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In the UK, we’re lucky to have access to the National Health Service (NHS), a free public healthcare system, however we know how much they're suffering from long waiting lists for diagnosis and testing, as well as surgery and treatment.
With private health insurance (also known as private medical insurance, or PMI), you can get fast access to quality healthcare, top consultants, treatment and care - for you and your family. LifeSearch experts are on hand to help you get sorted.
What is private health insurance?
Generally speaking, private health insurance is designed to cover medical conditions that respond quickly to treatment (usually called ‘acute conditions’). Typically, health insurance also covers costs of medical tests and diagnostic scans, elective surgery, hospital accommodation, consultant fees, treatment drugs and nursing care.
Private health insurance helps to pay for some, or all, of the medical treatment that someone needs. It allows quick access to top health care professionals, improving your chances of a quick, full recovery.
Most policies can be tailored to meet your needs and budget accordingly. You can have choices around the types of medical treatment covered, what level of cover will apply to those treatments, the location where your treatment is provided, whether you want outpatient care and the contribution you might be willing to make to the treatment cost (called ‘the excess’).
Do I need private health insurance?
While we enjoy a free public healthcare service, the NHS, they may not always offer access to all medication and treatments. Private healthcare is an alternative – but can be expensive if you’re paying for it out of your own pocket (often called ‘self-funding’). If you're employed, it's worth checking with your employer whether they have a scheme that you, and your family are eligible for.
The likelihood is that most of us will suffer from a condition, illness or need medical treatment during our lives. Private Health insurance (also known as private medical insurance) can provide a more affordable way of accessing private healthcare.
Did you know that 5.8 million people covered by private health insurance, 4.4m through their employer and 1.4million individually.* (ABI statistics, 2023)
How much does private health insurance cost?
Private health insurance will depend on many factors:
- Who is covered – yourself, you and your partner, or your family
- The level of cover you require – basic or comprehensive cover, and optional benefits
- Your post code - where you live can have a significant effect on cost of treatment and private medical facilities
- Your age – the older you are, the more expensive it is
- Your medical history and family history
There are a couple of other things to bear in mind too. Most policies have limits; this may be a financial limit for types of treatment or cover, consultant fees, or maybe a limit on the choice of hospitals you can choose from.
They may also have an excess, which means you pay up an amount towards a claim. The larger the excess the cheaper the premium, and some insurers will give you the option on its frequency. For example, each time you make a claim, or for the first claim you make each year.
The most important factor is ensuring the policy you choose is fit for purpose, and meets your needs. Any like-for-like comparison is tricky, as there are so many variables some policies may include cover as standard or as on others it's an optional extra.
Our examples below show illustrative price ranges for health insurance – with zero excess and full cancer treatment coverage*. Prices can vary considerably depending on the specific cover options you choose, as well as your age and medical history and location.
|
|
|
35 |
From £36.00 |
to £113.90 a month |
45 |
From £48.54 |
to £149.33 a month |
55 |
From £70.46 |
to £217.27 a month |
65 |
From £101.66 |
to £320.76 a month |
*assumed living in the Midlands (Worcester), with illustrations from 4 leading insurers (4C platform, February 2024)
1 ‘basic plans’ do not include any outpatient care cover. 2 ‘comprehensive’ plans tend to include unlimited outpatient care cover.
Most ‘basic’ plans don’t include ‘outpatient cover’, but some standard plans include this, up to specified limits, there are options to extend it higher, and most comprehensive plans include unlimited outpatient care/costs. LifeSearch will always recommend including an element of out-patients cover. Don’t worry, we’ll also give you the cost breakdown so that you can make an informed choice.
Most private health insurance policies are renewable annually. Your insurer will inform you of any changes to your policy, the cost and any changes to exclusions - as well as any new options which may be available to you.
Over time your product may change, for a number of reasons such as:
- Methods used to diagnose conditions become more advanced, or in use more, so doctors are able to identify some conditions earlier. Meaning that patients can be treated more quickly
- New drugs, such as those for the treatment of cancer, become available
- The technology used in surgery becomes more advanced
- As you get older, you're more likely to need treatment; your premiums could increase
Insurers take into account a number of factors to assess your risk, to provide you with the best cover at the best price. Depending on changes to your risk profile, and any evolution in the cover provided, the premiums you pay may change at renewal. So it's important to review your cover, and check that it's still meeting your needs.
If you need to lower the cost of your private health insurance, there are several ways to do this:
- exclude what you don’t need
- reduce the outpatient cover
- choose a higher excess
- if the NHS waiting list is shorter than the private one, you can have treatment on the NHS instead
- proving to some insurers that you're healthy
- reduce the number of hospitals you'd like to choose from
- it's usually cheaper to pay upfront for your annual policy, rather than paying a monthly premium
- see what your employer offers – many employers offer a type of health insurance as part of their employment package
- compare – it is best to shop around and compare quotes, to check out the best policy at the right price for you. Better still, seek advice from an expert broker - who can do all the legwork for you
You won't get your money back, but some insurers offer a ‘no-claims discount. Just like with car insurance every year you don't make a claim, you get an extra year of no claims discount, which could reduce the cost of your premium when you renew.
The downside to this is that if you do make a claim, your no-claims bonus will be reduced, and this could affect your next renewal premium. If you'd like to avoid this, you could look to insurers that are ‘community rated’, or simply have a no claims bonus system.
As most health insurance policies are annual contracts, it's important to check that you have the right cover in place to meet your needs.
You can change your private health insurance provider, but if you want to switch to a different insurer, there are three main things you need to consider:
- Timing - it's best to consider switching provider when your current policy reaches its renewal date, otherwise you may incur a fee for switching insurer, before the contract has come to an end.
- Compare - you should compare the benefits, policy terms, and cover limits from different providers carefully, so you get the right cover for you. Even if your personal medical exclusions stay the same with your new insurer, the overall cover is likely to be different. You should:
- compare the benefits of each insurer
- compare any cover limits or monetary amounts
- ask questions about how the cover works including your options to access care
- Existing conditions - some insurers might not cover illnesses or injuries you've had in the recent past, or any condition that you suffer from now, even if these were covered by your current insurer.
How does private health insurance work?
When you have private health insurance it allows you to claim for the cost of private medical care, instead of using the NHS, or self-funding.
Different insurers have different claims processes. If you're thinking of seeking private treatment, its always handy to check your insurer's website and your policy documents, to see whether there's any specific guidance.
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Get a referral from your GP
-
Inform your insurer
Once you've been given a referral letter, you'll need to tell your insurance provider that you want to make a claim. You’ll need: - your policy number.
- details of what your GP told you.
- details of your condition.
- details of your referral.
-
Your insurer covers the cost
If it is covered, the insurer will approve your claim and you’ll be booked into see a consultant and have any tests to diagnose your condition and recommended treatment path. The cost will be covered by your insurance provider so long as your policy is active. You may also be asked to pay an excess towards the cost of treatment, and limits may apply to the amount of costs covered, depending on your policy.
Every claim starts with an appointment with your GP. If you suspect you have a health problem, get in contact with your GP or healthcare provider, as you would for any medical issue. But let them know you've got private cover.
Following your consultation with your GP and, if required, they'll refer you to a specialist and then depending on your health insurance policy, you might be able to choose private hospitals or specialists which may not be available on the NHS.
Once you've seen a specialist, call your insurer again to let them know what steps will be taken next. Also make sure you understand how you'll pay for any consultations or treatment, either you'll have to pay and claim the money back, or your provider will pay directly.
What does private health insurance cover?
There is a wide choice of private health insurance policies available. These offer different types and levels of cover, with automatically included benefits and, sometimes, optional add-ons too. These mean you can tailor cover to your individual needs and your budget.
Private Health Insurance is designed to cover the cost of private medical treatment for ‘acute conditions’, that start after a policy begins. It includes access to independent healthcare services, which often means a speedy diagnosis and reduced waiting times for treatment.
An acute condition is a disease, illness or injury that is likely to respond quickly to the treatment that aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.
Different levels of cover are available to meet the needs of different customers. For example, you can choose the types of treatment that are covered by your policy and up to what cost.
Cover usually includes:
- The cost of hospital admission
- Diagnostic tests, such as MRI and CT scans
- Surgery
- The costs of seeing a consultant
- Hospital accommodation and nursing care
- Cancer drugs - some polices will include drugs that are not available on the NHS
Options may also include:
- Outpatient consultations
- Mental health treatment options
- Complementary therapies
- Physiotherapy and chiropody
What is not covered?
Your insurer will typically not cover ‘chronic conditions’. These are diseases, illnesses or injuries that have one or more of the following characteristics:
- Needs long-term monitoring, control and relief of symptoms
- Continues indefinitely
- Has no known cure, or is likely to come back.
Although initial diagnostic tests are usually covered, if such test then leads to a diagnosis of a chronic condition, the long-term treatment needed won't be covered alongside that. For example, if you developed symptoms of diabetes and your GP referred you to a specialist to diagnose the issue, your policy should cover this.
However, if you are then diagnosed with diabetes, any treatment, medication or check-ups would no longer be covered, and would instead pass to the NHS. You may, however, be treated for acute flare-ups of the condition, so it's worth checking with your insurer.
Normally, you will not be covered for any illnesses you are currently suffering from or have already had - sometimes referred to as ‘pre-existing conditions’.
Typically, conditions such as asthma and arthritis are excluded as standard. See below for other examples of excluded conditions.
- dental services (unless you've added it to your plan)
- organ transplants
- kidney dialysis
- cosmetic treatment
- normal pregnancy
- experimental or improvement treatment and drugs
- prescription drugs and dressings after leaving the hospital, or as an outpatient
- mobility aids such as wheelchairs and motor scooters
- gender reassignment
- HIV/Aids
- self-inflicted injuries and drug abuse
- infertility
- professional sport-inflicted injuries
What are the advantages of private health insurance?
Private health insurance is designed to cover the costs of private medical treatment. You can enjoy early consultations and fast treatment times, without being subjected to long waiting lists. It can also mean treatment in a private hospital from some of the country's top consultants and high patient/nurse ratios, which can be crucial for a speedy recovery. These hospitals also insist on high standards of comfort and catering, as well as having reduced risk of contracting superbugs, such as MRSA.
When compared with the NHS, there are advantages and disadvantages with private health insurance.
Advantages
- Faster access to healthcare – with quick referrals to specialists, testing and treatment – reduced waiting times, and flexibility to suit you
- Choice of healthcare – a wider range of providers hospitals and access to medication and treatments, that aren't always available on the NHS
- Private rooms and quality care – access to your own room hive amenities such as TV and Wi-Fi, quality meals and comfort. This also allows more flexible visiting arrangements
Disadvantages
- Premiums – private health insurance can be expensive. The more more coverage you need, the more expensive it is
- Range of cover – a policy may not cover all conditions, and some treatments may require additional out of pocket expenses
- Pre-existing conditions – most likely excluded, or coverage might be limited with higher premiums
If you're self-employed, or have a job where timing is an important factor, access to private healthcare can prove invaluable, as you can often choose when and where you're treated.
If your (or your partner’s) work offers private health insurance through an employee benefits package, it's unlikely that you'll need to take out private health insurance yourself. This can sometimes be a no-cost standard benefit (though you may pay tax on it), or an option you can choose to pay for. Just make sure you check what you're covered for, as your policy may not cover what you need it to.
However, if you need treatment, make a claim, and then later decide to leave your employer, it's worth checking whether you would be able to continue you membership with the same company privately. If not, you may be stuck without being able to get cover for an existing condition - or may need to pay higher premiums each month to keep your cover.
When you apply for a policy, you will need to provide some information to the insurer. You can choose whether to disclose your medical history up front or not, but this affects how you claim.
There are two main methods that insurers use to underwrite your application for health insurance cover – ‘full medical’ or ‘moratorium’.
Full medical underwriting - you disclose your full medical history from start, the insurer then assesses this information and complex exclusions where they think it's necessary. With your consent, the insurer may write to your doctor for more information, but they do not do so in every case. While it may take a little longer, the benefit of this is you know from outset what is and what isn't covered.
Moratorium underwriting - you do not need to tell the insurer about your medical history when you apply for the policy. If you claim, however, your insurer might ask for medical notes that are needed to decide if your claim can be covered, as the insurer will not cover treatment for any medical condition that you have received treatment for, taken medication for, asked advice on or had symptoms of which predates the starting date of the policy.
In other words, you will not be covered for any condition that existed in the past few years (usually, this is in the last five years, but the period of time may vary).
Whichever route you follow, you must answer all questions as fully and accurately as you can, to the best of your knowledge and belief. Insurers will only ask you for information that is relevant to the cover you are applying for.
Most insurers offer comprehensive and basic plans plus extras, which you can add (such as extra cancer care or outpatient treatment), so you can build the cover to suit your needs and budget.
Things to think about:
- Decide why you need private health insurance and what’s important to you
- Do you need to cover every eventuality, or more specific medical conditions?
- How much do you want to spend?
- Are you prepared to pay towards your investigations and treatment? Do you want your cover to include seeing a specialist and having diagnostic tests (for example X-rays and blood tests) as an outpatient?
- Do you want a choice of hospitals, or would you be happy to have treatment that you might need, in a hospital available from a limited range chosen from your insurer?
- What are you not covered for?
These could have a significant effect on how much you pay. The more your cover includes, the higher your premiums are likely to be.
LifeSearch is here to help you understand these questions. Our team will research your options and help you pick the cover that is most suitable for you and your family.
Health insurance usually covers conditions that occur or develop after you've taken out your policy. If you have a pre-existing condition, you'll generally still be able to buy private health insurance, but any treatment/cover for that condition this is likely to be excluded.
Some insurers offer cover for certain pre-existing conditions if they are seen as minor (but the definition for this can vary), or if they believe the symptoms are unlikely to come back again. If you haven't experienced any symptoms for around five years (this may vary), insurers may be more willing to cover you for the condition.
Who can private health insurance cover?
Make sure you know what you and your family's needs are and that the policy matches up. There are different types of health insurance available to choose from including:
How LifeSearch can support you
Protecting families is our business. Since 1998 we’ve protected hundreds of thousands of UK families – well over 1.8 million individuals – in the ways that are best for them, their needs, budgets and future plans.
LifeSearch are an independent intermediary who can provide you with top customer service and ongoing support should you ever need it.
Why get advice from LifeSearch
There are many different private health insurance choices available – with basic and comprehensive plans, and lots of optional benefits. All insurers have their own versions of these products and variants. And then there are medical advances, changes to treatments and newly approved drugs to consider too.
Without LifeSearch in your corner that’s a lot of reading and info to get your head around, and it’s not easy to compare like for like … research, reading and analysis you don’t have to do.
Frequently asked questions about private health insurance
The most common conditions and treatments claimed for under health insurance are:
- Musculoskeletal problems (knee, back or neck pains)
- Heart and circulatory diseases (coronary heart disease; arrhythmia)
- Eye and ear conditions
- Cancer
- Digestive system conditions (gastroenteritis, Crohn's disease and irritable bowel syndrome)
The minimum age you can buy a health insurance policy in the UK is 18. However, you're able to include under 18’s by adding them to a family insurance policy, or some insurers offer child-only health insurance policies.
Most insurers have an upper age limit, but this varies from insurer to insurer. Your age will affect the price of your premiums and you can expect to pay more, the older you are when you take out your policy.
It depends on your policy. It is possible to buy health insurance with zero excess (so you don’t pay anything towards a claim). However, the higher excess you have, the lower your health insurance premiums are likely to be.
Insurers offer different types of excess and limit levels. Depending on your policy type, you may need to pay an excess only once each policy year, while other policies will charge an excess each time you make a claim.
Some health insurance policies will include mental health cover. You may also have the option to include additional cover for mental health support, such as support teams, help lines and more. If mental health is an important requirement for you, talk with LifeSearch and we can help you understand the options available.
Health insurance can cover you for private healthcare in the UK, while critical illness cover pays out a lump sum or source of income, if you're diagnosed with a serious illness that your policy covers. Unlike health insurance that you claim on for private medical treatment, critical illness cover is there for financial peace of mind, if you're diagnosed with a serious illness (as defined by your insurer) during the term of your policy.
In-patient care, refers to any treatment that requires a stay in hospital or clinic, for at least one night.
Out-patient care, refers to treatments or tests that don't require you to be admitted to hospital. For example, minor diagnostic tests such as X-rays, or physiotherapy sessions.
Day-patient care, is when you are admitted to a hospital or clinic for an appointment that requires medical observation for a short period, but you don’t need to stay overnight.
You shouldn't need to go through a medical to get private health insurance. Most insurers will simply ask you to fill out a medical history form, so they can get an understanding of your lifestyle and medical history.
Although if you choose to take a Fully Medical Underwritten policy you will be asked to declare your medical details and your family medical history. If you opt for moratorium policy though you wouldn't need to do this.
Most private health insurance policies won't cover you if you become ill or have an accident abroad, but it's best to check this with your insurer, as policies do vary. If your policy does include cover abroad, it's likely to only pay out for emergency treatment.
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