Private Medical Insurance

What does it do?

Private health insurance – also known as ‘private medical insurance’ –  pays some or all your medical bills if you’re treated privately.

It gives you a choice in the level of care you get, and how and when it’s provided.

If you don’t want to use the NHS, it can be very expensive to use private treatment without it – especially for serious conditions.

What does it cover?

Like all insurance, the cover you get from private medical insurance depends on the policy you buy and who you buy it from.

The more basic policies usually pick up the costs of most in-patient treatments – such as tests and surgery – and day-care surgery.

Some policies extend to out-patient treatments – such as specialists and consultants – and might pay you a small fixed amount for each night you spend in an NHS hospital.

The pros and cons of private health insurance

Pros

• Specialist referrals. You can ask your GP to refer you to an expert or a specialist working privately to get a second opinion or specialist treatment.
• Get the scans you want. If the NHS delays a scan, or won’t let you have one, you can use your cover to pay for it.
• Reduce the waiting time. You can use your insurance to reduce the time you spend waiting for NHS treatment, if your wait time is more than six weeks.
• Choose your surgeon and hospital. You can (in theory) choose a surgeon and hospital to suit your time and place, which isn’t possible on the NHS.
• Get a private room. You’re more likely to get a private room, rather than stay in an open ward which might be mixed-sex.
• Specialist drugs and treatments might be available. Some aren’t available on the NHS because they’re too expensive or not approved by the National Institute for Health and Clinical Excellence in England and Wales (NICE) or the Scottish Medicines Consortium (SMC).
• Physiotherapy. You get quicker access to physiotherapy sessions if you have insurance than you likely would through NHS treatment.

Cons

• If you have a serious illness such as cancer, heart disease or stroke, you’ll get priority NHS treatment. NHS hospitals can be as good as, or better than, private hospitals
• Private medical insurance can be expensive – and the price will go up.
• Chronic illnesses may not be covered. Most policies don’t cover chronic illnesses which are incurable, such as diabetes and some cancers.
• Pre-existing medical conditions aren’t usually covered. You might be able to add them to the policy, but this is likely to push the price up

Talk to your expert IQ adviser to answer any PMI questions you may have.