What are common health insurance exclusions in the UK?

Chris Steele
Founder and Editor
Chris is our resident private health insurance and healthcare expert. He has over a decade of experience writing about private medical insurance and treatment. He's Chartered Insurance Institute qualified and is regularly quoted by the national press.
Chris Steele
Reviewed by
Reviewed by
Updated on
May 8, 2024

Good dental and optical care can help you stay healthy. If you pay for private treatment, health insurance or a cash plan can help you save money on dental and optical care. In this article, we look at different types of cover so you can consider your options.

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How does optical and dental cover work?

You can access dental and optical cover in two ways. If you've decided to invest in health insurance, you can add optical and dental cover to your policy as an optional extra. Alternatively, you can buy a cash plan. Health cash plans are available as standalone plans, or you can add them to your health insurance.

The main difference is that you can claim on your health insurance, and your insurer pays your dentist or optician for your treatment. With a cash plan, you pay your treatment costs upfront and claim reimbursement. Whichever you choose, you'll pay a monthly or annual premium for cover.

What are the benefits of optical and dental cover?

Optical and dental cover will pay for routine dental check-ups, eye tests, and treatments. It means your everyday healthcare costs are covered, so you're more likely to book regular dental appointments and your annual eye test knowing it's already paid for.

You'll also be covered for dental emergencies and other procedures, meaning a big bill won't catch you out if you need emergency care, significant dental work such as a crown or root canal treatment, or glasses or contact lenses.

Are there any disadvantages to taking out optical or dental insurance?

With any health insurance, there's always a risk that you'll pay for more than you use.

Health insurance covers private check-ups, which you won't need if you're entitled to free care due to age or medical history or because you receive certain benefits. With a cash plan, you'll need sufficient funds to pay for treatment upfront and then claim back the costs, which can be an issue if you lack disposable income.

A broker can help you weigh up the pros and cons and decide whether health insurance or a cash plan suits your circumstances.

A graphic explaining health insurance coverage for optical and dental services.

What does health insurance with optical and dental cover include?

Insurance can cover a full range of optical care and dental treatment, from regular check-ups to treatments, glasses and hearing aids. Policies typically include specified procedures and check-ups and set financial limits for each type of care. Some providers only offer a cash plan. However, suppose your policy has optical or dental cover as part of your healthcare cover. In that case, you'll be able to schedule check-ups and claim for care without incurring any costs upfront.

Insurers vary in the cover they offer, so always check your policy documents before you buy. Here's what you can expect to find on most policies.

Check-ups and treatment

Most policies have an annual limit on how much you can claim for dental check-ups, eye tests and treatment costs.

Dental care

Dental cover typically includes routine dental appointments, including checks and hygienist fees, x-rays, fillings, crowns, and tooth extractions.

Limits vary but are typically in the region of £250 to £300 per year for routine dental care. Some policies also apply an automatic £50 excess. This is likely sufficient if you only want to use your insurance for regular check-ups, but if you need more significant treatment, your policy may not provide enough cover. Private dental costs are rising, with a root canal costing £403 on average, which varies depending on your postcode. It's worth checking which dentists your policy covers and what your treatment costs will likely be.

Eye tests

It's essential to check whether your policy covers routine eye tests. Many do, but others only cover prescription glasses and contact lenses once your optician has prescribed them.

Dental accidents

There's typically separate cover for dental accidents and severe pain that over-the-counter medication can't control. The limit is usually around £600. Many insurers include overseas cover for emergency treatment abroad.

Other costs

Most policies cover the costs of glasses, contact lenses and hearing aids if your policy includes hearing cover. Some conditions apply; you can only claim replacement glasses or contact lenses if your prescription has changed since your last visit.

However, they often won't pay for dentures if your dentist prescribes those.

What exclusions apply to medical insurance?

All healthcare cover has exclusions that the policy doesn't cover. Some are standard exclusions that an insurer applies to every customer, while others depend on your medical history.

Policy exclusions

Health cover is designed to provide treatment for acute conditions. Typically, this means that insurance doesn't cover anything seen as a lifestyle choice rather than a medical necessity. Health cover won't pay for cosmetic procedures like tooth straightening, whitening, or veneers. Laser eye surgery is also sometimes excluded from optical cover.

Pre-existing and chronic conditions

All medical insurance excludes pre-existing conditions that you sought care or advice for in the five years before taking out your policy. Some insurers make exceptions regarding eye tests and dental check-ups but won't cover you if you need outpatient or hospital treatment for a pre-existing condition.

Chronic conditions can't be cured but can be managed long-term and aren't covered by insurance. If you have longstanding or pre-existing glaucoma, cataracts or macular degeneration, it'll be excluded from cover.

What do cash plans cover?

A cash plan pays cashback to reimburse you for your regular healthcare expenses. You pay a monthly premium and your check-up, tests and treatment costs upfront before claiming back the cost from your plan provider. Some plans also offer a fixed payment if you receive NHS care.

A cash plan typically covers eye tests, dental checks, and follow-up treatments, including glasses, contact lenses and dentures. Some go further and include laser eye surgery and even prescription goggles and gum shields for use in sports. Most plans also include emergency dental treatment.

Each plan provider offers different services, so always check the policy documents to ensure the cover meets your needs.

Read our reviews of the best healthcare cash plans in 2024 here.

Are there any exclusions?

One of the benefits of a cash plan is that there are often no exclusions for pre-existing conditions. Some eye conditions qualify you for free eye tests in any event. However, most plans have qualifying periods, meaning you can't take out a plan and immediately claim for care in some categories. Qualifying periods vary, and some are based on your medical history. Sovereign Health's plan applies a 12-month qualifying period on their optical benefit if you've had eye surgery.

Do cashback plans offer different levels of cover?

Most plans provide different cover levels to tailor your plan to your budget. The level of plan you choose gives you higher financial limits within each year. For example, if your dentist charges £238 for two routine checks and two hygienist appointments yearly, but your plan only pays £100 per year, you won't be able to claim the total cost.

Cover levels vary between three and five options, depending on your chosen provider. Some companies offer additional services, such as access to private GP appointments, telephone helplines and member reward schemes.

Can I add a cash plan to my health insurance?

Some providers only offer optical and dental cover via a cash plan when you take out medical insurance. While a standalone plan gives you a choice of coverage level, a plan added to your insurance often doesn't. Instead, your plan will include a single yearly limit within each category. They may also cover 100% of your total costs in some categories but only 80% in others. Coverage levels can also depend on the provider you choose. Vitality's plan pays 100% of your optical expenses up to £500 per year if you go to their partner, Vision Express. If you choose another optician, that drops to 80% with a £300 limit. Great news if you're happy to go to Vision Express, but less so if you'd rather stick with your local provider.

Get professional advice

We hope this guide has been helpful. myTribe guides aim to help you understand your health insurance and private healthcare options so you can make an informed choice. However, speaking to a specialist broker is the best way to decide what health insurance will work for you. Contact us for a comparison quote, and we'll introduce you to a regulated broker for tailored advice.

Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.

This article was written by:
Chris Steele
Founder and Editor

Chris is our resident private health insurance and healthcare expert. He has over a decade of experience writing about private medical insurance and treatment. He's Chartered Insurance Institute qualified and is regularly quoted by the national press.

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