How private health insurance works in the UK — what is private health insurance uk

Private health insurance in the UK is a policy that pays for private treatment of a condition that starts after you join, so that you can be seen, diagnosed and treated without waiting for the NHS to get to you. This page unpacks the three words doing the work in that sentence: private, treatment, and after. It does not replace the NHS, it does not cover everything, and its price depends on who you are rather than on a tariff anyone can print.

The decision behind the search is usually whether a policy is worth having, and if so what shape it should take. An FCA-authorised broker can price the options across several insurers in one conversation; fill in the form on this page to be put in touch with one. It is free and takes a few minutes. The shape is a quote rather than a rule, because what moves the price is your age, where you live, what you want covered and how much of each bill you will pay yourself, so read on first and you will know what the quote is describing. Private medical insurance, PMI, private health cover: the names are interchangeable, and the questions at the end deal with the few that are not.

What private health insurance is, and what it is not

It is an insurance contract, usually running a year at a time. You pay a premium. If, during the year, you develop a condition the policy covers, the insurer pays the hospital and the consultant for eligible treatment, less any excess you chose. The policy does not pay you; it pays for you. And it pays for a particular kind of illness.

Insurers divide conditions into acute and chronic, cover the first and exclude the second. An acute condition is one that treatment can put right: a hernia, a torn knee ligament, a cataract, gallstones. A chronic condition has to be managed for the long term rather than cured. The insurers write the definition themselves:

"The policy does not cover chronic conditions. A chronic condition is defined as a disease, illness or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests"

— Aviva, Healthier Solutions terms and conditions (April 2025 issue), page 3, read 4 September 2026.

That is the first characteristic in a list that runs longer, and yours will too. Freedom's guide puts the same idea in fewer words: chronic conditions are the "long-term management or maintenance of incurable, prolonged or lifelong conditions" (Freedom Health Insurance, Freedom Elite Policyholder's Guide to Cover, April 2025, page 8, read 4 September 2026). The practical test is whether the treatment has an end. Surgery that fixes the problem, scans that lead to a diagnosis, a course of therapy that finishes: those are what the product is built around. Monitoring that never finishes is not. Where a long-term condition flares up acutely, which side of the line it falls on depends on the wording, and that is a question to ask before you buy.

So the policy is not a replacement for the NHS, not a plan that pays for everything, and not a way of covering something you already have. The next three sections take those in turn.

What the NHS still does once you are insured

Everything the policy does not. Your GP stays your GP: a private policy covers specialist treatment, not primary care, and AXA's handbook draws the line even while offering its own video GP service:

"Your membership provides access to the AXA Doctor at Hand service for video or phone consultations. Your membership does not cover any other primary care services, such as any services that could be provided by GPs, dentists and opticians."

— AXA Health, Personal Health membership handbook (October 2024), page 12, read 4 September 2026.

Emergencies stay with the NHS too. Private hospitals in the main do not run accident and emergency departments, so if you are taken ill suddenly you are treated where the ambulance takes you, and the policy comes in afterwards, if at all, for planned follow-up. Chronic conditions stay there too, and so does anything the policy excludes.

The insurers assume this. Aviva pays you a sum if you choose NHS treatment for something it would have covered privately: "NHS cash benefit* £100 each night, up to 30 nights" (Aviva, Healthier Solutions terms and conditions, April 2025 issue, page 5, read 4 September 2026). Some policies go further. The six-week option, which lowers the premium, says that if the NHS can treat you within six weeks you use the NHS:

"You cannot claim for private treatment as an in-patient or day-patient, NHS cash benefit, NHS cancer cash benefit or for the cost of an NHS amenity bed if your treatment is available on the NHS (including accident or emergency admissions) within six weeks from the date your specialist recommends it. The six week option is not available to residents of the Channel Islands or the Isle of Man"

— Aviva, Healthier Solutions terms and conditions (April 2025 issue), page 11, read 4 September 2026.

What that trade is worth depends on the waits where you live, which private health insurance versus the NHS sets out by specialty and provider.

How a claim works, from GP to hospital

A claim is a chain, and each link is something the policy has a view on.

It starts with a referral. On the wordings we hold, the usual route into private treatment is your GP referring you to a specialist; AXA's scan benefit, for instance, says "A specialist must refer you" (AXA Health, Personal Health membership handbook, October 2024, page 4, read 4 September 2026). Some insurers let you skip the GP for certain conditions. Bupa's guide says: "If it's about: Cancer, Muscles, bones and joints, Mental health use our Direct Access service. This means you can call us about your symptoms without needing a referral from a GP." (Bupa, Bupa By You policy guide, BINS 14718, 2024, page 6, read 4 September 2026.) One policy's exception, not the market.

Then you tell the insurer before anything is booked. The part of any claims procedure that matters is contacting the insurer before treatment rather than presenting a bill after it. None of the extracts we hold sets out the procedure in full; your policy document will.

Treatment happens at a hospital on your list. Policies come with a list of hospitals the insurer will pay for, chosen at purchase. The Exeter offers "A choice of four treatment options: Guided specialist, Essential hospital list, Standard hospital list, and Extended hospital list" (The Exeter, Health+ Insurance Product Information Document, October 2025, page 1, read 4 September 2026). A wider list costs more; a guided option, where the insurer picks the specialist and hospital, usually costs less. Check which hospitals are on which list against where you actually live.

The policy pays by category. In-patient means you occupy a bed overnight; day-patient means admitted and discharged the same day; out-patient means consultations, tests and scans with no admission. In-patient and day-patient treatment is the core of every policy; out-patient cover is where the choices and the limits live. WPA's core cover, for example, pays "Out-patient Treatment Consultations with a Specialist – £250 (increase with the Extra Out-patient Consultations Optional Extra)" (WPA, Complete Health Insurance Product Information Document, November 2025, page 1, read 4 September 2026). The out-patient line on a quote is the one to read twice.

What you have is what the certificate says. Mental health, therapies, dental, optical and fuller out-patient cover are, on several wordings, options rather than core, and Freedom's guide is blunt about the consequence: "If you are covered for any of these additional benefits, they will be shown on the certificate. If an additional benefit is not shown on the certificate, you do not have that cover even though it is mentioned in this guide." (Freedom Health Insurance, Freedom Elite Policyholder's Guide to Cover, April 2025, page 10, read 4 September 2026.) On other insurers some of these sit in the core plan. The policy guide describes everything the insurer sells; the certificate describes what you bought.

Underwriting: what the insurer does with your medical history

Underwriting is how the insurer decides what to exclude for you personally, and it is the reason the product covers conditions that start after you join. Everything before that date is a pre-existing condition, and the starting position is that it is not covered:

"Any conditions, special conditions, pre-existing conditions, moratorium conditions, conditions or symptoms, illnesses or injuries you had before your policy started aren't usually covered. If a special condition applies, we'll send a confirmation of special conditions to the main member"

— Bupa, Bupa By You policy guide (BINS 14718, 2024), page 11, read 4 September 2026.

"Aren't usually" is doing honest work: a pre-existing condition can be covered if the insurer agrees, and a "special condition" is an exclusion written onto your policy and confirmed in writing. How far back "before your policy started" reaches is set by each insurer. Freedom names a period: "We will not cover a medical condition, or a related condition, you had within the five-year period before your cover with us started unless we have agreed to cover that condition." (Freedom Health Insurance, Freedom Elite Policyholder's Guide to Cover, April 2025, page 8, read 4 September 2026.) We hold no equivalent period for the other insurers, so do not read Freedom's as the market's.

How the insurer finds out what you had is the underwriting type, and AXA's handbook lists four: "(full medical underwriting) Continuing medical exclusions Medical history disregarded Moratorium. In the following panels, we've explained how each of these work" (AXA Health, Personal Health membership handbook, October 2024, page 14, read 4 September 2026). In plain words, and in general terms, since the panels themselves are not in the extract we hold:

• Full medical underwriting. You complete a health questionnaire when you apply. The insurer reads it, may ask your GP for more, and tells you up front what it will exclude.
• Moratorium. No questionnaire. The policy automatically excludes conditions you have had in a set number of years before joining, and can bring them back into cover once you have gone a set stretch after joining without symptoms, treatment or advice for them. The years on each side are in the insurer's wording; we hold none, so ask. Simpler to buy, but you find out what is covered when you claim.
• Continuing medical exclusions. For people switching insurers: the exclusions on your old policy are carried across rather than underwritten afresh.
• Medical history disregarded. Pre-existing conditions are covered. It is generally associated with employer schemes rather than individual policies; we hold no clause saying who is offered it, so confirm it.

Whichever route, the outcome is an exclusion or, sometimes, a loading: an addition to the premium for a specific risk rather than its removal from cover. We hold no clause on how any insurer applies loadings, so if a quote carries one, ask what it is for. Which route suits you turns on your own history, and it is the first thing to settle, because it changes what is excluded and what the premium is.

The excess, and the other things you might pay

An excess is the first part of each year's eligible treatment that you pay yourself. You choose the level when you buy, and a higher excess usually means a lower premium. WPA has the mechanism in one sentence: "Where an excess is chosen, you must pay your excess for eligible treatment up to your chosen level per Policy year before we provide benefit." (WPA, Complete Health Insurance Product Information Document, November 2025, page 2, read 4 September 2026.) Bupa's guide shows what it looks like on a bill:

"Helen has some physiotherapy which costs £250. We pay Helen's physiotherapist £150 and we'll let Helen know that she needs to pay the physiotherapist £100 (which is the policy excess). If Helen needs other treatment during the policy year, she doesn't need to pay another excess."

— Bupa, Bupa By You policy guide (BINS 14718, 2024), page 10, read 4 September 2026.

Three things to take from Helen. The excess comes off the bill, so you pay the practitioner rather than the insurer. On these wordings it is charged once a policy year, not once a claim, though not every insurer counts it that way. And it is only paid when you claim. What a private health insurance excess is goes further into each of these.

Two other things can leave you paying. A benefit limit, like WPA's £250 on out-patient consultations above, caps what the insurer pays in a category; once it is spent, the rest of that year's bills in that category are yours. And every policy has an exclusions list. The Exeter's product summary puts it under one heading: "What is not insured? Alcohol, drug or substance abuse. Convalescence & rehabilitation. Cosmetic and plastic surgery. Bariatric and weight loss surgery or treatment. Deliberate self-inflicted injury or suicide attempt" (The Exeter, Health+ Insurance Product Information Document, October 2025, page 1, read 4 September 2026). Add chronic conditions, pre-existing conditions and primary care from the sections above, and you have the outline of what a policy leaves out. The detail is in the wording, which is worth reading before the certificate arrives.

Individual, family and company cover

The same product is sold three ways. A personal policy is one you buy for yourself, underwritten on your own history. A family policy adds a partner and children, with an age limit for children set by the insurer. Whether the excess is charged once for the policy or separately for each person is not something we can state generally: of the wordings we hold, only Aviva's says it is “payable for each member every policy year”, and the others do not settle it. On a family of four that is the difference between paying an excess once and paying it four times, so it is worth asking before you buy.

Company private medical insurance, or group PMI, is a policy an employer buys with its employees as the members. The employer pays the premium and the employee is usually taxed on it as a benefit in kind; the size of the scheme shapes which underwriting routes the insurer offers, which is where medical history disregarded most often appears. We hold no group policy wording, so the terms of any scheme are for the employer or insurer to confirm; what carries over is the vocabulary, because the cover, the hospital list, the out-patient limit and the excess work the same way whoever is paying.

Whoever buys it, you have to be here to hold it. The Exeter's summary states: "You must have the legal right to reside in the UK (England, Scotland, Wales or Northern Ireland) and physically live in the UK for at least 180 days in each policy year." (The Exeter, Health+ Insurance Product Information Document, October 2025, page 1, read 4 September 2026.) It is UK residents' cover for UK treatment, which is why it is not travel insurance.

What treatment costs if you pay the hospital yourself

One way to understand what a policy is for is to look at what it would be paying. The figures below are self-pay prices: the cash cost of an operation as private hospitals publish it for patients paying for themselves, with no insurer involved. They are not premiums and say nothing about what a policy costs. We took them from the hospitals' own price pages on 4 September 2026; each row gives how many hospitals publish a price for that operation and the lowest, median and highest of them.

Self-pay cash prices for treatment, captured 4 September 2026 from the hospitals' published price pages. These are what an operation costs if you pay for it; they are not insurance premiums.

Hospital by hospital, the spread is real: on the same day a knee replacement was £17,000 at both Nuffield Health Highgate and Nuffield Health The Holly, £15,951 at Spire Alexandra and £16,218 at Spire Bristol. Every operation in the table is an acute condition of the kind the product exists for, and the spread is the point about hospital lists made in money: which hospitals are on your list decides which of these prices your insurer pays.

If the right-hand end of that table is the kind of bill you would want a policy to carry, that is the thing to have priced. Fill in the form on this page and an FCA-authorised broker will quote cover from several insurers for your circumstances, with the hospital list and excess set the way you want them.

Common questions

What is the difference between private health insurance and private medical insurance?

Nothing. Private medical insurance, or PMI, is what the industry and the policy documents call it; private health insurance and private health cover are what most people type. All three mean the product on this page.

What is permanent health insurance?

A different product, despite the name. Permanent health insurance is the older term for income protection: a policy that pays you a monthly income if illness or injury stops you working. It does not pay for treatment, and a medical policy does not replace your income.

Does UK private health insurance cover you abroad?

On the wordings we hold, no. Aviva's clause is one line: "Overseas treatment We do not pay for treatment outside the UK." (Aviva, Healthier Solutions terms and conditions, April 2025 issue, page 24, read 4 September 2026.) Treatment while travelling is what travel insurance is for; if an insurer sells an overseas option alongside the policy, ask what it excludes.

What are a health insurance group number, the private health insurance offset and a "private health fund"?

Vocabulary from other countries. Group number and group name are fields on an American insurance card; the UK equivalent on a company scheme is the scheme name and your membership number, both on your certificate. Health fund, offset and benefit code are Australian terms tied to a government rebate on premiums that the UK does not have: an individual gets no tax relief on premiums here.

If this page has done its job, you know what a policy pays for, what it does not, and which four or five choices on a quote are the ones that matter. The one thing it cannot tell you is the price, because that is yours. Fill in the form on this page and an FCA-authorised broker will take it from here.