What a UK private health insurance policy covers falls into three layers. Hospital and day-patient treatment for new conditions is the core; out-patient consultations, tests, therapies, mental health and some cancer cover are usually lines you choose to add; and a list of exclusions, typically chronic conditions, anything you had before joining, emergency care and routine pregnancy, applies whatever you pick. If you are deciding which layers to buy, the enquiry form here lets you request a free phone call from an FCA-authorised broker who can talk through the choices against your own situation.

The map below uses two insurers' own words: Bupa's By You policy guide (BINS 14718, for policies starting after 1 May 2024, © Bupa 2024) and AXA Health's Personal Health membership handbook dated October 2024, read from a copy that an intermediary publishes, not AXA itself; both were read on 4 September 2026. Page numbers are PDF pages. Other insurers write these clauses differently, which is why the certificate you are sent matters more than any summary.

Three layers: what is always in, what you add, what is out

AXA's handbook is blunt about the purpose: "your insurance is not designed to cover every situation. It is designed to add to, not replace, the NHS" (page 7). Its cover splits into a "core cover" table that applies to every member and an "Options" section that applies only to those who chose them. The options named there are out-patient cover, therapies, mental health, a dentist and optician cashback, an Extended Cover Option and travel cover. A third layer, the exclusions, applies whatever you choose.

Bupa's guide works the other way round: it sets out every possible option for its By You policies, then warns, "This means you may not have all the cover set out in this policy guide" (page 2). Its exclusions section "applies to your cover unless it says otherwise" (page 13). Reading a policy therefore means reading three documents together: the benefit table, the certificate that shows what you hold, and the exclusions.

Hospital stays and day-case surgery: the core

This is the base both documents build on. AXA's core table pays private hospital and day-patient unit fees "in full so long as you use a hospital or day-patient unit in our Directory of Hospitals" (page 3). The fees it lists include accommodation, diagnostic tests, theatre, nursing, drugs, dressings, radiotherapy and chemotherapy, with specialist fees in the same table. In Bupa's guide the equivalent lines are consultants' fees for hospital treatment and "Recognised facility accommodation charges including your meals and refreshments while you're having day-patient or inpatient treatment covered by your policy" (page 15).

Two things limit it. Where you are treated matters: at a hospital outside AXA's Directory the core table pays a cash sum instead of the fees, unless you hold the Extended Cover Option (pages 3 and 8). And a stay has to be for treatment: Bupa does not pay for accommodation when it is mainly used for "convalescence, rehabilitation, supervision or anything other than eligible treatment" (page 15). Hospital lists explained covers how the lists work, and surgery cover follows an operation from consultation to bill.

Out-patient cover: consultations, tests and scans

Seeing a specialist and having tests before or after admission is where the two documents leave most to your choice. In AXA's handbook, someone without an Out-patient Option has no cover for "out-patient diagnostic tests or consultations" (page 8), while the Standard Out-Patient Option pays for "Up to three specialist consultations a year" (page 5) and the Full option removes that yearly limit on consultations (page 6). Surgery as an out-patient is in AXA's core table instead, with "No yearly limit" (page 4). Bupa's guide pays consultants' fees "for outpatient consultations for acute conditions" (page 14), with your certificate showing your own allowances. On its Treatment and Care policy, out-patient consultations and tests are paid only in the six months after you are discharged from day-patient or in-patient treatment or an out-patient operation, and only when they relate to it (page 6).

Out-patient limits are generally one of the settings that moves a premium, so it can be worth seeing two versions side by side; a broker can quote both on a free call-back, priced on your age and health. The out-patient page sets out how the limits are written, and benefit limits explained covers the rest.

Cancer, mental health and therapies: look for them on the certificate

Bupa's guide says "Your membership certificate will show if you have cancer cover" (page 18) and "Your membership certificate shows if you have mental health cover" (page 20). On the mental health side it also states "We do not pay for treatment of dementia", that the certificate shows the maximum number of days covered for day-patient or inpatient mental health treatment, and that "Your policy covers one addiction treatment programme in each person's lifetime" (page 20).

AXA does it with options. Without the Mental Health Option there is no cover for "any psychiatric treatment", and without the Therapies Option none for "physiotherapists, acupuncturists, osteopaths or chiropractors" (page 8). Cancer cover in the same handbook comes at one of two named levels, Comprehensive Cancer Cover and NHS Cancer Support, and the certificate tells you which you hold (page 5). The side-by-side wording is on cancer cover, mental health cover and therapy cover. If you want to know how many physiotherapy or talking-therapy sessions a plan you are weighing would pay for, the broker can explain that plan's limit on the free call-back.

What a policy leaves out: chronic, pre-existing, emergency and routine pregnancy

Chronic conditions. Bupa states plainly that "Treatment of chronic conditions isn't covered" (page 28), and expected flare-ups of a long-term condition are treated as part of managing it. The exception is unexpected acute symptoms of a chronic condition that do not need prolonged treatment, as long as the treatment is likely to lead quickly to a complete recovery or quickly get you back to how you were before the flare-up. Bupa's own example is that "treatment following a heart attack as a result of chronic heart disease is covered". A second exception covers eligible treatment of cancer and mental health conditions where the certificate shows you have that cover.

Conditions you already had. AXA's wording is that the plan "is designed to cover necessary treatment of new medical conditions that arise after you join" (page 7). How far earlier history is excluded depends on how the policy was underwritten at the start; do insurers cover pre-existing conditions goes through the routes.

Emergencies. AXA says that "There are some conditions and treatments that the NHS is best at handling – emergencies are a good example" (page 7). Bupa's exclusion is specific: treatment in an NHS or private A&E department, urgent care or walk-in clinic "isn't covered" (page 27), and so is treatment following an admission through one. The exception is eligible treatment with a consultant in a recognised facility once you are no longer being treated in the A&E department, urgent care or walk-in centre.

Routine pregnancy. AXA writes "Few health insurance plans cover pregnancy and childbirth because they are not illnesses, and the NHS is set up to deal with them" (page 8), and its pregnancy section rules out the antenatal and postnatal monitoring and screening you have along the way (page 29). It does pay the additional costs of medical conditions that arise during the pregnancy, such as ectopic pregnancy or post partum haemorrhage. Bupa's list excludes "childbirth and delivery of a baby" but names miscarriage and the same kinds of complication as exceptions (page 35). The maternity pages cover what is on offer and the waiting periods.

Questions to put before you rely on any list of cover

  • Which of cancer, mental health, therapies and out-patient cover are on the certificate, and which are only in the brochure?
  • What is the out-patient limit, and does it apply to scans as well as consultations?
  • Which hospital list does the plan use, and is the consultant you have in mind on it?
  • How does the plan treat a condition you have had symptoms of before, under the underwriting route offered?
  • What happens if a condition is later classed as chronic: does cover stop, and from when?
  • Is there an option for dental, optical, private GP or treatment abroad, and what does it cost to add?

Short answers on what else is included

Does health insurance include VAT?

No. HMRC's guidance on GOV.UK states that "Insurance transactions are exempt from VAT" (Insurance, VAT Notice 701/36, paragraph 2.1, last updated 25 March 2026). The tax inside a private medical insurance premium is Insurance Premium Tax instead: HMRC's Notice IPT1 says every insurance contract is liable to it unless specifically exempted (paragraph 2.3), and that medical insurance does not get the exemption long-term insurance has (paragraph 5.4.1). The tax page explains how that plays out for employer-paid and personally bought cover.

Does medical cover include repatriation?

Both wordings centre on treatment in the UK. Bupa's exclusions say "Treatment you have outside of the UK isn't covered", except where the treatment is not available here and would otherwise be eligible, and then only up to the cost of the standard UK alternative (page 33); AXA's Extended Cover Option pays for treatment abroad "Up to the cost we would pay for equivalent treatment in the UK", provided a medical practitioner carries it out and AXA agreed the fee before you went (page 7). Neither clause is about getting you home, so if that is what worries you, ask the broker on your call-back whether a plan or its travel add-on would handle it, and compare travel and international cover.

Who does private health insurance cover?

The person named on the policy, and anyone added: a partner, children, or a whole household. What each person has is shown on the certificate, so check cancer and mental health cover for every name on the policy rather than assuming they match.

Does health insurance cover private GP appointments?

In AXA's handbook it is an option, not core cover: the Extended Cover Option lists fees for visits to a private GP for consultations at "Up to £500 a year" (page 7), so it applies only if you added that option. Bupa's guide takes a different route: outside its Direct Access areas of cancer, muscles, bones and joints, and mental health, it wants you to start with "one of our free digital GP appointments" or with your own GP, who makes the referral (page 6). See private GP access through health insurance.

What should private health insurance cover?

That depends on which bills you could not comfortably meet yourself and which you are happy to leave to the NHS. The hospital core is the base; out-patient cover, cancer, mental health and therapies are the lines to decide on deliberately rather than inherit by default.

To see these layers priced, request a call-back with the form and a broker will ring you, free of charge, to run through what each option adds.