Jane Dotson
Private medical insurance (PMI) is an optional form of health insurance available in the UK that covers the cost of private medical treatment for acute conditions that develop after the policy begins. It is designed to complement the services of the NHS by providing cover for the cost of prompt access to private treatment, advanced treatments, and access to cancer drugs and services not always available on the NHS. PMI is available at a range of different levels of cover at various premiums designed to meet the needs of different customers.
| Characteristics | Values |
|---|---|
| Purpose | Covers the cost of private medical treatment for acute conditions that start after the policy begins. |
| Coverage | Most policies cover inpatient and outpatient treatment. Some policies cover long-term treatment for cancer or mental health, even if there is no cure. Some policies also cover treatment for pre-existing conditions. |
| Exclusions | Most policies do not cover emergency treatment, maternity care, cosmetic surgery, or treatment for pre-existing or chronic conditions. |
| Cost | The cost of private medical insurance depends on factors such as age, medical history, family history of medical conditions, lifestyle choices, and the level of coverage chosen. |
| Flexibility | Private medical insurance allows individuals to adapt their plan to their needs, choosing the types of treatment covered, the level of coverage, the location of treatment, and the contribution towards treatment costs (excess). |
| Authorization | Prior authorization from the insurer is typically required before receiving treatment. An authorization number ensures that invoices are sent directly to the insurer for settlement. |
| Payment | Individuals usually pay a monthly or yearly premium for their private medical insurance. The insurer then pays for the covered treatment costs while the policy is active. |
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What You'll Learn
What does private medical insurance cover?
Private medical insurance (PMI) is designed to cover the costs of private treatment for unexpected (acute) medical conditions. It is usually designed for acute conditions, which are curable and short-term. It is important to note that PMI does not cover pre-existing conditions, and there may be other exclusions such as GP services, prescriptions, cosmetic surgery, and A&E admissions.
When you set up a health insurance plan, you can decide on the type of cover you need. Insurance companies typically offer a standard level of cover, with additional cover available for an extra cost. You can usually choose when and where to receive treatment, selecting from a list of approved practitioners and hospitals.
Most health insurance covers inpatient treatment, which includes staying in a hospital bed for tests or surgery. Some policies also cover outpatient treatment, where you do not need to stay in the hospital overnight. This could include scans, tests, or hospital appointments.
Some policies do cover long-term treatment for cancer or mental health, even if there is no cure. It is important to carefully review the details of any policy before purchasing it, to understand what is covered and what is excluded.
Private medical insurance can also provide access to specialist drugs and ongoing care that may not be available on the NHS.
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How much does private medical insurance cost?
Private medical insurance in the UK can vary in cost depending on several factors, including age, location, smoking status, BMI, and the level of cover chosen. While it is not possible to give an average price for health insurance, the average monthly cost in the UK for individuals is around £79.62, £146.86 for couples, and £165.67 for a family of four. The average yearly premium is around £1,500.
Age is a significant factor in determining the cost of private medical insurance. Healthcare costs increase steadily with age, and prices are higher for older customers. For example, a 50-year-old will pay around 66% more than a 30-year-old for the same policy, and a 70-year-old will pay approximately 132% more than a 50-year-old. A basic health insurance policy for a 20-year-old costs an average of £28.79 per month, while comprehensive cover costs £41.24. By age 70, these costs rise to £141.29 and £202.51, respectively.
Location is another critical factor influencing the cost of private medical insurance. Healthcare costs differ across the country, and premiums are typically higher in areas with higher medical treatment costs, such as London and the South of England. For instance, the average cost of health insurance in London is around 23% higher than in the rest of the UK, while Edinburgh is the cheapest place to buy health insurance, with premiums approximately 15% lower than elsewhere.
The level of cover chosen also impacts the cost of private medical insurance. Insurers often offer tiers of cover, ranging from basic to more comprehensive. Policies with higher limits and more optional benefits cost more. Additionally, the number of people covered under the policy will affect the price, with couples and families paying more than individuals.
Other factors that can influence the cost of private medical insurance include smoking status, with cover costing more for smokers, and BMI, with some insurers offering discounts for customers with a BMI within a certain range. Claims history can also affect the cost of renewals, with previous claims potentially increasing the price of premiums.
It is worth noting that private medical insurance is not necessary to lead a healthy life, as the NHS provides excellent care and treatment. However, some individuals prefer private healthcare to avoid long waiting lists and have more flexibility and speed in their treatment options.
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What doesn't private medical insurance cover?
Private medical insurance in the UK is designed to cover the costs of private treatment for unexpected (acute) medical conditions. It provides faster access to healthcare, avoiding NHS waiting lists and offering treatment when you need it. It is important to note that private medical insurance does not cover every medical need and there are some exclusions.
Most health insurance policies cover inpatient and day-patient treatments, where you stay in a private hospital for the day or overnight. Some policies also cover outpatient treatment, where you do not stay in the hospital but may have scans, tests, or appointments. Many insurers offer a digital GP service, but GP services are not usually covered by private medical insurance.
Private medical insurance typically does not cover pre-existing conditions, including any issues related to these conditions. These are conditions that were diagnosed, treated, or for which you sought medical advice before your insurance started. Insurers often refer to these as "pre-existing conditions". It is important to be honest and disclose your full medical history when applying for insurance, as your insurer may reduce your claim or refuse to pay if they find you have withheld information.
Private medical insurance also usually does not cover the costs of treating chronic or incurable conditions such as diabetes or arthritis. These are often referred to as ongoing conditions and include illnesses like asthma. Policies may also exclude coverage for maternity care, cosmetic surgery, and A&E admissions.
It is important to carefully review the exclusions of your policy and understand what is and is not covered before taking out private medical insurance.
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How do I get private medical insurance?
Private medical insurance (PMI) is designed to cover the costs of private treatment for unexpected (acute) medical conditions. By paying a regular premium to an insurance company, you can avoid paying the potentially expensive, unexpected costs of treatment and gain access to fast medical treatment from your choice of the UK's private healthcare providers.
PMI is available at a range of different levels of cover at various premiums designed to meet the needs of different customers. For example, you can have choices around the types of treatment covered, the level of cover, the location of your treatment, and the contribution you might be willing to make to the treatment cost (called 'the excess').
Most health insurance covers you if you need to stay in a private hospital for the day or overnight. Some policies will also cover outpatient treatment, where you don't stay in the hospital for the day or overnight, but you might have scans, tests, or hospital appointments.
If you're applying for an individual policy, you will need to provide some information to the insurer. You must answer all questions as fully and accurately as you can, to the best of your knowledge and belief. Insurers will only ask you for information that is relevant to the cover you are applying for. All PMI companies will offer the option of full medical underwriting, where you will be asked to give details of your medical history. With your consent, the insurer may write to your doctor for more information, but they do not do so in every case.
You can search for a suitable private health insurance plan online and on comparison websites. You can also call insurers to find out what they can offer you.
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How do I use private medical insurance?
Private medical insurance (PMI) is designed to cover the costs of private medical treatment for acute conditions that arise after your policy begins. It is a personal choice to have private medical insurance, and it is available at a range of different levels of cover and various premiums designed to meet the needs of different customers.
When taking out health insurance, it is important to look at exactly what is covered and what isn't. Insurers will ask you about your medical history and then confirm what your policy will and will not cover. Most health insurance covers conditions that develop after your policy has begun, but you won't usually have cover for conditions you already had or any pre-existing conditions. Many insurers describe the types of conditions that they will pay for as those that are short-term and respond to treatment.
If you are applying for an individual policy, you will need to provide some information to the insurer. You must answer all questions as fully and accurately as you can, to the best of your knowledge and belief. Insurers will only ask you for information that is relevant to the cover you are applying for. All PMI companies will offer the option of full medical underwriting where you will be asked to give details of your medical history. With your consent, the insurer may write to your doctor for more information, but they do not do so in every case.
If you are using private medical insurance, you’ll need an authorisation number from your insurer to ensure that any invoices from either the consultant you see or from the hospital are sent directly to them to settle. The consultant will charge for their professional fees, covering their time and expertise to perform the procedure, usually alongside a separate consultation fee. If you have an excess on your insurance, the insurer will pay everything to the hospital (and the consultant) with the exception of the excess. The hospital will invoice you separately for the excess. Before your treatment starts, you’ll be asked to provide a credit or debit card to cover any additional extras not covered under your policy at the hospital.
If you see your GP for a medical issue that needs investigation, they'll send you for diagnostic tests or scans to give you a diagnosis before referring you for specialist treatment. Depending on the treatment you need, that could mean spending some time on a waiting list. However, under the NHS Patient Choice Programme, they should let you know what your options for treatment are, including advising you that you can choose to have private treatment if you prefer.
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Frequently asked questions
Private medical insurance, also known as health insurance or PMI, pays for private medical treatment, tests, surgeries, and medication for acute conditions that develop after your policy has started.
Acute conditions are curable and short-term. Many insurers describe them as conditions that are short-term and respond to treatment.
Private medical insurance covers the cost of private treatment for acute conditions that start after your policy begins. It is available at different levels of cover and premiums to meet the needs of different customers. You can usually choose the types of treatment covered, the level of cover, the location of treatment, and the contribution you are willing to make towards the treatment cost (called 'the excess').
You can search for a suitable private health insurance plan online or on comparison websites. If you are applying for an individual policy, you will need to provide some information to the insurer. You must answer all questions as fully and accurately as you can. Insurers will only ask you for information that is relevant to the cover you are applying for.
