What is Private Medical Insurance?
Private medical insurance is a policy that pays for healthcare in private hospitals or clinics, giving you more flexibility and choice compared to the NHS.
Typical benefits include:
- Reduced waiting times for consultations, scans, and surgery.
- Choice of private hospitals and consultants.
- Access to drugs and treatments not always funded by the NHS.
- Comfort extras such as private rooms and flexible appointment times.
Unlike the NHS, PMI isn’t free. You pay monthly or annual premiums, and in return, the insurer covers part or all of the cost of private medical care (depending on your policy).
How Does PMI Work in the UK?
When you take out a private medical insurance policy, here’s what usually happens:
- Policy purchase – You choose a policy via an insurer or, ideally, through a health insurance broker who can compare the market.
- Paying premiums – You make regular monthly or annual payments to keep your cover active.
- Accessing treatment – When you develop a condition covered by your policy, you:
- Visit your GP (NHS or private).
- Request a referral.
- Contact your insurer to authorise treatment.
- Receiving treatment – You get care at a private hospital, clinic, or via digital health services.
- Claim settlement – The insurer pays the provider directly, though you may cover excess charges.
What’s Covered by Private Medical Insurance?
Most standard PMI policies include:
- In-patient and day-patient treatment.
- Surgery and hospital stays.
- Cancer treatment and therapies.
- Diagnostic tests and scans (if included in your plan).
Optional add-ons may include:
- Out-patient consultations.
- Mental health treatment.
- Physiotherapy and alternative therapies.
- Worldwide cover for treatment abroad.
What’s Not Covered?
Typical exclusions include:
- Pre-existing conditions (anything diagnosed before the policy started).
- Chronic conditions requiring long-term management (e.g. diabetes, asthma).
- Cosmetic surgery.
- Fertility treatment.
- Routine pregnancy care.
It’s essential to read the fine print, as exclusions vary between insurers. A broker can explain this clearly and ensure you’re not caught out.
Who Should Consider Private Medical Insurance?
PMI may benefit:
- Individuals – who want faster access to treatment.
- Families – who want peace of mind for children’s healthcare.
- Self-employed workers – who can’t afford long absences due to NHS waiting lists.
- Businesses – offering group medical insurance as an employee benefit.
Cost of Private Medical Insurance in the UK
The cost depends on:
- Your age.
- Where you live.
- The level of cover.
- Optional extras and hospital lists.
On average, according to MoneyHelper, policies range from £30–£150 per month for individuals. Families and group policies can be higher but often come with volume discounts.
Why Work With a Broker?
Buying direct from an insurer limits your choice. A broker can:
- Compare multiple insurers like Bupa, AXA Health, Aviva, WPA, and Vitality.
- Negotiate better rates.
- Ensure you understand exclusions.
- Provide ongoing support when you claim or renew.
Real-World Example
John, a 42-year-old small business owner in Manchester, needed PMI for himself and his family. Going direct to one insurer, he was quoted £220 a month. A broker reviewed his needs, adjusted his hospital list, and found an alternative policy that covered his family for £165 per month — saving £660 a year.
FAQs About Private Medical Insurance
1. Is PMI worth it if I already have the NHS?
Yes, because PMI provides faster treatment, wider choice, and extra services not always available on the NHS.
2. Can I keep using the NHS as well?
Absolutely. PMI is designed to complement, not replace, NHS care.
3. Do all insurers cover cancer treatment?
Most do, but the level of cancer cover varies. Always check the details.
4. Can businesses get tax relief on PMI?
Employer-paid PMI is a taxable benefit for employees. Check HMRC guidance for details.
Conclusion
Private medical insurance offers faster, more flexible healthcare, but choosing the right policy can be complicated. Understanding what’s covered, what’s excluded, and how costs are calculated is vital. For individuals, families, and businesses, working with a health insurance broker ensures you get a tailored plan that balances cost with cover — giving you peace of mind that you’re fully protected when you need it most.
