Private health insurance: outpatient cover

Out-patient cover pays for care that does not need a hospital bed: seeing a specialist, having a scan or blood test, a course of physiotherapy, sometimes an operation you walk out of the same day. It is also the part of a private medical policy that varies most between insurers, and the part most often switched down to bring a quote in. If you are deciding how much of it to buy, or whether a policy without it is worth having, an FCA-authorised broker can ask several insurers how each words it and price the answer. Submitting the form on this page starts an introduction, with no charge.

This page goes through out-patient cover benefit by benefit across eight insurers' documents, with therapies in the most detail. For limits as a general idea, and what they do to a bill, see private health insurance benefit limits explained.

What "out-patient" is, and why it is a separate line

A policy sorts treatment by how you are admitted. In-patient means a hospital bed overnight, day-patient means a bed for the day, and out-patient is everything else. The sorting matters because the limit is often attached to the setting. A policy can pay for an operation without a ceiling and still stop at a modest sum for the consultations and tests that came before it.

Three insurers' documents show how much that setting can vary. Freedom's guide lists out-patient treatment among its optional extras, not its core cover. Aviva's terms set a choice of out-patient limits, including nothing at all. Vitality's membership guide pays out-patient care up to a limit printed on the member's certificate. So "does private health insurance cover out-patient care?" has no single answer; it depends on the insurer and on what was chosen at the outset. The sections below take the parts of out-patient care in turn: the appointment, the test, the therapy and the operation.

Consultations: seeing a specialist or a doctor

The specialist appointment is the entry point to most claims, and the wordings differ on what has to happen first. Vitality's membership guide puts the referral in the benefit itself:

"Out-patient Cover You are covered up to the limit shown on your membership certificate for appointments with a consultant, following a referral from a GP"

— Vitality, Membership Guide (Your Personal Healthcare plan terms and conditions) (August 2024), page 16, read 10 October 2026.

The sum is not in the guide's text at all; it is on the certificate. The same guide's worked example later describes a member whose out-patient cover "is limited to £500 per plan year" (page 51), which shows one level a plan can carry and is not a statement of what every Vitality plan carries.

WPA's product information document gives the sum on the page. Its standard allowance for specialist consultations is £250 for the policy year, and an optional extra raises it (Complete Health, November 2025, page 1). The cap is on consultations in particular, so whether a scan draws on it is a question for WPA's full wording.

Aviva's terms include an option under which this benefit goes completely:

"If you have chosen option reduced out-patient cover – £0 limit we do not cover treatment as an out-patient, including consultations and diagnostic tests"

— Aviva, Healthier Solutions terms and conditions (April 2025 issue), PDF page 24 (printed page 22), read 4 September 2026. Aviva has since published a March 2026 issue, so check each Aviva line on this page against the version of the terms that arrives with your quote.

That is a clear sentence about a £0 option. Aviva's terms also say the £0 limit does not apply to out-patient treatment received through some of its networks (PDF page 8, printed page 6); which networks count turns on the policy, and the broker who phones you after the form can find out for you, free. On the same page as the £0 clause, Aviva says it does cover "up to two consultations with a specialist each policy year, and limited diagnostic tests", without saying which cover option that sentence belongs to.

For a doctor's appointment, as opposed to a specialist's, Aviva's terms are blunt: they exclude treatment provided by a GP and tests a GP requests, such as X-rays, blood tests and scans, with two speech therapy sessions per child as the stated exception (PDF page 23, printed page 21). Freedom's guide arranges it the other way, listing "private GP fees" among its optional additional benefits (page 10): available, but only if bought. Private GP access, and how a claim starts, is on the page on private GP access through a policy.

Tests and scans, in brief

Tests have their own page, scans and diagnostics, which quotes the clauses in full. For out-patient limits, what matters is whether a test draws on the same sum as the appointment. Vitality's guide counts tests ordered by your consultant, such as pathology, X-rays, ultrasound and ECGs, in the same out-patient benefit and up to the same certificate limit (page 16). AXA Health's handbook gives CT, MRI and PET scans a line of their own, paid in full at a scanning centre listed in AXA's Directory of Hospitals, on a specialist's referral (Personal Health handbook, October 2024, PDF page 4, printed page 3, read 4 September 2026). Aviva's terms cover out-patient CT, MRI and PET scans only at a diagnostic centre (PDF page 6, printed page 4). The Exeter's product information document names CT, MRI and PET scans, with professional fees where appropriate, among its out-patient benefits (Health+, MKTG770, June 2026, page 1); whether The Exeter pays for blood tests or ultrasound depends on the full policy, so ask before you count on it.

One Aviva row needs care. It pays for diagnostic tests "only if they" lead directly to covered in-patient or day-patient treatment, or take place within six months after such treatment for the same condition, and the row ends on the column heading "EXPERT SELECT" (PDF page 9, printed page 7). It reads two ways: as a rule for every Aviva cover option, or as a rule for the Expert Select option alone. Which reading is right is Aviva's to say, so ask which option the row belongs to before relying on either.

So "does it cover tests?" turns on four things a quote's headline will not show: whether a specialist must order the test, whether it shares the appointment's sum, whether scans have a line of their own, and whether the place you have it is on a list. Those four are worth putting to a broker alongside the price.

Therapies: sessions, sums, levels and options

Physiotherapy and the related treatments are where insurers' wordings differ most, because each insurer counts them in a different unit. Some count sessions, some count pounds, one offers a choice of levels, and some sell the cover as an add-on or option.

Aviva counts sessions. Its therapies benefit covers "up to ten sessions in combined total (for example five physiotherapy sessions and five osteopathy sessions) each policy year on referral from a GP for each separate condition" (PDF page 16, printed page 14). The same count appears in the table for Aviva's option D, which lists GP-referred physiotherapy, chiropractic, osteopathy and acupuncture at up to 10 sessions in combined total for each member, each condition, every policy year, and says claims on option D will not affect the no claim discount (PDF page 10, printed page 8). Separately, Aviva pays practitioners' fees, naming physiotherapists, osteopaths and psychiatric therapists as examples, up to the limits in its fee schedule (PDF page 14, printed page 12), so a session count and a fee ceiling can both apply.

Aviva's therapy cover also changes when other options are lowered. A member who has chosen reduced out-patient cover together with a selected benefit reduction, in either of the two combinations the terms name, gets no cover for specialist-referred treatment by a physiotherapist, osteopath, chiropractor or acupuncturist "in any circumstances" (PDF page 16, printed page 14). That is two choices in combination, and the clause is not a rule for a reduced limit alone.

WPA offers a choice of levels, made at the outset:

"Therapy – Choose: £500, £750, £1,000, £1,500 or Unlimited"

— WPA, Complete Health Insurance Product Information Document (November 2025), page 1, read 4 September 2026.

The choice is made when the policy is bought, so it is worth deciding before a quote is run rather than after.

Saga states a sum. Its policy book gives "up to £2,000 a year for therapists' and acupuncturists' charges" (HealthPlan Super, May 2025, page 4, read 4 September 2026). Any conditions on that sum sit in the full policy book, so check them before relying on it.

The Exeter splits it in two. Among the core out-patient benefits in its product information document are "Up to three sessions of post-operative physiotherapy" (Health+, MKTG770, June 2026, page 1). Wider therapy is a Health+ add-on, and the full Policy Document sets out what it buys: "GP or specialist referred treatment by a" physiotherapist, chiropractor, osteopath, acupuncturist, podiatrist, speech therapist or pain clinic, then "Dietician (maximum of two consultations for each member per policy year)". The add-on is chosen at "Unlimited", "Up to £1,000 per policy year", "Up to £500 per policy year" or "No cover" (Health+ Policy Document, MKTG762, July 2026, page 11). So the two-consultation maximum belongs to the dietician line. The shorter product summary prints the same bracket at the end of its whole therapies list, which can read as a cap on every therapy; the Policy Document's table is the one to go by.

AXA Health has a Therapies Option, and its line reads two ways, so here it is in full:

"Therapies Option table Fees for out-patient treatment by physiotherapists, acupuncturists, osteopaths or chiropractors No yearly limit that can include up to an overall maximum of ten sessions in a year on GP referral or when you have physiotherapist treatment through our muscles, bones and joints service"

— AXA Health, Personal Health membership handbook (October 2024), PDF page 6 (printed page 5), read 4 September 2026.

It could mean a ten-session annual cap, or ten sessions by those two routes with no stated yearly limit overall. The difference matters if you expect a long course of treatment; request a call-back and a broker can get AXA's answer on it for you, at no cost. The line shows that the option exists, not that it is the only way AXA pays for therapy.

Freedom lists "alternative therapies" among the optional additional benefits of its Elite guide, held only if shown on the certificate (page 10). Which treatments that covers is set out in the policy, so check the list before buying with it in mind.

Out-patient surgery is handled differently again. AXA Health's handbook shows "No yearly limit" for it (PDF page 4, printed page 3), and The Exeter lists out-patient surgery among its core out-patient benefits (page 1). Both are discussed with the other limit shapes on the limits page.

The insurers side by side

Each cell summarises the document named, not the whole of any insurer's cover. Where a cell says to check the full policy, the answer turns on that insurer's policy, and any gap that matters to you is one a broker can look up free once you ask for a call.

Bupa's single line, read 4 September 2026 from page 7 of its guide, is about what does not draw on that allowance rather than its size; it is quoted and explained on the limits page. With a quote in hand, ask for the table of benefits behind its out-patient figure and check which of these four columns it fills, and in what unit.

What a lower out-patient limit tends to do to the price

Taking a smaller out-patient allowance usually makes the premium lower. How much lower depends on the insurer, your age and the level chosen, and it can't be known without a quote, so this page does not put a figure on it. A broker can show the same cover quoted with a higher and a lower out-patient limit side by side.

The lower number is not the only difference, as the clauses above show. On Aviva's wording the £500 and £1,000 reduced limits also take out two kinds of treatment in every setting, pregnancy and childbirth complications and hospital dental surgery (PDF page 8, printed page 6), so a cheaper quote deserves a look at what it leaves out. The £0 option, as quoted above, removes consultations and diagnostic tests altogether, and paired with a benefit reduction it removes specialist-referred therapy too, so the cheapest version of a policy may have little to do with the appointments most people expect it to pay for. How a limit interacts with an excess is covered on what an excess is.

The sum also resets with the policy year, so a diagnosis late in the year and a course of physiotherapy that runs past renewal can draw on two limits; the yearly cost page works through how the year's clock runs.

Out-patient cover: short answers

Does private health insurance cover outpatient appointments with a specialist?

Often, up to a limit, but not on every policy. Vitality's guide pays consultations with a specialist after a GP referral, up to a sum on the certificate; WPA's sets £250 as standard; Aviva's has a £0 option that removes them; and Freedom's lists out-patient treatment as an optional extra. Which applies to you is on your quote and certificate.

Is there outpatient only health insurance?

In the eight insurers' policies above, out-patient cover is a benefit inside a policy that also has in-patient cover, and in some a benefit that can be added or taken away. If out-patient care is all you want, ask whether any insurer sells it on its own before ruling the idea in or out.

What does "additional outpatient" mean in health insurance?

Two insurers' wordings show what the phrase points at. Freedom's guide calls out-patient treatment an "optional additional benefit", shown on the certificate if you have it, and WPA's product information document names an "Extra Out-patient Consultations Optional Extra" that raises the consultation sum. In both, it means cover or a higher limit bought on top of the core policy.

Does private health insurance cover doctors' appointments?

Not a GP's, on Aviva's wording, which excludes treatment provided by a GP. Freedom sells private GP fees as an optional extra. In the other insurers' documents above, the consultation benefit is for a specialist.

If the out-patient limit on a quote looks too low or too generous for how you expect to use the policy, the next step is to see it beside other insurers' on the same terms. When the form on this page has gone off, a broker can set out the same policy at two or three out-patient levels, so you see what each step changes before you choose.