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Cheap Private Health Insurance

Private Health Insurance

What it is, how it works and where to buy

Tony Forchione
Tony Forchione | Edited by Gary Caffell
Updated Every six months

The NHS provides comprehensive treatment to anyone, regardless of their ability to pay. Yet if you want to opt for private care, it can be costly, so private health insurance could help. This guide explains how it works, what to watch out for and how to buy a policy.

Who's this guide for? Anyone looking for private medical treatment at a time and place that suits them. Alternatively, if you just want to claim back optical, dental or physio costs, see our Healthcare Cash Plans guide.

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What is private health insurance?

Put simply, private health insurance – or private medical insurance (PMI) – is a policy that covers the cost of private medical care should you become unwell. It works alongside the NHS, and often gives you access to shorter wait times, a choice of location or treatments only offered privately.  

You pay a monthly sum to the insurer, then it pays for certain private treatment you may need during the policy, such as consultations or surgery.

What does and doesn't it cover?

Health insurance is designed to cover you for non-routine tests and treatment for acute conditions (serious but curable and usually short-lived) that start after your policy begins. Therefore many chronic (often incurable, long-term issues such as arthritis or asthma) and pre-existing conditions are excluded as standard.

The exact range of medical treatments covered will vary based on the policy and the price you pay, though here are some examples: 

  • Tests or surgery as an inpatient (where you need to stay in hospital)
  • Hospital accommodation and nursing care
  • Consultations, tests and therapy as an outpatient (no stay required)
  • Medicine or drugs not available on the NHS

Basic plans usually cover essential treatments, whereas comprehensive cover can also include specialist therapies or medicines.

Typical conditions that are covered include musculoskeletal problems (eg, short-term back pain), digestive system conditions (eg, gastroenteritis), cancer, heart and circulatory diseases (eg, coronary heart disease) and eye and ear conditions (eg, an inner ear infection).

If your tests lead to a diagnosis of a chronic condition, the initial tests are usually covered, but the long term treatment isn’t. For example, if you developed symptoms of diabetes and your GP referred you to a specialist to diagnose the issue, your policy should cover this. However if you are then diagnosed with diabetes, any treatment, mediation or check-ups would no longer be covered, and would instead pass to the NHS. 

It's different from a critical illness insurance policy. Private health insurance pays for medical treatment to get you better, whereas critical illness pays out a lump sum to help offset any loss in income. A critical illness could be defined differently by each policy, but could include Alzheimer's or presenile dementia, cardiac arrest, deafness, loss of speech, paralysis of a limb, stroke or brain injury.

Should I get health insurance?

Any policy is optional, so you'll need to weigh up whether the monthly cost is worth it for you. But here are some key points to consider:

  • The NHS may be sufficient for your needs. Even with private health insurance, you'll still utilise the NHS for services such as your GP or A&E. Equally, if you get a serious illness, you won't necessarily receive treatment more quickly by being covered by a health insurance policy than you would under the NHS.

    For less serious cases, the benefit of a policy is usually part of the referral to a specialist for treatment, as you may have a wider choice of times or locations by going private, over sticking with the NHS. So paying for healthcare could be considered a luxury. 
  • Consider self-insuring. You don't need insurance to go private, you could opt to pick up any bill yourself. Rather than paying a monthly premium to an insurer, instead pay that amount into a top savings account. If you need treatment, you can dip into your 'insurance fund'. Plus you'll keep the cash if you don't claim.

    However be aware that this method takes time to build up and the treatment for certain conditions can be very expensive. For example, carpal tunnel release on one wrist is often around £2,000, cataract surgery on one eye around £3,000, but a hip or knee replacement starts around £10,000. So a combination of treatments could potentially run into £100,000s.  
  • Check if you're already covered by your employer. If you or a partner are employed, it's always worth checking if your employer(s) offer individual or family private health insurance. This can sometimes be a no-cost standard benefit (though you may pay tax) or an option you can choose to pay, often via your payslip.

    Firms' bulk-buying power often means they can negotiate big discounts, so find out the cost and cover, then compare it with the cheapest plans that match your needs.

Health insurance need-to-knows

If you think private health insurance is right for you, here are six key need-to-knows to understand before opting for a new policy.

  • 1. You can tailor a policy so you only pay for the extras you need

    Many providers sell cheap, basic plans to which you can add extras such as extra cancer care or outpatient treatment to suit your needs and budget. Decide why you need private medical insurance – to cover every eventuality or more specific medical conditions.

    You can also cut the cost by restricting when you use the policy. Several insurers will lower your premium if you choose what's called a 'six-week option'. This means if the waiting time with the NHS is six weeks or under, you'll be treated with the NHS. If it's more you'll be eligible for private healthcare.

    You can extend your policy to cover your family

    Family policies are available, in addition to an individual child's plan, though these are less common.

    Policies for children are designed to cover short-term conditions, in the same way that adult plans are, although some policies won't protect children for certain conditions or will only cover them for inpatient and outpatient hospital treatment – so always check the policy before you buy.

    Make sure you know what your family's needs are, then make sure the policy matches up. And remember – as most children's treatments are free on the NHS, the amount you can claim for is limited.

    Also be aware that some private hospitals may not be set up to accommodate children, so before you buy, check the insurer's list of hospitals to see if children are allowed, and that they're local.

  • 2. Choosing a higher excess can cut £100s off the cost, but claims could then be costly

    As with most insurances, you usually have to pay an excess, ie, an amount towards the claim. The larger the excess, the cheaper the premium. So consider what you'd be claiming for. Are you getting insurance to cover everything OR are you getting this only in case of a big medical issue such as a hip replacement? If the latter, look at pushing the excess up high to reduce your premium. For example, a 50-year-old's policy that's £858/year with no excess dropped to £619 with a £500/year excess.

    Once you've selected the excess, you'll then usually need to select the frequency of paying the excess – which differs from many other forms of insurance. The options are:

    • Each time you make a claim. This is where you pay an excess for each new claim. So if you have a policy excess of £200 and you have to make two claims, the excess works out at £400.

    • Only on your first claim. If you've a £200 excess on the policy, and needed to make two claims in the insurance year (ie, the 12 months from policy start date), you will only pay the £200 excess on your first claim. However, your premium would likely be more expensive and not every insurer offers this option. Also, if the claim (ie, treatment) continues into the next year, you'll need to pay the excess again.

    • You pay a percentage of the claim, but no excess. Insurer WPA offers 'shared responsibility' on its Premier or Elite plans, which means you'll pay 25% of any claim up to an agreed annual limit, rather than a fixed amount per claim. 

      If you go for this option make sure you have enough money set aside in to pay for any claims you'll need to make.

  • 3. Study any exclusions or restrictions carefully so you know what you're covered for

    In addition to excluding pre-existing or chronic conditions (eg, arthritis or asthma), there will usually be other exclusions or situations where you'll be unable to claim, such as cosmetic treatment, pregnancy, dental, self-inflicted injuries or those suffered doing dangerous pastimes (eg, skydiving). 

    Always check your policy carefully to avoid any nasty surprises if you were to make a claim. 

    Your choice of location and practitioner could still be restricted

    • Your policy will contain a list of hospitals you can attend, but extended choice can be costly. When you buy your policy, you'll typically choose a hospital list which will determine where you can be treated. The broader selection of hospitals you choose, the higher your premium will be. An extensive hospital list may not always be worth it, especially if you have some good hospitals near you – so always check first.

    • Treatment must be approved by the insurer. Insurers will pay in full, or up to the policy limit, for any consultations – but only if the consultant is on their approved list.

      If you do choose to have a consultation with a specialist or other practitioner who is not on an approved list, the insurer may not reimburse you the costs or will only pay up to the limits it would usually pay. This could leave you with a shortfall which the policy does not cover.

  • 4. Take note of the claims process as it varies between policies

    Always check with your insurer, but here's a typical claims process as a rough guide:

    1. Be referred from your GP for the treatment first
    2. Registering the claim with your insurer. You'll need to give details such as membership number, the date of the treatment, details of the procedure and the charge for each service and the total of all charges.
    3. Your insurer will check if you're covered.
    4. Your GP will then need to refer you to a hospital from a chosen list approved by the insurer, and you'll need to update the insurer throughout the process.

    The claims timeframe will likely vary based on the information you provided when you signed up. Here are the two different types explained: 

    • If you have to disclose your full medical history at the start. This is a full underwriting plan, so you clearly know which medical conditions the provider will cover, or exclude. In some cases, the insurer may need to talk to your doctor to get further information, so this could mean it takes longer to get cover. However any future claims shouldn't then require proof, so may be processed quicker.

    • If there's no health questionnaire. This is a moratorium underwriting option which is usually cheaper, quicker and easier at the start, especially if you have a clean bill of health. However, claiming is usually slower as you'll often need to prove you haven't had the condition before if you claim within the first two years (or longer for some conditions).

  • 5. Discounts are available for staying healthy with some insurers, plus check perks

    Some insurers will charge you less if you can prove you can stay in good health with regular exercise and healthy eating. Non-smokers will also benefit from preferential prices.

    With Aviva's My Health Counts, for example, you can save up to 15% on your renewal if you sign up, complete a health questionnaire and then log back in to update your score between 6 and 9 months into your policy.

    While VitalityHealth offers rewards for completing activities each week, which is tracked via a phone or activity tracker. However, always be aware that you might save more by switching provider.

    Check perks on offer

    There are often perks such as discounted gym membership. We've listed some examples below, but never choose a product based on freebies and sweeteners – make sure you get the coverage you need for a price you can afford.  

    • 50% off gym membership and activity tracker discounts with VitalityHealth via its Active Rewards scheme.
    • Discounts on Fitbit, English Heritage Annual Membership or relaxation remedies with Bupa.
    • Discounts on outdoor activities with Axa Health via its Axa ActivePlus.
    running on a treadmill

  • 6. Don't blindly auto-renew each year. Check if you can switch and save (though be careful if you've claimed)

    Health insurance premiums aren't fixed and the price will normally rise over time, usually annually. In addition, as you get older, you're more likely to need treatment and premiums increase to reflect this. So do a comparison each year to check if you can beat your renewal price.

    But be careful as most providers won't accept you if you have pre-existing conditions, so to remain covered for a condition you have, it may be better to stick with your current insurer. If you've had treatment via your policy in the last five to seven years, while your existing insurer will usually cover reoccurrences, a new one may exclude it as a pre-existing condition if it recurs within two to seven years.

    Haggle with your provider

    If the comparison sites (see how to cut costs below) show you're paying over the odds, take that price to your existing provider and see if it'll match it. If not, consider leaving (and politely tell it so, it may help). This MoneySaver told us:

    I'm paying £238/month for couple's private medical insurance with Bupa, but I got a quote from Axa for £146/month for better cover. I'm two months away from renewal with Bupa, and after telling them they're giving me one of those months for free.

    We've heard providers may even switch you to another of their own brands at a much lower cost (do let us know if that happens).

    Switch policy to cut the price

    If you already have a health insurance policy, and you find a cheaper quote elsewhere (make sure the cover is at the same level), all you need to do is set up the new cover to cut your costs. The savings can be huge...

    Was paying £175/mth – got it down to £96/mth by shopping around for the same level of cover.

How to buy private health insurance

With any insurance, the most important factor is ensuring it is fit for purpose and meets your needs. Any like-for-like comparison is tricky for health insurance policies, as there are so many variables. Some policies may include cover as standard, whereas on others it's an optional extra. 

You should always get quotes from various providers as prices can vary. We ran quotes from the biggest players in the market, based on a zero excess (so you'd pay nothing towards a claim), unlimited outpatient care and full cancer treatment coverage to show how much costs can differ:

  • A healthy, non-smoking 35-year-old. Prices ranged from £688/yr to £935/yr

  • A healthy, non-smoking 70-year-old. Prices ranged from £2,238/yr to £2,834/yr

If you can afford to, it's usually cheapest to pay upfront for your annual policy as insurers often provide discounts. Though always remember to go for a policy that works for you, no matter how good the discount is.

Here are two steps to help you find the best policy for you, and at the cheapest price.

Step 1. Use comparison sites to benchmark prices

This gets you multiple quotes from one form. You can then compare the cover and costs from various providers to find the best fit for you. We'd suggest checking both sites if you've time, though if you're not sure what you're doing, consider getting advice.

Step 2. For specialist advice and more options, contact a broker 

If you're not sure which policy to get, or have conditions making it difficult to find the right one, contact a broker for a more thorough search. It usually takes a bit longer but you should receive a much more bespoke quotation, with any exclusions clearly explained. Brokers often have connections with various insurers so may also be able to offer you a special deal.

Is there a fee?

Brokers get paid commission by the insurer, so if you are charged a fee (which must be disclosed upfront), do weigh up if that is the best or your only option.

How to find a broker

To find a broker, use the Association of Medical Insurers and Intermediaries, a trade association for independent medical insurance advisers. It has a list of members to choose from.

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How to complain about your insurance provider

The insurance industry doesn't always have the best reputation for customer service. Plus, while a provider may be good for some, it can be hell for others.

Common problems include claims either not being paid out on time or at all, unfair charges, or exclusions being hidden in small print. It's always worth trying to call your provider first, but, if not, then…

Free tool to help you complain

This tool helps you draft and manage your complaint. It's totally free to use, and it's offered by Resolver, a firm we work with to help people get complaints justice.

RESOLVER – FREE COMPLAINTS TOOL*

If the company won't help, Resolver also helps you escalate your complaint to the free Financial Ombudsman Service.

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