Health Insurance Quotes Guides

How does Private health insurance work?

With health insurance, or private medical insurance, as it's sometimes referred to, you pay a regular premium, and if you require treatment for an eligible condition, you can claim through the policy, which will cover the associated fees for private treatment in a private hospital.

Health insurance typically covers you for acute medical conditions, which are conditions that respond well to treatment. In addition to treatment, it can cover the costs of specialist consultations, diagnosis, and the aftercare related to a claim. This process is typically much quicker than through the NHS, offering appointment flexibility that suits your schedule.

In this guide, we will explore the key features and terminology associated with private health insurance, helping you understand the language and make informed decisions about your cover.

What does a health insurance policy include?

Usually As Standard

  • In hospital treatment such as an operation
  • Day patient treatment such as minor surgery
  • Specialist consultations
  • Diagnostic tests like x-rays and blood tests.
  • Diagnostic scans such as MRIs
  • Private cancer cover
  • Private GP service (video chat)

Optional

  • Outpatient consultations and diagnostic tests
  • Therapies such as physiotherapy
  • Dental cover
  • Travel cover
  • Mental health cover

Exclusions

  • Long term and incurable conditions (chronic conditions)
  • Emergency care (A&E)
  • Routine check ups
  • Claims without a GP referral (elective treatment)
  • Medical conditions you had before joining (pre-existing conditions)

Leading UK Insurers

Aviva

Information

Originally Norwich Union, Aviva are regarded as being the largest overall insurer in the UK with over 15 million customers. They have won the “Health Insurance Company of the Year” award on numerous occasions. Their Healthier Solutions product is rated…

AXA Health

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AXA PPP Healthcare have been in the market since 1940 and are one of the leading choices for many customers. Their Personal Health product is rated 5 stars by Defaqto. AXA Health UK is a leading health insurance provider that offers…

Bupa Health Insurance Review

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Compare Health Insurance Policies=#152266# BUPA Bupa, established in 1947, is one of the most recognised and trusted health insurance providers in the UK. Known for its comprehensive coverage and commitment to customer care, Bupa offers a range of health insurance plans that…

Vitality Health Insurance Review

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Compare Health Insurance Plans=#152266# Rebranded in 2014 from Pru Health, Vitality Health Insurance has emerged as a leading provider in the UK, offering a unique approach to health and wellbeing. Their innovative insurance products are designed to incentivise and reward individuals…

WPA

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WPA is a non-profit organisation which means money can be reinvested into the business to create a better customer experience. They have a shared responsibility element of cover which allows the client to make a co-payment for treatment costs, this…

Freedom Health Insurance

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Typical Health Insurance claim process

GP referral

All insurers require you to obtain a referral letter from a GP before you can start your treatment claim.

Specialist Consultation

Your GP has referred you for specialist treatment. Typically as an outpatient, which typically involves an initial consultation and diagnostic tests to assess whether additional treatment is necessary.

Hospital treatment

If further treatment is required, it is likely that this will take place in the hospital as an inpatient or day patient, such as for an operation. This could occur in either a private hospital or an NHS hospital with private facilities.

Follow up visits

After your treatment, you may be required to have a follow-up appointment with the specialist to review your care, and you might need some rehabilitative therapies as part of your recovery, such as physiotherapy.

Discharge

When your specialist is satisfied with your recovery, you will be signed off from check-ups and treatment, and you will be discharged. At this point, your claim with the insurer will conclude.

What our users are saying

What Affects Health Insurance Cost?

  • Your Age
  • Your Smoker Status
  • Your Postcode
  • The Amount Of Cover You Choose
  • Your Policy Excess
  • Which Hospitals You Would Like
  • No Claims Bonus
  • Some Insurers Offer A Discount if You're Healthy
Couple considering private healthcare

Choosing a private hospital

One of the benefits of private health insurance is that when you come to make a claim, you can have a say in where your treatment will take place. Most insurers offer two routes for choosing a private hospital: standard and guided.

Standard
When you take out a policy, you will select a list of hospitals, normally two or three are provided by the insurer. Your choice of hospital list will ultimately depend on your location, preferred facilities and budget. When you claim you can select any hospital on your chosen list.

Guided or Insurer-led
With this option, rather than choosing a list of hospitals when you join, your hospital is chosen at the point of making a claim with the help of your insurer. Upon starting your claim you will ask your GP for an open referral. This is where the GP recommends the type of treatment that is required but not a specific person or location. You would need to speak to your insurer, and they will provide a list of pre-approved hospitals to choose from. This is a more cost-effective option.

The Three Stages Of Treatment

Outpatient

Outpatients refer to appointments or minor treatments at a hospital or clinic that do not require an overnight stay or bed. This typically includes specialist consultations and diagnostic tests to assess a condition.

Day Patient

Day patients are individuals who receive treatment at a hospital or clinic without requiring an overnight stay. They typically undergo procedures or surgeries that allow them to return home on the same day after recovery.

Inpatient

Inpatients are individuals who are admitted to a hospital for treatment that requires at least one overnight stay. This typically involves more complex procedures or medical care that cannot be provided on an outpatient basis.

Medical Underwriting

What is medical underwriting?
When you take out a new health insurance policy, the insurer may ask you a series of medical questions to underwrite your policy. This process determines how they will cover you for any pre-existing medical conditions. There are two primary types of medical underwriting:

Full Medical Underwriting (FMU)

An in-depth medical questionnaire which will ask you to provide details about your medical history. In some cases, with your consent, the insurer may contact your GP to request additional information, although this is often unnecessary.

Before you take out the policy, the insurer will inform you about which medical conditions are covered and which are not. As a result you may have specific medical exclusions included in your policy.

Moratorium (MORI)

With the moratorium, you don't need to disclose your medical history when taking out the policy. However, any medical condition for which you received treatment, medication, advice, or showed symptoms within five years prior to the policy start date will be excluded for at least two years.

If you remain symptom and treatment free for two years after the policy begins, the insurer will cover that condition again.

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