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What does private health insurance include and exclude?

Most private health insurance policies will offer some level of cover for:

• Private treatment
• Hospital accommodation
• Nursing care
• Outpatient treatment (where you don’t stay in hospital overnight)
• Consultations

Extra cover that may be available can include psychiatric treatment, complementary therapies and drugs that aren’t available on the NHS (but that have been approved by the National Institute for Health and Care Excellence).

What are the different types of cover?

There are two main types of private health insurance: fully underwritten or moratorium policies.

Fully underwritten policies

If you choose fully underwritten private health insurance, you will have to give your provider your full medical history. It uses this to decide whether to insure you, and how much to charge.

Moratorium policies

With a moratorium plan, you will only need to give limited information to your insurer.

Buying a moratorium policy is more convenient than going through your extensive medical history with your insurer, but fully underwritten plans can actually be cheaper and you’ll know from day one which conditions you’re covered and not covered for.

Specialist policies

Some insurers also have specialist policies. For example, some only cover you when you have to wait longer than six weeks for NHS treatment. Other policies are designed specifically for the over-55s, or have a special focus on one disease, such as cancer.

Modular, pick-and-mix style policies are increasingly common. These cover you for inpatient treatments but also allow you to add or subtract elements of cover so that you tailor-make your insurance package.

Do you really need health insurance?

The NHS provides comprehensive healthcare that’s free at the point of need. 

Accessing private healthcare, meanwhile, is far from cheap: for example, the cost of hip or knee replacement surgery is easily likely to exceed £10,000. What’s more, the quality of private treatment isn’t likely to be better than that you’d receive through the NHS. So why pay?

The main appeal of private healthcare and insurance is greater choice of where and when you are treated, and the speed and convenience in getting the treatment.

Alternatives to health insurance

What do different private health insurers offer?

WPA

WPA – short for the Western Provident Association – is a not-for-profit private medical insurer originally founded in 1901.

Leading in our tables with a customer score of 74% and a claims score of 82%, WPA is a Which? Recommended Provider.

WPA’s main policy – Complete Health – comes with Core, Mid-Range and Comprehensive levels to choose from. Core provides inpatient and day-patient treatment, a remote GP service and NHS cash benefits (cash payments for time you spend in an NHS hospital). 

The two higher tiers build on the outpatient cover available and add cancer cover, as well as a range of extras such as overseas cover and mental health treatment. Most elements of cover within the three levels can be tweaked to preference.

The flexibility extends to how you want the insurer to calculate your premiums. You can select pricing based around a no-claims discount, which goes down when you claim, or ‘pooled risk pricing’. With this, your premium isn’t directly affected by claims you make but by claims and risk factors across the wider ‘pool’ of customers.

We did notice that its cancer cover – which funds some licensed drugs and therapies that aren’t available on the NHS – won’t cover drugs that haven’t been approved by the National Institute of Health and Care Excellence (NICE). Some providers will offer more extensive cover that includes some drugs that are yet to be NICE-approved.

Customers in our survey were highly positive about various areas of their experience of claiming, from the speed of claims to the choice of consultants available. It was also one of the highest scorers for clarity of terms and conditions.

Aviva

Aviva offers a comprehensive policy called ‘Healthier Solutions’, and a ‘Speedy Diagnostics’ policy.

Healthier Solutions – comes in ‘Limited’ and ‘Full’ tiers of cover. The main difference is that Limited lacks outpatient consultations, diagnostic tests, therapies, non-surgical treatment and outpatient mental health treatment, which come as standard with ‘Full’.

However, there are options to customise using either as a starting point to increase or reduce the cover. Non-standard options, such as inpatient mental health cover, and alternative treatments and therapies, can also be added.

Speedy diagnostics – as the name implies, in the main, this cover ends once a condition has been diagnosed. It pays for prompt access to tests, scans and hospital charges while a condition is being investigated.

Customers in our survey gave Aviva a customer score of 68%, placing it second of six providers rated. Claimants were impressed with the ease of the claims process and pleased with access provided to the services they wanted.

AXA Health

AXA Health is the second-largest health insurer in the UK.

Its Personal Health policy offers as standard inpatient treatment and cancer cover, alongside outpatient surgery, tests and scans.

You can tailor it to increase the range of outpatient cover available and other extras, such as mental health cover, therapies cover, travel insurance and cash contributions towards prescription optician and dentist costs.

AXA Health ranked third in our customer score table, with 63% – near the average of 64%. Respondents in our survey rated the ease of purchasing the policy and the choice of medical professionals available through their cover. 

Bupa

The largest health insurer in the UK, Bupa runs a wide network of private hospitals as well as offering insurance.

You can choose between its Treatment and Care and more expensive Comprehensive levels of cover. Both can be customised, but the core difference between the two is that the latter covers a wider range of outpatient tests and consultations than the former.

This includes a choice between full cancer cover and the more restrictive ‘NHS cancer cover Plus’, which comes into play specifically to cover eligible cancer treatment that isn’t available through the NHS.

Bupa customers placed it fourth (of six) in our survey, with 61%. Customers gave it four stars for choice of consultants available during a claim, matched only by WPA. It received a score of 70% for its claims service, which put it in joint third place with AXA Health.

Saga

Saga provides insurance exclusively to customers over 50. Its policy is underwritten by AXA PPP.

Saga offers three main plans: Super (the most comprehensive) Saver and Support (the least comprehensive).

All cover inpatient and outpatient treatment and cancer cover, mainly varying when it comes to scans, tests, consultations and therapies.

Policies can be tailored to add cash benefits for everyday health costs, and also increase the number of cancer treatments covered.

Saga customers in our survey awarded it a customer score of 60% (5th of six providers rated). It achieved the same ranking when reviewed for its claims service, with a score of 66%. 

Vitality Health

Vitality is well known for its Active Rewards Scheme, which rewards members for keeping fit and living healthily. Members get points for logging healthy activities (eg walking or gym workouts) via activity tracking devices. The points earn members discounts on products and perks with partner companies.

Vitality’s health insurance policy, like most, provides full inpatient cover, cancer care and outpatient surgical procedures as standard – with extras available such as mental health cover and travel insurance.

It has limited standard outpatient cover (£500 a year), but the plan is highly customisable and more cover can be added, with a ‘full cover’ option removing the cash limit.

Vitality Health customers placed it at the bottom of our customer score table with 55%. It also came bottom with its claims score of 61% (compared to an average of 72%).

How do I buy cheap private health insurance?

Speak to a broker for help

Private health insurance is a complicated product so it’s best to speak to a broker, especially if you have had medical problems or need specialist cover for certain illnesses.

To find a broker, check out the British Insurance Brokers’ Association (BIBA) or the Association of Medical Insurers and Intermediaries (AMII).

• Find out more: BIBA’s website
• Find out more: AMII’s website

Cut your costs by tweaking your policy

Once you have picked a policy, you can start to cut costs by tweaking the cover.

Start by considering your choice of hospitals. Most providers will give you a list to choose from and you may be able to cut costs if you opt for a shorter list.

Decide which parts of the cover are really important to you; many insurers allow you to pick and choose from modules. For instance, dispensing with, or reducing, outpatient cover (for the most part, consultations with doctors and scans), can take hundreds off the annual premium.

Some insurers also provide an option of scaling back on fully comprehensive cancer cover by providing cover, for instance, that only kicks in if you need treatments or drugs that aren’t available through the NHS.

Excesses, co-payments and wait periods

Next, think about adding an excess to your policy. If you’re content to contribute to the cost of treatment yourself your premiums will fall – just make sure you can afford to pay the excess.

‘Co-payments’ are a variation on the excess theme. With a co-payment, you commit to paying a percentage of a claim’s cost (say 10% or 15%) up to a maximum amount (say £1,000).

You’ll receive a discount on the premium because you’ll be leaning less on the insurer, but the maximum amount means you won’t find yourself facing unaffordable amounts.

Also consider whether you’d be willing to have some treatment on the NHS. Many policies allow you to choose discounted cover that kicks in only where the NHS can’t provide it quickly (usually six weeks). So, if speed of treatment is your main reason for going private, this can be a good compromise.

Take care if ditching and switching

Private health insurance is a little different than car and home insurance where switching each year brings you savings. Switching policies to get a better price – while certainly not impossible – should be done with care.

If your premium’s gone up and you eye a cheaper deal elsewhere, check what the terms of the switch would actually be before parting ways with your current insurer. Importantly, if you have any medical conditions that are currently covered, make sure the new policy will continue to cover these.

This can be complicated to navigate, so it could be worth consulting an adviser or broker if you’re not confident.

Stay as healthy as you can

Some insurers will give you discounts if you stay healthy. Aviva’s MyHealthCounts scheme, for example, rewards you with up to 15% off your renewal premium if you’re fit and healthy.

Comparing providers of private treatment

Going private for medical treatment gives you extra choice, but it also potentially opens up additional confusion when deciding where to go and working out how much procedures will cost.

Your GP may be able to provide some advice, as might your health insurer.

Another source of information worth considering is the Private Healthcare Information Network (PHIN), which was tasked by the Competition and Markets Authority to help make the private healthcare more transparent to consumers by compiling and publishing data on private hospitals and consultants.

You can use PHIN’s website to compare options in your area, including customer ratings of local private hospitals and fees charged by different consultants.

• Find out more: The PHIN website

How to claim on your private health insurance policy

Step 1: Read your policy document

Different health insurers have different claims processes. If you’re planning to seek private treatment, read the small print of your policy or check your insurer’s website to see whether there’s specific guidance.

Step 2: Speak to your GP

Start by speaking to your GP about your condition as you normally would. Your GP can refer you for private treatment. There are two main types of referral: an open referral, where your GP doesn’t address the letter to a specific consultant; or named referral, where a specialist is listed on the letter.

Read the terms and conditions of your policy to check which one your provider will want.

Step 3: Call your private health insurance provider

Next, call your provider and explain the situation. What you’ll need when you call will differ from provider to provider, but consider the following:

• your policy number
• details of what your GP told you
• details about your condition
• details of your referral.

Step 4: Call your private health insurance provider (again) once you have seen a specialist

Once you have seen a specialist, call your provider again to let them know what steps will be taken next. Also, make sure you understand how you’ll pay for any consultations or treatment – either you’ll have to pay and claim the money back, or you’ll provider will pay directly.

Step 5: Don’t be afraid to complain

If your claim doesn’t pan out as you expect, or you feel your insurer has treated you unfairly, don’t be afraid to complain.

Speak to your provider first, but if it isn’t proving helpful (and you’ve exhausted their complaints process) take the matter up with the Financial Ombudsman Service by calling 0300 123 9123.