Choosing the right type of cover
A good private medical insurance policy affords you the peace of mind that comes with the sure knowledge that if you are to become acutely ill or injured, then you can guarantee swift and expert treatment.
The sharp reduction in waiting times and more personalised approach is arguably the key benefit of private healthcare over and above the services offered by the NHS.
But there are various different types and levels of cover available. Over the course of this guide, we’ll go over the kinds of cover on offer and help you decide which is best for you, as well as going over a broad list of conditions and treatments that tend to be included or excluded from PMI policies.
In This Guide:
Do you already have cover from your employer?
Before you look into taking out a PMI plan, you should first check with your employer to see if you are already covered as part of their employee benefits package.
The same applies if you are a member of certain clubs, particularly health or sports clubs, or other professional organisations.
Importantly, even if you do already have private health cover as part of some kind of benefits or membership package, it still may not be the level of cover you actually require, so always check through the details of the policy carefully and if needs be, you can take out an additional policy.
Types of cover
A factor that will likely play a key role in the level of cover you end up wanting from your policy will be the price you are willing to pay. As a general rule, the higher the level of cover, the more your policy will cost.
Of course, other factors come into play such as your age, any pre-existing conditions you may have, and the balance between premiums and excess.
We’ll go over specifics (i.e. what kinds of conditions you can expect to be covered for) in the following section but broadly speaking, the different levels of cover on offer can be divided according to the types of treatment they will cover you for.
Most private medical insurance policies will cover you as a day patient and an inpatient that is, any treatment or tests you receive or undergo in hospital.
Some, more expensive policies will also cover any outpatient treatment you receive, such as on-going physiotherapy once you’ve left the hospital.
When it comes to private medical insurance, you get what you pay for, and so when you come to pick your policy it will involve a careful balancing of your priorities.
Cover and exclusions
It is important to remember that even if your PMI policy offers you full and extensive inpatient cover, not every treatment that requires you to stay in hospital overnight will actually be covered.
As a general rule, PMI is designed to cover you for treatment for acute conditions, that is, injuries or shorter term illnesses that can be cured relatively straightforwardly. Longer term or chronic conditions, on the other hand, tend not to be covered by most PMI plans. This can be put down to two basic reasons:
First, the bulk of the NHS’ funding goes towards helping to care for patients with chronic conditions, whereas private hospitals are more suited to dealing with conditions that can be treated or cured more quickly. This essentially means that you are likely to get a better service for free than you would if you paid for it, making private healthcare an unnecessary expense.
Second is the cost. To cover patients for treatment for long term or chronic conditions would be expensive, and this would translate into incredibly high premiums for the policy holder.
The following treatments and conditions are also generally not covered by most PMI providers:
- - GP visits
- - Dental treatment
- - Drug abuse
- - HIV/AIDS
- - Organ transplants
- - Sex changes
- - Injuries from ‘hazardous pursuits’ including ‘war risks’ o Also (deliberately) self-inflicted injuries
- - Pre-existing conditions
This list is not exhaustive; for a more complete list head over to our article Private Medical Insurance – Will You Be Covered?
It is important to note on the subject of pre-existing conditions that if you do have a condition like, say, diabetes, then it will likely be the case that your PMI supplier will not cover any treatment for your diabetes, but you will still be able to take out a policy, albeit at a slightly inflated price.
The same applies if you have a disability; you won’t be turned down for cover if you’re disabled (there are laws preventing this) but it may well be the case that you won’t be covered for any treatment relating to your disability.