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Private Medical Insurance Explained

While we are lucky enough to have the National Health Service (NHS) in the UK, navigating the world of healthcare can often feel like a never-ending journey, especially when it comes to understanding the intricacies of private medical insurance. In this guide, we aim to demystify private medical insurance, providing you with a clear and comprehensive guide to what it is, how it works, and how it can benefit you.

In This Guide:

How Does Private Health Insurance Work?

Private health insurance, also known as private medical insurance or PMI, is designed to provide swift access to medical services, supplementing the care available through the NHS. By paying a monthly premium, you gain access to private healthcare facilities that often feature shorter waiting lists compared to their NHS counterparts. This ensures quicker consultations, faster diagnostics, and timely surgeries.

What Does Private Health Insurance Cover?

Private health insurance covers a wide range of treatments, but no two policies will be exactly the same. However, you can expect many health insurance policies to include:

  • Inpatient treatments: These are treatments that require a hospital stay and are commonly covered under most private health insurance plans.
  • Surgical procedures: Operations necessary for treatment are usually included, whether they require an overnight stay or can be done in a day surgery.
  • Consultations with specialists: If you need to see a specialist, private health insurance often covers the cost of these appointments.

It is important to review your policy details as outpatient services and treatments for pre-existing conditions might not be covered or could have specific limitations. Some additional extras that can sometimes be added to private health insurance policies include:

  • Health Checks: Preventative care is crucial, and many private health insurance policies include annual health checks. These help detect potential health issues early, facilitating timely and effective treatment.
  • Mental Health Cover: More insurers are offering cover for mental health services, including therapy and counselling sessions, as well as inpatient mental health care, supporting both emotional and psychological wellbeing.
  • Alternative Therapies: Cover may extend to alternative or complementary therapies, such as acupuncture, chiropractic treatment, and homoeopathy, which are recognised for their benefits in managing various health conditions.
  • Access to Helplines: Many policies provide 24/7 access to medical helplines, offering immediate advice from healthcare professionals, which can guide you to the appropriate care or provide quick prescriptions.

What Are the Benefits of Private Health Insurance?

While you can access healthcare on the NHS for free, there are some benefits to taking out a health insurance policy, such as:

  • Reduced waiting times: One of the primary benefits of private health insurance is significantly reduced waiting times for treatment, which is especially valuable for urgent medical conditions.
  • Choice of doctors and facilities: You can choose your preferred doctors and healthcare facilities, which allows for personalised care tailored to your preferences.
  • Comfort during hospital stays: Most private health insurance plans offer the comfort of a private room, often with an en suite bathroom, providing a more comfortable and private environment for recovery.

What to Look for in a Private Health Insurance Policy?

When choosing health insurance, you'll need to think about a few different factors to make sure you're getting a plan that suits your needs. If you're new to private medical care, pay attention to the following before taking out a policy:


Most health insurance policies include an excess fee, which is the amount you pay out-of-pocket before your insurer covers the remaining costs. Choosing a higher excess can lower your monthly premiums, but this also means you'll pay more upfront for treatment when you make a claim. Consider your financial situation and how much you can afford to pay in the event of a medical need. This balance is crucial for making your insurance both affordable and practical.

Cover Limits and Benefits

Insurance plans vary in what they cover. Some might offer comprehensive inpatient and outpatient treatment, while others limit coverage to inpatient treatments only. If a plan covers only hospital admissions, you might not receive financial support for outpatient services such as follow-up consultations or ongoing therapies. Ensure that you understand the specific benefits and limitations of each plan, so you can choose one that best meets your healthcare needs.

Pre-Existing Conditions

Be aware of the policy regarding pre-existing conditions. Many private health insurance plans do not cover treatment for ailments you had before obtaining insurance until a specified waiting period has passed. Moreover, some may never cover certain chronic conditions. It's essential to disclose all existing health issues during the application process to ensure coverage and avoid disputes over claims.

How Much Does Private Health Insurance Cost?

The cost of private medical insurance can vary widely based on several factors, making it important to understand what influences premiums and how you might manage those costs effectively. Here's a breakdown of what determines the cost of private health insurance:

Factors Influencing the Cost of Private Medical Insurance

  1. Age: Generally, the older you are, the more you will pay for private medical insurance. This is because older individuals are statistically more likely to need medical treatment.
  2. Health History: If you have pre-existing conditions or a history of medical issues, insurers may consider you a higher risk, which could increase your premiums.
  3. Level of Cover: The extent of coverage you choose also affects your premiums. Comprehensive plans that cover a wide range of medical treatments, including outpatient services and specialist consultations, will cost more than basic plans covering only inpatient treatments.
  4. Lifestyle Choices: Factors such as smoking, excessive alcohol consumption, and high BMI (body mass index) can increase your risk profile and consequently your insurance costs.
  5. Location: Costs can also vary by location, with premiums typically higher in areas where private medical treatment costs are more expensive.
  6. Excess: The amount of excess you agree to pay affects your premium. A higher excess usually results in lower monthly premiums, but it means more out-of-pocket expenses when you claim.

With most forms of private medical insurance policy, the amount that you pay will go up as the years go by and you get older. However, this is not purely because you are ageing, as many people wrongly believe. Instead, it comes about as a result of general inflation and also due to the increasing costs of the methods used to diagnose the conditions that you may have. These increased overheads are then, unfortunately, passed onto the policyholder in the form of more costly premiums.

How to Reduce Health Insurance Costs

There are a few different things you can do to lower your private health insurance premiums. Remember, even if it doesn't seem like you're saving very much, costs add up over time and over the course of a year or more you could save a significant amount of cash.

  • Choose a higher excess: Opting for a higher excess can reduce your monthly premiums significantly. This means you will pay more out of pocket when you need medical treatment, but your regular payments will be lower.
  • Tailor your cover: Consider which aspects of cover are most important to you. Limiting your policy to essential services can decrease your premiums. For example, choosing a plan that covers only inpatient treatments can be less expensive than one covering both inpatient and outpatient treatments.
  • No-claims discount: Many insurers offer discounts if you haven't made any claims for a certain period. Maintaining good health and only claiming when absolutely necessary can lower your premiums over time.
  • Annual payment: Paying your premium in one annual sum instead of monthly instalments can often secure you a discount, as many insurers provide a lower rate for annual payments.

Find the Right Medical Insurance for You

Not every medical insurance policy will work for your needs, which is why it's so important to compare policies to find the one that not only gives you the amount of cover you're looking for, but matches your budget as well.