Falling ill can be pretty stressful. Whether you’re waiting for a diagnosis, for treatment or are just sitting in a doctor's waiting room, the worry can make hours feel like days. While the idea of sitting at home in pyjamas, eating chicken soup and binge-watching Friends for a week or two doesn’t actually sound too bad, the reality is that being forced to take time off work can cause a lot of hassle and anxiety.
Private medical insurance (also known as private health insurance) is designed to cover the cost of treatment for when you are unwell or injured, reducing stress and allowing you to focus on getting better.
This guide is designed to help you understand how private medical insurance works, what it covers, how much it costs and whether you need it.
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So, what exactly is private medical insurance?
Essentially private medical insurance (PMI) pays for private medical treatment if you fall ill. This translates to quicker consultations and treatment, access to medication that is possibly not available through the NHS and greater choice around your hospital or doctor. Ultimately, it’s a product that puts you in the driving seat when it comes to medical treatment.
How does private medical insurance work in the UK?
PMI works in a similar way to car insurance or mobile phone insurance. You pay a monthly or annual premium, then at the end of each year, you can choose to renew your insurance policy with your current insurer or swap to another. You can also choose whether to cover yourself, you and your partner or your whole family under your policy.
Private health insurance can work in several different ways depending on the type of policy, but usually covers:
Inpatient care: You're covered for surgery and tests that require an overnight stay.
Outpatient care: You're covered for consultations that do not require an overnight stay.
Day patient care: You're covered for treatments that do not require an overnight stay.
When you buy PMI, you will need to think about how much excess you would like - this is the amount you personally will still need to pay when you claim, with the insurer then covering any cost above this value. The higher the excess you go for, the cheaper your private health insurance policy will be.
What does private medical insurance cover?
While it does depend on the type of policy you purchase, typically, private health insurance covers the cost of medical treatments in private facilities for acute conditions (conditions with a start and, potentially, an end date). It will pay for private treatment for things as minor as a stitch, or as significant as brain surgery.
It could also cover:
In-patient care
Cancer treatment (depending on the level of cover selected)
Private Ambulance
Surgery fees
Oral Surgery (non-dental)
Diagnostic tests and consultations.
Often, insurance companies will provide a core private health insurance package, which you can then personalise to your needs by adding on extras, such as dental care, physiotherapy or mental health support. It’s a bit like buying an ice cream and then adding whatever toppings take your fancy, making it just right for you.
What isn't covered?
Treatment for long-term chronic illnesses, where the goal would be to limit and lessen symptoms, rather than recover fully, are not typically covered by private health insurance.
If you’re pregnant, in most cases you will not be covered for routine pregnancy care on your policy, but will be insured for any health complications, whether they are related to the pregnancy or not.
Other instances where you may not be covered can include:
Emergency treatment
Elective treatment - such as cosmetic surgery
Treatment for drug abuse
Treatment abroad
Organ transplants
Cover limitations could vary between providers, so it’s important to thoroughly read and understand your insurance documents to know exactly what is and isn’t covered.
Are there limitations?
Depending on your policy, there may be limits on how much you can claim, including:
The total amount you can claim
The amount you can claim for conditions
The amount you can claim for certain procedures or treatments
The amount you can claim for inpatient or outpatient treatment
In some cases, your insurer may only cover private treatment if you've waited a certain amount of time for treatment on the NHS and if the treatment is not available on the NHS.
Benefits of private medical insurance
Having private health insurance means that:
You have quicker access to a wider variety of specialist medications and treatments.
Getting both a medical appointment and a diagnosis is generally much faster, due to significantly reduced waiting times. The waiting time between an NHS GP referral and a consultant appointment can be up to 18 weeks [1]. This four and a half month wait can be reduced significantly with a private health insurance policy.
If you need one, you can get a second professional opinion in a speedy fashion, and quick referrals to specialists.
You will have more control and choice over where you are treated and, often, the guarantee of a private treatment room.
You will likely have access to a 24/7 virtual GP too, so you can get instant support and referrals where needed.
You would be helping to relieve some of the pressure faced by the already stretched NHS.
Do I need private medical insurance?
There are many reasons why private medical insurance could be a good idea for you. Being unwell is stressful enough, but having PMI helps to reduce worry and lessen the disruption caused by falling ill.
An important thing to know is that private health insurance is often offered by employers, as a kind of employee benefit, but of course this is not the case for everyone. In particular, if you are self-employed, you might need to take matters into your own hands and buy a personal policy.
Having private health insurance means that:
- You have quicker access to a wider variety of specialist medications and treatments.
- Getting both a medical appointment and a diagnosis is generally much faster, due to significantly reduced waiting times. The waiting time between an NHS GP referral and a consultant appointment can be up to 18 weeks [1]. This four and a half month wait can be reduced significantly with a private health insurance policy.
- If you need one, you can get a second professional opinion in a speedy fashion, and quick referrals to specialists.
- You will have more control and choice over where you are treated and, often, the guarantee of a private treatment room.
- You will likely have access to a 24/7 virtual GP too, so you can get instant support and referrals where needed.
- You would be helping to relieve some of the pressure faced by the already stretched NHS.
To sum it up, if you or your loved ones were to experience worrying symptoms, private medical insurance can give you some control over the situation. With this form of cover, diagnosis and treatment can be dealt with almost immediately, so you can get better and return to normal life, with limited disruption.
Whether or not PMI is right for you, the most important thing is to take the time to think through your options. Some people choose to ‘self-insure’ (put money aside each month to pay for any future private medical care), some pay for private treatment as and when it is needed, and others opt to rely on the NHS alone. All of these are viable options, it is just a case of figuring out what’s best for you and your family.
How much does private medical insurance cost?
Currently, the average yearly price for PMI, for people under the age of 65, is £1,500 a year, so around £125 a month. This might seem like quite a lot of money, but when you consider that a knee or hip replacement could cost between £10,000 to £15,000[2], a policy sounds like pretty good value!
The exact cost of your policy will depend on various factors, including the level of cover you want, the size of the excess you choose, whether you have made any previous claims and your:
Age - private health insurance costs more the older you get, so you will likely see your insurance premiums increasing each year.
Medical history - if you have had, or currently have health conditions, you may find that your policy is more expensive.
Your lifestyle - whether you smoke and your BMI will impact the price of private medical insurance.
Where you live.
If you're looking to reduce the cost of health insurance premiums, there are a few things you can do such as opting for a higher excess, as this could lower your monthly premiums.
You could add a waiting period to your policy, which means you agree to wait a certain amount of time before claiming on your insurance - this could also reduce your premiums.
There are so many things that can impact the cost of private health insurance. Give us a call on 01392 436193 and we will happily generate a personalised quote for you.
Can I get private medical insurance with a pre-existing condition?
Private medical insurance will not cover you for a medical condition that you already know you have when you take out the policy. This is because insurance is there to cover what might happen, not what is already happening - all the more reason to purchase a policy sooner rather than later, so you know you will be covered for everything.
That said, if you do have a pre-existing health condition, it certainly won’t rule out private health insurance altogether. You can still get insurance and be covered for anything new that arises, you just wouldn’t be covered for the original condition.
How can I buy private medical insurance?
As you can see, there are lots of things to consider when it comes to finding the best private medical insurance policy for you and your loved ones, so seeking the right advice can make a huge difference. The Cavendish team can guide you through all of these decisions, saving you time and hassle (and maybe even some pennies!).
At Cavendish Online, we work with the top private health insurers in the UK and can help you work out exactly how much cover you need and which insurer is best suited to you.
Call 01392 436193 (Monday - Thursday 9am - 5.30pm, Friday 9am - 5pm) to speak with one of our insurance specialists, who can guide you through the process and support you in choosing the best cover for you and your family.
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