Health insurance
Find the right private medical cover for your needs and budget.
If you’re considering health insurance in the UK, you’re likely weighing up the benefits of faster treatment against the monthly cost. Perhaps NHS waiting times have left you frustrated, or you’re worried about accessing the care you need when you need it. Since 2017, we’ve helped thousands of UK customers find the right health insurance policy for their circumstances, and this guide covers everything you need to make an informed decision. Affordable healthcare is a key goal of private health insurance, making accessible and budget-friendly options available to a wider range of people.
If you want to see your options and potential costs right away, you can get a quote quickly and easily using our online tools.
What you’ll learn in this comprehensive guide:
- How health insurance works in the UK and what it actually covers
- The different types of policies available and which suits your situation
- What determines your premium and how to get the best value
- Eligibility requirements and how pre-existing conditions affect cover
- The complete costs involved, including excess and co-payment options
- How to claim and what to expect from the process
We partner with insurance brokers. This means we work with multiple insurers to find cover that matches your needs, rather than selling you a single company’s products. Our advice is based on helping real customers navigate these decisions every day.
What Is Health Insurance?
Health insurance, also known as private medical insurance (PMI), is a policy that pays for private healthcare treatment in the UK. A private health insurance policy is designed to suit different needs and budgets, offering flexibility in coverage and cost. It gives you access to private hospitals and clinics, shorter waiting times, and often a choice of when and where you receive treatment.
Unlike the NHS, which is funded through taxation and free at the point of use, health insurance requires you to pay monthly or annual premiums. In return, you can bypass NHS waiting lists and access treatment that might otherwise take months or even years to receive.
How health insurance differs from NHS care:
Health insurance doesn’t replace the NHS—you remain entitled to all NHS services regardless of whether you have private cover. Many people use both, relying on the NHS for emergencies and routine care while using private insurance for elective treatments where waiting times are longer. Some insurers operate on a not-for-profit basis, prioritising member needs over profit.
Example: How health insurance works in practice
Sarah, aged 45 from Manchester, needed a hip replacement. On the NHS, her estimated waiting time was 18 months. With her health insurance policy, she was seen by a private consultant within two weeks, had her surgery within six weeks, and was recovering in a private room. Her policy covered the entire cost of treatment, minus her £200 excess. She was able to choose from a network of trusted healthcare providers, ensuring high-quality care.
The Association of British Insurers reports that over 4 million people in the UK have private medical insurance, with the majority accessing cover through their employer. However, individual policies are increasingly popular as NHS waiting lists have grown. Some providers offer award winning health insurance, recognised for their quality and service.
How Does Health Insurance Work?
Understanding how health insurance works helps you get the most from your policy and avoid unexpected costs. The process involves several stages, from choosing your cover to claiming treatment.
2.1 Choosing a health insurance policy
Start by comparing different health insurance policies to find one that matches your needs and budget. Consider factors like the level of cover, excess, and any exclusions. If you already have an existing health insurance policy, you can often switch to a new provider, and guidance is available to help ensure a smooth transition.
2.2 Getting a quote
Most providers offer online tools to get a personalised quote based on your age, health, and required cover. You can also speak to an advisor for tailored recommendations.
2.3 Paying premiums
Once you choose a policy, you’ll pay monthly or annual premiums to keep your cover active. Some insurers offer discounts for paying annually or for healthy lifestyle choices.
2.4 Making a claim
If you need treatment, contact your insurer to check what’s covered and get authorisation. Many insurers now allow members to manage their cover, make claims, and track progress easily through a dedicated app. This streamlines the process and helps you stay updated on your claim’s status.
Step 1: Choosing Your Policy
When you apply for health insurance, you’ll select the level of cover you need. Policies range from basic plans covering essential treatments to comprehensive cover including mental health, therapies, and wellness benefits.
You’ll provide information about your age, location, health history, and lifestyle. Insurers use this to calculate your premium—the amount you pay each month or year for cover. You can get a quote online to quickly compare pricing and coverage options from different providers.
Most policies offer options to adjust your excess (the amount you pay towards each claim) and choose whether to include extras like dental, optical, or maternity cover.
Step 2: Underwriting Your Application
Insurers assess your application through a process called underwriting. This determines what conditions they'll cover and at what price. There are three main underwriting approaches:
Full medical underwriting: You complete a detailed health questionnaire. The insurer reviews your medical history and decides which conditions to cover. Pre-existing conditions are typically excluded.
Moratorium underwriting: No health questions upfront. Instead, the insurer won't cover any condition you've had symptoms of, treatment for, or medical advice about in the previous five years. After two years of continuous cover without treatment for that condition, it becomes covered.
Medical history disregarded: No health questions asked, and all conditions covered from day one. This is the most expensive option but provides the most comprehensive cover.
Step 3: Using Your Policy
When you need treatment, the process typically works like this:
- Get a GP referral: Most policies require you to see your NHS GP first, who refers you to a specialist
- Contact your insurer: Before booking treatment, call your insurer to confirm your treatment is covered
- Choose your provider: Select from the insurer's list of approved hospitals and consultants
- Receive treatment: The insurer pays the hospital directly in most cases
- Pay any excess: You pay your excess amount, either upfront or when billed
Some policies allow self-referral to certain specialists, bypassing the GP requirement. This is common for physiotherapy, mental health support, and some diagnostic tests.
Step 4: Making a Claim
Claims are usually handled directly between your insurer and the hospital—this is called a "fee-assured" arrangement. You won't need to pay upfront and claim back.
However, if you use a provider outside your insurer's network, or if treatment costs exceed your policy limits, you may need to pay the difference yourself.
Insurers typically require you to notify them before treatment begins. Failing to get pre-authorisation can result in your claim being rejected, so this step is essential.
Timeline expectations:
- GP referral to specialist appointment: 1-2 weeks
- Pre-authorisation from insurer: 24-48 hours
- Consultant to treatment: varies by procedure, often 2-6 weeks
- Claim processing: usually immediate for pre-authorised treatment
Types of Health Insurance
Health insurance policies vary significantly in what they cover and how much they cost. Understanding the different types helps you choose cover that matches your needs and budget. A private health insurance policy can be tailored to cover not just yourself but also family members and loved ones, providing peace of mind for a range of needs.
Individual Health Insurance
Individual policies cover a single person and are tailored to their specific needs. You choose the level of cover, excess, and optional extras.
Best for: Single people, those without employer cover, self-employed individuals
Key features:
- Premiums based on your personal health profile
- Full control over policy features
- Portable—stays with you if you change jobs
- Can often add family members later. A private health insurance policy can be upgraded to include additional family members as your needs change, providing flexibility and peace of mind for you and your loved ones.
Typical cost range: £40-£150 per month depending on age, location, and cover level
Family Health Insurance
Family policies cover multiple family members under a single policy. This is often more cost-effective than separate individual policies. This provides peace of mind for your loved ones, ensuring they have access to medical treatment when needed.
Best for: Parents with children, couples, multi-generational households
Key features:
- Children often covered at reduced rates or free
- Single excess per family rather than per person on some policies
- Simpler administration with one policy to manage
- Family bonus options on some policies
Considerations:
- Cover typically ends for children at age 18-24
- Partners may need to be married or in a civil partnership
- Some policies limit the number of family members
Corporate Health Insurance
Many employers offer health insurance as a workplace benefit. Corporate schemes often provide better value than individual policies because the risk is spread across many employees.
Best for: Employees whose company offers this benefit
Key features:
- Often subsidised or fully paid by employer
- May include family members
- Usually continues only while employed
- Group underwriting can mean more inclusive cover
What to consider:
- Check what happens if you leave your job
- Understand any excess or co-payment requirements
- Review what's actually covered—corporate schemes vary widely
Cash Plan vs Health Insurance
Cash plans are sometimes confused with health insurance but work differently. While health insurance pays for treatment directly, cash plans reimburse you for everyday health costs.
Many people have both—health insurance for serious conditions and a cash plan for routine costs like dental check-ups and glasses.
What Does Health Insurance Cover?
Health insurance policies cover a wide range of treatments, but what’s included varies significantly between insurers and policy levels. Understanding what’s typically covered—and what’s not—helps you choose appropriate cover. Policies may address different areas of health, including physical, mental, and emotional wellbeing.
Core Cover (Usually Included)
Most health insurance policies include these elements as standard:
In-patient treatment: This covers surgery and procedures requiring an overnight hospital stay. It includes surgeon and anaesthetist fees, hospital accommodation, nursing care, and medications during your stay.
Day-patient treatment: Procedures performed in hospital where you go home the same day, such as minor surgeries, endoscopies, and some cancer treatments.
Out-patient treatment: Consultations with specialists, diagnostic tests, scans, and follow-up appointments. Most policies have annual limits for out-patient care.
Cancer treatment: Diagnosis and treatment of cancer, including chemotherapy, radiotherapy, surgery, and specialist consultations. Cancer cover is a core component of most policies.
Diagnostic tests: MRI scans, CT scans, blood tests, X-rays, and other investigations to diagnose conditions.
Enhanced Cover (Often Optional)
These elements may be included in comprehensive policies or available as add-ons:
Mental health treatment: Consultations with psychiatrists and psychologists, plus in-patient treatment for mental health conditions. Many policies now include this as standard, though with annual limits.
Therapies: Physiotherapy, osteopathy, chiropractic treatment, and other allied health services. Often subject to annual session limits or monetary caps.
Dental and optical: Some policies include or offer add-ons for dental treatment and eye care beyond NHS provision.
Maternity cover: Pregnancy and childbirth-related care. Usually requires a waiting period of 10-12 months before claiming and may have monetary limits.
Wellness benefits: Health screens, gym memberships, nutrition advice, and wellbeing apps. Many policies now offer rewards such as discounts on top brands like Fitbit and Gousto, encouraging healthy physical activity, self-care, and overall physical wellbeing. These rewards and incentives are increasingly common in comprehensive policies.
What's Typically NOT Covered
Understanding exclusions is as important as knowing what's included:
Pre-existing conditions: Any condition you had before taking out the policy is typically excluded, at least initially. This includes conditions you've had symptoms of, even if not formally diagnosed.
Chronic conditions: Ongoing conditions requiring long-term management, such as diabetes or arthritis, are often excluded or have limited cover. Policies generally cover acute episodes but not ongoing management.
Cosmetic surgery: Procedures for appearance rather than medical necessity, unless resulting from an accident or illness.
Fertility treatment: IVF and other fertility treatments are usually excluded, though some comprehensive policies offer limited cover.
Emergency treatment: A&E visits and emergency care are typically excluded—the NHS handles emergencies.
Routine check-ups: General health checks and screening (unless part of a wellness benefit) aren't usually covered.
Self-inflicted injuries: Injuries resulting from self-harm, substance abuse, or dangerous activities may be excluded.
Example: Understanding policy limits
James has a policy with £1,500 annual out-patient cover and unlimited in-patient cover. He needs physiotherapy (out-patient) and knee surgery (in-patient).
His physiotherapy sessions cost £65 each. He can claim up to 23 sessions before reaching his out-patient limit.
His knee surgery, including consultant fees, operating theatre, and overnight stay, costs £8,500. This is fully covered as in-patient treatment with no monetary limit.
Eligibility and Requirements
Health insurance is available to most UK residents, but insurers assess applications based on several factors. Understanding these requirements helps you prepare for the application process and set realistic expectations.
If you already have an existing health insurance policy, you can often switch to a new provider, such as Aviva. When switching, it is usually possible to carry over your medical underwriting and exclusions, which can make the transition to your new health insurance smoother and help maintain your cover without unnecessary interruptions.
Basic Eligibility Criteria
Age requirements: Most insurers accept applications from adults aged 18-75, though some cover children from birth. Upper age limits vary, and premiums increase significantly with age.
UK residency: You typically need to be a UK resident to apply for UK health insurance. Some policies require a minimum residency period.
No current hospital treatment: You usually can't take out cover while awaiting treatment or while in hospital.
How Pre-existing Conditions Affect Cover
Pre-existing conditions are the most significant factor affecting what health insurance will cover. Insurers define pre-existing conditions broadly—they include any condition you've:
- Been diagnosed with
- Received treatment for
- Had symptoms of
- Sought medical advice about
- Been referred for investigation about
This applies regardless of whether the condition is "resolved." A broken leg from 10 years ago might not affect your policy, but the insurer will still ask about it.
How insurers handle pre-existing conditions:
Example: Pre-existing conditions in practice
Emma, 38, had treatment for anxiety three years ago. Under full medical underwriting, her mental health may be excluded from cover. Under moratorium underwriting, she couldn't claim for anxiety-related treatment initially, but after two years without treatment, it would become covered.
Age and Premium Implications
Age significantly affects health insurance costs because older people statistically require more medical treatment. Here's how age typically impacts premiums:
Premiums are indicative and vary by insurer, location, and cover level.
For Self-Employed Individuals
Self-employed people often find health insurance particularly valuable because illness directly affects their income. However, the application process is the same as for employees.
Key considerations for self-employed applicants:
- No employer contribution means full premium payment
- Business protection insurance may complement health insurance
- Tax treatment allows business expense deduction in some cases
- Group schemes may be available through trade associations
For Older Applicants
If you're applying for health insurance later in life, be aware that:
- Premiums will be higher than for younger applicants
- More conditions may be excluded due to medical history
- Some insurers have maximum age limits for new policies
- Existing policies can usually be renewed beyond typical age limits
- Six-week wait options can reduce premiums (see costs section)
Complete Cost Breakdown
Understanding the full cost of health insurance helps you budget accurately and compare policies fairly. Many providers aim to deliver affordable healthcare by offering a range of private health insurance policy options tailored to different needs and budgets. Beyond the headline premium, several factors affect what you’ll actually pay.
Premium Factors
Your monthly or annual premium is calculated based on multiple factors:
Age: The most significant factor. A 55-year-old typically pays two to three times more than a 30-year-old for equivalent cover.
Location: Premiums vary by region. London and the South East typically have higher premiums due to higher treatment costs.
Cover level: Comprehensive policies cost more than basic cover. Adding extras like dental, optical, and therapies increases premiums.
Excess level: Choosing a higher excess (the amount you pay towards claims) reduces your premium. Excesses typically range from £0 to £500 or more.
Underwriting type: Medical history disregarded (covering everything from day one) costs significantly more than moratorium or full medical underwriting.
Hospital list: Policies limiting you to certain hospitals cost less than those offering nationwide choice.
Lifestyle factors: Some insurers offer discounts for non-smokers or those who exercise regularly.
Understanding Excess Options
Excess is the amount you contribute towards each claim before the insurer pays. Choosing a higher excess reduces your premium but increases your out-of-pocket costs if you claim.
Types of excess:
Example: Excess calculation
Tom has a £200 annual excess. He claims for a consultation (£250), an MRI scan (£450), and physiotherapy (£390) in one year.
Total claims: £1,090 His contribution: £200 (annual excess paid once) Insurer pays: £890
If he had per-claim excess, he'd pay £200 × 3 = £600, and the insurer would pay £490.
Co-payment Options
Some policies offer co-payment—where you pay a percentage of each claim rather than a fixed excess. This can reduce premiums significantly.
How co-payment works:
If you have 20% co-payment and receive treatment costing £5,000:
- You pay: £1,000 (20%)
- Insurer pays: £4,000 (80%)
Co-payment is often capped at an annual maximum, protecting you from very high costs in a bad year.
Six-Week Wait Option
Many insurers offer a "six-week wait" or "NHS fallback" option. With this, you agree to use the NHS if the waiting time is less than six weeks. If the NHS wait exceeds six weeks, you can use your private insurance.
This typically reduces premiums by 10-30% and works well for people primarily concerned about long NHS waits rather than immediate access.
Our Fees vs Going Direct
As a broker, we don't charge you fees for arranging health insurance. Our service is free to you—we're paid a commission by the insurer when you take out a policy.
What you get from using a broker:
- Access to multiple insurers through one application
- Expert advice on policy features and exclusions
- Help comparing like-for-like cover
- Assistance with claims if issues arise
- Ongoing policy reviews and switching support
Going directly to an insurer means you only see their products. Using a broker like us means we search across the market to find cover that matches your needs.
Total Cost Example
Here's what health insurance might cost for a typical policyholder:
Applicant: 45-year-old non-smoker in Birmingham Cover level: Comprehensive with mental health and therapies Excess: £250 per claim Hospital list: Nationwide
Example based on typical market rates—actual premiums will vary.
Advantages and Disadvantages
Health insurance offers significant benefits but isn’t right for everyone. Understanding both sides helps you make an informed decision.
Private health insurance aims to make affordable healthcare accessible to more people, helping you access private medical treatment without high out-of-pocket costs.
Some policies also offer rewards and incentives for healthy living, such as discounts, wellness benefits, or other perks that encourage a healthier lifestyle.
Key Advantages
1. Faster access to treatment
The most compelling reason for health insurance is avoiding lengthy NHS waiting times. While the NHS might take months for non-urgent treatment, private healthcare typically offers appointments within days and treatment within weeks.
For someone needing a hip replacement with an 18-month NHS wait, private treatment in weeks can transform their quality of life far sooner.
2. Choice of consultant and hospital
With health insurance, you often choose your specialist rather than being assigned one. You can research consultants’ expertise, read reviews, and select someone you feel confident in.
Similarly, you can choose from approved private hospitals, selecting based on location, facilities, or reputation.
3. Private rooms and facilities
Private hospitals typically offer single rooms with en-suite facilities, rather than shared wards. This provides more privacy, comfort, and often a better environment for recovery.
Visiting times are usually more flexible, and the overall experience tends to feel less clinical.
4. Flexible appointment times
NHS appointments often come with limited scheduling flexibility. Private healthcare typically offers more convenient appointment times, including evenings, weekends and bank holidays at some facilities.
For working professionals, this can mean less time off work and easier access to care.
5. Access to latest treatments
Some treatments, drugs, or techniques may be available privately before they’re approved for NHS use. Health insurance can provide access to cutting-edge care that wouldn’t otherwise be available.
6. Peace of mind
Knowing you can access treatment quickly if needed provides valuable peace of mind. For many policyholders, the reassurance alone justifies the cost, even if they rarely claim.
Many health insurance policies now include rewards for healthy behaviour, such as discounts on gym memberships, wellness products, or other wellbeing incentives.
A key goal of private health insurance is to provide affordable healthcare options for individuals and families, making quality medical care more accessible and budget-friendly.
Important Disadvantages
1. Ongoing cost
Health insurance requires continuous premium payments, whether you claim or not. Over decades, this represents a significant financial commitment. Someone paying £100 per month from age 40 to 70 would pay £36,000 in premiums.
If you stay healthy and rarely claim, this money might have been better used elsewhere.
2. Pre-existing conditions often excluded
Perhaps the biggest limitation is that conditions you already have typically aren't covered. If you develop a health concern and then try to get insurance, it's often too late for that condition.
This means health insurance works best when taken out while healthy—not in response to existing problems.
3. Doesn't cover emergencies
Health insurance isn't designed for emergency care. If you have a heart attack or serious accident, you'll still use the NHS A&E. Private insurance covers planned treatment, not emergency response.
4. Chronic condition limitations
Long-term conditions requiring ongoing management often aren't covered comprehensively. Health insurance typically covers acute episodes but not ongoing medication, monitoring, or management of chronic conditions.
5. Complexity of policies
Understanding what's covered, what's excluded, and how to claim properly requires attention to detail. Policies vary significantly, and the cheapest option may have limitations that only become apparent when you try to claim.
6. Premiums increase with age
Unlike fixed-rate products, health insurance premiums typically increase each year, particularly as you get older. A policy affordable at 40 may become expensive at 60 and potentially unaffordable at 70.
Is Health Insurance Right for You?
Consider health insurance if you:
- Value faster access to treatment over cost
- Have employer contribution towards premiums
- Want choice over when and where you’re treated
- Are concerned about specific conditions and want private options
- Have dependents whose health you want to protect
- Can comfortably afford premiums long-term
- Currently live in the channel islands
- Prioritise affordable healthcare and want to compare different private health insurance options to find a plan that fits your budget
Consider alternatives if you:
- Have limited disposable income
- Already have significant pre-existing conditions
- Rarely use medical services
- Would prefer to save money and pay for private treatment if needed
- Are comfortable using NHS services for most care
Health Insurance vs NHS: When Private Care Makes Sense
Understanding when private healthcare adds value helps you use your policy effectively and decide whether insurance is worthwhile. Please note that waiting times and service availability may differ in Northern Ireland compared to other UK regions.
Current NHS Waiting Times
NHS waiting times have increased significantly in recent years, making private healthcare more attractive for many conditions.
According to NHS England data, the average waiting time for elective treatment has grown substantially. While targets state 92% of patients should start treatment within 18 weeks, actual performance often falls short of this standard.
For specific procedures, waits can be even longer:
Wait times vary significantly by region and hospital trust. In Northern Ireland, waiting times for certain procedures may be longer or shorter than in other parts of the UK, and private healthcare options can also differ.
Conditions Where Private Care Excels
Health insurance provides most value for:
Orthopaedic conditions: Joint replacements, sports injuries, and spinal problems often have long NHS waits. Private treatment can mean returning to normal life months sooner.
Diagnostics: When your GP suspects a problem, getting scans and tests quickly can reduce anxiety and speed up treatment decisions.
Cancer care: While NHS cancer care is generally excellent, private treatment can offer faster initial diagnosis, second opinions, and access to newer treatments.
Mental health: NHS mental health services face significant pressure. Private psychiatry and therapy often offer quicker access and more sessions than NHS provision.
Elective surgery: Any planned surgery where timing matters benefits from private care's shorter waiting times.
When NHS May Be Better
Some scenarios where NHS care might be preferable:
Emergencies: A&E and emergency care. The NHS handles emergencies excellently, and private insurance doesn't cover them anyway.
Complex, multi-disciplinary conditions: Conditions requiring multiple specialties working together may be better coordinated through NHS centres of excellence.
Very specialised treatment: For rare conditions, NHS teaching hospitals often have the most expertise.
Long-term condition management: Ongoing monitoring and management of chronic conditions is typically handled by the NHS.
Pregnancy (standard): Straightforward pregnancies are well-managed by NHS maternity services. Private maternity care adds cost without necessarily improving outcomes for low-risk pregnancies.
Special Circumstances
Some situations require specific consideration when arranging health insurance. Here's how to navigate common special circumstances.
Health Insurance for Families
Family health insurance covers parents and children under a single policy. This ensures that both the policyholder and each family member, including loved ones, have access to necessary medical care and peace of mind. It’s often more economical than separate policies and simpler to manage.
What to consider:
- Children’s cover: Often included free or at reduced rates. Cover typically ends between ages 18-24, depending on the insurer and whether the child is in full-time education.
- Maternity: Standard policies don’t cover pregnancy. If maternity cover is important, you’ll need a specific add-on, usually with a 10-12 month waiting period before claims can be made.
- Step-children and adopted children: Usually covered under family policies on the same basis as biological children.
- Excess structure: Check whether excess applies per person or per family. Family excess means you pay once regardless of who claims.
Example: Family policy costs
A family of four (parents aged 40 and 38, children aged 12 and 8) might pay:
- Parents’ cover: £160/month combined
- Children: Often included free or £20-30/month total
- Total family premium: Around £180-190/month
This compares to separate individual policies potentially costing £200+ monthly.
Health Insurance for Over-50s
Taking out or maintaining health insurance as you get older requires specific considerations:
Premium increases: Expect premiums to rise annually, with larger increases as you age. A policy costing £100/month at 50 might cost £200/month at 65.
Medical history: More years means more potential health events. Applications later in life often have more exclusions.
Age limits: Some insurers don't accept new applications beyond certain ages (often 70-75). Existing policyholders can usually continue renewing.
Six-week wait option: This becomes increasingly valuable for older policyholders, reducing premiums while maintaining access when NHS waits are long.
Later life policies: Some insurers offer policies specifically designed for older applicants, with tailored cover and more realistic premiums.
Health Insurance for Self-Employed
Self-employed individuals often prioritise health insurance because illness directly impacts their income.
Key considerations:
- Tax treatment: Health insurance premiums may be tax-deductible as a business expense for sole traders and partnerships. Check with your accountant.
- No employer contribution: You'll pay the full premium yourself, unlike employees with company schemes.
- Income protection link: Consider combining health insurance with income protection insurance, which replaces income if you can't work due to illness.
- Business overhead cover: For those with business expenses, separate insurance can cover costs while you're unable to work.
Health Insurance with Pre-existing Conditions
Having pre-existing conditions doesn't necessarily mean you can't get health insurance, but it affects your options:
What to expect:
- Conditions will likely be excluded, at least initially
- Premiums may be higher
- Moratorium underwriting may work in your favour if conditions are old
- Medical history disregarded cover is available but expensive
Strategies to consider:
- Apply while conditions are stable, not during active treatment
- Consider moratorium underwriting if conditions are from more than 5 years ago
- Be completely honest on applications—non-disclosure can void your policy
- Focus on cover for conditions you don't already have
Example: Pre-existing condition strategy
David, 52, has well-controlled type 2 diabetes and wants health insurance. His diabetes will be excluded under most policies. However, he can still get cover for other conditions—cancer, heart problems, joint issues—that he doesn't currently have.
He chooses moratorium underwriting. His diabetes is excluded, but he's covered for new conditions. The policy still provides valuable protection.
Common Uses and Applications
Understanding how people use health insurance helps you assess whether it matches your likely needs. Health insurance policies can address different areas of health, including physical, mental, and emotional wellbeing.
Joint and Orthopaedic Treatment
Orthopaedic conditions—affecting bones, joints, and muscles—represent some of the longest NHS waiting times and most common health insurance claims. Maintaining physical health and mobility is crucial, and timely treatment helps prevent further complications and supports overall wellbeing.
Common claims include:
- Hip and knee replacements
- Shoulder surgery
- Back and spinal procedures
- Sports injuries (ACL repairs, rotator cuff surgery)
- Arthroscopy and joint investigations
Why insurance helps:
NHS waits for joint replacements frequently exceed 12 months. For someone in constant pain, private treatment in 6-8 weeks can be life-changing.
Example claim:
Margaret, 62, needed a knee replacement. NHS wait: 14 months. Her health insurance enabled private surgery within 5 weeks. Total cost covered: £12,500. Her excess: £200. She returned to gardening and walking within 3 months rather than waiting over a year just for surgery.
Diagnostic Scans and Tests
Quick access to diagnostics is one of health insurance's most valuable benefits. When your GP suspects a problem, waiting weeks for an NHS scan can be anxious time.
Common diagnostic claims:
- MRI scans
- CT scans
- Ultrasounds
- Blood tests and pathology
- Endoscopies and colonoscopies
- Cardiac investigations
Private diagnostics typically happen within days rather than weeks, enabling faster diagnosis and treatment decisions.
Cancer Diagnosis and Treatment
While NHS cancer care is generally excellent once treatment begins, health insurance can speed up the diagnostic phase and provide access to newer treatments.
What insurance typically covers:
- Specialist consultations
- Diagnostic tests and biopsies
- Surgery, chemotherapy, radiotherapy
- Newer drugs not yet on NHS
- Second opinions
- Private room during treatment
Important note: Some policies have financial limits on cancer treatment. Check your policy's cancer cover carefully—unlimited cover is preferable for this potentially expensive condition.
Mental Health Support
NHS mental health services face significant demand. Private mental health treatment through health insurance offers:
- Faster access to psychiatrists and psychologists
- More therapy sessions than NHS provision
- Choice of therapist and treatment approach
- In-patient treatment for severe conditions
Policies may provide support across different areas, including emotional support for various life stressors.
Typical policy limits:
Most policies include mental health cover but with annual limits—often £1,500-£5,000 for out-patient therapy or a set number of sessions. In-patient mental health treatment may have separate limits.
Therapies and Rehabilitation
Many policies cover allied health services that support recovery and ongoing health:
- Physiotherapy
- Osteopathy
- Chiropractic treatment
- Podiatry
- Speech therapy
- Occupational therapy
These therapies play a crucial role in maintaining and restoring physical health, helping individuals recover from injuries and improve their overall wellbeing.
These are usually subject to annual session limits (e.g., 20 sessions per year) or monetary caps.
Application Process
Applying for health insurance is straightforward, though thoroughness at the application stage prevents problems later.
11.1 Research and compare providers
Start by researching different health insurance providers and comparing their policies, benefits, and costs. Use online comparison tools to quickly see which plans best fit your needs and budget. You can get a quote online to instantly view your options and estimated costs.
11.2 Check eligibility
Review the eligibility criteria for each policy, including age limits, pre-existing conditions, and residency requirements.
11.3 Choose your cover level
Decide on the level of cover you need, such as inpatient, outpatient, or comprehensive plans, and consider any optional extras.
11.4 Complete the application
Fill in the application form with accurate personal, medical, and lifestyle information.
11.5 Submit supporting documents
You may need to provide proof of identity, address, and medical history. If you are switching from an existing health insurance policy, you may also need to provide details of your current coverage and any exclusions.
11.6 Await underwriting and approval
The insurer will assess your application and may request further information or medical reports before confirming your cover.
Step 1: Research and Comparison
Before applying, understand what you need from a policy:
- What level of cover do you want?
- Are there specific conditions or treatments you’re concerned about?
- What’s your budget for premiums?
- Do you want to include family members?
- How important is hospital choice?
When comparing their policies, benefits, and costs, it's also important to review the reputation and network of each healthcare provider to ensure you have access to trusted medical professionals and services.
We can help you compare policies from multiple insurers to find appropriate cover. Our service is free—we’re paid by the insurer you choose.
You can get a quote online to quickly compare prices and coverage from leading health insurance providers.
Step 2: Complete Your Application
The application requires:
Personal information:
- Name, address, date of birth
- Contact details
- UK residency confirmation
Medical history (for underwritten policies):
- Current and past conditions
- Medications you take
- Hospital treatment in the past
- Family medical history (some insurers)
Lifestyle information:
- Smoking status
- Occupation
- Sometimes height and weight
Be completely honest: Non-disclosure can void your policy when you claim. If you're unsure whether to mention something, mention it. The insurer will decide if it's relevant.
Step 3: Underwriting Decision
The insurer reviews your application and issues terms:
- Standard terms: Full cover as per the policy, no special exclusions
- Exclusions applied: Specific conditions excluded from cover
- Premium loading: Standard cover but at a higher premium
- Declined: Insurer won't offer cover (rare for health insurance)
You'll receive documentation showing exactly what's covered and any exclusions.
Step 4: Policy Start
Once you accept the terms and set up payment:
- Cover begins from the agreed start date
- You receive full policy documents
- You get details of how to claim
- Any excess requirements are confirmed
Cooling-off period: You typically have 14-30 days to cancel without penalty if you change your mind.
What Documents You'll Need
To apply, have ready:
- Identification (passport or driving licence)
- Proof of address
- GP details
- Details of any medications
- Information about previous claims (if switching insurers)
- If you are switching from an existing health insurance policy, have details of your current policy and any exclusions ready.
Timeline Expectations
- Application to quote: Same day or next day
- Underwriting review: 1-5 days for most applications
- Policy start: Can be immediate or a chosen future date
- Documents issued: Within 7-14 days of policy start
Health Insurance vs Alternatives
Understanding how health insurance compares to alternatives helps you decide the best approach for your healthcare needs.
Health Insurance vs Self-funding
Some people choose to save money and pay for private treatment when needed rather than paying ongoing premiums.
When self-funding works:
Self-funding suits people with substantial savings who are comfortable accepting the risk of major expenses. If you have £20,000 or more accessible for health emergencies, rarely need medical treatment, and would use the NHS for most care anyway, self-funding might make financial sense.
However, major illnesses can cost far more than most people realise. Cancer treatment can exceed £100,000. Multiple conditions or complications quickly deplete savings.
When insurance works better:
Insurance provides certainty. You know treatment costs are covered within your policy terms. This suits people who want guaranteed access, couldn't easily absorb a large medical bill, and value peace of mind highly.
Calculation example:
Consider someone paying £100 monthly for health insurance from age 40 to 65. That's approximately £30,000 in premiums (accounting for increases).
If they need one major procedure—say, cancer treatment at £50,000 or a hip replacement at £15,000—insurance pays for itself. If they stay healthy, they've paid for peace of mind.
Health Insurance vs NHS Reliance
Relying entirely on the NHS is a valid choice. Understanding the trade-offs helps you decide.
NHS strengths:
The NHS provides world-class emergency care, excellent specialist centres for complex conditions, and comprehensive coverage with no exclusions for pre-existing conditions. It's free at point of use, requires no applications or paperwork, and treats everyone regardless of their health history.
Where private insurance adds value:
Private insurance excels for elective procedures with long NHS waiting times, situations where timing matters (such as getting back to work quickly), and mental health support where NHS provision is stretched.
Many people use both—NHS for emergencies and excellent specialist services, private insurance for procedures where waiting times would significantly impact their quality of life.
Health Cash Plans as a Complement
Health cash plans work alongside insurance, covering everyday health costs that insurance doesn't typically address.
Cash plans reimburse set amounts for dental check-ups, opticians, physiotherapy, and similar routine costs. They're inexpensive (often £10-20 monthly) and pay out regardless of where you receive treatment.
A comprehensive healthcare approach might combine:
- Health insurance for major medical treatment
- Cash plan for routine dental and optical costs
- NHS for emergencies, GP care, and routine services
- Self-funding for small expenses below your excess
Common Mistakes to Avoid
Learning from others' mistakes helps you get more from your health insurance and avoid costly errors.
Mistake 1: Not Disclosing Medical History
The most serious mistake is failing to declare all relevant medical history during application. Whether intentional or accidental, non-disclosure can void your entire policy.
When you claim, insurers often request GP records. If they find undisclosed conditions, they can refuse claims or cancel your policy retrospectively—even if the undisclosed condition is unrelated to your claim.
Solution: Disclose everything, even if you think it's minor or irrelevant. Let the insurer decide what matters. If in doubt, mention it.
Mistake 2: Skipping Pre-authorisation
Booking treatment before confirming with your insurer can leave you facing bills you assumed were covered.
Solution: Always call your insurer before booking any treatment. Get written confirmation where possible and keep reference numbers.
Mistake 3: Using Non-approved Providers
Choosing a hospital or consultant not on your insurer's approved list can mean paying the full cost yourself or receiving reduced reimbursement.
Solution: Check the approved list before booking. If you want a specific provider who isn't listed, ask your insurer if they can be added or negotiate a fee agreement in advance.
Mistake 4: Letting Cover Lapse
Allowing gaps in cover, even briefly, can have lasting consequences. New policies will underwrite you fresh, conditions you've developed become pre-existing and excluded, and moratorium periods restart.
Solution: Maintain continuous cover. If switching, ensure the new policy starts before the old one ends. If cost is an issue, reduce cover rather than cancelling entirely.
Mistake 5: Not Reviewing Annually
Setting up a policy and never reviewing it can mean overpaying for cover you no longer need or missing out on better options.
Solution: Review your policy annually at renewal. Compare the market every few years. Adjust cover as your circumstances change.
Mistake 6: Waiting Until You're Ill
Trying to get health insurance only when you have health concerns defeats the purpose. Pre-existing conditions are excluded.
Solution: Take out health insurance while healthy. Cover is in place before conditions develop—this is when insurance provides most value.
The Claims Process: Step by Step
Understanding how to claim properly ensures you get the treatment you need without unexpected problems or costs.
Before Treatment: Getting Pre-authorisation
Pre-authorisation is essential for almost all health insurance claims. This is where you contact your insurer before booking treatment to confirm it's covered.
Why pre-authorisation matters:
- Confirms your treatment is covered under your policy
- Tells you how much excess you'll pay
- Ensures the hospital and consultant are on the approved list
- Prevents claim rejection for treatable conditions
- Identifies any policy limits that might apply
How to get pre-authorisation:
- Get a referral letter from your GP (for most treatments)
- Contact your insurer by phone or through their app/website
- Provide details of the condition and proposed treatment
- Receive confirmation of cover, usually within 24-48 hours
- Book treatment with approved providers
What happens if you don't get pre-authorisation:
Insurers may refuse claims if you don't get pre-authorisation. At minimum, you might face delays and need to provide additional documentation. At worst, your claim could be rejected entirely, leaving you to pay thousands of pounds yourself.
During Treatment: What to Expect
Once pre-authorised, the treatment process is straightforward:
Direct billing (fee-assured):
Most private hospitals and consultants work on a "fee-assured" basis with insurers. This means:
- The hospital contacts your insurer directly
- Treatment costs are agreed in advance
- The insurer pays the hospital directly
- You only pay your excess amount
Your responsibilities during treatment:
- Present your insurance details at registration
- Pay any excess if required upfront
- Follow the agreed treatment plan
- Keep records of all treatment received
Example: A typical claim journey
Susan needs a knee arthroscopy. Here's her journey:
- Week 1: GP refers her to a knee specialist
- Week 1: Susan calls her insurer for pre-authorisation
- Week 2: Insurer confirms cover, £150 excess applies
- Week 2: Susan chooses a consultant from the approved list
- Week 3: Consultation with specialist, who recommends surgery
- Week 4: Surgery performed at approved hospital
- Week 4: Hospital bills insurer directly (£4,200)
- Week 5: Susan receives invoice for £150 excess
- Week 6: Fully recovered and back to normal activities
Total out-of-pocket cost: £150. Time from referral to recovery: 6 weeks.
After Treatment: Follow-up and Ongoing Care
Your policy may cover follow-up consultations and rehabilitation:
Typical post-treatment cover:
- Follow-up appointments with your consultant
- Physiotherapy (often subject to session limits)
- Further diagnostic tests if needed
- Medication for a defined period
What to watch for:
- Session limits on therapies (e.g., 20 physio sessions per year)
- Time limits on follow-up care
- Separate pre-authorisation for rehabilitation
- Transition from acute to chronic care (which may not be covered)
Common Claims Problems and How to Avoid Them
Problem: Claim rejected for lack of pre-authorisation
Prevention: Always call your insurer before booking any treatment, even if you're confident it's covered.
Problem: Consultant not on approved list
Prevention: Check the consultant is on your insurer's list before booking. If you want a specific consultant who isn't listed, ask your insurer if they can be added or negotiate a fee agreement.
Problem: Treatment costs exceed policy limits
Prevention: When getting pre-authorisation, specifically ask about any limits that might apply. If treatment is expensive, confirm the full cost is covered before proceeding.
Problem: Treatment deemed not medically necessary
Prevention: Ensure your GP referral clearly explains why treatment is needed. If there's disagreement, ask your consultant to provide supporting evidence to the insurer.
Problem: Excluded condition—claim rejected
Prevention: Understand your exclusions before you need to claim. If you're unsure whether a condition is excluded, ask your insurer before seeking treatment.
Choosing the Right Policy
With multiple insurers offering different products, choosing the right policy requires understanding what matters most for your situation.
Key Factors to Consider
1. Cover level
Decide what you actually need cover for:
- Basic: In-patient treatment, cancer care, consultations
- Comprehensive: Adds mental health, therapies, out-patient extras
- Premium: Maximum flexibility, wellness benefits, enhanced limits
2. Hospital list
Insurers have different hospital networks:
- Extended: All major private hospitals, maximum choice
- Standard: Most private hospitals, good geographical coverage
- Select: Limited to specific hospital groups, lowest premiums
Check which hospitals are included and whether they're convenient for you.
3. Excess level
Higher excess means lower premiums but more cost when claiming:
- £0 excess: Maximum convenience, higher premiums
- £100-250 excess: Balance of cost and convenience
- £500+ excess: Significant premium savings, only worth it if you rarely claim
4. Out-patient limits
Many policies limit out-patient cover (consultations, scans, therapies):
- Some offer unlimited out-patient cover
- Others cap at £500-£2,000 annually
- Essential for people likely to need therapies or regular consultations
5. Mental health cover
If mental health matters to you, compare:
- Is it included or an add-on?
- What's the annual limit?
- Are there session limits for therapy?
- Is in-patient psychiatric care covered?
Comparing Policies Effectively
When comparing health insurance policies, ensure you're comparing like with like:
Create a checklist:
| Feature | Policy A | Policy B | Policy C |
|---|---|---|---|
| Monthly premium | |||
| Excess | |||
| Hospital list tier | |||
| Out-patient limit | |||
| Mental health included? | |||
| Therapies included? | |||
| Cancer cover limit |
