
As an FCA-authorised expert that has helped arrange over 800,000 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.
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.
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:
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.
Core cover usually includes:
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.
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:
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.
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:
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.
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.
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?
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:
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.
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.
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:
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.
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:
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.
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:
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.
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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