How does private health insurance work in the UK?

What is private health insurance?

Also known as private medical insurance (PMI), private health insurance pays for private medical treatment, tests and surgery if you are ill or injured during the policy's term. It's usually designed for acute conditions, which are curable and short term.

You usually pay a monthly amount for your health insurance, which is called the premium. Your insurer can then pay if you need treatment that it covers while the policy is active.

It's designed to offer treatment alongside the service provided by the NHS. For example, appointments with your GP would still be through the NHS. But with medical insurance you could get the following benefits:

• You may be able to skip NHS waiting lists

• A choice of where you get treatment

• A private room

• A wider range of treatment types

Here's how it works in principle:

1. You pay annually or monthly for your health insurance

Paying this keeps your cover active; the cost depends on a few things, such as your age, health, what level of cover you choose and any extra add-ons (for example, dental cover).

2. See your GP first if you have symptoms

Even if you have private insurance, most insurers want a GP referral before they approve any tests or treatment. That doesn't mean you have to continue treatment with the NHS; it's just a starting point for your insurer.

3. You call your insurer to start the claim

Contact your insurer and provide your GP's notes or referral. They'll then check what your policy covers and agree to either cover it, ask for more information or tell you it's not included.

4. You're offered a choice of consultants and hospitals

If your treatment is approved, you can pick where and who you see. Usually these appointments are quicker than the NHS; you might go to a private hospital or wing for treatment too.

5. You get your treatment or tests and follow-up care

Your bill goes straight to your insurer usually, but you'll have to pay any excess that's on your policy.

If you need physio or any post-op checks, these should be covered by your private health insurance. That's as long as the condition is still classed as short-term and treatable.

More things to know

Anything routine or long-term, like asthma or diabetes, isn't covered by your health insurance. But the NHS can offer you treatment for it as normal.

There's a different process for pre-existing conditions too, as they're not usually covered by your health insurance unless you specifically agreed to it with your insurer.

If your condition is chronic, so long-term or recurring, your health insurer probably won't cover you. It might cover the initial investigations and tests to get a diagnosis. But it won't cover the long-term treatment.

The only time this is slightly different is if you have an 'acute flare-up'. Sometimes your health insurer might cover short-term treatment for this. But this is only if your insurer decides it is an 'acute flare-up'.

Once your condition is labelled as chronic, private insurers probably won't continue to cover your treatment. But the NHS will be able to help you.

What's the difference between private health insurance and the NHS?

We are lucky in the UK to have a National Health Service which is free (at the point of service) if you need medical treatment. However, there is also the option of private healthcare, which can help you skip waiting lists, choose your hospitals and doctors, and access treatments not covered by the NHS. Private healthcare comes at a cost, however, but private health insurance can help cover this.

What does private health insurance cover?

When it comes to coverage, every insurer varies, but usually it helps you cover the cost of medical treatment outside of the standard NHS route.

Because you pay monthly or annually for it, you get added perks that the NHS can't offer. For example, reduced wait times and private hospitals.

It's almost like a fast-track service. You still get to use the NHS, but private medical insurance can get you quicker appointments, more choice of consultants and access to private hospitals.

It's not designed to replace the NHS; it's designed to complement it.

You can also choose to add extras to your policy, like:

• Mental health support

• Dental treatment

• Outpatient cover (any treatment or test which means you don't have to stay overnight)

• Cancer care

These usually come at an extra cost ,though. Make sure you check your policy so you know exactly what's covered.

What is not covered by private health insurance?

Here's what's not covered by private health insurance:

• Chronic or pre-existing conditions

• Routine GP care and prescriptions

• A&E visits and emergency care

• Cosmetic procedures (unless medically necessary)

• Long-term care and rehabilitation for chronic conditions

• Experimental or high-risk treatments

• Non-medically necessary treatments

How much does private health insurance cost?

The cost of your health insurance policy depends on the following factors:

• Your age, as it costs more when you are older

• Your medical history, e.g. if you had cancer, diabetes or high blood pressure

• Your family's history of conditions like heart disease, cancer or strokes

• Your lifestyle could make premiums higher if you smoke or are overweight

• What you choose to cover, as including more conditions and types of treatment costs more

How can you get cheaper private health insurance?

Private health insurance doesn’t have to cost the earth, and there are ways to reduce your premiums.

• A no claims discount: Once you have had health insurance for a while, your premiums could get cheaper if you do not make any claims.

• The excess: This is the amount you have to pay towards treatment yourself when you claim. Choosing a higher excess usually makes your premiums lower but makes claiming on the policy more expensive.

• Adding a wait period: This could give you cheaper cover. It means that if the NHS waiting list is less than your wait period (e.g. six weeks), you must get your treatment through the NHS. If the waiting list is longer, your policy pays for private treatment.

• Using nominated hospitals: Your premium could be cheaper if you only choose to be covered at a few hospitals or surgeries. Check the ones you choose are located nearby or offer the specialist treatment or facilities you may need.

• Improving your health: Some insurers reduce your premiums if you do not smoke or regularly use a gym.