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Private medical insurance

Private medical insurance provides the insured person with extra support if they become ill or have an accident. This insurance usually covers the cost of in-patient treatments (for ex., tests, surgeries), day-patient treatments (day care) and out-patient treatments. However, private medical insurance won't cover the cost of chronic, pre-existing or incurable diseases.

Whilst the UK has one of the leading universal health care systems in the world, roughly 1 in 10 still elect to purchase private health insurance that allows them to reclaim the costs of private medical treatment. Indeed the number of people in the UK who purchase medical insurance is only rising, especially amid fears of an under-resourced and over-burdened NHS. That being the case, it’s important to think about whether private health insurance is something you and your family might need, or if you already have it, whether you need to refresh your policy.

In this article we’ll give you the definitive guide to private health insurance, including what coverage it covers, how to choose the best insurance policy for you and your loved ones, plus the top health insurance providers in the market today.

What is Private Health Insurance

Simply put, private health insurance covers the cost of treatment in the private health care system, so if you decide to get treated outside of the NHS, opting for private treatment instead, you can offset some, if not all, the costs.

As per other insurance policies, you will pay an insurance premium, monthly or annually, that keeps coverage in-force. There will be policy terms and conditions, as well as exclusions that determine which kind of situation you will be covered under, and how much money you are able to claim. This will vary from insurance provider to insurance provider, so it is important to be aware of your policy wording and read it comprehensively. If you do have any queries as to when and where you’d be covered, be sure to speak to a policy advisor as soon as possible - it is always better to get any potential misunderstandings out the way before the situation arises.

What does Private Health Insurance Cover?

Whilst the NHS provides free treatment to all UK residents, there are some hospitals and clinics run independently of the National Health service by companies in the private or independent healthcare sector. Unlike the NHS, use of these independently-run services requires payment by yourself or whoever is being treated - this private healthcare can be costly, but purchasing a private health insurance policy can help meet the associated expenses.

Private health insurance will cover both the diagnostics that identify injury, illness or disease, together with the subsequent treatment and necessary steps to recovery, until you are restored back to your original health.

Generally speaking there are two kinds of coverage most commonly available today. The first is inpatient coverage, sometimes referred to as Core Cover.

This is usually the cheapest option and most basic package. It pays for your hospital and treatment costs once you are in the hospital being treated. You might be admitted to a hospital overnight, or taken in for surgery. If you elect to have this done in a private healthcare facility as opposed to the NHS (or even the private wing of an NHS hospital which usually ends up cheaper), then your “core cover” healthcare policy will pay out the agreed sum as per the policy wording.

It will cover a wide range of conditions, plus surgeries and medical specialists’ fees and drugs if you need to spend time in hospital as an in-patient. Do note that any drugs taken as an out-patient (i.e. once you’ve left hospital) will not usually be covered hereunder.

The next option is that of outpatient care, which tends to be added as an extra-coverage to any core coverage you might already have. The two together can be termed as “comprehensive cover”, and will pay for (in addition to the coverage you have as an inpatient) for diagnostics and specialist referrals recommending other medical practitioners such as dieticians, orthoptists or speech therapists for example. You will be able to see specialist consultants, and your insurance policy should cover fees for consultations when you’re being seen as an out-patient to diagnose any eligible condition (having been initially referred by your GP or another doctor). Further to these consultations, you will have the benefit of diagnostic tests that your consultant might ask for to help determine what condition you might have. Whilst you are undergoing these tests, your policy will pay for any private health charges in full, including any fees for analyzing the results.

These are the two main coverages of private healthcare insurance, but as with any insurance product, there are an abundance of extras that you can also add to your policy. This includes:

  • Dental cover (dentist fees)
  • Optician fees (including eye tests, prescribed glasses and contact lenses)
  • Additional out-patient therapy treatment like physiotherapists, chiropractors and osteopaths
  • Mental health (including diagnostic tests, cognitive behavioral therapies, and psychiatric treatment)
  • Travel option for emergency medical expenses when abroad

As you can see there are an array of options available for you to tailor your healthcare policy to your own individual needs - it might almost seem overwhelming, so it’s important to take the time to figure out what type of cover is good for you. Whilst you won’t want to overpay for coverage that you don’t need, you don’t want to be in a position where you find yourself without the necessary financial protection.

In addition to the different coverages available, there are also policies that apply to different types of policyholders:

  • Individual: this covers the sole policyholder only
  • Family Health: this will cover you, your partner and children up to a certain age
  • Child Health: separate from any individual or joint coverage you might have, this covers your child/children only, protecting the limits of insurance available to them. I.e. if you were under a family policy and you happened to use up all policy limits in your treatment, then your children might not have protection until your policy renews or you purchase another.
  • Joint Health: joint health covers yourself and another policyholder, usually a Significant Other, sharing policy limits. It can however be more cost effective, depending on your risk profile.
  • Self-Employed Health

What are the Benefits of Private Healthcare?

With free medical treatment available via the NHS, what are the benefits of using private health insurance to access private healthcare? There are three main benefits:

Waiting Time

The main issue for the NHS today is that of an under-resourced institution that is desperately over-burdened by the number of patients in its care. With this difficulty comes long waiting times, be it for immediate treatment or surgeries scheduled for the future. Whilst you might have to be on the waiting-list for a much-needed heart-surgery for months, this might only be weeks in the hands of a private clinic. Indeed for serious health conditions, time is of the essence, and in many cases can be the difference between life and death. This makes purchasing health insurance an easy choice for many concerned about their well-being, and the NHS’s ability to treat them quickly and efficiently if the time coms.

Choice of Treatment

You will have a much wider choice of hospitals and clinics in the private sector rather than when being treated under the NHS. Many NHS patients just don’t have this luxury of choice when the NHS finds itself at over-capacity throughout the year. Purchasing health care insurance allows you to determine which hospital and medical specialist is right for you and your condition, giving you much firmer control over your diagnosis, treatment and recovery.

Comfort

As opposed to the multi-patient hospital wards that many might find themselves being treated in as an in-patient, private healthcare will usually come with a private room, or indeed just speedier, cleaner clinics. When it comes to your private room, many will find this to be more comfortable and with better facilities such as an ensuite bathroom, dedicated nurse, and TV and WiFi.

What is the Best Health Insurance Plan For Me?

Everyone’s circumstances are different, and as such an insurance plan that is suitable for one might not be suitable for another. If you live by yourself for example with no dependents, then an individual policy will obviously be better suited than a family one. You might have a family that is covered under your employer’s health insurance benefit - however, perhaps there are historical family conditions that need more specialist cover not available under this work perk.

It’s also good to think about how much you want to spend on your insurance premiums, as well as how much risk you want to take on yourself. If it’s on the higher end, then perhaps you’ll consider a policy with a higher excess point that can bring the costs of insurance down.

Finally, take into account your individual health and family history, combining them with the policy’s terms and conditions. Make sure your expectation for coverage lines up with the policy wording, or else you might discover when it’s too late that a condition you really needed cover for is actually excluded.

So, when it comes to the question of who is the best health insurance provider out there, it can come to something pretty subjective. At the same time, you can look to more tangible statistics such as pay-out rates and customer reviews for a more objective evaluation.

As such, here are the top-rated Defaqto Healthcare providers (for individual health) for 2020. Defaqto is an independent financial services reviewer, whose five and four star ratings are trusted in giving an objective opinion on how good a product-offering is. The table is in no particular order, aside from showing the 5 star providers first. 5 stars means defaqto sees their product as an outstanding offering in its field. 4 stars means a good quality offering is provided.

Insurance Provider Defaqto Star Rating
Aviva Health UK Limited 5 Stars
AXA PPP healthcare Ltd 5 Stars
Bupa 5 Stars
Health-on-Line Company (UK) Ltd 5 Stars
Saga 5 Stars
The Exeter 5 Stars
VitalityHealth 5 Stars
CS Healthcare 4 Stars
Freedom Healthnet 4 Stars
General & Medical Healthcare 4 Stars
Health-on-Line Company (UK) Ltd 4 Stars
WPA (Western Provident Association) 4 Stars

Health Insurance Cost Comparison

The table below shows costs for comprehensive care (i.e. in-patient and out-patient) for a healthy non-smoking thirty-year old male. As you can see, the excess is the same for each, and applies per annum.

Insurance Provider Per Month Cost Excess Inpatient Cover? Outpatient Cover?
General and Medical £23.72 £250.00 Yes Yes
Bupa Fundamental Health Insurance £36.74 £250.00 Yes Yes
Aviva £37.23 £250.00 Yes Yes
Axa £38.06 £250.00 Yes Yes
Health-On-Line £43.35 £250.00 Yes Yes
The Exeter £48.35 £250.00 Yes Yes
Vitality £49.63 £250.00 Yes Yes
CS Healthcare £56.96 £250.00 Yes Yes
Freedom £71.46 £250.00 Yes Yes
WPA £74.85 £250.00 Yes Yes

FAQ’s

How Can I Bring The Cost of My Medical Insurance Down?

Much like life insurance or critical illness cover, your medical insurance is determined in large part by your own health and risk factors. Some, such as age is something you can’t do much about, however, improving your general health and fitness can do a lot to not only bring down the cost of your insurance policy, but also improve your overall well being itself. Other ways to decrease your annual insurance outgoings included agreeing to pay a higher excess per claim, and also looking for a no-claims discount that can potentially bring your costs down year-on-year.

Are my children covered?

Depending on what coverage you purchase, your children can be covered under the medical insurance policy you elect to buy. Whilst you can obtain a medical insurance policy on the basis of an individual policyholder, there are many policies that allow you to add coverage for your children in addition - this coverage will usually last until they are eighteen years old.

Are Emergencies Covered?

Emergencies and trips to A&E are all paid for and treated under the NHS - private healthcare insurance is designed to cover treatment following a referral by a specialist or local doctor.

Will My Healthcare Insurance cover me abroad?

As a general rule, healthcare insurance does not automatically come with worldwide coverage that allows for treatment abroad and when traveling. However, speak with your insurance provider about adding this on to your healthcare policy, or alternatively buy a travel insurance policy to meet those needs as and when they arise.