Private Medical Insurance

Private medical insurance provides cover for individuals who wish to seek private medical treatment outside the NHS when they are ill. This gives the individual the choice of specialist consultant, the hospital and the timing of the treatment. Unlike critical illness insurance and permanent health insurance, the contracts are renewable on an annual basis and premiums increase with the age of the client.

When looking at cover, it is useful to know that treatment is categorised in the following way:

  • In-patient – when you go to hospital for private treatment or investigations and stay for one night or more;
  • Day-patient – sometimes referred to as day-care or day-case and is when you go into hospital for private treatment or investigations but do not stay in hospital overnight; and
  • Out-patient – when you receive treatment or investigations which do not need you to stay in hospital as either an in-patient or day-patient.

There are a large variety of schemes available from low-cost budget plans offering limited cover, to those that offer wide ranging cover and benefits. Some illnesses and treatments will never be covered but the following are found in most schemes:

  • Usually included:
    • Cover for treatment of short-term (acute) medical conditions;
    • In-patient tests;
    • Surgery; and
    • Hospital accommodation and nursing.
  • Sometimes included:
    • Out-patient tests;
    • Out-patient consultations with a specialist;
    • Overseas cover; and
    • Cash payment for treatment received as an NHS in-patient.
  • Usually not included:
    • Conditions you had before taking out the insurance (commonly known as pre-existing conditions);
    • GP services;
    • Cover for long-term illnesses which cannot be cured (usually referred to as chronic conditions); and
    • Accident and emergency admission.

Conditions or treatments normally outside cover include drug abuse, self-inflicted injuries, out-patient drugs and dressings, HIV/AIDS, infertility, normal pregnancy, cosmetic surgery, gender reassignment (also known as sex change), preventative treatment, kidney dialysis, mobility aids, experimental treatment, experimental drugs, organ transplant, war risks, injuries arising from dangerous hobbies (often called hazardous pursuits).

Whichever scheme you choose, it is likely that your premiums will rise above the rate of general inflation. This is because of factors which affect how healthcare is provided in all western economies. Your choice of cover will affect what you pay, so your premiums will increase with the more specifications you make or want.