Using a broker to buy private health insurance

Type "health insurance agency" into a search engine and most of what comes back is American. The phrase is: in the United States an agency sells policies on behalf of insurers and is the ordinary way to buy. In the UK the same job is done by a broker, an intermediary or an adviser, and you will struggle to find a firm here that calls itself an agency. If that is what you were looking for, this page is about the thing you actually want: a firm that takes your circumstances once, comes back with quotes from several insurers, explains the differences, and handles the application.

If you would like to be put in touch with one, fill in the form on this page and an FCA-authorised broker will contact you. It is free, it takes a few minutes, and it commits you to nothing. The rest of this page is for deciding whether that is the right move, and what to ask when they ring.

One thing to know before you read on. This site is not a broker and is not authorised by the FCA. It introduces readers to one broker, and it may be paid for the introduction. That is a commercial arrangement of exactly the kind the rest of this page tells you to ask about, so treat it the same way: we are not comparing brokers for you, we are introducing you to one, and every check below applies to that firm as much as to any other.

Agency, broker, adviser: what the names mean in the UK

Private medical insurance (PMI) is sold here through a handful of channels, and the labels overlap.

• Broker, or intermediary. A firm authorised by the Financial Conduct Authority to arrange insurance with insurers it does not own: the names you know, such as Bupa, AXA Health, Aviva and Vitality, and smaller specialists you may not. Some brokers work across most of the market; many work from a panel of insurers they hold agreements with. Either is legitimate, and the firm must tell you which it is.
• Adviser. Usually the person at the broker who advises you. "Health insurance adviser" and "advisor" are both in use in the UK; the spelling varies, the meaning does not. A private medical insurance adviser is a specialist. A general financial adviser is different: arranging PMI needs general insurance permissions, and many financial advisers refer it to a specialist firm rather than handle it themselves.
• Agency. Not used for a firm in the UK, though the word survives in the industry's back office. A broker holds an agency with each insurer it can place business with: an account through which it submits applications and services the policies. A broker who says it "has agencies with all the main insurers" is describing its reach, not its name. A medical insurance agency in the American sense, selling plans from a marketplace, has no UK equivalent.
• Tied agent, or appointed representative. A firm that sells one insurer's products, or that operates under another regulated firm's permissions rather than its own. Neither is improper, but neither is a comparison either, and the firm must say which it is before you buy.
• Comparison sites. PMI suits aggregator quoting badly, because underwriting, hospital lists and outpatient limits all move the price and a two-minute form captures none of them well. Most comparison sites run a small panel or pass your details to a broker anyway.
• Direct. The insurer's own sales team. Knowledgeable about their product, and only their product.

That back-office sense of "agency" has one consequence worth knowing. The agency on your policy can be moved. If you bought through a broker and later want a different firm to look after it, you sign a short letter of authority appointing the new one, and the insurer transfers the agency to them. Your cover, your underwriting and your premium stay as they are; only who services the policy changes. Choosing a broker is not a decision you are stuck with for the life of the policy.

If you have arrived from the US, two further differences matter. The NHS is still there for you whatever you buy, so UK policies are designed to sit alongside it and mainly pay for diagnosing and treating acute conditions. And there is no enrolment window or government marketplace: you can buy at any time of year, through whichever channel you like.

What a broker does that you cannot easily do yourself

The useful part of the work happens before a quote is produced. Policies are not interchangeable, and the cheapest premium on paper is often the one whose hospital list leaves out the place you would actually want to be treated.

A competent broker will:

• Take a proper fact-find. What you want the policy to do, what you can afford each month, where you live and how far you would travel for treatment, who else is to be covered, and your medical history.
• Explain the underwriting choice. Most individual policies are sold on moratorium terms, under which anything you have had symptoms, treatment or advice for in the years before you join is excluded until you have gone a set period on the policy without it recurring. Full medical underwriting asks for your history up front and tells you what is excluded from day one. The periods and the detail vary by insurer, and which suits you depends on your history. The wrong choice is the commonest route to a refused claim.
• Walk you through the levers. Hospital list, excess, outpatient limit, whether to accept NHS treatment when the wait is short, whether to let the insurer choose the consultant, the level of cancer cover, mental health and therapies. These are where the real price differences come from, and a broker can show you what each one does to the quote.
• Quote the same specification across several insurers. Harder than it sounds, because insurers bundle benefits differently, and comparing two quotes properly takes someone who knows both products.
• Put the awkward question to the insurer. If there is one specific thing you need to know, whether a policy would pay for a lactation consultant, say, or for a particular clinic you have in mind, a broker can ask the insurer in writing before you buy. That is a different thing from guessing at the policy wording yourself.
• Handle the application. Including the medical declaration, which matters more than most buyers realise: an incomplete or inaccurate declaration is the usual reason for a disputed claim, and a broker who has asked the right questions reduces that risk.
• Help when you claim. You still contact the insurer to claim, but if a pre-authorisation stalls or the insurer disputes whether something is covered, you have someone to call whose job is to sort it out.
• Re-broke at renewal. Premiums rise each year with age and medical inflation, and renewal is where a broker either justifies their commission or quietly collects it. Expect them to check the market and tell you whether to stay or move.

How a broker is paid, and how this site is paid

In most cases you pay the broker nothing directly. The insurer pays them commission: a share of your premium when the policy starts, and a share again at each renewal for as long as it stays with that insurer. The commission comes out of the premium rather than being billed to you on top. Whether the premium itself is the same as the insurer's direct price is a fair question, and one you can test yourself by getting the same specification quoted both ways. It is also a fair question to put to the broker.

Ask what they will earn from your policy. A reputable firm will tell you without fuss. A small number of advisers charge a fee instead of, or on top of, commission, usually for complex company schemes, and any fee must be disclosed before you commit.

The commission model has a conflict built in, and it is better named than ignored: a broker is paid more when you buy a bigger policy, and paid again when you renew. Most manage it well. The way to tell is whether their recommendation is explained in terms of your needs rather than the policy's features, and whether they are willing to suggest the cheaper option when it fits.

Now the same honesty about us. This site is not FCA-authorised and sells nothing. When you fill in the form, your details go to one FCA-authorised broker, and we may be paid a fee for that introduction. We do not compare brokers, we do not search the market, and nothing on this page is advice. What we can say is that the firm is authorised, which you can confirm on the FCA register the moment you have its name, and that the questions further down are the ones to put to it. If you are content with that arrangement, the form on this page is how the introduction happens. If you would rather find a broker yourself, the checks below work just as well for one you find.

Broker or direct: how to decide

There is no single right answer, but there is a reliable way to think about it.

Going direct makes sense when you already know exactly which insurer and which policy you want, perhaps because you are rejoining a former employer's insurer, or because one insurer has a feature nothing else offers. For a first policy, for anyone with a medical history, and for anyone who already holds a policy and is thinking of moving it, the case for a broker is strong.

If you are buying for a business rather than for yourself, the case is stronger still: company schemes have moving parts, from how employees' medical history is treated to what happens at renewal after one large claim, and insurers negotiate harder on group business with a broker who places a lot of it.

Switching insurers: where a broker earns their keep

The single most valuable thing a broker does is move you from one insurer to another without losing you cover.

If you simply take out a new policy, your underwriting starts again from scratch. Anything you have been treated for since the original policy began is now a pre-existing condition for the new insurer and may be excluded. If you have claimed for anything in the last few years, a fresh policy may be worthless for exactly the thing you are most likely to claim for again.

The alternative is switch underwriting. Under continued personal medical exclusions, usually shortened to CPME, the new insurer takes on the exclusions from your existing policy as they stand, rather than reassessing you. Some insurers offer a continued moratorium on a similar basis. Either way you keep the position you have built up, provided you have held cover continuously, have no claim in progress, and meet the new insurer's switch conditions. Those conditions vary, and some insurers will not accept switches from certain products or with certain claims histories.

A broker who handles switches every week knows which insurers will accept yours, what they will ask about recent claims, and when staying put is the better answer. Doing this yourself, direct, is where buyers most often lose cover without realising it until they claim.

How to choose a broker, and what to ask

Private medical insurance brokers range from one-person specialists to national firms, and size tells you little. Check the following before you give anyone your medical history, including the firm we introduce you to.

• They are on the FCA register. Search the Financial Services Register for the firm's name and confirm it has permission to arrange general insurance. If it is an appointed representative, the register shows the principal firm responsible for it. Being regulated means a complaint about the advice can go to the Financial Ombudsman Service.
• Panel, or wider. Ask which insurers they can place business with and which they cannot. Many perfectly good brokers work from a panel; you simply need to know what you are not being shown.
• Health insurance is what they do. A firm that mainly sells mortgages, life cover or car insurance and does PMI on the side is less likely to understand underwriting switches or hospital list tiers.
• They talk about underwriting before price. If the first thing you hear is a premium, be wary. The order should be needs, underwriting, specification, then price.
• They will say what they earn. A firm that is evasive about commission is telling you something.
• They stay involved after the sale. Ask what happens at renewal and what help they give at claim time. "We send you the renewal notice" is not a service.
• Reviews, read carefully. Look for ones that mention renewals and claims rather than how friendly the sales call was.

The questions to put to a broker

• Are you authorised by the FCA to arrange insurance, and what is your firm reference number?
• Which insurers do you have agencies with, and which can you not place business with?
• Would you recommend moratorium or full medical underwriting for someone with my history, and why?
• If I switch from my current policy, which insurers would accept my existing exclusions?
• How are you paid on this policy, and does it change which insurer you put in front of me?
• What will you do at renewal, and what will you do if a claim is declined?
• What happens to my details if I do not go ahead?

A good firm answers all of these without hesitation, in the time it takes to get you a quote. One that will not has answered the first question for you. Put them to whichever broker you end up speaking to, including the one we introduce; the answers are the quickest test of whether our introduction was any good.

Warning signs

• You cannot find the firm on the FCA register, or the name on the register does not match the one on the website.
• You are given a premium before anyone has asked about your health.
• You are moved to a new policy without being told what happens to your existing exclusions.
• Pressure to sign today to "hold the rate". Ask how long the quote is valid; a rate that must be accepted on the spot is a sales technique, not an insurance term.

What happens after you fill in the form

1. The broker contacts you. Expect a proper conversation rather than a two-minute form: what you want from the policy, your budget, who is to be covered, and your health. Be candid; anything left out here can surface at claim time. This is also the point to check the firm's name against the FCA register, before you go further than the basics.
2. A recommendation. A small number of options, normally two or three, each with a specification and a premium, and a written explanation of why they are recommended and what has been left out.
3. Questions and adjustments. Move the excess, change the hospital list or add outpatient cover and see what it does to the price.
4. Application. The broker submits it. With full medical underwriting the insurer may ask for more information or, occasionally, a GP report. With a moratorium there is little paperwork.
5. Policy documents. Read the exclusions and the hospital list, even if you have been through them on the call. You have a cooling-off period, normally 14 days, to cancel if anything is wrong.
6. Renewal, a year on. The notice arrives a few weeks before the date. A good broker will have reviewed it before you do.

Nothing in those six steps obliges you to buy, and the first one costs you nothing but a few minutes. If you have read this far and a broker still looks like the right route, the form on this page is the next step: fill it in, take the call, and ask the questions above.