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 750,000 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.
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.
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 single most important concept to grasp is that standard UK PMI is designed to cover acute conditions.
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).
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 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. |
A knowledgeable PMI broker like WeCovr can model these different scenarios for you, finding the sweet spot between comprehensive protection and an affordable premium.
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.
This is the most common type for individuals and families. It's a "wait and see" approach.
This method is more detailed and provides complete clarity from day one.
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. |
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.
Simple Example (Per Policy Year Excess of £250):
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.
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:
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.
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.
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.
These are modern policy features designed to provide excellent value by helping insurers manage costs. They represent a trade-off between choice and price.
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.
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.
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:
We believe in adding value beyond the policy itself. When you arrange your private health cover through WeCovr, you also receive:
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.
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:
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.
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.
Get your free, no-obligation quote from a WeCovr expert today. We'll compare leading UK providers to find a policy that protects your health and fits your budget.