How does private medical insurance work in the UK?

In the UK private medical insurance is designed to pick up from the point of a GP of specialist referral for consultations, tests or treatment. 

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What is private medical insurance & what does it cover?

Private medical insurance (PMI), also known as health insurance, is designed to cover you for the cost of private medical treatment for acute conditions. Some benefits of having private medical insurance cover include:

  • Access to faster treatment than on the NHS.
  • Control over when, where and who you are treated by.
  • Giving acces to a private room rather than being on a busy ward.


Acute conditions are categorized of having a rapid onset but can typically be resolved within six months. Examples of acute conditions are a broken bone, heart attack or a stroke.

Chronic conditions have a long-term impact and can rarely be cured. Examples of chronic conditions include Asthma, Diabetes and Parkinson disease.

It is important to note that an acute condition can become a chronic one and vice versa a chronic condition can become an acute one. For more advise on which conditions can be covered get in touch. 

Inpatient treatment refers to treatment where you need a hospital bed overnight. More minor procedures may allow you to be discharged the same day and this is known as day-patient cover. In-patient and day-patient procedures form your core cover, and very rarely can these be altered when taking out a policy.

Outpatient cover on the other hand refers to diagnostic tests, scans, consultations and procedures that do not require a hospital bed. You can choose to remove outpatient cover, but if you are concerned about speed of treatment then this is not recommended, as it can delay treatment.

Moratorium Underwriting – The Moratorium underwriting doesn’t need you to declare your full medical history. Instead it works on the basis that any conditions that have occurred in the 5 years prior to the start of your cover are excluded until you have a 2-year continuous “trouble free”* period after taking out cover.

*be mindful that each insurer has their own version of what they consider a trouble free period to be, to be sure you have the right moratorium for you and your history please get in touch.

Full Medical Underwriting – Full Medical Underwriting will require you to disclose your entire medical history to the insurer. This then allows the insurer to provide you with a list of specific exclusions based on your disclosed pre-existing medical conditions.

If you are looking to switch health insurers, had a minor gap in cover or are moving off a company policy then other underwriting options will be available. Discover more underwriting options >>

Getting an appointment with your GP can be a lengthy process and when you are eventually offered an appointment it may not be very convenient. Depending on the health insurer you will either be given access to a Private GP or can choose to add this as an option. Some insurers offer digital GP access, so you don’t even need to leave home, or the office, to attend your consultation.     

Find out more about how Private GP works with private Medical Insurance >>

The price of a health insurance policy is impacted by a range of factors, some of these will be in your control and others will not. 

  • Age
  • Smoking status
  • Postcode
  • Hospital List 
  • Outpatient Cover
  • Six-week Option 
  • Excess
  • Additional Therapies

Read our full guide on How much does private health insurance cost? >>

We recommend, before setting up a policy, that you get in touch with a specialist health insurance broker who are authorised to provide advice. Most of the big insurers, along with other brokers and comparison websites, sell policies on a non-advised basis. With non-advised sales, as the customer, you are responsible for determining which policy is best for you. This can prove tricky as there are several options that make up a policy and should be tailored to your needs.

  • Step 1 – Decide on why you are considering cover and what areas of cover are most important to you.
  • Step 2 – Decide on why you are considering cover and what areas of cover are most important to you.
  • Step 3 – We will then take some time to understand you and your reasons for looking at cover. Then we will ask some brief medical questions. Why do we need to ask these questions? To ensure you are getting the correct level of cover and your underwriting fits with your needs.
  • Step 4 – We will then obtain quotes from our leading panel of insurers and get back to you with our advice on which is the most suitable policy.
  • Step 5 – If you then wish to go ahead with a policy, we can set this up directly with the insurer on your behalf.
  • Step 1 – Firstly, you will need to visit your GP who will need to refer you to a specialist when medically necessary.
  • Step 2 – Let your GP know you have private medical insurance and if you need to see a specialist, your GP will be able to provide you with a referral letter.
  • Step 3 – Once you have a referral letter you can then contact your insurer. They will likely ask you for your policy number, as well as any details your GP has provided.
  • Step 4 – Your insurer will then be able to approve eligible claims and you will be able to book the necessary treatment, tests or scans as soon as possible with a consultant and hospital of your choice from you hospital list.
  • Step 5 – Following your treatment, the bill will go to your insurer for payment.

Find out more about – How to make a claim? >>