Private Medical Insurance FAQs

What is private medical insurance for?

Some frequently asked questions about private healthcare insurance

Private medical insurance is designed to cover the costs of private treatment for unexpected (acute) medical conditions. By paying a regular amount (premium) to an insurance company, you can avoid having to pay the potentially expensive, unexpected costs and you gain access to fast medical treatment from your choice of the UK’s private providers. Many insurers describe the types of conditions that they will pay for as those that are short-term and respond to treatment. They will not generally cover the costs of treating on-going conditions that you were aware of before you were insured.

What is not covered by private medical insurance?

Private medical insurers will usually not cover you for any conditions that were diagnosed, treated, or for which you sought medical advice before your insurance started. They will also usually not cover the costs of treating chronic, incurable conditions. In addition there will be a list of exclusions on your policy – these commonly include GP services, prescriptions, and A&E admissions

Are there limits on what I can claim each year?

Depending on the policy you have, there may be limits on the total amount you can claim on certain types of treatments. This is common for such treatments as physiotherapy, chiropractics, osteopathy etc. Check your policy documents or contact your insurer to find out if you have limits to bear in mind.

Could my premiums go up if I make a claim?

Some policies do reward members who do not claim on their private medical insurance policies.
Even if you make no claims, however, the cost of your annual premium is likely to rise over time reflecting your age and the rising costs of providing medical care – new drugs and technologies in hospitals are often expensive.

What details of my health will I need to provide to get PMI?

When you apply for medical insurance you will need to make a declaration on a form regarding any pre-existing and past medical conditions. If you have any pre-existing conditions they will not normally be covered by your new policy for a set period of time – perhaps two or five years.

Can I get private medical insurance if I have a disability?

Yes, but you will need to disclose your disability in your medical history declaration. Your insurer may not cover treatments you require as a result of your disability since they involve a pre-existing condition.

Can I move to a new insurer?

Yes it is possible to change insurer. Speak to an insurance broker or a new insurer and they will be able to advise you about the way switching will affect the terms and level of your cover.

How do I make a claim on my private medical insurance?

It is usually necessary to go to your GP and get a referral for private treatment in order to make a claim to your insurer. Often a claims form will need to be signed by your GP or the specialist you are referred to. If you do not have a claims form you should request one from your insurer. Once you have a referral from your GP simply contact your insurer to confirm that they will cover you – this is called claims authorisation. You can also clarify with them how they will pay for the claim and what to do next.
For more information see our Payment Process page.

If I am insured will I have to pay towards my hospital treatment?

Under most private medical insurance policies you will need to pay an excess charge on each claim, while the insurer will cover the costs of eligible treatment under that claim. Some policies also require you to meet a proportion of treatment costs up to a specified limit. You will need to consult your policy documentation to confirm arrangements for your scheme.

What is a co-payment?

A co-payment is when you share some of the costs of your treatment with your insurer. The amount you need to co-pay will depend upon your policy, the location and type of treatment you are having. When you contact your insurer for authorisation of a claim you can check if any co-payment will be required.

Is private medical insurance regulated?

Yes, the Financial Services Authority (FSA) regulates the sale of all types of insurance including medical insurance. If an insurer or insurance broker is a member of the General Insurance Standards Council (GISC) they will also be bound by the regulations of that body.

Where can I get advice on buying private medical insurance?

The Association of British Insurers (ABI) publishes a free guide to purchasing medical insurance, designed to help you understand more about how private medical insurance works, so that you can make an informed choice before buying a policy. Visit www.abi.org.uk

Given that private medical insurance can be a difficult product to understand we suggest that it would be worth discussing with a PMI broker who will be able to review your policy and could give you options. If you need to find a broker then you should look for one who is authorised by the FSA. The Association of Medical Insurance Intermediaries website can help people looking for a suitable broker. Visit www.amii.org.uk  

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