As an FCA-authorised broker that has helped arrange over 750,000 policies, WeCovr understands that choosing private medical insurance in the UK can feel complex. This guide simplifies the process, providing you with the essential questions to ensure you find the right cover for your needs and budget.
Navigating the world of private medical insurance (PMI) requires a bit of homework. To make an informed decision, you need to look beyond the monthly premium and understand the intricacies of the policy. Think of it as investing in your future health and peace of mind. Getting it right means having a safety net you can rely on when you need it most.
This comprehensive checklist is designed to empower you. We'll walk through the ten most important questions, demystifying the jargon and highlighting the details that truly matter.
This is the most fundamental question. At its heart, private medical insurance in the UK is designed to cover the cost of treatment for acute conditions that arise after your policy has started.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Think of conditions like hernias, cataracts, or joint problems requiring replacement.
CRITICAL POINT: Standard UK private medical insurance does not cover chronic or pre-existing conditions.
The core of any PMI policy is built around three types of care:
Type of Care | Description | Real-Life Example |
---|---|---|
In-patient | You are admitted to a hospital and stay overnight for one or more nights for treatment. | Having a planned hip replacement surgery and staying in hospital for several days to recover. |
Day-patient | You are admitted to a hospital or clinic for a planned procedure but do not stay overnight. | Undergoing cataract surgery or an endoscopy and going home the same day. |
Out-patient | You visit a hospital or clinic for a consultation, diagnosis, or treatment but are not admitted. | Seeing a specialist consultant, having diagnostic tests like an MRI scan, or attending a physiotherapy session. |
Most entry-level policies cover in-patient and day-patient care as standard. Comprehensive plans will also include extensive out-patient cover. Understanding this distinction is key to managing your budget and expectations.
Knowing what isn't covered is just as important as knowing what is. Every policy has a list of general exclusions. While these vary slightly between insurers, they almost always include:
Don't let this list put you off. The purpose of PMI is to complement the NHS, not replace it. It gives you control and choice over eligible, acute conditions, helping you bypass long waiting lists. According to NHS England data for 2025, the number of people on waiting lists for consultant-led elective care remains a significant concern, reinforcing the value of having a private alternative.
'Underwriting' is how an insurer assesses your medical history to decide the terms of your policy. In the UK, there are two main types.
With FMU, you complete a detailed health questionnaire when you apply. You must declare your full medical history. The insurer then assesses this information and will state clearly from the outset which conditions, if any, will be excluded from your cover.
This is the most common and simpler option. You don't need to provide your full medical history upfront. Instead, the insurer automatically excludes any condition for which you've had symptoms, medication, or advice in the 5 years before your policy started.
However, if you then go for a set period without any treatment, advice, or symptoms for that condition (usually 2 continuous years after your policy starts), the insurer may add it to your cover.
Here’s a simple comparison:
Feature | Full Medical Underwriting (FMU) | Moratorium (Mori) Underwriting |
---|---|---|
Application | Long health questionnaire required. | No initial medical questions. |
Exclusions | Clearly defined in your policy documents from the start. | General exclusions for conditions from the last 5 years. |
Clarity | High. You know what's covered immediately. | Lower. The claims process can be slower as history is checked then. |
Best For | People who want absolute clarity and have a complex medical history. | People in good health who want a quick and simple start. |
A specialist PMI broker like WeCovr can explain these options in detail and help you decide which is the right fit for your circumstances.
An 'excess' is the amount you agree to pay towards the cost of a claim. For example, if your policy has a £250 excess and your eligible treatment costs £3,000, you pay the first £250 and the insurer pays the remaining £2,750.
The excess is usually payable once per policy year, per person. You can choose your excess level, and this has a direct impact on your monthly premium.
The rule is simple: a higher excess leads to a lower premium.
Excess Level | Example Monthly Premium* | How it Works |
---|---|---|
£0 | £85 | You pay nothing towards your claim; premiums are highest. |
£250 | £70 | A popular, balanced option. |
£500 | £60 | A good way to reduce premiums if you can afford the initial outlay. |
£1,000 | £45 | Offers the lowest premiums but requires a significant contribution at claim time. |
*Premiums are illustrative for a 40-year-old non-smoker and will vary based on many factors.
Choosing the right excess is about balancing affordability with risk. Consider how much you could comfortably pay if you needed to make a claim tomorrow.
Insurers don't provide access to every private hospital in the country on every policy. They group hospitals into lists or tiers, and your choice of list affects your premium.
When getting a quote, think about where you would want to be treated. Do you need access to a specific specialist hospital, or are you happy with the options in your local area? WeCovr’s advisors can help you compare policies based on which hospitals are most important to you, ensuring you don’t pay for access you don’t need.
While the best private health cover provides generous benefits, almost all policies have limits. These can be:
It’s crucial to check the small print for limits on:
Policy Tier | Out-patient Cover Limit | Complementary Therapies Limit | Mental Health Cover |
---|---|---|---|
Entry-Level | £0 or up to £500 | Often not included | Usually an add-on |
Mid-Range | £1,000 - £1,500 | Up to £500 | Often included with limits |
Comprehensive | Fully Covered | Fully Covered | More extensive cover included |
These limits are a key way insurers differentiate their products. A cheaper policy might look appealing, but if its out-patient limit is too low, you could end up paying for consultations and scans yourself.
The UK private medical insurance market is highly competitive, so providers often include valuable extra benefits to stand out. These can significantly enhance the value of your policy. Look out for:
When you buy a policy through WeCovr, you also get complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to support your health goals. Furthermore, customers who purchase PMI or life insurance with us are often eligible for discounts on other types of cover, providing even greater value.
Your initial premium is not fixed for life. It's important to understand why your payments will likely increase each year at renewal. There are three main drivers:
It’s also worth noting that all premiums are subject to Insurance Premium Tax (IPT), a government tax currently set at 12%. Any changes to IPT will affect your premium.
A policy is only as good as its claims service. You want a process that is simple, quick, and stress-free. The typical claims journey looks like this:
A smooth claims process is a hallmark of the best PMI providers. High customer satisfaction ratings on independent review websites are a good indicator of a company that looks after its members.
While you can buy private medical insurance direct from an insurer, using an independent, FCA-authorised broker like WeCovr offers several significant advantages, at no extra cost to you.
Feature | Using a Broker (like WeCovr) | Going Direct to an Insurer |
---|---|---|
Choice | Compare policies from a wide range of leading UK insurers. | Limited to the products offered by that one company. |
Advice | Expert, impartial guidance to find the policy that best suits your specific needs and budget. | Advice is biased towards their own products. |
Price | Brokers can find the most competitive prices across the market. | You may not get the best value available. |
Simplicity | We do the hard work of comparing features, limits, and hospital lists for you. | You have to do all the research and comparison yourself. |
Support | Ongoing support, including help at renewal or if you have issues with a claim. | Support is limited to that insurer's customer service team. |
Cost | The service is free. Brokers are paid a commission by the insurer you choose. | The price is the same, but without the expert guidance. |
Using a broker ensures you get a holistic view of the market. We can explain the subtle but crucial differences between policies that you might otherwise miss, helping you avoid costly mistakes and securing a private health cover plan that truly protects you.
Answering these ten questions will put you in a strong position to choose the right private medical insurance. The next step is to see what's available.
Contact WeCovr today for a free, no-obligation quote. Our expert advisors will compare leading UK providers for you, answer all your questions, and help you find the perfect policy for your peace of mind.