10 Questions to Ask Before Buying PMI
Navigating the world of private medical insurance (PMI) in the UK can feel overwhelming. At WeCovr, an FCA-authorised broker that has helped arrange over 800,000 policies, we believe that the right information empowers you to make the best choice for your health and finances. This guide provides the essential questions to ask.
WeCovr's essential buyers checklist
Choosing a private health cover plan is a significant decision. To ensure you get a policy that fits your needs and budget, it's vital to ask the right questions. We've compiled the top 10 questions every prospective buyer should ask, based on our extensive experience helping thousands of clients across the UK. Think of this as your personal checklist for a smarter, more confident purchase.
1. What's Actually Covered (and What's Not)?
This is the most fundamental question. A private medical insurance policy isn't a blank cheque for all healthcare. It's designed for specific circumstances, and understanding its limits is crucial to avoid disappointment later.
The Golden Rule: Acute vs. Chronic Conditions
The single most important concept to grasp is that standard UK PMI is designed to cover acute conditions.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include a broken bone, appendicitis, a cataract, or a hernia.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, has no known cure, is likely to recur, or requires palliative care. Examples include diabetes, asthma, arthritis, and high blood pressure.
Crucially, standard private health cover does not pay for the ongoing management of chronic conditions. It also won't cover any pre-existing conditions you had before you took out the policy (more on this in Question 3).
Core Cover vs. Optional Extras
Every policy is built on a foundation of 'core cover', with the option to add extra benefits for a higher premium.
| Coverage Type | What It Typically Includes | Is It Core or Optional? |
|---|---|---|
| In-Patient Care | Covers costs when you are admitted to a hospital bed overnight. This includes surgeon fees, anaesthetist fees, hospital accommodation, and nursing care. | Core |
| Day-Patient Care | Covers procedures where you are admitted to a hospital bed but do not stay overnight, such as an endoscopy or minor surgery. | Core |
| Out-Patient Care | Covers consultations, diagnostic tests (like MRI scans), and therapies that do not require a hospital bed. This is a vital but usually optional extra. | Optional |
| Mental Health | Can range from basic in-patient cover to comprehensive out-patient therapy and psychiatric support. | Optional |
| Therapies | Covers treatments like physiotherapy, osteopathy, and chiropractic care. | Optional |
| Dental & Optical | Covers routine check-ups, emergency dental work, and costs for glasses or contact lenses. | Optional |
Real-Life Example: Imagine you develop sudden, severe knee pain.
- Your GP suspects a torn ligament. The GP visit itself is on the NHS.
- Without out-patient cover: You'd join the NHS waiting list for an MRI scan and a consultation with an orthopaedic specialist.
- With out-patient cover: Your PMI policy would pay for a prompt private MRI scan and specialist visit, often within days.
- If the specialist recommends surgery (an in-patient or day-patient procedure), your core cover would pay for the private operation, bypassing the longer NHS surgical waiting list.
2. How is My Premium Calculated (and How Can I Lower It)?
Your monthly or annual premium isn't a random figure. Insurers use several key factors to calculate the risk and, therefore, the cost. Understanding these factors gives you the power to influence your premium.
| Factor | How It Affects Your Premium | Why? |
|---|---|---|
| Age | Higher Premium as you get older. | The statistical likelihood of needing medical treatment increases with age. |
| Location | Higher Premium in major cities, especially London. | Private hospital and specialist costs are significantly higher in urban centres. |
| Lifestyle | Higher Premium for smokers. | Smoking is linked to a wide range of health conditions, increasing risk. |
| Cover Level | Higher Premium for more comprehensive cover. | Adding out-patient, mental health, or therapy cover increases the potential for claims. |
| Excess | Lower Premium for a higher excess. | You agree to pay more towards any claim, reducing the insurer's liability. |
| Hospital List | Lower Premium for a more restricted list of hospitals. | Using a curated list of network hospitals helps the insurer manage costs. |
Top Tips for Lowering Your Premium
- Increase Your Excess: Choosing a £250 or £500 excess instead of £0 can significantly reduce your premium. Just be sure you can afford to pay this amount if you need to claim.
- Add a 6-Week NHS Wait Option: This is a popular choice. If the NHS can provide the in-patient treatment you need within six weeks, you use the NHS. If the wait is longer, your private cover kicks in. This can lower premiums by up to 25%.
- Choose a 'Guided' Option: Agreeing to use a specialist from the insurer's pre-approved list (see Question 7) rather than choosing any consultant you wish can lead to substantial savings.
- Review Optional Extras: Do you really need full dental and optical cover, or comprehensive therapy options? Tailoring the policy to what you truly value is key.
A knowledgeable PMI broker like WeCovr can model these different scenarios for you, finding the sweet spot between comprehensive protection and an affordable premium.
3. What Type of Underwriting Should I Choose?
Underwriting is how an insurer assesses your medical history to decide what they will and won't cover. This is where the rules on pre-existing conditions are applied. There are two main types in the UK.
Moratorium (Mori) Underwriting
This is the most common type for individuals and families. It's a "wait and see" approach.
- How it works: You don't declare your full medical history upfront. Instead, the insurer automatically excludes any condition you've had symptoms, treatment, or advice for in the five years before your policy started.
- The '2-Year Rule': An excluded condition may become eligible for cover later, but only if you go for a continuous two-year period after your policy starts without experiencing any symptoms, needing treatment, or seeking advice for that condition.
- Pros: Quick and simple application process.
- Cons: Lack of certainty. You might not know if a condition is covered until you make a claim, which can lead to delays and potential disputes while the insurer investigates your history.
Full Medical Underwriting (FMU)
This method is more detailed and provides complete clarity from day one.
- How it works: You complete a detailed health questionnaire, disclosing your full medical history. The insurer then reviews this and tells you explicitly what is and isn't covered from the outset. Any exclusions are listed clearly on your policy documents.
- Pros: Complete transparency. You know exactly where you stand from the start.
- Cons: The application process is longer and more intrusive.
| Feature | Moratorium (Mori) | Full Medical Underwriting (FMU) |
|---|---|---|
| Application Process | Quick and easy, no health forms. | Longer, requires a detailed health questionnaire. |
| Clarity on Cover | Can be ambiguous until a claim is made. | Clear from the start; exclusions are written on the policy. |
| Pre-existing Conditions | Automatically excluded for a set period. | Assessed individually and may be permanently excluded. |
| Claim Process | Can be slower as insurer may need to investigate medical history. | Generally faster as cover has been pre-agreed. |
| Best For... | People with a clean bill of health seeking a quick start. | People with a complex medical history who want certainty. |
4. What is an 'Excess' and How Does it Work?
An excess (sometimes called a deductible) is a pre-agreed amount of money that you contribute towards the cost of a claim. The insurer pays the rest.
Understanding how your excess is applied is vital, as it differs between insurers.
- Per Claim/Per Condition: You pay the excess once for each separate condition you claim for. If you have two unrelated claims in a year, you would pay the excess twice.
- Per Policy Year: You pay the excess on the first claim(s) up to the agreed amount. Once you have paid the total excess amount for that year, all subsequent claims in the same policy year are paid in full by the insurer. This is generally the more favourable option.
Simple Example (Per Policy Year Excess of £250):
- Claim 1: You have a consultation and scan costing £800. You pay the first £250. The insurer pays the remaining £550. You have now met your excess for the year.
- Claim 2 (in the same year): You need physiotherapy costing £400. You pay £0. The insurer pays the full £400.
Choosing a higher excess is one of the most effective ways to lower your premium. However, it's a balance. Set it too high, and you might be deterred from using your policy for smaller claims.
5. Which Hospitals Can I Use?
Your choice of hospital has a direct impact on your premium. Insurers group private hospitals into lists or tiers, often based on cost. London hospitals, for example, are typically the most expensive in the UK.
Common Hospital List Tiers:
- Local/Network List: A curated list of hospitals, often excluding the most expensive city-centre facilities. This is the most budget-friendly option.
- National List: Offers access to a wide range of private hospitals across the UK, providing more choice and flexibility.
- Premium/London List: The most comprehensive list, including top private hospitals in Central London (e.g., The London Clinic, Cromwell Hospital). This option carries the highest premium.
Actionable Tip: Before committing, ask for the hospital list for the policy you're considering. Check that it includes convenient, high-quality hospitals near your home and workplace. There's no point paying for a national list if you're happy with the excellent private hospital just down the road.
6. Does the Policy Cover Mental Health?
With growing awareness of mental health challenges, this has become a critical question for many buyers. According to the NHS, 1 in 4 adults in the UK experience a mental illness. Standard PMI policies often provide limited mental health cover, so it's essential to check the details.
- Basic Cover: Many core policies will only cover mental health if it requires in-patient treatment (i.e., you are admitted to a psychiatric hospital). They may also place a cap on the cost or duration of this treatment.
- Comprehensive Cover (Optional Extra): A mental health add-on can transform your cover. It typically includes:
- Out-patient consultations: Access to psychiatrists and psychologists without being admitted to hospital.
- Therapy sessions: A set number of sessions for talking therapies like Cognitive Behavioural Therapy (CBT).
- Digital support: Access to mental wellness apps, online resources, and virtual therapy sessions.
If mental wellbeing is a priority for you or your family, investing in a policy with a strong out-patient mental health benefit is highly recommended.
7. What are the 'Guided' or 'Expert Select' Options?
These are modern policy features designed to provide excellent value by helping insurers manage costs. They represent a trade-off between choice and price.
- Traditional PMI: You get a GP referral and can choose any specialist recognised by your insurer.
- Guided/Expert Select PMI: You still get a GP referral, but instead of open choice, the insurer provides you with a shortlist of 3-5 specialists they have selected for their record of quality and cost-effective care. You choose from this pre-approved list.
Why consider a guided option? The premium savings can be substantial, often 15-20% lower than a traditional plan. You are still seeing a highly-qualified consultant, but you are giving up the freedom to choose a specific individual yourself. For many, this is a price well worth paying.
At WeCovr, we can explain the nuances of the guided options from leading providers like Aviva, Bupa, and Vitality, helping you decide if it's the right fit for you.
8. What Happens if the NHS Can Treat Me Quickly? (The 6-Week Option)
This is another popular cost-saving feature, sometimes called the 'NHS wait' or 'NHS six-week' option. It works as a safety net.
How it Works: When you need an in-patient or day-patient procedure, if the NHS waiting list for that specific treatment in your local area is less than six weeks, you agree to use the NHS. If the waiting list is longer than six weeks, your private medical insurance policy activates, and you can proceed with private treatment immediately.
Why is this valuable? Given the persistent pressure on NHS services, waiting lists for many routine procedures are often significantly longer than six weeks. For context, the median waiting time for NHS consultant-led elective care in England has frequently exceeded 14 weeks in recent years. By adding this option, you are essentially betting that the wait will be long, allowing you to secure a lower premium while still retaining access to prompt private care when it's most needed.
9. Are There Any Extra Benefits or Wellness Programmes?
The best PMI providers today do more than just pay for treatment when you're ill; they actively encourage you to stay healthy. These 'wellness' benefits can add significant day-to-day value to your policy.
Look out for features like:
- Digital GP: 24/7 access to a GP via phone or video call. This is incredibly convenient for getting quick advice, prescriptions, or referrals.
- Wellness Rewards: Points-based systems that reward healthy behaviour. You can earn discounts on your premium, free coffee, cinema tickets, or even smartwatches for tracking your steps, going to the gym, or completing health checks.
- Health and Wellness Apps: Many policies now include subscriptions to mindfulness, fitness, or nutrition apps.
- Second Medical Opinion Services: If you are diagnosed with a serious illness, this service allows you to have your diagnosis and treatment plan reviewed by a world-leading expert at no extra cost.
WeCovr's Exclusive Client Benefits
We believe in adding value beyond the policy itself. When you arrange your private health cover through WeCovr, you also receive:
- Complimentary access to CalorieHero: Our advanced AI-powered calorie and nutrition tracking app to support your health goals.
- Multi-policy discounts: As a WeCovr client, you can get discounts on other types of cover you might need, such as life insurance or income protection.
A healthy lifestyle is your first line of defence. Aim for a balanced diet rich in whole foods, 7-8 hours of quality sleep per night, and at least 150 minutes of moderate-intensity activity per week, as recommended by the NHS. Your PMI policy is there to support you when things go wrong, but these daily habits are your foundation for long-term wellbeing.
10. Why Should I Use a Broker Like WeCovr Instead of Going Direct?
You can go directly to an insurer, but you would only see their products and hear their perspective. An independent broker works for you, not the insurance company.
Here’s why using an FCA-authorised broker is the smart choice for buying private medical insurance UK:
- Impartial Expert Advice: We are not tied to any single insurer. Our job is to understand your unique needs, budget, and priorities, and then search the market to find the best policy for you. We translate the jargon and explain the small print.
- Market Comparison: We have access to policies and deals from a wide range of leading UK insurers. This ensures you see a fair comparison of what's available, not just a single option.
- No Cost to You: Our service is free for you to use. We are paid a commission by the insurance provider you choose, which is already built into the policy price. This means you don't pay more for our expert guidance.
- Ongoing Support: Our relationship doesn't end once you buy. We are here to help with policy renewals, and can even offer assistance if you run into any issues when making a claim. Our high customer satisfaction ratings reflect our commitment to our clients.
Navigating the complexities of underwriting, hospital lists, and optional extras is what we do every day. Let us do the heavy lifting, saving you time and potentially a lot of money, while ensuring you get the health cover you truly need.
Will my private medical insurance premium increase every year?
Do I need a GP referral to use my private health cover?
Can I get PMI if I have a pre-existing condition like diabetes or asthma?
Ready to Find the Right Cover?
Answering these 10 questions will put you in a strong position to choose the right private medical insurance. The next step is to see what policies are available for your specific circumstances.
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
By tapping the button below, you can book a free call with them in less than 30 seconds right now:
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WeCovr is an insurance specialist for people valuing their peace of mind and a great service.👍 WeCovr will help you get your private medical insurance, life insurance, critical illness insurance and others in no time thanks to our wonderful super-friendly experts ready to assist you every step of the way.
Just a quick and simple form and an easy conversation with one of our experts and your valuable insurance policy is in place for that needed peace of mind!