How does private health insurance work in the UK?

Private health insurance enables access to high-quality medical care with no delay, making it a very popular choice for people from all walks of life. The market is more competitive than ever nowadays, so it’s relatively easy to find the best health insurance policy within most budgets.

To make sure you know what you’re paying for before securing a plan of your own, we’re here to explain exactly how private health insurance works in terms of charges, claims, and more.

What is the purpose of private health insurance?

In the UK, private health insurance is designed to cover the cost of private treatment for acute conditions. These are short-term, curable health issues rather than long-term, chronic illnesses people tend to live with their whole lives. Some benefits of having private medical insurance include:

  • Quick access to health care at the point of need rather than waiting for treatment or a diagnosis on an NHS waiting list, which are currently at the highest levels
  • Control over where and when you are treated and who by
  • Access to a private room rather than being in a busy ward
  • The option to receive specialist drugs and treatment unavailable on the NHS

However, private health insurance can’t be used for everything. It’s up to you what level of cover you want, so you may prefer to choose a more basic option for the sake of a lower price (provided that the policy still adequately meets your needs).

Private health insurers could also put exclusions on your plan. For example, covering pre-existing conditions can be difficult for some companies, though others may allow it in particular circumstances.

What are the types of private health insurance

The type of private health insurance depends on who you want to cover on the policy. The main kinds are:


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You can also get international health insurance if you’re going to be overseas for a prolonged period. In addition, you may like to add extra cover so that you can access private cancer, mental health and physiotherapy services.

How do you pay for private health insurance?

You normally pay a monthly premium, but the cost of your private health insurance depends on many factors, including age, lifestyle, medical history, and the cover you’re requesting. You may also be able to claim cashback known as the NHS cash benefit if you decide to receive healthcare in an NHS hospital rather than a private one.

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Which are the UK's best health insurers?

Click on each of the health insurers to find out more about what cover they do or don’t offer. Each page also has ‘Key Points’ as well as ‘Things to consider’. 

Will I have to pay an excess?

As a general rule, the higher excess you pay, the lower your monthly, quarterly, or annual health insurance policy premiums will be. These companies will usually provide you with and discuss your excess options once you request a quote.

Some of the best insurance providers, such as AXA Health, will also explain in detail the covered health services, cover limits, and more. Make sure you pay attention and ask as many questions as you can.

How do private health insurance claims work?

Your insurer will pay out on your behalf if you need hospital treatment while your policy is active. For them to do this, you will need to make a claim. The general steps you need to take when making claims from your private healthcare insurance provider are as follows:

Check your policy details

It’s important to check your policy to see whether you’re actually entitled to make a claim. There may be limits on how much you can claim per condition, for example, or how much you can claim per type of medical treatment.

If you have added a six-week option to bring down the price of your health insurance policy, you will also be unable to claim on your private health insurance if the NHS can see you within six weeks. Make sure you understand these details to avoid disappointment.

Make your claim

Every provider has its own process, but most will need your GP to refer you to a specialist, and this referral should be in writing. The reason private healthcare insurance providers require this is to ensure that you, the client, will see the right specialist for your condition. You can then contact your insurer via their customer helpline and provide the information you need to start the claims process.

Some companies will refer you to a specialised healthcare provider without involving a GP. In these cases, you will be able to start the claims process online or over the phone. Once done, all you have to do is wait for the approval of your claims.

Receive your treatment

After your insurer agrees to cover the cost of treatment, you can choose one of the approved healthcare providers outlined in the hospital list on your policy and book an appointment immediately. Your insurer will pay them directly, which means you don’t need to claim any money back yourself.

If you are concerned about NHS wait times, explore private health insurance options

How does medical underwriting impact how private health insurance works?

Choosing the right medical underwriting is hugely important, as it can impact the potential exclusions applied to your private medical insurance. In a nutshell, underwriting determines how much of your medical history you’ll disclose to your insurer and how it is used to select exclusions. Hence, we cannot stress enough how crucial it is to get professional advice before you make a decision.

We offer free, expert, independent advice here at Healthcare Clarity. We’ll be totally transparent, but you have no obligation to follow our recommendations.

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Do private health insurance premiums change?

Yes, private health insurance premiums often increase at the point of renewal for a number of reasons, whether due to medical inflation or a change in your circumstances which means you will be more likely to make a claim. Prices may also rise if you’ve recently made a claim or simply because you’ve aged into a higher bracket.

However, you can ensure you aren’t paying over the odds by having your medical insurance policy reviewed before you renew it and potentially by switching providers for a more affordable plan. Get a quote from Healthcare Clarity now to explore the options available to you.