TL;DR
As an FCA-authorised expert that has helped arrange over 900,000 policies, WeCovr understands that navigating the private medical insurance market in the UK can feel complex. This guide simplifies the process, giving you the confidence to choose the right private health cover for you and your family in 2026. WeCovr's checklist of key questions every buyer should ask Choosing private medical insurance (PMI) is a significant decision.
Key takeaways
- Diabetes
- Asthma
- High blood pressure
- Crohn's disease
- Most types of arthritis
As an FCA-authorised expert that has helped arrange over 900,000 policies, WeCovr understands that navigating the private medical insurance market in the UK can feel complex. This guide simplifies the process, giving you the confidence to choose the right private health cover for you and your family in 2026.
WeCovr's checklist of key questions every buyer should ask
Choosing private medical insurance (PMI) is a significant decision. With NHS waiting lists remaining a key concern for many, having a private healthcare plan offers peace of mind and faster access to treatment. But not all policies are created equal.
To help you make an informed choice, our experts have compiled the 10 most important questions you need to ask before you buy.
1. What does private health insurance actually cover?
This is the most fundamental question. At its core, private medical insurance in the UK is designed to cover the costs of diagnosis and treatment for acute conditions.
What is an acute condition? 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 cataracts, joint problems needing replacement, hernias, or appendicitis.
The Golden Rule of PMI: Acute vs. Chronic It is crucial to understand that standard UK private health cover is not designed for chronic conditions. A chronic condition is one that is long-lasting and often has no known cure. It can be managed with medication and monitoring but continues indefinitely.
Examples of chronic conditions typically excluded from cover include:
- Diabetes
- Asthma
- High blood pressure
- Crohn's disease
- Most types of arthritis
PMI is your safety net for new, unexpected health issues, not for the ongoing management of long-term illnesses.
What's included in a typical core policy? Most entry-level policies focus on providing cover for in-patient and day-patient treatment.
- In-patient treatment: When you are admitted to a hospital and stay overnight.
- Day-patient treatment: When you are admitted to a hospital for a procedure but do not stay overnight.
Core cover usually includes:
- Hospital accommodation fees
- Surgeons' and anaesthetists' fees
- Specialist consultations while you are in hospital
- Diagnostic tests and scans (like MRI or CT scans) during your hospital stay
- Cancer cover (this is often comprehensive, but check the specifics)
2. How does the underwriting process work?
Underwriting is how an insurer assesses your medical history to decide what they will and won't cover. This is where the term "pre-existing condition" becomes very important. A pre-existing condition is any illness or injury you've had symptoms of, received advice for, or had treatment for before your policy starts.
Crucially, standard private medical insurance does not cover pre-existing conditions.
There are two main types of underwriting in the UK:
| Underwriting Type | How it Works | Pros | Cons |
|---|---|---|---|
| Moratorium (Mori) | The most common type. You don't declare your full medical history upfront. Instead, the insurer automatically excludes any condition you've had in the 5 years before your policy starts. | Quicker and simpler to set up. No lengthy medical questionnaires. | There can be uncertainty at the point of claim, as the insurer will investigate your history then. Delays are possible. |
| Full Medical Underwriting (FMU) | You complete a detailed health questionnaire, declaring your full medical history. The insurer then tells you exactly what is excluded from day one. | Provides complete certainty about what is covered and what isn't right from the start. Claims can be faster. | The application process is longer. Exclusions are often permanent and cannot be reviewed. |
Moratorium Underwriting in More Detail With a moratorium, if you go for a continuous two-year period after your policy starts without needing any treatment, advice, or medication for a previously excluded condition, the insurer may agree to cover it in the future. This is often called a "rolling moratorium."
Choosing the right underwriting is vital. An expert PMI broker can help you understand which option is best for your personal circumstances.
3. What isn't covered by a standard policy? (The Exclusions)
Understanding what your policy doesn't cover is just as important as knowing what it does. While exclusions vary between providers, some are almost universal across the UK private health cover market.
Common Exclusions in UK PMI:
- Pre-existing Conditions: As mentioned, any condition you had before the policy began.
- Chronic Conditions: Long-term illnesses that require ongoing management rather than a curative fix.
- Accidents & Emergencies (A&E): The NHS provides an excellent emergency service. If you have a heart attack, stroke, or are in a serious accident, you should call 999 and go to your nearest NHS A&E. PMI is for non-emergency elective treatment.
- Routine Pregnancy & Childbirth: Standard maternity care is not covered, though some comprehensive policies may offer cover for complications.
- Cosmetic Surgery: Procedures done purely for aesthetic reasons are excluded. However, reconstructive surgery after an accident or illness (like breast reconstruction after a mastectomy) is often covered.
- Mental Health (on basic plans): While many comprehensive plans now offer excellent mental health support, it's often an add-on or excluded from budget policies.
- Dental, Optical, and Hearing Care: These are usually optional extras.
- Experimental or Unproven Treatments: Insurers will only cover treatments that are evidence-based and widely recognised.
Always read the "key facts" and "policy wording" documents carefully to understand the full list of exclusions. A good broker will highlight these for you.
4. How much will my policy cost and what affects the price?
The cost of private medical insurance, known as your premium, can vary significantly. Several factors influence the price you pay.
Key Factors Affecting Your PMI Premium:
- Age: This is the single biggest factor. Premiums increase as you get older because the statistical likelihood of needing treatment rises.
- Location: Healthcare costs are higher in certain areas, particularly central London. Living in a more expensive postcode will increase your premium.
- Level of Cover: A basic in-patient-only plan will be far cheaper than a comprehensive policy with full out-patient cover, therapy options, and dental benefits.
- Excess (illustrative): This is the amount you agree to pay towards any claim. A higher excess (£500 or £1,000) will lower your monthly premium. A lower excess (£100 or £0) will increase it.
- Hospital List: Insurers offer different tiers of hospitals. A plan that gives you access to every private hospital in the UK, including top London clinics, will cost more than one with a more restricted local network.
- Underwriting Type: Sometimes, full medical underwriting can result in a slightly different premium compared to a moratorium policy, depending on your health history.
- Lifestyle: Some insurers may ask about your smoking status. Smokers often pay higher premiums.
To get an accurate idea of your potential costs, it's best to get a personalised quote. WeCovr can compare the market for you in minutes, finding a policy that balances your budget with your healthcare needs, at no extra cost to you.
5. Can I choose my own hospital and specialist?
Flexibility and choice are two of the main reasons people buy private health cover. The ability to choose where and by whom you are treated is a major benefit over the 'take what you are given' nature of public healthcare.
Understanding Hospital Lists Insurers group private hospitals into "lists" or "networks." Your choice of hospital list directly impacts your premium.
- Standard List: Includes a broad range of private hospitals across the UK, but may exclude the most expensive ones in central London.
- Extended/Premium List: Includes almost all private hospitals in the UK, offering maximum choice. This is the most expensive option.
- Local/Reduced List: A more budget-friendly option that restricts you to a specific list of hospitals, often within your local area.
Choosing Your Specialist Most policies allow you to be treated by any specialist or consultant, provided they are recognised by the insurer and practice within your chosen hospital network. Some policies may offer a "guided" or "expert select" option, where the insurer recommends a specialist for you. This can sometimes reduce your premium, but it limits your choice.
When considering a policy, think about what's important to you. Do you want the freedom to choose any hospital in the country, or are you happy with a good local option to keep costs down?
6. What are the different levels of cover available?
Private medical insurance isn't a one-size-fits-all product. You can tailor your policy by mixing and matching different levels of cover to suit your needs and budget.
The Main Building Blocks of a PMI Policy:
| Level of Cover | What it Typically Includes | Ideal For |
|---|---|---|
| In-patient Only | The most basic level. Covers you only when you are admitted to a hospital bed for treatment (day-patient or in-patient). Diagnostic tests and consultations are only covered once you are admitted. | Those on a tight budget who want a safety net for major surgery and serious, acute illnesses. |
| Comprehensive Cover | Includes everything in the in-patient plan, plus full out-patient cover. This means consultations, diagnostic tests, and scans before you are admitted to hospital are also paid for. | People who want complete peace of mind and the fastest possible diagnostic journey from start to finish. |
| Out-patient Limits | A middle ground. You get out-patient cover, but it's capped at a certain amount per year (e.g., £500, £1,000, or £1,500). This helps keep premiums lower than a fully comprehensive plan. | A good compromise for balancing cost and cover. Popular with many buyers. |
Popular Optional Add-ons: You can further customise your policy with extras like:
- Mental Health Cover: Access to psychiatrists, psychologists, and therapy sessions.
- Therapies Cover: Pays for physiotherapy, osteopathy, chiropractic treatment, and more.
- Dental & Optical Cover: Contributes towards routine check-ups, treatments, glasses, and contact lenses.
7. What is an excess and how does it work?
An excess is a fixed amount of money you agree to pay towards the cost of your treatment each time you make a claim. The insurer pays the rest.
For example, if your policy has a £250 excess and you have a procedure that costs £4,000, you would pay the first £250, and your insurer would cover the remaining £3,750.
How Excess Affects Your Premium Choosing a higher excess is one of the most effective ways to reduce your monthly premium.
- Illustrative estimate: A £0 excess means the insurer pays for everything. This results in the highest premium.
- Illustrative estimate: A £1,000 excess means you contribute more towards a claim. This results in the lowest premium.
Most insurers offer a range of excess options, typically from £0 up to £1,000 or more. You can also choose whether the excess is payable per claim or per policy year. An annual excess means you only pay it once per year, no matter how many claims you make.
When selecting an excess, choose an amount you would be comfortable paying if you needed to make a claim tomorrow.
8. Are there any extra benefits or rewards?
The UK private medical insurance market is highly competitive. To stand out, many of the best PMI providers now include a wealth of extra benefits designed to help you stay healthy, not just treat you when you're ill.
Focus on Wellness and Prevention Modern PMI is about proactive health management. Look out for benefits like:
- Digital GP Services: 24/7 access to a GP via phone or video call, often with the ability to get prescriptions delivered to your door.
- Wellness Programmes: Many insurers offer discounts on gym memberships, fitness trackers, and healthy food. Some even reward you for being active with cinema tickets or free coffee.
- Mental Health Support: Access to telephone helplines, counselling sessions, and apps for mindfulness and stress management.
- Second Opinion Services: The ability to get a world-leading expert to review your diagnosis and treatment plan.
At WeCovr, we go a step further. All our private medical and life insurance clients receive complimentary access to CalorieHero, our exclusive AI-powered calorie and nutrition tracking app. We believe in empowering our clients to live healthier lives, and tools like this can make a real difference.
Furthermore, when you purchase a PMI policy through WeCovr, you can often benefit from discounts on other types of insurance, such as life or income protection cover, helping you protect your family's financial future more affordably.
9. How do I make a claim?
Knowing you'll have a smooth and simple claims process is essential for your peace of mind. While the exact steps can vary slightly between insurers, the general process is straightforward.
A Typical PMI Claims Journey:
- Visit Your NHS GP: Your journey almost always starts with your GP. You discuss your symptoms with them as you normally would.
- Get an Open Referral: If your GP believes you need to see a specialist, they will write you an "open referral" letter. This letter describes your condition but doesn't name a specific specialist.
- Contact Your Insurer: You call your insurer's claims line and provide them with the details from your GP's referral.
- Get Authorisation: The insurer checks that your condition is covered by your policy. If it is, they will provide you with a pre-authorisation number. They will also help you find a recognised specialist and hospital from your chosen network.
- Book Your Appointment: You can now book your consultation or treatment. You give the hospital your policy number and pre-authorisation code.
- Bills are Settled Directly: The best part. The hospital and specialist will send their bills directly to your insurer. Apart from your excess (if you have one), you don't have to worry about payments.
The key is to always get pre-authorisation from your insurer before you book any treatment. If you don't, they may refuse to cover the costs.
10. Why should I use a broker like WeCovr instead of going direct?
You can buy private health cover directly from an insurer, but using an independent, FCA-authorised broker like WeCovr offers several distinct advantages, especially in a complex market.
The Benefits of Using an Expert Broker:
- Whole-of-Market Advice: An insurer can only sell you its own products. A broker can compare policies and prices from a wide range of leading UK providers, ensuring you find the best possible deal.
- Expert, Unbiased Guidance: The world of PMI is filled with jargon – moratoriums, hospital lists, out-patient limits. Our specialists speak plain English and take the time to explain your options, helping you build a policy that truly fits your needs.
- No Extra Cost to You: Our service is free. We are paid a commission by the insurer you choose, which does not affect the price you pay. You get expert advice and market comparison without it costing you a penny.
- Assistance with Claims: If you ever run into an issue with a claim, having a broker on your side can be invaluable. We can advocate on your behalf to help resolve disputes.
- Annual Reviews: The best policy for you today might not be the best one next year. We can help you review your cover annually to ensure you're still getting the best value, especially as renewal premiums can increase.
With high customer satisfaction ratings, WeCovr is dedicated to making private medical insurance simple, transparent, and accessible. We do the hard work so you don't have to.
Your Next Step to Peace of Mind
Navigating the world of private medical insurance in 2026 doesn't have to be a challenge. By asking these ten simple questions, you can cut through the noise and focus on what really matters: finding the right protection for your health.
The UK's private healthcare landscape offers incredible choice and speed of access, providing a valuable alternative and supplement to the NHS. Whether you're concerned about waiting times, want more control over your treatment, or simply desire the peace of mind that comes with a comprehensive health plan, PMI is a powerful tool.
Ready to explore your options? Let our friendly experts provide you with a free, no-obligation comparison quote today. We'll help you find the best PMI provider for your needs and budget, giving you clarity and confidence in your choice.
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Will my premium go up every year?
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.












