What’s the difference between comprehensive health insurance and basic health insurance plans?

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What do basic health insurance plans cover?

Every health insurance plan includes certain types of coverage as standard. Even if you want to avoid adding optional extras to create a more comprehensive health insurance plan, a basic policy will let you access private healthcare and membership benefits.

Here are a few treatments and services you can expect your health insurance plan to cover as standard.

Inpatient and day-patient treatment

All health insurance policies cover inpatient treatment, including surgery, meaning you can avoid NHS waiting lists if you need a hospital stay. You'll also have a private room and may benefit from facilities such as an ensuite bathroom and chef-prepared meals.

Your treatment is also covered if you're treated in a day-patient unit.

Cancer care

Cancer will likely affect 50% of us during our lifetime, so cancer treatment forms an essential part of most health insurance plans. With a few, it's optional: AXA Health, for example, lets you choose NHS Cancer Support instead of full cancer cover to lower your premium, and you'd then have cancer treatment on the NHS. Health insurance typically covers the costs of surgery, radiotherapy and chemotherapy. Some insurers offer other therapies and services such as nutritionist appointments, wigs, prosthetics and reconstructive surgeries.

It's worth shopping around for the best deal as insurers differ in the levels of coverage they offer. Paying an additional premium can give you extended coverage.

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Mental health support

All health insurance plans offer some form of mental health support. This varies by health insurance company: some, such as WPA and Vitality, include a limited number of counselling or CBT sessions as standard, while others, such as Bupa and AXA Health, only pay for talking therapies such as CBT if you add mental health cover. Some allow you to self-refer for a limited number of sessions without seeing your GP. There are also mental health helplines for advice about your or your children's emotional health.

Insurers vary in the number of mental health conditions they cover, so it's a good idea to check what's included before you choose your policy.

Virtual GP services

Virtual or digital GP services let you book an online GP consultation 24/7. It's great news if you struggle to get an appointment with your NHS GP at a convenient time. Some virtual services offer video appointments. Others let you enter your symptoms into an app, and a doctor will call you back.

Virtual or telephone appointments aren't usually suitable for patients with complex medical needs. However, they can be ideal for straightforward issues that require a private prescription or consultant referral.

A choice of consultant and hospital

Private medical insurance lets you choose your hospital and consultant, like the NHS. Depending on your chosen insurer, you can choose from a list of private hospitals or a private hospital bed in an NHS hospital.

Each insurer has several hospital lists and includes their standard list on all health insurance policies. You can choose your hospital and consultant based on the facilities and whether it's close to home. You can also select a consultant who's an expert in the procedure you need. Your consultant choice may be limited if you've opted for guided consultant choice, where your insurer gives you a shortlist of consultants.

Membership perks and discounts

A health insurance plan can offer perks and discounts, such as free coffee or discounted cinema tickets and gym memberships. Some plans provide discounts to all members, while others offer you the chance to earn enhanced rewards.

For example, Vitality's rewards programme lets you set health and activity goals and earn rewards for hitting them.

What do comprehensive health insurance policies cover?

A comprehensive health insurance plan gives you more coverage and access to a broader range of treatments. Some insurers offer pre-designed comprehensive health insurance plans, or you can add optional extras to their standard health insurance plans.

Here are some features you'll find with a comprehensive health insurance plan.

Outpatient treatment

All comprehensive health insurance plans cover outpatient treatment, basically anything that doesn't require a hospital stay. Outpatient care includes consultant appointments, physiotherapy treatment and diagnostic tests and scans.

It's well worth including outpatient coverage on your health insurance policy as it means you won't have to wait for a diagnosis and can start treatment more quickly. If you need physiotherapy, your comprehensive health insurance will likely cover it; you may be able to refer yourself for a limited number of sessions.

Outpatient cover is the policy benefit that has the biggest impact on price, so compare plans with and without it before you decide.

Alternative therapies

Private medical insurance typically gives you access to cutting-edge treatments and new drugs that aren't yet available on the NHS. A comprehensive health insurance policy can also provide alternative treatment options and therapies, such as acupuncture, homoeopathy or osteopathy, that standard plans from most insurers, such as AXA Health and Aviva, don't cover.

Extra treatment sessions or more extensive coverage

All health insurance plans include financial limits or specify the number of treatment sessions available. Opting for a comprehensive medical insurance plan will cover more sessions or higher treatment costs. You can also pay more to increase the limits on specific treatments.

A comprehensive health insurance plan can also include different types of treatment. For example, AXA Health's Extended Cover option pays up to £500 a year for visits to a private GP.

More comprehensive mental health coverage

All medical insurance plans offer some mental health support, from counselling to telephone helplines or online resources. However, comprehensive health insurance plans provide extended coverage for more serious mental health conditions.

While all medical insurance includes inpatient care, this often doesn't apply to psychiatric treatment. You'll need comprehensive health insurance to access inpatient or day-patient treatment.

Dental and optical cover

The NHS provides free dental treatment and free eye tests in some circumstances. However, more of us now pay for our routine dental and optical care. Adding optical and dental coverage to your comprehensive health insurance could save you money if you already pay for private treatment.

Depending on your chosen policy, your comprehensive medical insurance could pay for your routine check-ups, treatments, glasses, and contact lenses if needed. However, some insurers, such as Aviva and Freedom, only pay for glasses and contact lenses if your prescription has changed.

A wider choice of hospitals

As mentioned, standard health insurance plans only include an insurer's basic hospital list. However, insurers also offer extended lists at an extra cost. Extended hospital lists reflect that private healthcare costs more in some locations because of higher wages or facility costs.

You'll typically pay more for treatment in most major cities. Unsurprisingly, Central London has the highest costs. Most insurers offer an extended list and an extended plus Central London list. These are ideal if you live in London or another major city and want to ensure you can have treatment close to home.

What's excluded from coverage?

Even the most comprehensive medical insurance still has exclusions. Health insurance coverage is only available for acute conditions that arise after you buy your health insurance policy. Acute conditions are illnesses or injuries that can be cured with treatment, such as hip replacements, surgery for broken bones, or cancer treatment.

Your health plan won't cover chronic conditions such as diabetes, asthma or angina that can't be cured but can be monitored and controlled long-term.

Medical insurance also comes with standard exclusions. For example, plans don't cover cosmetic surgery or fertility treatment, among other things, and most exclude treatment for addiction, although Bupa's mental health cover includes one addiction treatment programme in your lifetime. Some insurers have longer exclusion lists, so always check the small print.

Other exclusions depend on your medical history and whether you have any pre-existing conditions. With moratorium underwriting, any condition you've had symptoms, treatment or advice for in the five years before your cover starts (three years with Saga) is excluded at first. If you then go two continuous years on the policy without symptoms, treatment, medication or advice for it, your insurer might cover it, but conditions that need regular treatment or medication are unlikely ever to qualify. With full medical underwriting, the conditions your insurer excludes are listed on your policy.

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