Updated: December 14, 2022
What Private Medical Insurance Can Cover
Wondering what private medical insurance covers? We look at what's typically covered, what may not be, and how to find the right policy for your needs
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Author: Richard Angliss - Finance Expert
Updated: November 20, 2019
The prospect of fast access to top-quality healthcare makes getting private medical insurance, also known as PMI or private health insurance, an attractive option for many people.
PMI will cover your private healthcare costs for a wide range of medical needs in exchange for a monthly premium.
But the advantages of having private UK medical insurance are only worth the cost if your policy is the right match for your specific needs or health concerns. So before taking out PMI, you’ll need to know which health conditions and medical treatments you can get cover for.
In this article, we cover….
What’s covered by private health insurance?
When it comes to health insurance, many providers make a distinction between acute and chronic conditions.
Most PMI policies are designed to cover acute conditions, but there are comprehensive policies which also insure against aspects of chronic or specialist health conditions.
Generally, the more comprehensive your cover, the higher the cost of your private medical insurance.
We work with insurance advisors who can check to see what options for cover are available to you and help you find your best match offer. Get in touch by making an enquiry and we’ll connect you with one of the independent insurance experts we work with.
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Acute conditions covered by private health insurance
Private health insurance policies are most commonly designed to cover you for acute conditions such as curable diseases, injuries, emergencies or short-term illnesses.
Some examples of commonly covered acute conditions include joint pain that’s treatable with joint replacement, broken bones, hernias and cataracts.
What doesn’t private health insurance cover?
Not all medical treatment will be covered by private health insurers. Most UK insurers won’t cover any medical conditions you have at the time of taking out a PMI policy and, as a general rule, chronic illnesses that can’t be cured aren’t covered by insurers.
Each provider will have their own set of rules and policies for the cover they offer, but conditions not typically covered by PMI include…
- Fertility treatment
- Standard pregnancy and childbirth care
- Emergency care
- Pre-existing medical conditions
- Treatment required after exposure to war or terrorism
- HIV / aids
- Self-inflicted injuries
Chronic conditions often not covered
Private medical insurance is usually not designed to cover chronic health conditions. Some examples of chronic conditions you’re unlikely to find cover for include:
- Multiple sclerosis
- Motor neurone disease
- Heart failure
But, what happens if you develop a chronic condition after taking out private health insurance? Will your policy cover your diagnosis?
The good news is that if you’ve taken out PMI and then experience symptoms of a chronic health condition, you’ll be covered for visits to specialists and consultants up to the point of receiving a diagnosis.
If you have concerns over your PMI covering any chronic illness you may develop after purchasing a policy, make an enquiry and we’ll match you with an expert who can help you find the most affordable niche or specialist policies.
Are therapies covered?
Private medical insurance providers cover certain types of therapies, including:
However, some policies may have limits for the number of appointments they cover, so if you’d like your private cover to include therapy for back pain or another longer-term condition, you’ll need to ensure this is negotiated as part of your policy.
If you’d like help in finding and selecting PMI with cover for therapy, get in touch. We work with experienced independent insurance experts who make the process straightforward and have the tools and knowledge to take you directly to the most comprehensive cover at the most competitive price.
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Which services does PMI cover?
Many private medical insurance policies are designed to cover inpatient-only care. They’ll guarantee you have access to the best possible healthcare if you have an unexpected accident, injury, or illness.
Inpatient-only health insurance is the low cost PMI option, but there are plenty of more comprehensive PMI products on offer which could include outpatient care and therapy.
Depending on the insurer, you may be able to tailor your private health care by selecting policy add-ons to include the services you require.
Does it cover dermatology?
Skin conditions are covered by some private health insurers, but you’ll have to search the market and carefully compare policies to ensure the PMI you take out would cover the cost of a dermatologist visit.
Acne, psoriasis, rosacea and mole mapping are examples of things you could request to have included in your PMI.
One of the advantages of top quality health care is that it can often help to quickly diagnose any skin condition and ensure you get a tailored treatment plan for your needs.
Fertility treatment or sexual health
Fertility treatment such as a vasectomy reversal or IVF would usually require a specialist policy to be covered by a private health insurer. The same applies to visits to the gynaecologist, sexual health clinic or endocrinologist and special needs such as HIV care, circumcision or vaccinations.
With the help of an insurance expert, you may be able to find an add-on policy to include some of your more specialist needs.
Contact us to be put through to one of the insurance experts we work with who can do the legwork of researching specialist add-ons for you and advise you on your best match policy.
Are X-rays covered?
As an important part of diagnostic tests X-rays are covered by many private health insurance providers. To guarantee your private medical insurance would cover you for X-rays, carefully check the fine print of an insurance policy, or get help from one of the expert advisors we work with by making an enquiry.
Does private health insurance cover diabetes?
It’s not always easy to find private health insurance for diabetes. This is because diabetics are prone to a higher risk of closely related health issues. However, you may be eligible for some niche or specialist private health insurance policies which cover the illness.
If you have a pre-existing condition and are struggling to find affordable private health insurance, you can get cover which excluded the condition if it is the cause of excessive prices. For the right level of cover at the best possible price, contact us to speak to one of the insurance experts we work with.
They will be happy to answer your questions and help you navigate the fine print of the terms and conditions of any specialist policy.
Can I get private cover for psychiatric treatment?
For many health insurers, psychiatric treatment for conditions such as dementia, depression or ADHD will need to be added to the policy.
However, how much psychiatric treatment you’re entitled to will vary from one provider to the next. To ensure you’re fully covered for any psychiatric treatment you’d like access to, it’s best to speak to an insurance expert who understands the insurance market and policy details.
Private health insurance and surgery cover
Many private health insurance policies will include full cover for surgeries, including:
- Knee and hip replacement
- Lap band surgery
- Jaw surgery
- Heart surgery
Inpatient treatment is often considered part of a core care package. This means your insurer will cover the cost of diagnosis, consultations, surgery, drugs and any associated costs.
Are prescriptions covered?
You can get prescription coverage when you take out private medical insurance. If this is important to you, it’s necessary to carefully check the terms of the policy you are choosing as every provider and product will handle pharmacy prescriptions differently.
Some policies will cover prescriptions if you are an inpatient and others will extend to out-patient prescriptions, those prescriptions you pay for when you’re not being treated in hospital as a private patient.
Every provider will treat these prescriptions differently, both in terms of what sort of prescription they will reimburse you for and the number of prescriptions covered.
To make sure you get the right level of prescription coverage in your policy, make an enquiry and talk to one of the experts we work with.
All the experts we work with are independent financial advisors with access to private medical insurance from every provider in the UK. They will find and compare the products most suited to your needs and help you get the cover you want at the best available price.
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Can I pick and mix specialist health cover policies?
You may be interested in getting private medical insurance for a specific health condition. Maybe your family’s medical history makes you more vulnerable to developing a certain illness, and you’d like to ensure you’d receive optimal healthcare for early diagnosis or treatment.
Some insurers have specialist policies designed specifically for those above a certain age bracket, or with a focus on one illness, such as cancer. With many serious health conditions, getting an early diagnosis can be life-saving, and it’s not uncommon for NHS waiting time for specialist consultation to be over 6 weeks.
How to design specialist PMI policies
Private health insurance can provide you with instant access to quality care and offer a greater selection of treatment options and on-demand specialist expertise than the NHS typically provides. However, if you have very specific health concerns such as lupus, Crohn’s disease, sleep apnea, or rheumatoid arthritis which you’d like to have covered in your insurance, it’s best to consult an insurance expert.
Speak to one of the insurance experts we work with for a full consultation on how to tailor your cover to get the insurance plan that would best suit your situation. Contact us to be put in touch with an insurance advisor who can help you make the best decision for your future private medical care.
Private medical insurance exclusions
Certain health conditions such as heart disease, high blood pressure, diabetes and some cancers are commonly excluded from private health insurance policies.
However, even where conditions are diagnosed as chronic, some insurers may cover initial treatment, how much of the initial medical care and cost you could be covered for will vary from one provider to the next.
In some cases, the insurance limit may be a cost limit, in other policies, the cover may be limited by the number of inpatient days, or number of outpatient consultant visits. If you’d like to ensure your private health care provides you with some initial cover for commonly excluded conditions, speak with an expert advisor.
Speak to a private medical insurance expert
A stitch in time saves nine when it comes to protecting your health. Acute conditions can become chronic if not quickly treated. NHS treatment waiting times can be very long and there are many cases where getting a quick, professional diagnosis for a health concern will save undue stress, worry, time, and money.
When selecting a private health insurance policy, you’ll need to carefully balance the pros and cons of different premium prices with the extent of the cover offered. Speaking to an insurance expert will give you the peace of knowing that your PMI policy is the best match for your needs and you’re not paying any more than necessary.
Call 0808 189 0463 or make an enquiry and we’ll match you with one of the independent insurance experts we work with.
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About the author
Richard Angliss has made a career in financial services which stretches over 40 years.
His early career was spent learning about the various financial products and applying them to prudent advice, working for one of the largest life assurance and investment firms. After that he joined the financial services arm of a very well-known firm providing independent advice to their 8 million customers.
For the last 20 years he has been involved in building software solutions that help Advisers and clients work together to achieve good financial outcomes and helping to set up three independent advisory firms. He also has written many articles for financial services publications and provided commentary for newspaper journalists.
At an early stage in his career he realised the great satisfaction that comes with being able to help people achieve their goals and protect their families. “Regulation of financial services has hugely impacted on ensuring people get appropriate advice. The issue these days is access to that advice and just as importantly regular reviews to make sure that everything stays on track”.
With the growing development of online resources such as Online Money Advisor he sees a great future for people to access advice to make their pension and investment work harder for them. Plus, of course, to ensure they have insurance products in place that will be required when unforeseen events happen.
He knows getting that balance right is crucial to prudent financial planning and the wellbeing of individuals and their families.