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What does UK Private Health Insurance cover?

That’s partly up to the individual. Private Medical Insurance offers a large degree of flexibility so that customers can tailor their benefits to suit their exacting needs. 

This is especially important in the retail market (rather than the corporate one), as individual customers can have very different needs.  For example, somebody in their 20’s might want a high level of physiotherapy cover, whereas a person in their 50’s may want cancer screening included in their plan.

Insurers do not list conditions covered, instead they break it down as follows:

Out-patient treatment (a hospital or clinic appointment where you don’t occupy a bed)

  • Consultations with a specialist
  • Diagnostic tests such as blood tests and x-rays
  • Diagnostic scans such as MRI, CT and PET
  • Radiotherapy/chemotherapy
  • Other cancer drugs and biological therapies
  • Pre-admission tests
  • Physiotherapy
  • Chiropractic
  • Osteopathy
  • Chiropody/podiatry
  • Homeopathy
  • Psychiatric/Mental health

In/Day-patient treatment (when you are admitted to hospital and occupy a bed)

  • Private hospital accommodation costs
  • Drugs and dressings
  • Specialist fees
  • Anaesthetist fees
  • Diagnostic tests and scans
  • Cancer drugs and biological therapies
  • Prosthesis

Other benefits

  • Virtual GP/telemedicine
  • Private prescriptions
  • GP and nurse helpline
  • Home nursing
  • Private ambulance
  • NHS cash benefit
  • Parent accommodation
  • Maternity cash benefit
  • Pregnancy complications (limited)
  • Dental cover
  • Optical cover
  • Travel cover
  • Health screening

Importantly, Private Medical Insurance is designed to cover Acute medical conditions, not Chronic ones.

Acute – A condition that responds well to active treatment and where the patient can be returned quickly to their previous state of health/degree of activity.

Chronic – A condition which cannot be cured and does not improve through active treatment.  Chronic conditions can typically only be “maintained” or “managed”.  A good example is asthma or Type 1 diabetes. 

Cover is available for an “acute flare-up” of a chronic condition, assuming the chronic condition came to existence after the start date of your plan.

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With over 30 years of combined experience in Private Health Insurance, Engage Health Group is expertly placed to help you find the right insurance package and avoid any nasty surprises.

Will Private Medical Insurance cover pre-existing health conditions?

Like all insurance, Private Medical Insurance is there to protect for the unknown, not for conditions which are already known to us or likely to occur.

With this being the case, insurers offer a range of ways for customers to take out a policy.

Moratorium underwriting: The simplest set-up option

Also known as ‘underwritten at point of claim’, this method is the simplest and least labour-intensive way to begin a new Private Medical Insurance policy.

Moratorium underwriting eradicates the need for you to complete medical forms or health declarations. Instead, it is agreed at the start of the policy that any conditions you have suffered with five years prior to the scheme start date, will not be covered.

However, if you complete a full two years covered by the policy with no treatment, advice, medication, or symptoms of the pre-existing condition; it will automatically become covered once again.  Any new conditions that arise from the first day of cover onwards will be covered immediately.

The downside of Moratorium underwriting is that it can delay the claims process. This is because the insurer will want to verify the condition being claimed for wasn’t pre-existing – so expect some due diligence! 

Full Medical Underwriting (FMU): The fast claim option

Also known as ‘underwritten at inception’, with Full Medical Underwriting, customers are required to complete a medical questionnaire prior to the policy start date.

This would ask for details of medical history such as:

  • GP and specialist appointments
  • Hospital stays
  • Ongoing medication
  • Any other conditions which you may have suffered with previously

Once submitted, the questionnaire is passed to the insurer’s medical underwriting team, who may choose to liaise with your GP and/or request further information.  Following assessment, the insurer may choose to apply specific medical exclusions (conditions which will not be covered). 

The benefit of this form of underwriting is that customers will know from the outset what they are and aren’t covered for, and therefore the claims process will be a lot quicker and more streamlined.  The downside is that the process can sometimes take weeks to complete.

Continued Personal Medical Exclusions (CPME/CME): The transferable option

Also known as “switch”, CPME is for customers who already have UK Private Health Insurance in place, but would like to transfer to a new insurer and retain their previous underwriting and medical underwriting start date.

This will either be because of enhanced benefits elsewhere, a service issue with the holding insurer, or for a premium saving.

For customers transferring in this way, a “medical switch declaration” would need to be satisfied which contains several questions.  The questions asked in this declaration can vary considerably between insurers, with some more lenient and less obtrusive than others.  Generally speaking, insurers want to check that a customer transferring to them with continued underwriting has not recently suffered with a serious medical condition, and that there is nothing significant planned or pending in the near future.

Medical History Disregarded (MHD): The non-intrusive option

This form of underwriting means that irrespective of a customer’s medical history, their policy will cover them.  

MHD is only likely to be in place if a customer has transferred from a company scheme to an individual scheme. If they were on a MHD scheme when they were an employee, then it’s possible to continue on that basis on an individual UK Private Health Insurance scheme.

It is not available to select for a new UK PMI schemes, but can be sourced under International Private Medical Insurance.

What isn’t covered by Private Medical Insurance in the UK?

  • Pre-existing conditions (see underwriting section)
  • Routine pregnancy
  • Congenital conditions
  • Chronic conditions
  • Accident & Emergency
  • Planned Treatment overseas
  • IVF and infertility treatments (unless advised otherwise)
  • Gender reassignment (unless advised otherwise as part of a large corporate scheme)
  • Cosmetic treatment

“I was very impressed with the service from Nick (at Engage). Health insurance is a bit of a minefield and Nick was great at guiding me through it to find the right solution.”

Claire, Individual

Why use a UK Private Health Insurance broker?

At Engage Health Group we appreciate that every customer is an individual and as such, a “one size fits all” approach is simply inadequate. As a UK Private Health Insurance broker we work one-to-one with our customers in order to deliver a scheme tailored to their budget and needs.

Here are three key reasons why it’s worth speaking to our team of expert consultants:

We are independent

We work with all health insurers but with no allegiance to any. Therefore, you can be assured that any advice given is completely unbiased, impartial and based on real customer experiences.

We are genuine experts

Our team have worked with multiple insurers and intermediaries for over 20 years and we have become a trusted and respected source of advice and guidance.

As members of the Association of Medical Insurance Intermediaries (AMII), we are endorsed to assist individuals with their health insurance needs. Martin Lewis’ MoneySavingExpert recommends that customers searching for Private Medical Insurance (new or existing) use AMII certified intermediaries to assist them, and we’re delighted to be included in this distinguished group.

We are FREE

Our service is completely free of charge and we will never charge you a fee or handle your own money.  What’s more, the premium you pay will be the same as if you were to go directly to the insurer, meaning that you can enjoy our expert service AND secure the best possible price.

We take time to get to know our customers and strive to deliver first class service and expert advice in an easy-to-understand way. We find it is warmly received in the complex world of health insurance!

With so many insurers and multiple benefit levels to choose from, it is easy to become lost in the associated technical jargon and end up more confused than when you started.

Learn more in our blog post: Why use a health insurance broker?

How much does UK Private Medical Insurance cost?

With each policy having a modular set of benefits, there are thousands of variations which can be selected, and therefore thousands of potential costs.

Below gives an indication of cost based on a mid-range selection of benefits:

PROVIDER
30 YEARS OLD COST PER YEAR
40 YEARS OLD COST PER YEAR
50 YEARS OLD COST PER YEAR
60 YEARS OLD COST PER YEAR
Aviva
£968.04
£1200.84
£1491.60
£2108.76
AXA
£487.92
£600.96
£783.24
£1203.84
Bupa
£663.12
£824.52
£1117.08
£1440.84
Exeter
£668.52
£808.44
£1043.52
£1554.40
Freedom
£649.08
£817.56
£1143.84
£1647.84
Vitality
£697.56
£870.24
£1134.00
£1650.36
WPA
£639.84
£827.28
£1050.12
£1413.96

Correct as of April 2020. Based on £1.000 out-patient cover, full therapies, £100xs, non-London hospitals, newly underwritten.

How does the No Claims Discount (NCD) work?

Health Insurance No Claims Discounts work in very much the same way as car and home insurance: every year you are claim-free awards a greater percentage discount on your premium.  However, if you do make a claim, your premium will increase as a result.

Some customers like the NCD arrangement as it offers an element of control over how their premiums will increase from year to year.  For example, some customers may choose to pay smaller claims costs themselves to ensure the next year premium isn’t affected.

The alternative to a NCD policy is one where the premium isn’t affected by claims, but where the premium increases gradually each year along with everyone else’s.  This is known as ‘Community Rated’ and essentially means that while no discounts will be offered if you don’t claim, you also won’t see a large increase if you do.

Individual Private Medical Insurance providers give different options for NCD which are highlighted below:

Insurers who operate No Claims Discount/individual performance pricing

Aviva

AXA PPP

Bupa

Vitality

Insurers who operate Community Rated pricing

Freedom

National Friendly

WPA

Insurers who operate both

The Exeter

In the absence of a soothsaying crystal ball, nobody knows which route will be best for each individual. What’s most important is understanding how your chosen insurer operates so that you can make an informed decision ahead of buying a policy.

What is the best Private Medical Insurance in the UK?

The UK has some fantastic health insurance providers and they all bring something unique to the market. Regrettably it’s impossible to pinpoint “the best” as this varies dependent on individual needs (benefits levels, budget etc), however, you can find out more by viewing our Guide to UK Health Insurance Providers.

Read: Top 10 tips for taking out private medical insurance.

Private Health Insurance UK
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