What is private health insurance?

Private health insurance pays towards eligible private medical treatment, mainly for acute conditions that start after cover begins. Exclusions and limits apply. It’s also called private medical insurance.

How private health insurance works

You pay for cover, and the insurer pays eligible claims under the policy terms. How much it pays depends on your chosen benefits and any limits. You may have to pay part of the bill yourself.

You can pay a private healthcare provider directly for an appointment or treatment without insurance. With insurance, you pay for future cover under agreed terms. It doesn’t pay every private bill.

An acute condition is an illness or injury that can respond to treatment aimed at recovery. Chronic conditions need ongoing care or monitoring. Private medical insurance focuses on acute treatment.

People consider cover for access to private appointments or planned hospital treatment. It may offer a shorter wait for eligible care. Appointment availability still matters, alongside the policy’s rules on hospitals and consultants.

The policy terms apply from the agreed start date. Buying insurance after a problem begins won’t usually cover that problem. A later diagnosis doesn’t necessarily change this.

What a policy can cover

Policies vary. A benefit being available doesn’t mean it’s included in every plan. Start with hospital cover, then check the options.

In-patient and day-patient treatment

Core cover includes eligible in-patient and day-patient treatment. In-patient care means admission to hospital with an overnight stay. Day-patient care means admission to a hospital bed for treatment and discharge the same day.

This part of the policy covers eligible surgery and associated hospital care. Check whether consultant and anaesthetist fees are covered and what rules and limits apply.

Outpatient care and other benefits

Outpatient care means consultations, tests or treatment without hospital admission. Examples include specialist appointments and diagnostic scans. Check any limits on this cover. Some policies offer little or no outpatient benefit.

A policy can cover an operation but leave you paying for earlier outpatient consultations. Our guide to outpatient cover explains the distinction.

Check whether consultations and scans share a limit or have separate allowances, and what happens when these run out. How benefits are grouped affects how much the policy pays towards an episode of care.

Other options include physiotherapy and mental health treatment. Check cancer cover closely because treatments and limits vary. Some policies offer dental and optical benefits as optional additions.

Check each benefit separately. Every policy has terms and exclusions, however much cover it offers. MoneyHelper’s guide to private medical insurance gives an overview of common cover and exclusions.

Private health insurance doesn’t remove your right to NHS care.

What private health insurance usually excludes

Private medical insurance doesn’t pay for every kind of healthcare. Common exclusions include the following.

• Pre-existing conditions, subject to the underwriting terms.
• Ongoing treatment and monitoring of chronic conditions.
• Routine pregnancy care and childbirth.
• Cosmetic treatment carried out to change appearance.
• A&E and emergency care.

A pre-existing condition can include a problem that caused symptoms before cover began, even without a diagnosis. The insurer’s definition and underwriting terms decide how it’s treated.

Chronic conditions need long-term management. A policy may cover investigations before a condition is identified as chronic, then exclude ongoing care. Check cancer benefits for separate terms rather than assuming the general rule applies.

Read the exclusions alongside the benefits. A treatment listed as a benefit doesn’t override an exclusion that applies to your claim.

How underwriting affects your cover

Underwriting is the process insurers use to decide your cover terms, including how pre-existing conditions are treated. Two common approaches are full medical underwriting and moratorium underwriting.

Full medical underwriting means the insurer assesses medical information before agreeing terms. It lists any personal medical exclusions when offering cover.

Moratorium underwriting excludes pre-existing conditions under rules about the period before cover started. Some may become eligible later if the policy’s criteria are met. Time passing alone doesn’t make them eligible.

The specialist explains the differences. Our guide to pre-existing conditions and underwriting covers the terms in more detail.

Switching insurer needs care. Continued personal medical exclusions may be available, subject to acceptance. Benefits and other terms won’t necessarily stay the same. Check the new benefits, exclusions and limits before ending your existing policy.

Using private insurance alongside the NHS

Private health insurance doesn’t remove your entitlement to NHS care. You can use the NHS for care outside your policy or choose NHS care even when private treatment is covered.

NHS care remains free at the point of use for most UK residents, although some services have charges. Private insurance adds another route for eligible planned care. Your NHS GP can still be part of your care.

The NHS is there for emergencies. Private insurance excludes emergency treatment and doesn’t replace A&E. The NHS explains when to go to A&E and how to get help.

When care involves private and NHS services, make sure clinicians know what treatment you’re receiving. Check with the insurer before assuming it will pay for a private appointment or procedure.

How making a claim usually works

The process varies by insurer and benefit. Planned care often needs a GP referral. Some services allow direct access under policy rules.

1. Check the insurer’s process and any referral requirement.
2. Contact the insurer for approval before booking private care.
3. Confirm that the hospital and consultant are recognised under your cover.
4. Check any excess, benefit limit or fees you would need to pay yourself.

The insurer may need information to assess whether your claim is eligible. A referral alone doesn’t confirm cover.

Approval for an initial consultation doesn’t automatically cover later tests or treatment. Check again if the proposed care changes. Keep the insurer’s approval details as a record of what was agreed.

If a bill exceeds what the policy allows, you could face a shortfall. Confirm the fees with the insurer before treatment so you know what it will pay.

Insurers may pay healthcare providers directly. Arrangements vary, so check which bills the insurer settles and which you must pay.

What affects the cost of cover

Cost depends on your age, postcode, who’s covered and your chosen benefits. Underwriting and the hospital list affect both terms and cost.

An excess is the amount you agree to contribute towards eligible claims. A higher excess may reduce the cost of cover but means paying more when claiming. Check how frequently it applies and whether it applies separately to each person.

The hospital list sets out where you’re covered for treatment under your policy. A narrower list may cost less. Check that the locations work for you.

Adding outpatient cover or other options can increase the cost. Insurance Premium Tax also applies. Our guide to what affects the cost of private health insurance explains the main factors.

Costs can change at renewal. Check whether cover still fits your ongoing budget, including the excess and treatment you’d need to pay for yourself.

What to check before choosing cover

Start with the care you want covered. Compare the benefits and exclusions against that aim. A lower quote may mean less cover or a different excess.

Check outpatient limits and the hospital list. Look at cancer and mental health benefits if these matter to you. Read the policy documents, including personal exclusions, before deciding.

If your policy covers more than one person, check each person’s terms. They won’t necessarily have the same personal exclusions, and limits aren’t always shared.

With ChoosePrivate, you answer a few quick questions about the cover you want and how to contact you. There are no health questions. A health insurance specialist then contacts you by phone or email. The insurer provides your chosen policy.

A health insurance specialist gives quotes and explains cover, including the limits that affect your choice. To start the conversation, compare private health insurance.

Common questions

Last updated 8 November 2026