Private medical insurance: an in-depth guide
While the National Health Service (NHS) offers an essential safety net for all, many of us are increasingly seeing the benefits of taking out private medical insurance (PMI). PMI can supplement care available through the NHS, giving peace of mind that you will receive a high standard of care without delay.
By Alan Boswell Group
Under private medical insurance, you still have the same access to the NHS, but you won’t have to join a long waiting list to receive non-emergency treatment. Getting treatment privately is also possible without private medical insurance, but it is likely to cost you substantially.
The main benefit of private medical insurance is the increased options available to you; you can continue to use the NHS services but also take advantage of greater access to specialist treatment and reduced waiting times available to you privately.
Our in-depth guide covers the most commonly asked questions about PMI to help you decide if it’s right for you.
What is private medical insurance?
Private medical insurance is a health insurance policy that will pay for some or all your medical bills if you decide to be treated privately. As with any insurance policy, the type of cover will vary between providers, and there are often add-ons that can be selected for an additional premium.
What does private medical insurance cover?
PMI is generally designed to cover short-term or acute issues, where treatment can remedy your condition, returning you to a similar state of health prior to the treatment being needed.
Most policies cover the majority of in-patient treatments and day care surgery. Some also cover outpatient treatment, such as appointments with specialists and consultants, as well as more long-term conditions, such as cancer treatment.
What isn’t covered by private medical insurance?
A standard private medical insurance policy generally won’t cover you for any illnesses or injuries resulting from a pre-existing condition. Failing to inform your providers about such a condition may invalidate the policy if you need to make a claim.
Conditions which aren’t curable but are manageable with medication, such as diabetes or epilepsy, won’t be covered. Regular childbirth, non-essential cosmetic surgery, and organ transplants are also not covered.
Some pre-existing conditions can be covered after a set amount of time, subject to certain conditions set out under moratorium underwriting.
How much is a policy going to cost?
The cost of a policy depends on two main factors; your circumstances and the policy options and level of cover you choose.
Your insurer will consider your age, where you live, how many people you want the policy to cover, and your lifestyle choices, such as whether you smoke or not. As with all insurance policies, the more additional benefits you choose, the higher your premium will be, so you’ll also need to decide on the extent of cover you want.
Will I need to complete an extensive medical form?
The medical form you’ll need to fill in depends on the type of underwriting you choose.
You can choose full medical underwriting, which will require you to disclose details of any medical treatment or conditions you have or moratorium underwriting, which allows the insurer to access your medical records when you claim, removing the need for you to fill in a long form.
What is the difference between private health insurance and private medical insurance?
Nothing, they are the same cover.
What does private healthcare mean?
Private healthcare is medical treatment which you pay for yourself, either through private medical insurance or directly to a healthcare provider. This is separate from accessing care through the NHS, which provides universal state-funded healthcare.
What is the main purpose of private health services?
The primary motivation for choosing private healthcare is generally the choice it provides, whether that be in terms of the hospital you go to, the timing and type of treatments you can access, or the medication provided, including some which may not be offered on the NHS due to their cost. All this means you can tailor treatment to your preferences.
Why is health insurance important?
Having a private health insurance policy means that everything you’re entitled to is clearly specified in the terms and conditions. There’s no doubt or uncertainty about whether a particular course of action can be afforded.
Health insurance provides peace of mind that if you fall seriously ill or are badly injured, you won’t need to worry about treatment delays or limitations.
Benefits and cover of private health insurance
Why do people go to private healthcare?
While the NHS offers wide ranging treatment and care, people are often faced with significant wait times from diagnosis to treatment. Even before COVID-19, the demand for hospital treatment was outstripping capacity, but since the pandemic hit, waiting times have increased further, and it is expected that it will take years for the service to catch up.
Private healthcare removes this barrier for acute conditions, especially those classed as non-emergency (routine) or specialised treatments, allowing you to access care at a time and place that suits you.
PMI also affords you access to a more comfortable environment, including en-suite and private rooms, plus a wider range of food choices, making your treatment less stressful.
Can I get private health insurance with a pre-existing condition?
You can take out PMI if you have a pre-existing condition, but your insurer is unlikely to provide cover for the specific condition.
Make sure you check the type of underwriting for your health plan to see if your pre-existing conditions will be covered in the future and if in doubt, speak to your provider.
Can I add family to my private medical policy?
Yes. Whether you have an individual PMI policy or are part of a group policy, you can add your family in exchange for an increase in your premium.
If you are adding family members to a group policy, employers usually deduct this through payroll deduction.
What are the benefits of private healthcare?
The main benefits of PMI are:
Choice of healthcare provider and a more comfortable environment
Faster access to care
A wider choice of treatments
Access to medicines and treatment not available through the NHS
Higher staffing levels
Can you get an ambulance with private healthcare?
With ambulance wait times becoming increasingly long, there has been an expansion in private ambulance services in recent years. However, PMI is not meant for emergency treatment, so you should access the NHS in an emergency requiring an ambulance.
Does private healthcare cover A&E?
No, private healthcare does not provide emergency treatment. Accident & Emergency (A&E) services are only provided by the NHS, and your private healthcare would be used if you subsequently require non-emergency care, treatment, or surgery.
Claims and renewals of private health insurance
How many times can I claim on my health insurance in a year?
When you take out a health insurance policy, you will agree a sum insured with your provider, which is the monetary limit of the total amount of cover they will provide. You can make as many claims as you need up to the sum insured agreed.
How does the policy work if I need to claim?
When you visit your GP, ask for an open referral letter – this will explain what treatment you need. Then you’ll need to contact your insurer to find out if they’ll cover the cost of treatment. You may also need to pay a health insurance excess, depending on what you agreed when you took out your policy.
Once your insurer agrees, you can either ask them to book an appointment with a specialist for you or book it yourself. After you have received the treatment, your insurer will pay the fees owed directly to the facility.
How can I save money on my private health insurance?
As with any purchase, it’s worth shopping around for the best deal on private health insurance, and you may find it helpful to speak to an insurance broker who’ll be able to provide expert advice. For example, it may be that you don’t need to take out your own policy if you can be added to a family member’s plan.
Whatever level of cover you choose, it’s important to know what your policy covers you for, as this will impact the premium you pay. For example, you might decide to remove some of the optional add-ons from your policy, reduce your level of outpatient cover, opt for a limited list of hospital options, or a higher excess, all of which can reduce your premium.
As always, if you’re unsure about anything or just want to check that you’ve understood your policy properly, speak to your proposed provider or broker before signing up.
Does private health insurance go up if you claim?
You’ll generally find that the cost of your cover will go up if you’ve made a claim, with the precise nature of your claim being assessed to decide how much it will increase by.
Is it better to get health insurance through work or privately?
Some companies offer private healthcare as part of their overall benefits package, either at the company’s or employee’s cost. Even if you do have to pay a premium to join a work-based scheme, you’ll tend to find it works out cheaper than arranging an individual policy.
Can you purchase private health insurance for a short period of time?
It is possible to purchase short-term health insurance, but not all providers offer it. They can provide temporary medical cover if you are between health plans, are outside enrolment periods, or are looking for preventative care.
Be aware that short-term health insurance cover varies greatly depending on the plan and the insurance company, so make sure you’re aware of the full details of any plan you are considering.
What is the process for renewing a private health insurance policy?
As with other areas of insurance, your provider will contact you towards the end of your current policy to offer you a renewal. At this point you should consider if you’d like to continue with the policy and whether your needs have changed since you last renewed it.
For example, you may wish to add extra cover to give you greater treatment options, but equally, you may decide to remove extras that you feel you won’t use.
Obtaining private health insurance
Are there any age restrictions for obtaining private health insurance?
Most providers don’t place an age limit on their policies; however, you will find that your premiums will be higher as you get older.
How long does it take for private health insurance to become effective after purchasing a policy?
With most policies, you can use your private health insurance as soon as the policy has been taken out. However, it’s always worth checking the small print before you sign up, as policies may feature a waiting period of at least a month.
What is the process for filing a claim with private health insurance?
If you need to make a claim, you should visit your GP first for a consultation and preliminary diagnosis. Most insurers now provide a virtual GP app, to allow individuals to speak to a qualified, NHS recognised GP. This has helped in a time where seeing a GP is very difficult, due to wait times.
If the GP confirms that you need further treatment, ask for a referral letter, either for a specific consultant or specialist or a more general open referral letter. An open referral letter will detail exactly what kind of care or treatment your GP believes you require but won’t refer you to a particular healthcare professional or specialist.
Once you have a referral letter, you can contact your insurer, who will be able to advise whether your policy covers the recommended treatment.
Your provider can then advise you of your options, pre-approve your treatment, and advise you of any excess you’ll need to pay.
Are there any exclusions or waiting periods associated with private health insurance?
As always, it’s important to check for exclusions before you sign up for a policy.
Generally, most insurers won’t cover pre-existing conditions and may not cover chronic conditions that need ongoing or long-term treatment, although you can sometimes claim for unexpected flare-ups of chronic conditions.
Other procedures, such as cosmetic surgery, are generally not covered by health insurance.
The range of exclusions varies by provider and policy, so if you’re unsure, make sure you speak to your provider so that you’re clear on what you can and can’t claim for before you sign up.
Some policies offer a six-week option, meaning that instead of claiming on your policy immediately, you will use the NHS if it can deliver inpatient or day patient treatment within six weeks of your referral. This can be a good option to consider if you’re looking to reduce the cost of your cover.
Can you change your private health insurance policy at any time?
Yes, you can, but if you want to change provider, it makes sense to do so at the end of the policy term at renewal, as changing before then may mean that you still have to pay for the duration of your existing cover or an admin fee to cancel the policy. You’re also unlikely to receive a refund on your policy if you have already made a claim in that policy year.
What factors determine the cost of private health insurance?
Each insurer will have its own criteria for working out the cost of your cover, but there are some general factors that will be considered including:
Your age
Where you live
Your medical history (when changing insurers)
Your lifestyle
The level of cover you choose
Your claims history
Payment frequency i.e. monthly or annual
Any additional people you add to your plan
Are there any tax benefits associated with purchasing private health insurance?
If you get health insurance through your employer, you will usually pay tax on the cost of the insurance premiums as it is considered a benefit-in-kind.
If you’re self-employed, health insurance could play a key role in getting you back to work as quickly as possible, so it may be possible to class the premiums as a legitimate business expense, so it’s certainly worth speaking to your insurance provider about this.
While it’s separate to PMI, it’s also worth considering taking out income protection insurance to provide financial protection if you’re unable to work due to illness (especially if you are self-employed due to lack of sick pay).
How do you choose the right private health insurance policy for your needs?
As we’ve discussed, health insurance policies tend to offer a baseline of cover that excludes certain treatments. However, most providers will offer more than one level of cover, so make sure you’re comparing like for like when you’re deciding what to take out.
One key factor to consider is how the insurer assesses any pre-existing medical conditions you have. Insurers will either use moratorium underwriting, which, at the time of claiming, only looks at conditions you've suffered in the past five years, or full medical underwriting, which will go through your entire medical history and may put exclusions on conditions you've suffered historically, even if you've not had any symptoms for some time.
Cover for medical treatments and procedures
Which diseases are not covered by health insurance?
We mentioned that most insurers wouldn’t cover pre-existing conditions, chronic conditions, and other procedures, such as cosmetic surgery.
However, other health conditions may also be exempt, so make sure you discuss any concerns you have with your provider before you take out a policy.
For example, conditions such as allergies, birth control, deafness, corrective eyesight surgery, sleep problems, and speech disorders aren’t generally included in a standard policy, so check your details carefully.
What types of medical treatments and procedures are typically covered by private health insurance?
Private health insurance is designed to cover short-term, acute conditions where treatment should remedy a condition, returning you to a similar state of health as you were in before the treatment was needed.
Most policies cover the majority of in-patient treatments and day care surgery, while some also cover outpatient treatment, such as appointments with specialists and consultants.
Find out more
For more information on private medical insurance and how it could benefit you, contact our expert team.