What do even the most basic health insurance policies cover?

Private health insurance enables you to get private medical care for acute conditions diagnosed after you've taken out the policy. Even basic private medical insurance covers eligible inpatient and day-patient treatments. That means you'll be able to avoid time on an NHS waiting list and receive prompt access to treatment whether you need to be admitted to the hospital or come in for regular treatments in a day unit.

Typically, you'll also be given a choice of consultant and hospital. This could be one of the private hospitals in your insurance provider's network or a private room in an NHS hospital. Whichever you choose, you're likely to be given a private room so you won't be in a noisy general ward.

How does private health insurance work?

Private health insurance allows you to choose the cover that's right for you. Depending on your priorities and budget, you can choose a comprehensive policy to cover every eventuality or select something more tailored. Every health insurance provider offers core cover and a range of optional extras that you can add on if you want.

Private health insurance premiums vary depending on different factors, including the kind of cover you have, how old you are and where you live (although this doesn't apply to every insurer). Tailoring your cover lets you choose the elements that are most important to you whilst also fitting in with your budget.

Once you've chosen and taken out your policy, you'll start paying a monthly premium. When you need care, you may be able to go straight to your insurer for diagnostic tests or see your GP to get a referral for specialist treatment, depending on the type of policy you have.

Whatever the process, when you contact your private health insurer to make a claim, they'll take it from there.

What conditions and treatment costs does private health insurance cover?

Private health insurance works on the basis that some types of treatment are covered as standard whilst others are only offered as an optional extra. Your policy is also likely to have limits on the amount of cover they'll provide for different treatments. This could be a financial limit or a cap on the number of private treatment sessions you can have. You may have the option to increase the number of private medical treatment sessions you can access.

Here are some treatment types you can expect to receive as part of your core cover and others that are usually only available as an added extra.

1. Inpatient and day-patient care

Every private health insurance policy includes both inpatient and day patient care. If you need to be admitted for hospital treatment or attend a day unit, your private medical insurance will cover your treatment costs. It includes cover for surgeries from cataract removal, hip replacements, and cancer treatment.

However, this type of health insurance won't include any diagnostic tests, so you'll still need to see your GP for tests, scans and a referral for further medical treatment.

2. Cancer treatment

Cancer treatment forms a crucial part of every private health insurance policy. This isn't surprising given that it's likely to affect 1 in 2 of us in our lifetime. Cancer cover typically includes surgery, radiotherapy and chemotherapy. Some insurance providers will also pay for additional therapies and support services, for example, access to nutritional advice, reconstructive surgery, wigs and prosthetics.

There are different levels of cover available, with some treatments being included as standard whilst you can pay an additional premium to access a broader range of treatments and services. Some of the best health insurance companies also include genetic testing and stem cell therapy as part of a comprehensive policy. If there's a family history of cancer, it's well worth comparing the different levels of cover available.

3. Access to a digital GP

GP services are under pressure, with an overall lack of qualified staff and limited funding, so getting an appointment with your GP can be challenging. Appointments are typically only available during working hours which is inconvenient if you need advice that works with your schedule.

A digital or virtual GP service can solve this problem by allowing you to get medical advice at a convenient time. Some will enable you to book an online appointment to be seen via a video call, whilst others take the form of an app where you can enter your symptoms, and a medical professional will review them and call you back. They'll often be able to issue a private prescription and may be able to refer you for further treatment.

Whilst this isn't the right approach for every health issue, it can offer you a quick and simple solution when you need it.

4. Rehabilitation

Your private health insurance can cover the cost of rehabilitation treatment, but we need to sound a note of caution. Likely, this kind of medical treatment will only be covered as standard if you need it after surgery.

If you need physiotherapy, osteopathy or chiropractic treatment as a standalone service, it usually won't be covered by a basic policy. Where rehabilitation is covered, there will usually be a limit on the number of sessions you can have.

5. Optional extras

When you take out private medical insurance, your provider will offer you a range of optional extras that aren't included in their core policy. Some will allow you to add other types of treatment, whilst others will let you increase your cover limits so you can have more private treatment sessions than your core policy allows.

Here are just a few of the things that you can expect to see as an optional extra.

Outpatient treatment

Outpatient cover is offered as an optional extra by most insurance providers. It allows you to receive private treatment when you don't need to be admitted to a hospital. Outpatient cover includes outpatient consultations or physiotherapy for injuries that don't need surgery.

This type of health insurance will also give you access to diagnostic tests, such as scans or blood tests, so it can help you get a diagnosis and start treatment more quickly than would be possible if you had to spend time on an NHS waiting list. This could be a massive advantage if you have a condition such as cancer that benefits from prompt access to treatment or if you simply want to be treated quickly so you can get on with your life.

Additional therapies and treatment sessions

Generally speaking, medical insurance will give you access to a wider range of treatments, therapies and specialist drugs than you'd receive via the National Health Service. Though most providers will draw the line at experimental treatments, they'll often be willing to consider medications that don't have NHS funding. However, these often won't include therapies like homoeopathy or acupuncture unless you opt to add them to your medical insurance policy.

Medical insurance also gives you a specified number of treatment sessions. You can opt to increase your treatment limits if you're likely to need further treatment.

Dental and optical cover

If you aren't eligible for free dental care or free eye tests on the NHS, you're likely already paying for private healthcare to look after your eyes and teeth. It's worth discovering whether adding dental and optical care to your health insurance could help you save money.

Health insurance will typically pay for your checkups along with routine dental treatment. Many health insurers will also pay for glasses or contact lenses if your prescription has changed since your last checkup or if you need them for the first time.

Eye tests can act as an early warning system for other conditions such as diabetes, so this could be a valuable additional extra if that's a concern for you.

Mental health treatment

Many health insurers include some informal mental health support as part of their services. Some offer access to a helpline that customers can contact 24/7. This could be as simple as articles and information on their website to help visitors look after their mental health.

However, if you're diagnosed with a mental health condition that needs formal treatment, you may need additional mental health insurance coverage. Some insurers offer a limited number of counselling or cognitive behavioural therapy sessions as part of their core policies and extend this to unlimited treatment sessions along with inpatient, day-patient and outpatient cover as an optional extra.

A better choice of private hospitals

Private medical insurance gives you access to a network of private hospitals and treatment centres, depending on your chosen insurer. Each provider has their own hospital list, which could be made up of their own hospitals, private facilities in NHS hospitals or a combination of the two. Some insurers also work with other companies to allow customers access to a broader range of facilities. They'll factor in the cost of treatment at each hospital when calculating your health insurance premium.

You can pay for access with an additional premium covering the higher costs. This can mean that hospitals with higher fees, for example, those in central London, aren't included in their standard list but are offered separately. This may be worthwhile if you live in a more expensive area and would prefer to travel to a local hospital for treatment.

What private health insurance doesn't cover

Health insurance is designed to provide private healthcare when you have an acute condition that can be cured with a course of treatment. Of course, that means that some conditions and treatments won't be included and where you'll need to seek NHS treatment.

Each insurer has a list of standard exclusions that you'll need to check before deciding whether they're the right provider. Other exclusions will be based on your medical history.

Chronic conditions

A chronic condition can't be cured but needs ongoing treatment and management. Chronic illnesses can also come with potential complications that your insurers will classify as a pre-existing medical conditions. For example, you won't be able to access private healthcare for diabetes, asthma, or high blood pressure as your GP or specialist will be responsible for monitoring those and prescribing appropriate medication.

Pre-existing medical conditions

Pre-existing medical conditions are relevant for medical insurance because they'll be excluded from cover for the first couple of years at least. Pre-existing conditions are any illnesses or conditions you've been treated for or had advice about in the five years before you took out the policy.

Your insurer won't cover treatment for any pre-existing condition for the first two years of your policy. However, if you haven't needed any treatment or advice during that time, you can opt to add it on.

Full medical underwriting could help to give you more certainty

There are two types of medical underwriting that you'll come across when you're looking for health insurance; moratorium underwriting and full medical underwriting. Both have a two-year moratorium when you first take out the policy. The main differences are in the health insurance cost (moratorium underwriting is typically cheaper) and the amount of information you're asked to provide when you take out the policy.

With moratorium underwriting, your insurers will only look into your medical history when making a claim. It could mean that your private health insurance claims are refused because of something that turns up in your medical records. The claims process can also take longer because they need to investigate.

If you choose full medical underwriting, you'll need to provide details of your medical history when you take out the policy. It allows your insurers to confirm what is and isn't covered from the outset, giving you more certainty.

Other exclusions

As we've already mentioned, each insurer has a standard list of exclusions where you won't be able to claim for private healthcare. Some insurers' lists are longer than others, so checking in case something potentially important to you isn't covered is essential.

The standard exclusions that you'll find with most health insurers are:

  • Treatments and rehabilitation for addiction
  • Cosmetic surgery and other non-surgical cosmetic and weight loss procedures
  • Pregnancy and maternity cover - although some insurers provide cover for pregnancy complications and related treatments.

Other services and benefits

There are several different insurers and policies in the health insurance market, and each has its focus and approach. This means that the additional services and benefits on offer will vary from insurer to insurer.

Virtual GP and NHS cash benefit

Most health insurance will give you access to a 24/7 virtual or online GP service to get a private appointment to suit your schedule.

You may also be able to opt to receive an NHS cash benefit which will pay you a cash sum if you receive NHS treatment. This could include a fixed amount for each night you spend in a hospital bed or for each outpatient treatment session. While you can't access private healthcare, you could put your payment towards car parking or your own private room. This could be a real benefit if you need treatment for a pre-existing condition.

Insurance cover when you're travelling

Some insurers will only provide health insurance for treatment within the UK, however, others offer you the option to add travel insurance or international health insurance for UK residents abroad. This is worth considering if you travel frequently and already pay for travel insurance separately. It also means you're covered if you need healthcare abroad.

Offers and discounts to save you money every day

Your health insurance policy can also give you access to special offers and discounts. This could include products and services to support a healthy lifestyle, such as health club memberships or a fitness tracker. Others offer discounts at high street stores to make your coffee fix more affordable.

What types of health insurance policies are available?

Medical insurance isn't one size fits, and different insurers offer various policies.

If you only need cover for yourself, every insurer offers a single policy designed for one person. You can also get couples policies that provide a discount if you take out joint cover for you and your partner.

There are a few options if you want to add your children to your policy. Some allow you to include your children free of charge or add multiple children and only pay for the first one. We've also seen policies where you can add children who live with you up until they're 30. With home ownership becoming more challenging, we suspect it might be helpful for many families.

Grandparents holding grandchildren
Some private health insurance policies can extend to your wider family

WPA also offers a multi-generational policy that allows you to include members of your extended family living at different addresses. This could be ideal if you'd like to make life easier for your children and grandchildren or if you're caring for elderly family members as your health insurance covers them too.

It's also worth checking to see if you can get a discount based on your work. WPA offers a discount to self-employed contractors and people in specific professions.

Will I still need the NHS?

Healthcare cover can't replace the NHS altogether. You'll still need them if you have chronic illnesses that require ongoing management. Whilst most insurers offer you access to a private GP, these services aren't always suitable for more complex conditions. Your NHS GP may still need to assess and refer you before you can get private care.

It's also important to remember that your insurance may only go so far. You may need more treatment sessions than your insurance will cover. Alternatively, you could make a claim only to have it refused because the treatment you need is related to a chronic illness or a pre-existing condition.

Getting professional private medical insurance advice

As you can see, many different private medical insurance options are available on the market. The right insurance for you will depend on many factors, from your circumstances to your budget.

You could spend a lot of time on the internet or calling insurers only to find that you don't like what's in the small print when you receive your quote.

You can get free private medical insurance advice from an FCA-authorised expert

Speaking to a broker regulated by the financial conduct authority lets you provide details of your circumstances, health needs and budget without doing hours of research. They'll be able to give you expert advice on the insurance products that will meet your needs. They know each policy's details so they can advise you on the right cover for your circumstances and budget.

Compare Health Insurance with myTribe

At myTribe, we provide you with straightforward guides and information so that you can do your own research. We'll also give you a comparison quote and put you in touch with a high-quality, regulated broker who can give you specialist advice.