What’s an outpatient limit with health insurance?
Adding outpatient cover to your health insurance gives you access to diagnostic tests, treatments, and therapies. This guide explains how outpatient cover limits work and how leading insurance providers differ in their coverage.
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Full Bio1 min read about outpatient limits
An outpatient limit is the amount you can claim in a year for outpatient consultations, tests, scans and treatments. Once you reach this limit, you’ll usually need to pay further costs counted towards that allowance yourself. Some benefits, such as eligible scans or cancer treatment, may sit outside it.
Insurers give you the option to have an outpatient limit to reduce your premiums, but you can also opt for unlimited cover if that’s your preference.
Most providers limit outpatient cover using a monetary amount, for example £500, £1,000 or £1,500 per policy year.
What is outpatient treatment?
Outpatient treatment typically doesn’t require hospital admission, meaning an outpatient receives treatments and returns home. Outpatient treatment can include minor surgeries, diagnostic tests, consultant appointments or therapies such as physiotherapy.
For example, if you need to stay overnight in a hospital bed to undergo major surgery, your care is classed as inpatient treatment. There is also day-patient treatment where you might need to stay in a day-patient unit for several hours but return home afterwards. Core health insurance cover typically includes inpatient treatment as standard. However, you’ll often need to pay more for outpatient cover.
How does outpatient cover work?
Health insurance policies include some forms of treatment as standard. You’ll typically get inpatient cover and cancer treatment even with the most basic health insurance policies. Health insurance policies also offer various optional extras so you can choose the cover that meets your needs.
Optional extras usually include outpatient cover, enhanced mental health support and optical and dental cover. However, it’s worth considering what outpatient treatments you’ll likely need when obtaining health insurance quotes. Most policies now include some outpatient services in their core cover but offer others at an additional cost.
Read next
What a basic policy covers as standard and what a comprehensive plan adds, including outpatient treatment.
Is any outpatient treatment included in core coverage?
Most insurers now include some outpatient cover in their core policies, such as minor diagnostic tests, scans and some outpatient surgical procedures.
We recommend adding outpatient cover to your health insurance policy because it can give you faster access to diagnostic tests. However, many policies now offer tests and scans in their core cover.
The outpatient services offered vary between insurers, so you should carefully compare quotes and insurance policy documents before buying.
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Compare health insurance prices from leading insurers with different outpatient limits and find the right cover for you.
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How outpatient limits affect your cover
An outpatient limit caps the benefits counted towards that allowance in a policy year. Other benefits may have separate limits or be paid in full, depending on your policy. Once you use up an allowance, you’ll usually need to pay further costs counted towards it yourself until it resets.
Some private health insurance companies offer different levels of coverage, so you can pick the one that fits your budget.
To see the difference a limit makes, compare health insurance quotes with and without full outpatient cover.
Major health insurers’ outpatient coverage
To give you an idea of the types of outpatient cover included in each private health insurance plan, we’ve reviewed what each provider offers. Below are the 10 insurers in our 2026 ratings, in the order we rank them (see how we rate insurers).
While this article focuses on the outpatient cover included in each policy, you must consider what each policy offers in a broader sense before buying. Comparing quotes through myTribe can help you see what level of cover you’re likely to need and what fits your budget.
Bupa outpatient cover
Bupa’s Treatment and Care and Comprehensive policies cover outpatient treatment differently. Their lower-cost Treatment and Care policy covers outpatient therapies such as physiotherapy once your condition has been diagnosed, but covers specialist consultations and tests only for six months after hospital treatment, and only when they relate to it. Beyond that, the policy covers private inpatient treatment if you must stay in a hospital bed overnight or have major surgery.
Bupa’s comprehensive policy includes outpatient cover for specialist appointments, tests, and treatments, including mental health support and therapies. You can choose annual coverage limits of £500, £1,000 or unlimited online (or £750 by phone) to cover all your outpatient treatment. Outpatient cancer treatment doesn’t count towards the allowance, and your treatment must be with a consultant and facility Bupa recognises.
WPA outpatient cover
WPA Complete Health includes £250 a year towards outpatient consultations, with optional extras for more cover. Its core cover also includes outpatient procedures and MRI, CT and PET scans.
Their optional extras include three categories of outpatient care: consultations, therapy and tests. You can skip the consultation cover if the £250 provided by their core coverage will likely be enough for your needs. Equally, if you’re happy to pay for some physiotherapy, you may not need therapy cover. However, to ensure fast access to tests, you can choose the tests option with unlimited coverage. WPA also offers other outpatient cover options for mental health care and cancer cover.
The Exeter outpatient cover
The Exeter Health+ includes outpatient surgery, CT, MRI and PET scans, and up to three specialist-referred physiotherapy sessions after each operation in core cover. You can choose comprehensive or guided cover.
The Exeter takes the same approach to optional extras as other insurers, with separate add-ons for outpatient and therapies cover. Their outpatient cover pays for specialist consultation fees and diagnostic tests, and you choose between £500 a year, £1,000 a year or unlimited. With the £500 or £1,000 options you can add unlimited diagnostics, so only consultation fees count towards your limit. You’ll need separate therapies cover for physiotherapy, osteopathy or chiropractic treatment.
Vitality outpatient cover
Vitality includes outpatient surgical procedures in its core cover. Vitality’s private medical insurance focuses on helping its customers improve their health and wellbeing. You’ll need to add outpatient cover as an optional extra to access tests, scans and consultant appointments, although core cover includes up to six physiotherapy sessions a year with a physiotherapist in Vitality’s network. With outpatient cover, consultations, consultants’ fees, physiotherapy and diagnostic tests are paid up to a limit you choose, or in full. Consultant-referred MRI, CT and PET scans and physiotherapy within Vitality’s network are paid in full whatever limit you choose.
Aviva outpatient cover
Aviva’s health insurance plan, “Healthier Solutions”, is a comprehensive policy which includes inpatient treatment, cancer care and outpatient cover as standard. Outpatient cover includes tests, scans and X-rays.
Outpatient cover is unlimited unless you choose to reduce it: you can cap it at £1,000 or £500, or remove it, to lower your premium. Outpatient surgery, CT, MRI and PET scans, radiotherapy, chemotherapy and cancer treatment sit outside the limit.
If you’ve had specialist treatment from a consultant who then refers you for physiotherapy, it’s included in core coverage. However, you’ll need to add therapies cover to access physiotherapy with a GP referral.
AXA Health outpatient cover
With the AXA Health Plan you build your cover from separate options, so you’ll need to choose its Outpatient diagnosis and care option to be covered for outpatient treatment. Once you have, AXA Health pays for specialist consultations, outpatient diagnostic tests when a specialist refers you and scans at an agreed centre, which could help speed things up compared to NHS waiting lists.
You choose between three specialist consultations a year and unlimited consultations. Physiotherapy, osteopathy and chiropractic treatment are included, up to 10 sessions a year, with a GP referral or through AXA’s online muscle, bone and joint service.
Freedom outpatient cover
Freedom’s core policy pays for MRI, CT and PET scans following a specialist referral, although not if your GP requests them. Specialist consultations and other tests, such as blood tests, are only available with Freedom’s optional outpatient cover.
If you add outpatient cover, you can choose £1,500 or a full refund for specialist fees, including diagnostic tests and physiotherapy, and £750 for tests your GP arranges. Physiotherapy on a GP referral is limited to six sessions.
Saga outpatient cover
Saga’s policyholder must be aged 50 or over, and its outpatient cover is set by the plan you choose rather than a limit you pick. Saver Plus has a £1,500 annual limit and Secure £2,500, shared between specialist consultations, tests and therapies such as physiotherapy, while Super has no limit on consultations, tests or physiotherapy. MRI, CT and PET scans are paid in full on all three and don’t come out of the allowance. The entry-level Support plan doesn’t cover outpatient consultations or tests at all.
National Friendly outpatient cover
National Friendly Level 1 covers outpatient treatment, while Level 2 covers inpatient and day-patient treatment; you can choose either or both. Choose your policy carefully if mental health coverage is important to you, as only Level 1 includes it. National Friendly’s outpatient cover includes MRI, CT, and PET scans, but they come out of your overall outpatient cover limits rather than being part of a separate diagnostic category.
While some providers offer unlimited outpatient cover, National Friendly’s maximum is only £2,000 or £5,000, whichever you choose, a year on Level 1, compared to up to £1 million a year for inpatient treatment on Level 2. Level 1 supports customers who want their healthcare plan to provide a quick diagnosis, so it includes outpatient consultations, tests and scans, as well as physiotherapy before any hospital treatment. Some minor surgical procedures, such as carpal tunnel release, are also covered. Level 2 only covers physiotherapy after inpatient treatment.
General & Medical outpatient cover
With General & Medical, your outpatient cover depends on which of its four plan levels you pick and whether you add the Plus upgrade. Essentials Standard only pays up to £500 for consultations and scans linked to a hospital admission, while Essentials Plus has a £1,500 limit and pays physiotherapy in full. Everyday Standard has a £500 limit. Everyday Plus and Lifestyle pay scans in full but cap consultations at £1,500, Lifestyle Plus and Elite pay both in full, and Lifestyle and Elite also pay physiotherapy in full.
Choosing the right outpatient cover
The right outpatient limit depends on your health, your budget and how quickly you’d want to be seen. Comparing quotes side by side is the quickest way to see what each insurer would cover and what it would cost.
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Disclaimer: This is general information, not personal advice. Speak to a qualified broker before making a decision. Our broker partners compare policies from a panel of leading UK insurers, but not all insurers may be available.