The NimbleFins Guide To Purchasing Private Healthcare Insurance In The UK
Choosing the right health insurance plan for you or your loved ones is certainly not a decision you want to take lightly, and as with most types of insurance one size does not fit all.
The private health insurance market is vast and can be confusing to those navigating it for the first time (and even for those who aren’t!). From understanding medical jargon, cover options and even where to purchase private health insurance in the first place, there is undoubtedly lots to think about.
To help with this we have put together a comprehensive guide to purchasing private health insurance in the UK so you can feel more confident in going away with the knowledge you need to make an informed decision about what insurance policy is right for you. We will dive into what private health insurance is, what is and isn’t typically covered as well as things to look out for when purchasing a policy and the all-important detail of how much this is going to cost you.
- What is Private Health Insurance?
- What does Private Health Insurance cover?
- What should I look out for when purchasing Private Health Insurance?
- How much does Private Health Insurance Cost?
- Where can I purchase Private Health Insurance from?
- Do I really need Private Health Insurance?
- Are there alternatives to Private Health Insurance?
- FAQ's
What is Private Health Insurance?
According to the British Medical Association (BMA) the purpose of Private Health Insurance (PHI) is to help you pay for private medical treatment and care for short-term, curable conditions when you need it most. This type of insurance is designed to work alongside the NHS, which grants free access to a variety of different healthcare services to UK residents.
Whilst many can and do rely on the treatment available from the NHS, this can often be met with longer wait times and you will find some types of treatments and services will require you to pay out of pocket anyway! Hence, PHI is a desirable option that many choose to opt for — it can give you greater control over your healthcare, for example, the flexibility to choose the location of your treatment as well as increasing your access to a choice of specialist services and treatments that are not covered by the NHS.
What does Private Health Insurance cover?
As with any type of insurance the amount and type of cover will differ between providers. That being said, you will find that most PHI policies will cover the following as standard:
- Inpatient Treatment: this applies to any treatment that requires a patient to stay in hospital overnight for at least one night. Most PHI will cover costs for diagnostic tests, consultant fees as well as your stay in hospital and any additional care you need
- Outpatient Treatment: covers the costs of consultations, diagnoses and treatments where overnight stays aren’t required
- Day Patient Treatment: for those requiring more regular consultations, appointments and tests
It is important to note that whilst many PHI providers cover the above, this can vary between policies. In some case, you may find that coverage does not extend to outpatient treatment and care, so be careful here and ensure you read your policy wording carefully to ensure you understand what exactly is and isn't covered.
What is and isn't typically covered by Private Health Insurance?
| What is typically covered? | |
|---|---|
|
Inpatient Treatment | 
|
|
Outpatient Treatment |
|
|
Day Patient Treatment |
|
|
Hospital Accommodation & Nursing Care |
|
|
Emergency Treatment | 
|
|
Pre-existing Medical Conditions |
|
|
Chronic (long-term) Medical Conditions |
|
|
Dental Care |
|
|
Mental Health Conditions |
|
|
Drug and Alcohol Dependency |
|
|
Non-essential Cosmetic Treatments |
|
|
Fertility Treatment or Normal Pregnancy |
|
Remember, the level of cover can vary from policy to policy, so the above is intended to be used as a guide only. We always recommend taking the time to read through your policy wording carefully to ensure you know what events you are covered against. If in doubt, you can always contact your insurer who will be happy to take through your options with you.
What should I look out for when purchasing Private Health Insurance?
As with any type of insurance it is important to do your research so you don't get caught out. Here we've outlined some key 'watch-outs' that we recommend keeping in mind when you're looking to purchase PHI.
Make sure you understand exactly what you are buying
Private health insurance can be a confusing field to navigate, especially to those who are looking to take a policy out for the first time. PHI is no different to other types of insurance in that the level of cover can vary drastically both between and within providers, and you are given the freedom to choose things like what treatments are covered, where the treatments are carried out as well as any contributions you might want to make towards a claim (your excess)!
This may seem like a lot of responsibility, indeed, when it comes to yours and your families health it certainly isn't a decision to take lightly! Though it may not be the most thrilling task, taking the time to sit down and properly read through the terms and conditions of any policy you are looking to purchase can save you alot of money and trouble further down the road.
What type of cover is right for me?
Before purchasing any type of insurance it is important to sit down and think about what type of cover is appropriate to your needs. If you don't, you may find yourself paying out of pocket for an event you thought you were covered for, but weren't, or you may find you are overpaying for coverage that you simply do not need!
Both of these scenarios are far from ideal, so here are a few questions you might want to ask yourself:
- How much are you willing to spend?
- What illness or injuries do you want to be covered against?
- What types of treatment do you want to be included in your cover?
- Are you willing to make a contribution towards the cost of your treatment? (i.e. an excess)
- Would you prefer to choose the hospital that provides your treatment, or are you happy for your insurer to decide this?
Asking yourself these questions can really help you to nail down the specific type and level of cover that is right for your needs. Of course, the more benefits you wish to include in your policy, the higher your premiums will be. Likewise, you'll inevitably come across a range of budget-friendly options that seem appealing but offer very little coverage.
Although we all like to save money where we can, when it comes to your health we really do recommend prioritizing cover over cost — ensuring your cover is tailored to your specific needs and can offer you protection when you need it most is, in our view, worth spending that little bit extra.
Understanding your insurance excess
In a nutshell, this is the amount of money that you, as the policyholder, have agreed to pay towards any claim you make. Remember, your health insurance excess directly affects your premium — the more you are willing to contribute towards settling a claim the lower your premium will be, so if it is financially viable for you it can be an easy way to save some money.
However, it's important to take into consideration how much you can realistically afford to pay out of pocket as you these costs can and do add up!
How and when you pay your insurance excess can vary between providers, but broadly speaking you'll find it will either have to be paid every time you claim or you may just have to pay it once during each policy year.
Be aware of factors that can affect your premium
Your health insurance excess is not the only thing that can affect the cost of your premium, and it's good to be aware of the factors that can increase and decrease the cost of your cover. Aside from the type and level of cover, there are some key types of information that insurers will take into account when calculating a quote. These can include:
- Age
- Location
- Medical history
- Lifestyle (e.g. smoking or consuming alcohol)
Some factors you simply have no control over, for example, as much as I'm sure we would all like to knock a few years off our age this simply isn't possible! However, there are some factors that you can control — making positive changes to your lifestyle such as cutting down alcohol consumption or the amount you smoke will all lead to insurers looking at you more favorably. Put simply, this is because some behaviors and lifestyles are associated with increased risks of certain diseases and therefore an increased likelihood of needing to claim on private health insurance.
Similarly, those with a history of previous illness or who suffer from pre-existing medical conditions are likely to receive higher insurance premiums. Naturally, insurers will see individuals who fall into these categories as inherently more 'risky' and more likely to, again, make a claim.
Don't be caught out by your policy exclusions
As with all types of insurance, private health insurance plans come with a set of exclusions that details what medical conditions and treatments aren't covered by your policy. These can vary between plans and insurance providers so we always recommend reading your policy documentation carefully to avoid getting caught out here. The last thing you need when undergoing treatment is to find out the procedure or condition you thought was covered by your policy is actually excluded!
Whilst the full set of exclusions, terms and conditions of your policy will be available to you prior to signing the dotted line, here are some of the more common exclusions that are good to be aware of:
- Pre-existing conditions
- Emergency treatments
- Cosmetic procedures
- Chronic illnesses
- Drug and alcohol abuse
- Self-inflicted injuries
Read up on your protection and rights
When purchasing private health insurance in the UK there are certain rights that you have as a consumer.
Confidentiality: due to the nature of health insurance, your provider will need to collect sensitive information about you such as details about your medical history. Because of this, any provider must practice confidentiality and let you know who has access to your information, what it may be used for and the circumstances under which this information might be shared. Importantly, you can ask to see any information that an insurer has collected about you.
Complaints: insurers as well as those offering advice on private health insurance must have their own complaints procedure in place, details of which will typically be available to you in your policy documents. Whilst the private health insurance market is highly regulated and authorized by the Financial Conduct Authority, things can and do happen which can make your experience less than satisfactory.
Ensure you read up on the details of your insurers complaints procedure so you can exercise your right to complain should you need to. If you do make a complaint and are unhappy with how this has been handled by your insurer then the Financial Ombudsman Service will typically be able to help you settle this dispute (and their service is free!).
Compensation: in the UK, the Financial Services Compensation Scheme can protect you if a firm is unable to pay your claim. If this does happen (e.g. if your insurer goes out of business), the FSCS can step in to pay compensation.
Cooling-off period: just like any other type of insurance, when purchasing private health insurance you have a right to a 'cooling-off period'. This is the period of time stated in your policy documents during which you can cancel your purchase. Whilst the minimum period offered is typically 14-days, some insurers do offer longer.
Should you wish to cancel your policy during this period you are entitled to a full-refund as long as you have not yet made a claim. Do be aware that some insurers charge administration fees but again these will be detailed in your policy documents.
Take a look at your insurers claims process
The process of making a claim can vary between insurers so it's important to read up on this to avoid unnecessary delays. The details of any claims process will be outlined in your policy documents, so you should be made aware of exactly what information you need to supply as well as who you need to speak to.
Here is a rough guide to a typical claims procedure:
- Your GP must refer you for your treatment
- Register the claim with your insurer — you will usually be asked to provide details such as your membership number, date and type of treatment as well as the total costs of this.
- Your insurer use this information to see if your policy covers this
- If you are covered, your GP will then need to make a referral to a hospital which is approved by your insurer — don't forget to keep you insurer updated along the way!
Of course, the time-frame of make a claim can vary depending on your specific insurers procedure.
Check what discounts are available
It's always good to be on the look out for discounts and deals that insurers may be offering. The good thing about private health insurance is insurers often incentivize consumers by offering perks for staying healthy — you will often find they will charge you less if you can show them you are trying to stay in good health, through doing things like regular exercise, eating a healthy and balanced diet and not smoking.
Aviva, for example, offers their My Health Counts service, an online health questionnaire and programme that users can fill out which firstly let's you understand more about you health but can also help you earn a discount off your renewal premium!
Another tool at your disposal is comparison websites which make it even easier to see what providers and policy types are out there and how much they cost. Here, you can quickly compare prices and levels of coverage so you can make a more informed decision about whether a policy is both affordable for you as well as meeting your healthcare needs.
Here are some of the best comparison sites out there that you may want to take a look at:
We found that both sites include a nice mix of providers including many of the UK's leading insurers such as Bupa, Aviva, AXA, Vitality and The Exeter.
If you are still unsure about what policy is best for you, you can contact a broker for more specialized advice and a more bespoke quotation. Whilst this can take longer than using a comparison site, you will usually find things are explained very clearly and there is also the opportunity for you to ask questions, too. Also, some brokers may even be able to offer you discounted deals!
Keep in mind that brokers can charge a fee for their service, but this should always be disclosed upfront. To find a specialist broker, we recommend using Association of Medical Insurers and Intermediaries (AMII).
How much does Private Health Insurance cost?
It's difficult to say exactly how much taking out private health insurance will cost you — as we have already seen, there are many different factors that can affect the cost of your premium.
Nevertheless, it's important to keep in mind the cost of some of the most popular private medical procedures. Knee or hip replacement surgery, for example, can cost on average between £10,000-£15,000 and chemotherapy can cost upwards of £30,000! So, whilst you may find some private health insurance plans to be a little pricey, it could certainly be a worthwhile investment.
Where can I purchase purchase Private Health Insurance?
According to the Association of British Insurers there are a few different ways you can purchase private health insurance in the UK:
- Direct from the insurer
- Through an independent advisor
- Through an agent (e.g. bank, building society or retail outlet)
- Through an insurance broker
Applying for private health insurance doesn't have to be a complicated process, and can be done over the phone, face-to-face, online and even by post. When making an application you will be asked to provide details about your health and this is an incredibly important step of the process. The information you provide will form the basis of your contract, so any declarations and answers you give must be done accurately and to the best of your knowledge.
Any untruthful information you provide could result in your insurer refusing to pay out for a claim and could even lead to the termination of your policy.
Do I really need to purchase Private Health Insurance?
Taking out private health insurance is most certainly down to personal preference. Many people find they are more than happy with the care and treatment that is available through the NHS, however, some may find having more control and choice over their healthcare to be more desirable. Also, if you are in a position where you are more likely to need to access certain types of treatment then again, having more control over who are where this treatment is carried out might be a priority for you.
Here are some questions that are worth having a think about to help you decide whether opting for private health insurance is right for you:
- Are you happy relying on the NHS for your treatment?
- Do you already have insurance in place as a result of your employee benefits package?
- Are you in a position where you can afford to take out private health insurance?
- Would it be more cost effective to pay for individual treatments as and when you need to?
- Do you simply prefer private healthcare?
- Are you happy to face potentially lengthy wait times for treatment on the NHS?
If, for example, you are in a position where you have some disposable income that could be put towards private health insurance and you would prefer to go without lengthy wait times for treatments then certainly private health insurance could be an option for you. We must stress though that the NHS is a fantastic service and choosing to rely solely on this does not impact your ability to live a long and healthy life.
Are there alternatives to Private Health Insurance in the UK?
Aside from healthcare services provided by the NHS there are a few other alternatives available to you in the UK.
- Healthcare cash plans: unlike private health insurance plans, healthcare cash plans are designed to cover everyday healthcare needs such as going to the dentist or going to the opticians. Whilst they are generally a much cheaper alternative to private health insurance, their cover is unlikely to extend to move serious health conditions and treatments
- Discretionary insurance: some companies offer discretionary insurance, a mid-point between full private health insurance and cash plans. Customers pay a fix amount per month, however, there is no guarantee that your treatment will be funded — each cased is judged individually, and it is up to the insurance provider to decide whether a case qualified for funding
- Critical illness insurance: this type of cover is often sold with life insurance and is designed to support you financially if you are diagnosed with a specific condition listed within your policy. The types of critical illness covered by your policy can vary, but you will generally find things like strokes and heart attacks are included. This one-off, tax free payment can be used to cover the costs of medical treatments, modifications needed to your home (e.g. to make it wheelchair accessible) and even to help pay off your mortgage
- Self-funding: of course, there is the option to simply pay for your medical costs as and when you need to. In some cases this may save you money in the long run if you find you don't have recurring healthcare expenses, however, this can be risky and you could find yourself faced with mounting medical bills. It's also worth thinking carefully and whether you are comfortable going without the security blanket that healthcare insurance plans offer.
The decision of whether to opt for healthcare insurance or to simply go without is not one that should be taken lightly — we always recommend doing your research and speaking with experts to help you make the most informed decision, and one that is right for your individual circumstances.
FAQ's
This will vary depending on your provider, so be sure to ask your insurer about your claims limit before signing on the dotted line.
Again, this will depend on the specific type of policy you take out. There are certain types of schemes that restrict this choice so make sure to conduct thorough research beforehand.
Some insurers do not extend their cover to include medical costs outside of the UK. This is particularly true for companied such as the United States, as insurers are very wary of the higher cost of treatment here — these are important questions to ask before signing your contract!
In terms of accessing medical services in the EU, due to the nature of 'Brexit' this is slightly less straight-forwards than it was previously. We've put together a guide on European Health Insurance Card's and whether they are still valid, which you can check out here.
Importantly, you will not be refused private health insurance cover simply because you have a disability. You may find your insurer will refuse to cover certain types of treatment that is needed because of your disability, however, there are laws in place which require the reasons for this to be both reasonable and fair.
If you are looking to switch insurers there are a few points that are worth considering:
- Compare cover: it may sound obvious, but make sure you compare the benefits, costs and claims limits of any new providers you are thinking of switching to to avoid downgrading!
- Pre-existing conditions: be wary as some insurers will not cover conditions you have recently been diagnosed with or that which which you are currently suffering from, as they can consider these to be 'pre-existing conditions'. This can be the case even if these conditions have been covered by your current insurer.
- Choosing the right time to switch: you'll find it's usually best to consider switching at your renewal date. If you wish to switch at any other time during your contract then double check if you will lose any payments.