What Is Covered Under Private Medical Insurance

The National Health Scheme (NHS) resembles a health insurance policy and is available to all citizens of the United Kingdom. However, those who would rather faster treatments skipping the long waiting lits of the NHS opt for private medical insurance. These private medical insurance policies cover for the cost of some if not all private medical healthcare.

They provide policyholders with faster access to healthcare and policyholders do not need referrals from their General Practitioners to get treated.

 Factors To Consider Before Choosing A Private Health Insurance Policy

Before taking out a private medical insurance policy, there are quite a number of factors that should be considered to determine which policy is best suited for you, these factors include:

  • Premiums: The costs of the premiums should be considered to ensure that you can make the payments regularly as missing a payment could affect your policy. Hence, you should keep your eye out for a policy that would match your budget.
  • Out-of-pocket expenses: Usually, health insurance plans come with other expenses such as the deductible amount as well as copayment or coinsurance. These extra charges should also be considered before settling on a policy.
  • Networks: You need to consider whether or not your health insurance limits you to only receiving care from within its network of healthcare providers.
  • Available Perks and Benefits: You should also find out if your insurance plan comes with benefits and what those benefits are.
  • Coverage: Just how much coverage does your plan provide you with.

What Do Private Medical Insurance Plans cover?

An alternative to the long waiting process of the NHS, private medical insurance is considered very appealing by a number of people which generally explains why they prefer to opt for it instead. However, unlike NHS treatments, private health insurance does not cover all illnesses and conditions. As a result, before taking out a private medical insurance policy, it is important to check what coverage it offers to know what it covers and what it does not cover. This way, you definitely would not be surprised to find out that your health insurance plan does not cover the care you need.

Generally this private medical insurance covers could be divided into hospital cover, general cover and ambulance covers. Depending on the state government, ambulance covers are made available with other policies.

  • Hospital Cover :

This cover allows you choose the doctor you want to attend to you. You are also allowed to choose whether or not you would like to either be treated either at a private or public hospital, this is however dependent on which hospital your doctor works at. If you choose to be treated at a private hospital then you would be placed on a waiting list which you have no control over.

On the other hand, at a private hospital, you are immediately attended to and you also enjoy benefits such as private rooms, longer visiting hours, great choice of food to mention a few.

The hospital cover provides coverage for

  • Private hospital treatments
  • Ambulance services
  • Surgeries including major eye surgery, plastic and reconstructive surgery, open heart and bypass surgery
  • All inpatient tests
  • Cost of nursing care and hospital accommodations
  • Reimbursed cash of the amount spent on treatment under the NHS as an inpatient
  • All forms of therapy including physiotherapy
  • Outpatient tests, consultations and treatments
  • Dental care
  • General Cover:

Known as ancillary cover, general treatment cover provides cover for all of the treatment provided by ancillary healthcare providers. This coverage is at the same time dependent on the policy you choose as not all general cover policies cover all healthcare costs. General cover provides coverage for:

  • Dental care
  • Chiropractic treatments
  • Home nursing treatments
  • Podiatry
  • All forms of terapy
  • Eye treatments


  • Prostheses

What Does Private Medical Insurance Not Cover?

As mentioned earlier, while private health insurance policies might provide faster healthcare treatments, they however have limitations to the coverage they provide depending on the policy, you as the insured have decided to take out. These general exclusions to private medical insurance include:

  • Pre-existing Condition:

Sicknesses which policyholders already had or had showed symptoms of in the past are not covered by private medical insurance policies. That is, if you had already been diagnosed and received treatment for a particular illness under the NHS, then your private medical insurance policy does not cover for it.

  • Private medical insurance does not cover for treatments that have been rejected by the NHS. This is because they fund illnesses approved by the National Institute of Clinical Excellence (NICE) and are also available within the NHS. However, policies with much larger coverage also cover approved treatments both within the United States and Europe, although they are more expensive and charge higher premium.
  • Certain private hospitals also lack emergency and intensive care units, meaning that in such cases, treatments can only be provided in public hospitals under the NHS.
  • Chronic illnesses such as HIV, cancer are not covered by private medical insurance policies.
  • Cosmetic surgery or sex reassignment
  • Fertility treatments or normal pregnancy
  • Self-inflicted injuries from dangerous hats
  • Corrective eyesight surgery

Asides the aforementioned, private medical insurance policies do not also cater fo illnesses not listed in the contract. As a result, before signing a policy contract, it is essential that you have an understanding of just how much coverage you are or are not entitled to.

Other Policies to be considered:

While you might not be entitled to full coverage under your private insurance policy, there are also other policies that could be taken out to supplement your health insurance. These policies would provide you with the rest of the coverage you need, thus ensuring that you are protected, these include:

  • Dental insurance
  • Life insurance
  • Accident insurance
  • Critical illness insurance
  • Travel medical insurance

If you want even faster medical treatments without waiting lists or referrals then private health insurance policies are right for you. However, they do not provide as much coverage as the NHS, as a result you might end up having to cover the payment of certain treatments not covered in the policy yourself.