How Does UK Health Insurance Work?

People staying in the UK find themselves lucky to have a National Health Service which is free (at the point of service) if you need medical service. One of the most celebrated institutions is the NHS and in the last year it has repeatedly shown how much it does, and also how useful it is whenever we become unwell and in need of health services.

If you intend to skip waiting on the waiting list, choose your hospitals and doctors, and access treatments not covered by the NHS, there is an option of private healthcare. Private healthcare comes at a cost, however, private health insurance can help cover this cost.

Advantages and disadvantages of private healthcare

There is a huge advantage that comes with private healthcare but it surely comes at a cost. Below are some of the advantages and disadvantages of using private healthcare.

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Advantage include;

  • Quicker treatment
  • You get to choose your hospital and doctor
  • You have your private room
  • Covers treatment not available on the NHS 


  • Quite expensive
  • Comes with exclusions
  • Access usually comes with it
  • Most of the treatment offered by private health care is usually offered free by the NHS.
  • There is usually no A&E department in private hospitals.
  • You might get better care through the NHS
  • Options for your treatment may not be local.

How does private health insurance work?

Private Health Insurance also known as Private Medical Insurance (PMI), pays for tests and surgery, and private medical treatment if you are ill or injured during the policy’s term. It is designed basically for acute illnesses, which are curable and short-term.

A monthly fee is usually paid for the insurance, which is called the premium. When you need treatment, your insurer can then pay while your policy is active.

It is designed to offer healthcare services alongside the services provided by the NHS. For instance, for any appointment you have with your GP, it would still follow through the NHS. But with medical insurance, you could get the following benefits:

  • You are likely to be asked to skip the NHS waiting lists.
  • A choice of where you get treatment
  • A private room
  • A wider range of treatment types

What does it cover?

As it is with every Insurance policy, they can be quite different and they depend on the insurer, but most policies include the following: 

  • An Inpatient: This includes staying in a hospital bed for tests or surgery.
  • An outpatient: this is you do not need to stay overnight. It is purely for consultation treatment.
  • A day- Patient: This involves regular appointments but no overnight stay.

Several options are available when it comes to health insurance. The fewer elements it will cover, the cheaper your policy.

Comprehensive health insurance is usually more expensive and this is because it provides the highest level of coverage. It usually covers you for a long list of treatments while cheaper policies may be more limited.

From a range of options, some health insurers let you pick exactly what is covered from a range of options like:

  • Psychiatric treatment
  • Physiotherapy
  • Treatment for specific diseases like cancer
  • Dental treatment
  • Optical appointments
  • Mental health treatment
  • Medical treatment and nursing at home.

What is not covered?

There is a different limit and exclusion on each policy, but most do not cover the following: 

  • Chronic diseases such as HIV, include ongoing treatment for long-term conditions that are incurable.
  • Elective treatments that you choose to have, including cosmetic surgery and treatment for fertility.
  • A&E departments are run by the NHS so emergency treatments are not covered by private health insurance, treatment for drug abuse, e.g. Spending time in rehabilitation.
  • Treatment abroad, but this should be taken care of by travel insurance
  • Treatment and care during pregnancy, complications, and emergencies are sometimes covered.

Medical conditions you already have are not covered by many policies, for instance, if you have hypertension. Though some policies include some coverage for pre-existing conditions.


Cover limits

Policies come with limits like other types of insurance on how much you can claim. These can include annual limits on:

  • The total amount you can claim
  • How much you are entitled to per condition
  • How much an inpatient or outpatient treatment can claim
  • How much you can claim per type of treatment (e.g. Physiotherapy)

For private treatment, some policies allow you to pay if you have waited six weeks or more for the treatment you need on the NHS.

What types of private health insurance are available?

A lot of policies are on the market and it is important to find one that suits you at an affordable price.

For instance, you could get coverage designed for:

  • Yourself
  • You and your partner, with a joint policy
  • Your whole family
  • Your child

while comprehensive medical insurance covers a wider range of medical services, there are more specific policies that can cover specific treatments including:

  • Dental costs
  • Cancer
  • Optician costs like check-ups or new glasses
  • Medical care during pregnancy

For older folks, they will pay more for insurance. This is because the risk of needing treatment increases as you get older.

How much does private health insurance cost?

The following factors would determine your health insurance policy:

  • Your age, as it cost more as you age
  • Your medical history, EMG if you had diabetes, high blood pressure, or cancer.
  • Your family’s history of conditions like heart disease, stroke, cancer.
  • If you smoke or are overweight, your premium could be higher because of your lifestyle.
  • Including more conditions and types of treatment costs more

The possibility of getting some policies can be affected by these factors. For instance, some insurers do not offer coverage for pre-existing conditions.

How to cut the cost

There are ways you can reduce your premiums.

  • A no-claims discount: once your health insurance has been for a whole, your premiums could get cheaper kg you don’t make any claims.
  • The excess: this refers to the amount you have to pay towards treating yourself when you claim. Your premium can be lower when you choose a higher excess but makes claiming on the policy more expensive
  • Adding a waiting period: this could give you a cheaper cover. It means that if the NHS waiting list is less than your wait period. (for instance, six weeks), you must get your treatment through the NHS. Your policy pays for private treatment if the waiting list is longer.
  • Using nominated hospitals: You can get a cheaper premium if you only chose to be covered at a few hospitals or surgeries. Look out for the ones that are located nearby or offer the specialist treatment or facilities you may need.
  • Improving your health: Some premiums are reduced if you do not smoke or you regularly use a gym.