The definitive manual on personal health insurance. Learn how private medical insurance operates, what is covered, and which insurers have received the highest ratings from actual customers.

What does private health insurance entail?

Private medical insurance, commonly known as PMI or private health insurance, covers millions of people in the UK.

What is it then? How does it function, too?

Private health insurance, at its most basic level, pays for private medical care if you become ill.

Private health insurance, however, varies from provider to provider and may not always cover everything.

In general, health insurance is intended to cover the cost of elective surgery, diagnostic tests, and private care for medical disorders that respond swiftly to therapy (often referred to as “acute” conditions).

Everything you need to know about private health insurance is covered in this guide, from how it operates to which companies provide the greatest customer service.

What benefits and exclusions come with private health insurance?

Your provider will choose what is covered for you, however certain aspects are often covered by most policies. Those marked with a are typically omitted, whereas those with a are covered as standard.

Treatment in a hospital

The majority of insurance plans pay for testing, surgery, and other expenditures associated with inpatient care, which requires a hospital bed for the day or night.

Outpatient therapy

Many policies cover outpatient therapy, but the amount you can claim may be regulated. Outpatient treatment includes consulting with a consultant and getting tests or scans to assist identify illnesses.

Less expensive policies have lower limitations and cover fewer forms of outpatient therapy.

Hospital lodging and nurse attention

Most insurance offer a hospital stay and limited nursing care.

Specialty medications

Some policies will cover medications that are not available through the NHS but have received National Institute for Health and Care Excellence approval.

Additional cover

The amount of mental health care that different insurers will cover. The distinction between long-term care (which isn’t covered) and curable sickness (which is covered) is hazy in this area, making it challenging for clinicians. Psychiatric care may be covered by comprehensive insurance, but not always.

Additionally, some insurance provide parental accommodations while your child is in the hospital, a private ambulance, home nursing, a 24-hour counselling line, and complementary therapies like physiotherapy and chiropractic care. Again, a thorough policy is more likely to have these provisions.

Medical conditions that already exist

If you’re healthy, purchasing private health insurance is simpler. Pre-existing medical disorders are frequently excluded by insurers, who instead emphasise diseases that heal rapidly.

Private health insurance is still appropriate for those with pre-existing diseases, despite this; it may be challenging to obtain the coverage you require.

More persistent circumstances

Longer-term medical care, such as kidney dialysis, or ailments like asthma are not covered by your insurance.

Additional conditions

Drug misuse, typical pregnancies, organ transplants, infertility, and unnecessary cosmetic procedures are among the other exclusions.

What are the many cover types?

Private health insurance generally comes in two flavours: fully underwritten and moratorium policies.

Completely underwritten insurance

You will be required to supply your provider with your complete medical history if you choose fully underwritten private health insurance.

Moratorium measures

You will only have to provide your insurer with a small amount of information if you have a moratorium plan.

While purchasing a moratorium insurance is more convenient than having your insurer read over your complete medical history, fully underwritten plans can be more affordable and let you know right away which ailments you are and are not covered for.

professional policies

Additionally, some insurers offer specialty coverage. For instance, some only provide coverage if you must wait more than six weeks for NHS care. Other policies are tailored exclusively for people over 55 or put a particular emphasis on a certain illness, like cancer.

Policies that are modular and flexible are becoming more prevalent. These provide coverage for in-patient procedures while also allowing you to customise your insurance plan by adding or removing coverage components.

Do I really require a private setting for my care?

The NHS, which offers comprehensive healthcare that is free at the moment of need, is a blessing that we have in the UK.

Meanwhile, obtaining private treatment is quite expensive; for instance, hip or knee replacement surgery will probably set you back more than £10,000. Furthermore, the quality of private medical care is unlikely to be superior to that of NHS care. then why pay?

The key benefits of private healthcare are the expanded options for where and when to receive treatment, as well as the efficiency and ease of the process.

Therefore, private health insurance is one way to shorten drawn-out wait times without having to have tens of thousands of pounds on hand.

What is the price of private health insurance?

Private health insurance premiums differ from person to person and from cover to cover, just like many other insurance types.

Similar to how the cost of treatment might vary greatly depending on where you reside, so can the premium you’ll have to pay.

Inevitably, premiums increase as people age. A comprehensive health insurance plan may cost a few hundred pounds per year for younger users. Customers who are past retirement age are more likely to have coverage that is well into the thousands.

The table below provides some sample quotes of what two couples (aged 35 and 55) may be expected to pay yearly if they were looking for operation insurance, comprehensive heart and cancer insurance, and treatment insurance (such as physiotherapy).

For those with pre-existing conditions and/or prior claims, costs may be significantly higher, and they also increase with age.

Provider Policy name 35 year-old couple 55 year-old couple
Aviva Limited Cover with Other Treatments & therapies £736 £1,236
AXA PPP Core Cover with Therapies option £1,053 £1,822
BUPA Treatment & Care £1,073 £2,090
Saga Saver Plus n/a £1,389
Vitality Personal Healthcare £1,212 £1,911

The following are some representative quotes that were acquired from the websites of various insurers in September of 2021. We chose the most affordable mix of coverage options that would provide full inpatient care, comprehensive heart and cancer insurance, and partial coverage for therapies for a couple living in South London who were both in good health.
Coverage for outpatients was dropped in cases where it was feasible to do so. We chose not to pay any further fees, although we did pay for a waiting period when it was provided.

The most reputable and customer-friendly private health insurance providers

If they fail to meet your expectations in terms of service, they cannot be considered a reliable private health insurer.

In the months of May and June of 2021, we conducted a poll among 538 members who have their own private health insurance and have filed a claim in the previous five years. Members are able to view how well five different insurance providers, including Aviva, AXA PPP, BUPA, Saga, and Vitality Health, performed in our evaluation of their service.

In May 2021, we surveyed 538 members Connect Panel who claimed within the prior 5 years. Customer Score reflects respondents’ overall level of satisfaction with, and likelihood of recommending, the insurer. Customer Score sample sizes – Aviva (64), AXA PPP Healthcare (103), Bupa (195), Saga (45), Vitality Health (40)

What services do the various private health insurance companies provide?

Aviva

Both a comprehensive policy known as “Healthier Solutions” and a policy known as “Speedy Diagnostics” are available from Aviva.

The coverage levels for Healthier Solutions are referred to as “Limited” and “Full.” The most notable distinction is that the ‘Limited’ option does not include any outpatient consultations, diagnostic tests, therapies, non-surgical treatment, or outpatient mental health treatment. All of these are included in the ‘Full’ option.

However, there are options to customise the cover by increasing or decreasing it, and you can use either as a starting point. Alternate treatments and therapies, as well as in-patient mental health coverage, are examples of non-standard options that can be added to an insurance plan.

As the phrase “speedy diagnostics” suggests, this cover is typically terminated as soon as a condition has been identified and diagnosed. While a condition is being investigated, it pays for expedited access to diagnostic procedures like tests and scans as well as hospital bills.

AXA PPP

AXA PPP Healthcare is the nation’s number two health insurer after the National Health Service.

Alongside outpatient surgery, diagnostic tests, and imaging scans, the company’s Personal Health Policy provides inpatient care that is standard, which includes comprehensive cancer treatment.

You have the option to tailor the plan to increase the range of outpatient coverage that is available, as well as other extras, and add a waiting period of six weeks.

You can also reduce the amount of cancer coverage you have to “NHS Cancer Support” in order to bring the premium down. AXA will not cover the cost of your cancer treatment if you have “NHS Cancer Support,” unless the treatment involves licenced cancer drugs that aren’t made available through the NHS.

Bupa

In addition to providing health insurance, Bupa operates a sizable network of private hospitals, making it the largest health insurer in the UK.

You have the option of selecting the less expensive “Treatment and Care” level of coverage or the more expensive “Comprehensive” level of coverage. The most important distinction between the two is that the second one provides coverage for a wider variety of outpatient tests and consultations than the first one does.

One of the aspects in which Bupa stands out from its competitors is the fact that it provides standard coverage of one month’s worth of treatment for mental health conditions.

You have the ability to make additional adjustments to the cover levels and excesses within both of Bupa’s coverage tiers.

This includes the option to choose between comprehensive cancer coverage and the more limited “cancer cover plus” policy, which kicks in specifically to cover necessary cancer treatment that is not provided by the NHS.

Saga

Saga is an insurance company that only serves customers over the age of 50.

Saga provides a total of five different plans, ranging from “Super,” which is the most all-encompassing choice, to “Saver” and “Support,” which are the simplest plans and can only be purchased over the phone.

All three plans, Super, Secure, and Saver Plus, provide coverage for inpatient and outpatient surgery, chemotherapy, radiotherapy, and surgical cancer treatment, as well as scans and therapies; however, the benefit limits for certain categories, such as scans, differ between the three plans.

The benefit package for dental injuries and mental health treatment are both included in the Super upgrade.

You have the ability to tailor and improve your policy so that it covers hypertension, adds cash benefits for everyday health costs, and extends the level of cancer cover so that it can fund treatment with drugs that are not available on the National Health Service.

Health and Vitality

The Active Rewards Scheme, which gives members perks for leading healthy lives, is one of the most well-known aspects of Vitality. Members earn points when they use activity tracking devices to record positive behaviours (such as going for walks or working out at the gym). Members can use the points to purchase discounted goods and receive other benefits from affiliated businesses.

As is the case with the majority of health insurance policies, the one offered by Vitality includes, as standard coverage, comprehensive inpatient care, cancer treatment, and outpatient surgical procedures, in addition to optional benefits such as mental health support and in-home nursing.

Standard outpatient coverage is limited (£500 per year), but the plan is highly customizable, so additional coverage can be added as needed. Additionally, there is an option for “full cover,” which removes the cash limit.

You have the option of selecting a fixed excess payment to make toward claims, and you can choose whether the payment is to be made per plan year or per claim (reducing the premium).

Where can I find reasonably priced private health insurance?

Talk to a broker for assistance, please.

Because private health insurance is such a complex product, it is in your best interest to consult with a broker, particularly if you have a history of medical issues or require specialist coverage for a specific illness.

Check out the British Insurance Brokers’ Association (BIBA) or the Association of Medical Insurers and Intermediaries to locate a broker. Both of these organisations exist in the United Kingdom (AMII).

Learn more about it here:

The website of the BIBA
Learn more about it here:
The website of AMII
You can reduce your expenses by making some changes to your policy.

After selecting a plan, you can begin to bring down the premium by making adjustments to the coverage.

To get started, think about the hospitals that are available to you. The majority of service providers will give you a list from which to choose, and if you select a shorter list, you might be able to reduce the amount of money you spend.

Because many insurers let you pick and choose which modules to include in your policy, you should first determine which aspects of the coverage are the most essential to you. For example, eliminating or reducing coverage for outpatient care, which typically includes visits to the doctor and diagnostic imaging, can shave hundreds of dollars off the cost of the annual premium.

Some insurance companies also offer the possibility of purchasing less comprehensive cancer coverage. For instance, you might be able to purchase insurance that will pay out benefits only in the event that you require medical care or medication that isn’t made available by the National Health Service.

Co-payments, excess charges, and time spent waiting all add up.

Next, give some consideration to including an excess in your policy. Your monthly premiums will be lower if you are willing to pay a portion of the cost of your treatment out of pocket; however, you must ensure that you have the financial means to cover any deductibles or copayments.

Co-payments are a twist on the traditional concept of excess payments. By agreeing to make a co-payment, you are committing to pay a certain percentage of the total cost of a claim (for example, 10 or 15 percent), up to a certain maximum amount (for example, $1,000).

Because you will be relying less on the insurer, you will receive a discount on the premium; however, the maximum amount ensures that you won’t find yourself facing amounts that are unaffordable to you.

Think about whether or not you would be open to receiving some treatment from the NHS as well. There are many policies that give you the option to purchase discounted coverage that takes effect only in situations where the NHS is unable to provide it promptly (usually six weeks). Therefore, if the speed of treatment is the primary reason behind your decision to seek care privately, this may be an acceptable compromise for you.

Be wary of giving up and starting over.

Contrary to auto and homeowner’s insurance, switching companies every year does not result in cost savings with private health insurance. Although trying to switch from your current service provider to one that offers a better deal is certainly not impossible, doing so can be challenging.

Conditions that you’ve developed while you were covered by the prior policy are likely to be considered pre-existing and, as a result, will not be covered unless you’ve expressly arranged for the same conditions and exclusions to be covered by your prior insurer. This arrangement is known as Continued Personal Medical Exclusions, and it applies only if you’ve done so.

Your premiums will increase as you get older because the insurance industry views you as posing a greater risk to your health as you get older. This will make it more difficult to find a better deal that is also affordable.

If you are thinking about cancelling your current policy and getting a new one, you should always compare the potential new policy to the one you currently have to ensure that the new one meets all of your requirements.

Maintain the highest possible level of health.

If you maintain a healthy lifestyle, you may be eligible for discounts from certain insurance companies. For example, if you participate in Aviva’s MyHealthCounts programme and maintain a healthy lifestyle, you could receive a discount of up to 15 percent on your renewal premium.

What are some of the other options available besides private health insurance?

You are provided with a private health insurance plan by your employer.

This is more of an alternative method of possessing health insurance than it is a replacement for health insurance itself.

One of the benefits of working for many companies is receiving health insurance.

Policies that you buy independently from an insurer are typically more expensive and restrictive, such as not covering pre-existing conditions, compared to employer-sponsored private health insurance plans, which are typically less expensive and more generous.

Cash plans for medical care

Cash plans for healthcare are typically much more affordable than private health insurance; however, they are only intended to cover routine healthcare costs such as visits to the dentist, the purchase of glasses or contact lenses, or physiotherapy.

The protection you purchase is not likely to extend to covering the expenses associated with significant medical treatment, such as an operation.

You will be responsible for paying a monthly premium, and the provider of the cashplan will reimburse you for any medical expenses that are covered by the plan. There is a cap placed on the total amount of money that can be claimed in a given year, and higher caps are placed on more extensive policies.

Critical illness cover

Critical illness insurance cover is commonly sold in conjunction with life insurance and will pay out a cash lump sum in the event that you are diagnosed with one of a number of critical illnesses listed on the policy. These critical illnesses can include certain types of cancer, a heart attack or stroke, multiple sclerosis, or the loss of limbs. Other critical illnesses include Alzheimer’s disease and multiple sclerosis.

A critical illness policy can be used to pay for anything, including medical treatment costs, modifications to your home (such as mobility aids, specialised equipment, or structural changes that are required due to a disability), or even to pay off your mortgage.

The one thing that it does not do, which is something that income protection does, is provide a regular income.

Because the illnesses covered by different insurers differ, it is important to seek advice before purchasing a policy and to read the policy document thoroughly. Pre-existing conditions are typically not covered, but some insurers will determine whether or not they will cover you based on your medical history.

Learn everything you need to know about critical illness insurance by reading our comprehensive guide.

Self-paying

It’s true that the majority of people who utilise private healthcare do so through their insurance, but “self-paying” is becoming an increasingly common payment method.

The initial consultation and any necessary diagnostic costs will be included in the costs that you can expect to rack up. Additionally, the price of the treatment itself, as well as hospital fees and followup care, will be included in these costs. These items are frequently sold in bundles at hospitals.

The price that you, as a self-paying patient, would pay and the price that an insurer would be billed for are frequently not the same. There are times when insurers are able to negotiate lower prices; however, there are also times when there are better discounts that are only available to self-paying customers.

a comparison of the various private treatment providers

Choosing to pay for your own medical care gives you more options, but it may also make it more difficult to decide where to get treatment and calculate the total cost of the procedures you need.

Your primary care physician and/or health insurer are two potential sources of information and guidance in this matter.

The Private Healthcare Information Network (PHIN), which was tasked by the Competition and Markets Authority to help make the private healthcare sector more transparent to customers by compiling and publishing data on private hospitals and consultants, is another source of information that should be taken into consideration.

You can compare the various options available in your region by using the PHIN website. This will include customer ratings of local private hospitals as well as the fees charged by various consultants.

Learn more about it here:

The website of the PHIN.
Instructions for filing claims with a private health insurance policy

Step one: Read your policy document

Claim filing procedures can vary widely between health insurance providers. If you intend to seek private treatment, you should read the fine print of your insurance policy or check the website of your insurer to see if there is any specific guidance available.

Step two: Consult your primary care physician.

In the first step, you should discuss your condition with your primary care physician as you normally would. You can get a referral for private treatment from your primary care physician. There are primarily two types of referrals: an open referral, in which your primary care physician does not address the letter to a particular consultant, and a named referral, in which a specialist is listed on the letter. Both of these types of referrals are considered to be primary types.

Check with your provider to see which of your policy’s terms and conditions they require by reading through the stipulations.

Step three: Contact the company that provides your private health insurance.

After that, you should call your provider and discuss the situation with them. What you’ll need to have on hand when you call will vary from service provider to service provider, but take the following into consideration:

The number of your policy.
information regarding what your primary care physician has told you Information regarding your condition
Specifics regarding your recommendation.
Fourième étape: When you have finished seeing the specialist, give your private health insurance provider a call (again).

Call your primary care physician once you have finished seeing the specialist so that you can update them on the next steps that will be taken. Also, make sure that you have a clear understanding of how you will pay for any consultations or treatment; either you will be required to pay out of pocket and then submit a claim for reimbursement, or your provider will pay directly.

Fifth step: Don’t be afraid to voice your concerns.

Do not be afraid to file a complaint with your insurance provider if you feel that you have been treated unfairly or if the outcome of your claim does not match your expectations.

Talk to your service provider first, but if that doesn’t help (and you’ve gone through their complaints process to its conclusion), call the Financial Ombudsman Service at 0300 123 9123 and take your complaint there if it still isn’t resolved.