Health insurance

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What is health insurance?

Health insurance helps cover the cost of private treatment for pre-agreed conditions.

You'll sometimes hear it called private medical insurance (PMI), but in most cases the product is the same – although exactly what's covered will vary from policy to policy.

You’ll pay a monthly or annual premium and when you need to access private medical care, your insurance policy will cover some or all of these costs.

Double check you don’t already have health insurance through your employer before taking out your own cover. Some companies offer private healthcare as part of a benefits package. It tends to be for the employee only, but sometimes it extends to your family too.

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Health insurance could help you get treatment sooner.

The waiting list for hospital treatment rose to a record of nearly 7.5 million people in May 2023. The 18-week treatment target has not been met since 2016, according to The NHS.

The average waiting list time was 13.6 weeks according to The NHS.

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What types of health insurance policies are available?

To make sure you choose the right type of health insurance, first work out who you want it to cover:

Individual only cover

This is a policy that covers you for private medical care. Your partner and family won’t be covered by your policy.

Family health insurance

Family health insurance can cover your whole household for one monthly premium.

You'll all be able to get faster access to a wider range of treatments than you might be offered on the NHS.

Joint cover

A joint policy covers you and your partner.

Again, some employers offer joint health insurance as part of your work benefits so it’s worth checking with them first.

International health insurance

International health insurance covers the cost of treatment for you and your family while you’re living abroad.

It’s different to travel insurance, which will only cover healthcare costs during shorter trips.

What’s covered by health insurance?

It depends on the level of cover you have. 

Basic health insurance policies will cover:

  • In-patient treatments, like routine health checks, tests and surgery
  • Overnight stays

Mid-level policies usually include the above, plus:

  • Out-patient treatment (medical care that can be done without an overnight stay in hospital)

Comprehensive policies include all of the above, as well as:

  • Mental health care
  • Physiotherapy
  • At-home care

What’s not covered by health insurance

Health insurance policies don’t generally cover:

  • Chronic conditions
  • GP services
  • Accident and emergency admissions
  • Pre-existing conditions
  • Drug abuse
  • Self-inflicted injuries
  • Infertility
  • Cosmetic surgery
  • Preventative treatment
  • Mobility aids

How does private health insurance work?

You might think you don't need private health insurance if you’re entitled to treatment on the NHS. But PMI works alongside your NHS treatment, giving you faster access to a greater range of treatments.

You’ll pay monthly or yearly premiums and choose your excess at the outset. The excess is the amount you agree to pay towards your treatment cost.

For example, if your excess is £100 and you have a treatment costing £500, your insurance will cover £400 and you’ll pay the £100 excess yourself.

How to access private treatment

If you get ill, you’ll need to make an appointment with your GP first.

Tell your GP that you have private medical insurance. They’ll be able to refer you for any private treatment that’s available under your policy.

How much will a private medical insurance policy cost?

This depends on your personal circumstances and the level of cover you need.

Your personal circumstances include things like your age, whether you smoke or vape, where you live and your medical history.

Whether you choose a basic, medium or comprehensive policy, your voluntary excess and how many nominated hospitals you choose will all affect the price too. 

You might be able to bring your premium down by choosing a six-week wait option on your policy. This means that if the NHS waiting list is less than six weeks for the treatment you need, you’ll have it done on the NHS instead.

Cost of private treatments

Treatment Cost
Wisdom tooth removal £2,450
Hip replacement £13,402
Knee replacement £14,449
Gall bladder removal £6,620
Cataract surgery £2,775
Slipped disc removal £8,555
Laparoscopic hernia repair £3,530
Colonoscopy £2,200
Gastroscopy £1,880
Carpal tunnel release £2,088
Tonsillectomy £3,084
Knee arthroscopy £4,220
Abdominal hysterectomy £8,014
Shoulder replacement £13,050

According to MyTribe Insurance in August 2023

How to get a health insurance quote and how to claim

Getting a health insurance quote online couldn’t be simpler – fill in some details, compare your policy options and pick which one is right for you.

Claiming can be pretty straightforward too. It starts with a GP appointment to get a diagnosis and referral. Then your insurer can check it covers that condition and help you book a consultation where you’ll come up with your treatment plan.

Your insurer will be in touch if there’s any excess to pay.

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According to the Office for National Statistics, the amount spent on healthcare was equal to £3,227 per person in 2018.

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Benefits of private health insurance

Private health insurance has its advantages:

  • You can access treatment and diagnostic scans quickly
  • Extra support with your recovery – things like extended physiotherapy, which you might not be offered through the NHS
  • Access to a wider range of treatments and drugs
  • The freedom to choose – your hospital, consultant and facilities
  • Simple referrals to specialists if you need a second opinion

Potential disadvantages of private health

But it isn’t a cure-all:

  • It can be expensive and the cost increases as you get older
  • Chronic or incurable conditions are rarely covered, and neither are injuries from some high-risk activities
  • Pre-existing medical conditions are rarely covered. If you want cover for one, it’ll cost a lot more
  • There’s no guarantee you’ll get access to a particular treatment or drug, or that unconventional treatments will be covered by your policy

How can I cut the cost of health insurance?

There are a few steps you can take to bring costs down:

  1. Give up smoking

    Non-smokers usually get a cheaper deal. There are NHS support services that can help you quit

  2. See what your job package offers

    Your company may offer free healthcare – check before you buy a policy

  3. Increase the excess

    But only if you’d be able to afford to pay that amount upfront

  4. Pay annually

    A lump sum generally works out cheaper than monthly premiums

  5. Live a healthy lifestyle

    Certain insurers will give you a cheaper deal if you stay fit

  6. Exclude anything you don’t need

    Are there any treatments you feel you could cut from your policy?

  7. Shop around

    Compare your options to make sure you’re getting a great deal

Frequently asked questions

The NHS is responsible for Covid-19 diagnosis and treatment so the pandemic can be closely monitored. This means it’s unlikely coronavirus testing or treatment would be covered by private healthcare. 

But some policies do pay out if you’re diagnosed with and/or treated for Covid-19 via the NHS, as long as you have NHS cash benefit included in your policy. 

Some will also include treatment for mental health conditions related to coronavirus, if you have mental health cover. It’s best to check your policy or contact the insurer to find out exactly what’s covered. 

It’s up to you. Health insurance gives you access to treatment quickly at private hospitals – skipping waiting lists or accessing drugs that aren’t available through the NHS.

Depending on how extensive the cover is, whether you’re trying to get cover for a pre-existing medical condition, or whether you want to add your family, private medical cover can get expensive.

If you’re considering going private for particular reasons, check policy documents when you’re comparing insurers to make sure you’re covered for what you need.

Dental insurance is one – this can pay out to help you with NHS or private treatment.

You’ll pay an upfront sum and then claim it back through your insurance.

Healthcare cash plans are different to health insurance. They’re payment plans that can include things like optician costs, dental treatment and physiotherapy. 

You pay a monthly amount into the scheme. Then, if you receive medical treatment, you send the receipt to your insurer who will reimburse you.

The benefits of being a private patient will depend on your policy but could include:

  • Shorter waiting lists than the NHS
  • Private rooms, possibly with own en-suite
  • Facilities such as a television
  • Possible access to a wider range of treatments than what is available on the NHS

Have a think about:

  • What conditions you’d like to cover
  • What treatments you’d want on the policy
  • What level of cover you need
  • Your budget
  • How long you’re happy to wait before you make a claim (there may be a qualifying period)

If you’re self-employed, you won’t be able to get tax relief as the insurance isn’t directly related to your business.

Switching insurers is usually a smooth transition. However, you should check with your current provider to make sure you’ll be covered, even while you’re making the move.

If you leave your current insurer before the term of contract is complete, you may be charged.

Read the terms and conditions of your policy carefully before you take the plunge.

Private healthcare could offer your child benefits including:

  • Specialist treatment options that aren’t available through the NHS
  • Private hospitals with private accommodation – that could include you as a parent being allowed to stay in the hospital with your child
  • Shorter waiting times than the NHS waiting list

But private health insurance shouldn't be seen as a replacement for the NHS – your child can still access free NHS treatment.

Eye care cover (sometimes known as optical cover) pays for treatment and medication for certain optical conditions.

Most insurers won’t cover optical care as standard – it usually comes as an optional extra you can add to your policy at an additional cost.

Find the answers in our health insurance guides

Page last reviewed: 12 August 2023

Page reviewed by: Holly Thomas

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