here are some considerations to help you determine if health insurance is right for you:

You may benefit from PMI if:

• You prefer not to wait for NHS treatment: If you want fast access to medical care and wish to avoid waiting times.
• You want access to private hospitals: If you prefer the facilities, comfort, and privacy provided by private hospitals.
• You require frequent medical consultations: If you often need to see specialists or require regular medical consultations, health insurance may provide easier and fast access. However, please note that your premiums may be higher.
• You want a broad range of treatment options: Health insurance may give you access to a wide array of treatments and therapies, including alternative and complementary therapies.
• You have specific health concerns: If you have a family history of certain illnesses or are concerned about specific health issues, having insurance can provide peace of mind and comprehensive care options.
• You value mental health services: Many health insurance policies include mental health coverage, providing access to counselling, therapy, and psychiatric care.
• You want continuity of care: With private health insurance, you can often see the same healthcare professionals consistently which offers continuity of the management of your health conditions. 

You may not need PMI if:

• You are content with NHS care: If you are satisfied with the level of care and services provided by the NHS.
• You have existing coverage through work: If your employer provides comprehensive medical insurance as part of your employee benefits package.
• You can afford to pay for treatments out-of-pocket: If you have sufficient savings, it may be more cost-effective to pay for private treatments as needed rather than maintaining regular insurance premiums.

How much does health insurance cost?

The cost of health insurance can vary widely based on several factors. Understanding these factors can help you get a clearer picture of what influences the premiums you might pay. Here are some key elements that impact the cost of health insurance:
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1. Age: Older individuals typically pay higher premiums due to increased health risks and the likelihood of needing more medical care.
2. Coverage level: The extent of coverage you choose will influence the cost. Comprehensive plans with extensive benefits and out-of-pocket costs tend to be more expensive than basic plans with limited coverage.
3. Policy type: Individual, family, or group policies have different pricing structures. Family and group policies may offer discounts but can also be influenced by the health status of all covered members.
4. Excess amount: The amount you agree to pay out-of-pocket before the insurance coverage kicks in (known as the excess) can affect your premium. Higher excess amounts typically result in lower premiums, and vice versa.
5. Lifestyle factors: Lifestyle choices such as smoking and physical activity levels can impact the cost of health insurance. Healthier lifestyles may lead to lower premiums.
6. Location: The cost of healthcare services varies by region, which can influence the cost of your health insurance.
7. Additional benefits: Policies that include extra benefits like dental and optical cover, mental health services, or alternative therapies might come with higher premiums.
8. Claims history: If you have a history of making frequent claims, your premiums may be impacted by moving down the no claims discount scale.
9. Hospital list: Access to a larger network of hospitals and specialists can increase the cost of your policy. Restricted network plans might be less expensive.

Six things to think about when buying private medical insurance

When considering PMI, it's essential to evaluate various factors to ensure you choose the best plan for your needs. Here are six important things to think about:

1. Gather questions and information

Before getting started with private medical insurance, make sure you gather all the necessary information and questions. Take note of your healthcare needs, current health status, and any specific treatments or services you might require. Write down questions about coverage, exclusions, waiting periods, and any other concerns you might have. Being well-prepared will help you make informed decisions when discussing options with providers or brokers.

2. Reach out to an independent broker

An independent broker can provide unbiased advice and help you navigate the complexities of PMI. Brokers have access to a wide range of policies from different insurers and can compare options on your behalf. They can also explain the fine print, ensuring you understand what each policy covers and any potential limitations. Using a broker can save you time and help you find the best deal tailored to your needs.

3. Compare your options across the UK

The UK health insurance market offers a variety of plans from different providers, each with its unique features and benefits. Take the time to compare different options, considering factors such as coverage, premium costs, a network of hospitals and specialists, and customer reviews. Comparing multiple policies will give you a better understanding of what is available and help you choose the plan that offers the best value for money.

4. Consider cost savings

While private medical insurance can be a significant financial commitment, there are ways to save on costs. Look for policies that offer discounts for healthy lifestyles, no-claims bonuses, or family plans. Some insurers provide lower premiums if you agree to use specific hospitals or if you opt for higher excess payments. Assess your budget and determine how much you can afford to spend on premiums while ensuring you still get the coverage you need.

5. Review that you’re happy with the included cover

Thoroughly review the details of the coverage provided by each policy. Ensure that it includes the treatments and services you might need, such as inpatient and outpatient care, diagnostic tests, specialist consultations, and mental health services. Check for any exclusions or limitations, such as pre-existing conditions or specific treatments not covered. Confirm that the policy aligns with your healthcare needs and expectations.

6. Evaluate additional benefits

Some private medical insurance policies come with additional benefits that can enhance your overall healthcare experience. These might include access to wellness programs, virtual GP consultations, health screenings, or discounts on gym memberships. Evaluate these extra perks to determine if they add value to the policy and align with your health and wellness goals. Extra benefits can sometimes justify a higher premium if they provide significant value to you and your family.

How to get private medical insurance

Getting health insurance involves a few straightforward steps to ensure you find the right policy for your needs. Here’s a simple guide to help you through the process:
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1. Contact an independent broker: Reach out to an independent insurance broker who can provide unbiased advice and access to a range of policies.
2. Communicate your needs: Clearly outline your healthcare needs, preferences, and budget to the broker.
3. Request policy comparisons: Ask the broker to compare policies across the UK, detailing coverage options, premiums, and additional benefits.
4. Review the options: Carefully review the policies presented, considering factors like coverage, cost, and hospital networks. Request further comparisons if needed.
5. Make an informed decision: Select the policy that best fits your needs and budget, ensuring you understand all terms and conditions.
6. Purchase the policy: Complete the application process with the broker’s assistance to secure your health insurance policy.

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To get started, complete the following form and one of our independent brokers will be in touch to help.