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How private health insurance works

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What is health insurance?

Health insurance is a form of coverage that takes care of the expenses associated with private medical services. Despite the availability of free healthcare through the NHS in the UK, private health insurance provides the advantage of quicker access to specialized treatment and diagnosis, all at your convenience. It offers a range of benefits, from facilitating prompt appointment bookings to accommodating surgeries or therapies based on your schedule.

These insurance policies typically cover health conditions that arise after the policy has been initiated. Since policies can vary, it's crucial to select one that aligns with your specific needs. You have the option to obtain coverage for yourself, or opt for a joint health insurance policy that extends protection to both you and your partner

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What does private health insurance cover?

The cover provided by your health insurance will depend on the type of policy.

What can be covered

  • Hospital charges: Tests, scans, appointments, and X-rays.
  • Specialist fees: Health care that needs to be done within an overnight stay in hospital.
  • Diagnostic tests app: Virtual GP appointments that give you access to a GP from your home.
  • Radio/Chemotherapy: Carried out by a specially trained physiotherapist.

Not generally covered

  • Pre-existing conditions: Medical conditions that you already have before taking your policy.
  • Emergency treatments: Care to address sudden or severe medical conditions or injuries that require immediate attention.
  • Cosmetic surgeries: Treatments to enhance appearance rather than to address medical conditions.
  • Treatments available on the NHS: Services that can be accessed through the NHS, which would exempt the need for private health insurance.
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What are the benefits of private medical insurance?

Waiting times reduced

Waiting times reduced

Faster access to consultants, tests, therapies, and treatment.

Specialist referrals

Specialist referrals

Receive treatment from experts in their field.

Hospital and surgeon of choice

Hospital and surgeon of choice

You can usually choose a specialist and hospital that suits you. However, one may be picked for you by your insurance provider.

Private Rooms

Private Rooms

Experience enhanced comfort during your stay with facilities like en-suite rooms and TVs.

Aftercare and recovery

Aftercare and recovery

Quickly access treatments like physiotherapy.

Treatments by specialists

Treatments by specialists

Access to treatments and medications not offered by the NHS may be a possibility.

Private healthcare's potential disadvantages

  • Expenses can escalate, particularly as you age.
  • Coverage typically excludes pre-existing medical conditions.
  • Chronic illnesses are often not covered.
  • Injuries resulting from high-risk activities, such as extreme sports, are usually not covered.

There are different types of health insurance plans available.

Choosing the right health insurance is a big part of the process. Start by figuring out why you need it and who you want it to cover.

Individual health insurance - you can quickly access medical care without NHS waiting times, offering more choices for consultants and hospitals.
Joint health insurance - covers both you and your partner, often being more cost-effective than separate policies.
Family health insurance - covering your entire family under one policy, is usually more affordable than individual coverage for each family member.
Child health insurance - provides reassurance that your child will receive prompt treatment in private hospitals and clinics if they become ill.
Self-employed health insurance - invaluable for those who are self-employed or have rigid working hours, allowing flexibility in choosing when and where to receive treatment.

Before you start comparing policies, see if your employer already provides you with private health insurance.

How does private health insurance work?

Private health insurance works similarly to other types of insurance. You pay a premium on a monthly or yearly basis.

Additionally, you will agree an excess, which represents your contribution to any claim. In exchange, you can make claims for the expenses related to private medical care, rather than covering the costs personally or relying on NHS treatment.

Getting started with private healthcare:

If you develop a health issue with an existing policy, consult your GP as usual, informing them about your private cover. Inquire about available options, and they may suggest a specialist or a private treatment centre. Alternatively, you can select your preferred specialist.

If you're unsure about which specialist to consult or where to seek treatment, request an open referral letter from your GP.

Some comprehensive private medical insurance plans offer access to a private GP for initial diagnosis, necessary referrals, or prescriptions as part of the claim process.

How to submit a claim

Begin by reaching out to your insurance provider, and they will guide you on the necessary steps. If your NHS GP has provided a referral letter, share it with your insurance provider.

If the required private treatment is covered by your policy, your insurance provider will approve the claim and guide you through available options.

They will inform you of any policy limits and assist in locating suitable consultants if you are unsure about where to seek treatment.

What is the cost of private health insurance?

The cost of private health insurance in the UK will vary based on several factors, including:

  • Your age – as you age, the likelihood of developing health issues increases, leading to higher premiums.
  • Your postcode– living in London or other major cities may result in higher costs for private health insurance, as hospitals and treatment centres are typically more expensive.
  • Your cover level– comprehensive coverage is more costly than a basic plan, and optional extras may also raise your premium.
  • Your excess level– opting for a higher excess can reduce the premium cost but ensure you can afford it in case you need to make a claim.
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What are the benefits of private medical insurance?

Consider the following when comparing health insurance quotes:

Cover level

Cover level

Most eventualities are covered without a cost limit in a comprehensive policy, while cheaper policies impose a cap on your potential claims.

Hospital Location

Hospital Location

Hospitals in major cities like London may charge more.

Benefits

Benefits

Incentives might include discounts on gym memberships.

Exceptions

Exceptions

For instance, you might discover that the policy covers only limited outpatient treatment or excludes it entirely.

Cost

Cost

As you age, health insurance prices are likely to be more expensive since the likelihood of making a claim increases.

Waiting period

Waiting period

Keep an eye out for a specified waiting period. For instance, some health insurance providers may restrict you from making a claim in the initial three months.

What steps can I take to secure a cheaper health insurance quote?

Here are some ways that could assist in lowering the cost of your health insurance:

1. Opt for a higher excess

Ensure it is both realistic and affordable, as you'll need to pay it before processing any claim.

2. Opt for reduced outpatient cover

Consider potential medical costs when deciding how much cover you want. Do you require additional coverage for specific activities or sports?

3. Opt for a reduced list of hospitals

Make sure there are appropriate options, as your access will be limited to a narrower range of hospitals.

4. Opt for a six-week option

If NHS treatment is available within six weeks, some insurance providers won't allow you to make a claim.

What is required for obtaining a health insurance quote?

We'll need to know the following to find you a suitable quote:

1. Policy Type

Are you traveling within the UK, Europe, or beyond? Are you seeking an individual policy, a joint policy, or a family policy?

2. Cover Level

How much cover do you need? Consider potential medical expenses. Do you require additional coverage for specific activities or sports?

3. Personal Details

You'll be required to provide information such as your age and address.

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Frequently asked questions