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.
1 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, your insurance won't cover any further outpatient costs.
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, however, there are a couple that do it based on the number of consultations instead.
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 in-patient 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 in-patient treatment as standard. However, you'll often need to pay more for outpatient cover.
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How does outpatient cover work?
Health insurance policies include some forms of treatment as standard. You'll typically get in-patient 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.
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What a basic policy covers as standard and what a comprehensive plan adds, including outpatient treatment.
Is any outpatient treatment included in core coverage?
The short answer is yes; you'll find some outpatient cover included in health insurance providers' core coverage. While standard health insurance policies used only to include in-patient treatment and exclude outpatient treatments, many now include minor diagnostic tests, scans, and even 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.
See how much health insurance costs with or without outpatient cover
Compare health insurance prices from leading insurers with different outpatient limits and find the right cover for you.
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Coverage limits
When a health insurance policy mentions coverage limits, it refers to the amount your policy will pay out each year. There are different coverage limits for each type of cover. For example, there will likely be a set figure to cover private in-patient care costs and a separate one for outpatient cover. When you've hit your annual limit, your insurance won't cover more private healthcare.
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.
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. Speaking with a health insurance broker can help you understand what coverage level you'll likely need and how to get the best coverage for your budget.
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Our ratings of the UK's 10 leading health insurers, with how the top five compare on score, monthly cost, main strength and trade-off.
Bupa
Bupa offers two policies with different approaches to outpatient cover. Their lower-cost Treatment and Care policy includes outpatient therapies such as physiotherapy as standard, but not specialist consultations, tests and scans. Beyond that, the policy covers private in-patient 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, £1000 or unlimited to cover all your outpatient treatment. Unlimited coverage only applies if you receive treatment at a Bupa-approved hospital or treatment centre.
WPA
WPA's Complete Health policy is highly flexible, letting you tailor your coverage to your needs. Their core coverage includes £250 a year towards outpatient consultations, and also covers 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
The Exeter's Health+ policy has comprehensive and guided options that offer flexible private medical insurance cover. Their core coverage is excellent and includes outpatient surgical procedures to give you quick access to treatment if you don't need in-patient care. You can also access CT, MRI and PET scans and up to three sessions of outpatient physiotherapy after surgery if required.
The Exeter takes the same approach to optional extras as other insurers, with separate add-ons for outpatient and therapies cover. Their outpatient cover includes unlimited consultant appointments and tests, but you'll need separate therapies cover for physiotherapy, osteopathy or chiropractic treatment.
Vitality
Vitality's private medical insurance focuses on helping its customers improve their health and wellbeing. They include outpatient surgical procedures in their core cover and were among the first insurers to do this. You'll need to add outpatient cover as an optional extra to access tests, scans, consultant appointments and physiotherapy. There are two levels of outpatient cover; limited offers unlimited cover for scans, but everything else is subject to a pre-agreed limit. Full cover is unlimited for all outpatient services.
Aviva
Aviva's health insurance plan, "Healthier Solutions", is a comprehensive policy which includes in-patient treatment, cancer care and outpatient cover as standard. Outpatient cover includes tests, scans and X-rays.
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
AXA Health Insurance is one of the UK's largest health insurance plan providers. You'll need to add outpatient cover as it isn't included in their standard policy. While you'll need to see an NHS consultant for your initial appointment, AXA Health Insurance includes diagnostic surgery and scans in its core cover, which could help speed things up compared to NHS waiting lists.
AXA's outpatient cover includes unlimited specialist fees for consultations, diagnostic tests, and outpatient medical treatment. AXA doesn't include physiotherapy in their outpatient cover, meaning you'll need to add therapies cover if you want outpatient treatment and physiotherapy.
Freedom
Freedom Health Insurance offers its customers flexible private medical insurance with comprehensive in-patient care coverage. Their 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 invest in enhanced outpatient cover, you can access physiotherapy subject to overall policy limits. Freedom also pays cashback for treatments, including outpatient procedures, minor surgeries, and routine dental and optical care.
Saga
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
National Friendly offers four levels of coverage with increasing limits on in-patient care and outpatient treatments. Choose your policy carefully if mental health coverage is important to you, as not all policy levels include 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 £5,000 compared to up to £1 million for in-patient treatment at higher levels. 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 in-patient treatment.
General & Medical
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, and 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
Our guides explain how outpatient cover works, but the right level for you 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 health insurers, but not all insurers may be available.