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Health insurance what it covers and what it costs
Private health insurance pays for private treatment when you develop a new, short-term condition, often getting you seen within days rather than months. This guide explains what's covered, what it costs, and how to choose the right policy.
Health insurance, also called private medical insurance, is a policy that pays for private treatment when you develop a new, short-term medical condition. You pay a monthly or annual premium, and your insurer covers eligible treatment at private hospitals and clinics.
Health insurance doesn't replace the NHS. You'll still use your GP and A&E as normal. What it does is give you an alternative route to diagnosis and treatment for new conditions, often within days rather than months.
Health insurance, often called private medical insurance (PMI), is a financial product that pays for the cost of private medical treatment when you become unwell. You pay a monthly or annual premium, and in return, your insurer covers eligible treatment costs at private hospitals and clinics.
The key word is "eligible". Health insurance isn't a blank cheque for all healthcare. It's designed for acute conditions, illnesses or injuries that are new, short-term, and likely to respond to treatment. A knee injury requiring surgery, a newly discovered tumour needing investigation, or a hernia that needs repair would all typically be covered. Long-term conditions like diabetes, asthma, or ongoing arthritis management are not.
Health insurance doesn't replace the NHS. You'll still use your GP for everyday healthcare, A&E for emergencies, and NHS services for chronic condition management. What private cover does is give you an alternative route when you need diagnosis or treatment for something new, often getting you seen within days rather than months.
Important distinction: Health insurance is separate from health cash plans. Cash plans reimburse you for routine costs like dental check-ups and eye tests. Health insurance covers more substantial medical treatment, including hospital stays, surgery, and specialist consultations.
The rise in health insurance purchases over the past few years isn't hard to understand when you look at the numbers.
According to the House of Commons Library, around 7.4 million patient pathways were on NHS waiting lists as of August 2025. The British Medical Association reports that only around 61% of patients are currently starting treatment within 18 weeks, well below the 92% target the NHS is working towards.
These delays have real consequences. Someone waiting for a hip replacement might spend months in pain, unable to work. A person with symptoms that need investigation faces weeks of uncertainty before getting answers.
LaingBuisson's research shows the private medical insurance market reached £8.64 billion by the start of 2025, with 13.83% year-on-year growth. Around 8.4 million people now have private medical cover, with the majority through employer-sponsored schemes.
Why people choose private cover
Understanding what's included in your policy matters, and the detail varies significantly between insurers and cover levels. Here's what a comprehensive policy typically includes.
This is the core of any health insurance policy. It covers treatment where you're admitted to hospital, either overnight (in-patient) or for a same-day procedure (day-patient).
Typical coverage includes:
Out-patient cover pays for consultations and tests that don't require hospital admission. This is often where you'll use your policy first, when your GP refers you to a specialist for investigation.
Coverage typically includes specialist consultations, diagnostic tests such as MRI and CT scans, blood tests and X-rays, physiotherapy sessions, and follow-up appointments.
The level of out-patient cover is one of the biggest differences between basic and comprehensive policies. Basic policies might have a £500 annual limit or exclude out-patient care entirely, while comprehensive policies often provide unlimited out-patient cover.
Cancer treatment is one of the most valued benefits of health insurance. Coverage typically includes specialist oncologist consultations, diagnostic tests and biopsies, surgery to remove tumours, chemotherapy and radiotherapy, specialist cancer drugs, and follow-up care and monitoring.
Most policies provide comprehensive cancer cover even at basic levels. Some comprehensive policies also include access to newer cancer drugs that might not yet be available through the NHS.
Most policies now include some level of mental health cover, typically consultations with psychiatrists, psychotherapy and counselling sessions, and in-patient psychiatric care on comprehensive policies.
Coverage limits vary significantly. Basic policies might cover 10-20 therapy sessions per year, while comprehensive policies might offer unlimited out-patient mental health cover.
Many policies cover complementary therapies with annual limits, such as physiotherapy, osteopathy, chiropractic treatment, and acupuncture on some policies. This is particularly useful after surgery or for musculoskeletal problems. Typical limits range from £500 to £2,000 per year depending on your policy level.
If you develop persistent back pain, a basic in-patient-only policy won't help with the specialist consultation or MRI needed to find out what's wrong. You'd need to use the NHS for diagnosis, then potentially claim for private surgery if needed.
Just as important as knowing what's covered is understanding the exclusions. These apply across virtually all individual health insurance policies in the UK.
Any health condition you had before your policy started is not covered. The insurer uses underwriting to identify these, either by asking about your medical history upfront (full medical underwriting) or applying a moratorium, which automatically excludes anything you've had symptoms or treatment for in the five years before joining.
If you had physiotherapy for back pain three years ago, back-related conditions would likely be excluded. If you've been taking medication for anxiety, mental health treatment would be excluded.
Conditions that can't be cured and require ongoing management are excluded, including diabetes, asthma, high blood pressure, arthritis, Crohn's disease and ulcerative colitis, epilepsy, and ongoing management of heart disease. Health insurance is designed for acute conditions that respond to treatment, not lifelong management.
Elective cosmetic surgery isn't covered. That said, reconstructive surgery following illness or accident is usually covered. Breast reconstruction after cancer treatment, for example, would typically be included.
Standard health insurance doesn't cover routine pregnancy, maternity care, or childbirth. Some policies offer this as an optional extra with waiting periods, but it's expensive and often comes with significant restrictions.
Your regular GP visits remain through the NHS. Health insurance covers specialist care once you've been referred, not everyday primary care. However, many policies now include access to virtual GP services, allowing you to get phone or video consultations for advice and referrals.
Emergencies are handled by A&E and NHS emergency services. If you have a heart attack, stroke, or serious accident, you'll be treated by the NHS regardless of whether you have private cover. Some policies provide an NHS cash benefit if you receive treatment through the NHS that your policy would otherwise have covered.
Standard check-ups and screenings aren't covered. Some policies offer health assessments as an optional extra, but routine blood tests, cervical smears, and mammograms come through the NHS.
Health insurance policies come in different tiers, allowing you to choose based on your priorities and budget.
Basic policies cover the essentials: in-patient and day-patient treatment. They're the most affordable option and protect against the big, expensive scenarios, like needing surgery.
What's typically included: in-patient hospital stays, day-patient procedures, basic cancer cover (surgery, chemotherapy, radiotherapy), and virtual GP access on most policies.
What's typically excluded: out-patient consultations and tests, extensive mental health cover, and therapies like physiotherapy.
Best for people on tighter budgets who want protection against major medical expenses but are happy to use the NHS for initial diagnosis and investigation. Typical cost: £30-60 per month for a healthy 40-year-old.
Mid-range policies add out-patient cover, bridging the gap between basic and comprehensive. You get coverage for specialist consultations and diagnostic tests, not just treatment once you're diagnosed.
What's typically included: everything in basic policies, plus out-patient consultations (often with limits), diagnostic tests such as MRI and CT scans, limited mental health cover, and some therapies cover.
Out-patient limits vary widely. A £500 limit might cover one consultation and one scan, while a £1,500 limit gives more flexibility. Check whether the limit is per condition or per policy year.
Best for people who want faster diagnosis as well as treatment, and value seeing a specialist quickly when symptoms arise. Typical cost: £50-90 per month for a healthy 40-year-old.
Comprehensive policies offer the highest level of cover, with generous or unlimited out-patient benefits and extensive additional features, including unlimited in-patient and day-patient cover, extensive or unlimited out-patient cover, comprehensive cancer cover (including newer drugs), enhanced mental health cover, therapies cover, home nursing, and often parent accommodation for child patients.
Best for people who want maximum flexibility, those with employer-funded cover, or families wanting comprehensive protection. Typical cost: £80-150+ per month for a healthy 40-year-old.
Some insurers offer a hybrid option: the policy only pays out if NHS waiting times exceed six weeks. If the NHS can treat you within six weeks, you use NHS services. If not, you can go private.
This significantly reduces premiums because many conditions can be treated within six weeks on the NHS. It's a middle-ground option for people who are comfortable with some NHS wait but want a safety net for longer delays. Best for budget-conscious people who want protection against the longest waits but don't need the fastest possible access.
Compare cover levels
Health insurance costs vary dramatically based on personal factors. A 30-year-old non-smoker might pay significantly less each month than a 60-year-old taking out the same policy.
Based on research from multiple brokers and insurers, the table below shows typical monthly premium ranges for cover with a £250 excess.
These are indicative ranges. Your actual premium depends on multiple factors including your location, chosen insurer, and specific policy options.
Age: The single biggest factor. Premiums increase as you get older because the likelihood of needing medical treatment rises with age.
Location: Where you live affects your premium because private healthcare costs more in some areas. London and the South East are typically more expensive than northern regions. Some insurers offer lower premiums if you restrict your hospital list to specific regions.
Level of cover: Basic, in-patient-only policies cost significantly less than comprehensive policies with full out-patient cover.
Excess: The excess is the amount you pay towards each claim. Choosing a higher excess, for example £500-1,000 instead of £0-250, can reduce your premium, but you'll pay more if you need to claim.
Smoking status: Smokers typically pay more than non-smokers due to associated health risks.
Hospital list: Most insurers offer different hospital networks. A comprehensive list including all UK private hospitals costs more than a restricted list of partner hospitals.
No-claims discount: Some insurers offer discounts if you haven't claimed in previous years, similar to car insurance.
Not sure which level of cover you need?
An advisor can talk through your priorities and compare cover from a wide range of insurers to find options that fit.
Four major insurers dominate the UK private medical insurance market, together holding the majority of market share according to LaingBuisson data.
Beyond the big four, other providers include WPA, known for comprehensive cover and excellent customer service though typically at premium prices; Freedom Health Insurance, which offers more budget-focused options; The Exeter, a specialist in personal health insurance; and Saga, which focuses on the over-50s market.
Providers
Bupa
The largest and most recognised health insurer in the UK, operating its own network of hospitals and clinics alongside access to other private facilities. Known for extensive networks, strong cancer care, and good digital claims tools, though often among the more expensive options.
AXA Health
Formerly PPP Healthcare, offering a range of policies from basic to comprehensive with particular strength in mental health support and digital health services, including 24/7 virtual GP access.
Aviva
Offers health insurance alongside a broader insurance product range, known for flexible policy design, competitive pricing, and good therapies cover, though hospital networks can be more limited on some policies.
Vitality Health
Takes a different approach, rewarding healthy lifestyle choices with discounts and benefits through a wellness programme. The rewards system requires engagement to get full value, and base premiums can be higher.
Health cash plans are a different product from health insurance, but they're worth understanding as they can complement or sometimes substitute for private medical insurance, depending on your needs.
A health cash plan pays you fixed cash amounts towards routine healthcare costs. You pay upfront for treatment, submit a receipt, and get money back up to annual limits.
Typical coverage includes dental check-ups and treatment, eye tests and glasses, physiotherapy sessions, prescription costs, and health screenings.
Cash plans don't cover hospital treatment, surgery, consultations with specialists, diagnostic scans, cancer treatment, or anything requiring admission. These are the areas health insurance covers.
Cash plans are significantly cheaper than health insurance. Individual plans typically cost £7-40 per month, and family plans typically cost £15-60 per month. Providers include Medicash, Simplyhealth, Westfield Health, and Sovereign Health Care.
Health cash plans make sense if you regularly pay for dental check-ups, glasses, and physiotherapy, if you want to claim back routine costs but don't need hospital cover, if your budget doesn't stretch to full health insurance, or if you already have health insurance but it doesn't cover dental and optical.
Example: If you spend around £200 on dental care, £150 on glasses, and £200 on physiotherapy each year, a cash plan costing £15 a month could reimburse more than you pay in premiums.
Some people have both: health insurance for major treatment and a cash plan for routine costs. This can work well, especially if your employer provides one type of cover and you purchase the other yourself.
Selecting health insurance involves balancing your priorities against your budget.
Ask yourself whether you want fast diagnosis or just fast treatment. If you want quick access to specialists and scans when symptoms first appear, you need out-patient cover. If you're happy using NHS diagnostic services and only want private surgery if needed, basic in-patient cover might suffice.
Consider how much you can afford each month, being realistic. A comprehensive policy you struggle to maintain is worse than a basic policy you can sustain long-term. Also think about how much you could afford towards a claim; if you could comfortably pay £500 or £1,000, a higher excess saves money on premiums. Finally, consider how important hospital choice is to you.
Step by step
Assess what matters to you
Decide whether you want fast diagnosis as well as fast treatment, how much you can afford each month, how much you could put towards a claim, and how important hospital and consultant choice is to you.
Decide on your cover level
Choose basic cover if budget is your main concern, mid-range if you want faster diagnosis as well as treatment, or comprehensive if you want maximum protection and flexibility.
Configure your policy
Fine-tune your excess, hospital list, out-patient limits, and any optional extras like a mental health boost, dental and optical, or travel cover.
Compare quotes
Get quotes from multiple insurers, or speak to an advisor who can compare across a wide range of providers. The same cover level can vary significantly in price between insurers.
Applying for health insurance involves disclosing your health history so the insurer can assess your risk and set your premium.
Full medical underwriting (FMU): You answer detailed questions about your medical history upfront. The insurer then tells you exactly what's excluded before you buy. This gives certainty but requires more effort at application.
Moratorium underwriting: You don't need to declare your medical history when applying. Instead, any condition you've had symptoms, advice, or treatment for in the past five years is automatically excluded. After two continuous years without symptoms, advice, or treatment for that condition, it may become eligible for cover.
FMU gives clarity from day one but requires more disclosure. Moratorium is quicker to set up but creates uncertainty about what's covered until you've built up a treatment-free period.
Typical application questions cover your age, address, and occupation; smoking status; height and weight; medical history if you're going through full medical underwriting; and GP details, as some insurers access records with your permission.
Once approved, you'll receive policy documents detailing your cover, an Insurance Product Information Document (IPID) summarising key features, a membership card or digital access, and details of how to claim and get treatment authorised.
Most policies have a 14-day cooling-off period during which you can cancel for a full refund if you change your mind.
When you need treatment, here's how the claims process typically works.
Always call your insurer for pre-authorisation before booking treatment. This is the most common cause of rejected or reduced claims. Use approved consultants and hospitals, keep every receipt even if most costs are settled directly, and claim promptly, most policies require claims within three to six months of treatment.
Claims process
Get a GP referral
For most specialist treatment, you'll need a referral from your GP explaining your symptoms and why you need to see a specialist. Some policies include access to virtual GPs who can provide referrals more quickly.
Contact your insurer for pre-authorisation
Before booking treatment, call your insurer to confirm cover and get a pre-authorisation code. They'll check whether the condition is covered, whether your consultant and hospital are approved, and what your policy covers for this treatment.
Book and attend treatment
Once authorised, book your appointment or procedure. Insurers often pay the hospital or consultant directly. If you need to pay upfront, keep receipts to claim reimbursement.
Submit any outstanding claims
If you've paid for anything not directly settled, submit receipts through your insurer's app or online portal. Most insurers process claims within a few days.
Health insurance in the UK is regulated by the Financial Conduct Authority, which means you have significant protections as a consumer.
The Financial Conduct Authority's Consumer Duty requires insurers to act in good faith, avoid causing foreseeable harm, enable customers to pursue their financial objectives, provide products that offer fair value, and communicate clearly to support understanding. This means insurers must treat you fairly, explain things clearly, and ensure their products genuinely meet your needs.
Before buying, you must receive an IPID, a standardised summary of what's covered and excluded. This short document is your first line of defence against misunderstandings.
You have 14 days after purchase to cancel your policy and receive a full refund, no questions asked.
If you're unhappy with your insurer, complain to the insurer first; they must respond within eight weeks. If you're still unsatisfied, you can escalate to the Financial Ombudsman Service, which provides free, independent dispute resolution. If your insurer fails and can't pay claims, the Financial Services Compensation Scheme may compensate you.
You have a legal obligation to take reasonable care not to make misrepresentations when applying for insurance. Be honest about your medical history. If you're found to have withheld information, your policy could be voided or claims rejected.
For free, independent guidance on health insurance and other financial products, you can also visit MoneyHelper. The Association of British Insurers also publishes independent guidance on how private medical insurance works and the protections in place for consumers.
In our experience helping people with health insurance, these are the most common errors.
Avoid these pitfalls
Not understanding what's excluded
Don't assume everything is covered. Pre-existing conditions, chronic illnesses, pregnancy, and cosmetic procedures are typically excluded. Read your policy documents carefully.
Forgetting to pre-authorise treatment
This is probably the most common claims issue. Always call your insurer before booking treatment. Going ahead without authorisation risks having your claim rejected.
Choosing based on price alone
The cheapest policy isn't always the best value. A slightly more expensive policy with better out-patient cover might save you money if you need diagnosis and investigation.
Not reviewing at renewal
Your circumstances change. Review your policy each year to ensure it still meets your needs. You might be able to switch to a better-value option or adjust your cover level.
Assuming employer cover is enough
If you have employer-provided health insurance, check what it actually covers. Some employer schemes have more restrictions than individual policies. Also consider what happens if you leave your job, and whether you'd be able to continue cover independently.
Waiting until you're unwell to buy
Health insurance covers new conditions that arise after you join. If you wait until you have symptoms before purchasing, those symptoms and any resulting diagnosis won't be covered. The best time to buy is when you're healthy.
Not using your policy
People often forget they have health insurance, or don't realise they could use it for something. If you have symptoms, check whether your policy could help rather than automatically joining an NHS waiting list.
If you've decided health insurance might be right for you, here's how to move forward.
Speaking to an advisor means you get expert guidance on your options. We compare a wide range of insurers, and the price you pay is the same as going direct.
Generic online quotes give you a rough idea, but personalised quotes based on your age, location, health, and preferences give you more accurate pricing. We can provide these with a quick phone call or online questionnaire.
Don't be afraid to ask about exclusions, waiting periods, and exactly what happens when you claim. A good advisor will explain things in plain English and make sure you understand what you're buying.
There's no rush. Compare a few options, think about what matters most to you, and make sure you're comfortable with your choice. Remember the 14-day cooling-off period gives you a chance to change your mind if needed.
Independent guidance on health insurance and the wider insurance market.
Common questions
Whether health insurance is worth it depends on your circumstances, priorities, and budget. It's worth considering if you're worried about NHS waiting times, value choosing your own consultant, want faster access to diagnosis, or if you're self-employed and need to minimise time off work. It may not be worth it if you're on a tight budget, are generally healthy and comfortable using NHS services, or if you have significant pre-existing conditions that would be excluded anyway.
You can get a health insurance policy if you have pre-existing conditions, but those specific conditions won't be covered. The policy would cover new, unrelated conditions that arise after you join. Some conditions may become covered under moratorium underwriting if you go two years without symptoms, advice, or treatment.
Most policies allow you to claim immediately for new conditions that arise after your start date. However, there are often waiting periods for specific benefits. Mental health cover sometimes has a 30-day wait, and if your policy includes pregnancy cover, there's typically a 10-12 month waiting period.
Standard UK health insurance is designed for treatment in the UK. If you need cover while travelling abroad, you'll need travel insurance. Some insurers offer optional worldwide cover as an add-on, but this is separate from standard private medical insurance.
Usually, yes. Most policies let you choose your surgeon or consultant from a list of specialists who work with your insurer's hospital network. If you don't have a preference, your insurer can recommend someone.
A "per claim" excess means you pay the excess amount each time you make a new claim for a different condition. A "per policy year" excess means you only pay the excess once per year, regardless of how many claims you make. Per policy year excess is generally more favourable.
If you have employer-provided health insurance, your employer typically doesn't see individual claims or medical details. Insurers provide employers with aggregate data, not personal information. Your medical records remain confidential.
Many policies offer no-claims discounts, similar to car insurance. Making a claim may reduce or remove this discount at renewal, potentially increasing your premium. Some insurers allow you to protect your no-claims discount for an additional fee.
Generally, no. Once you start a course of treatment privately, you need to continue privately. You can't mix NHS and private care for the same condition in the same treatment episode. You can, however, use NHS services for some conditions and private services for others.
If you have employer-provided insurance and leave your job, your cover typically ends with your employment. You may have the option to continue the policy individually through a continuation option, but this usually requires you to apply within a specific timeframe and will involve paying the full premium yourself.
For most specialist consultations and treatments, yes, you'll need a GP referral. However, many policies now include virtual GP services that can provide referrals, and some insurers allow direct access to certain services like physiotherapy.
Yes, most insurers offer family policies that cover you, your partner, and your children. Adding family members increases the premium, but family policies are often cheaper than buying separate individual policies for everyone.
Health insurance pays for private medical treatment when you're unwell. Critical illness cover pays a one-off lump sum if you're diagnosed with a specified serious illness, such as cancer, heart attack, or stroke. They serve different purposes, and many people have both.
Standard health insurance doesn't cover routine dental care. For dental cover, you'd need a health cash plan or a separate dental insurance policy. Some health insurance policies offer dental as an optional add-on.
For individuals paying for their own health insurance, there are generally no tax benefits, as premiums are paid from taxed income. However, employer-provided health insurance is a taxable benefit-in-kind. For self-employed people, health insurance premiums cannot usually be claimed as a business expense.
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Health Insurance
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