What Does Private Medical Insurance Cover?

Get My Instant Quotes
Compare Top UK Insurer Quotes Logos

Health Insurance Coverage Explained

Health Insurance covers you for treatment of acute medical conditions in private healthcare facilities

It provides you with faster access to healthcare treatment with no waiting lists, in hospitals with facilities such as private rooms and round-the-clock visiting hours.

Most Private Health Insurance covers inpatient treatment as standard; depending on how comprehensive your policy is, you may also have outpatient treatment covered.

Inpatient and Outpatient Health Insurance Coverage

Medical treatment is split into two key components:

  • Inpatient treatment
    Most Health Insurance policies cover inpatient treatment as standard – it’s known as ‘core cover’. This involves an overnight stay in hospital, such as if you’re admitted for surgery. Day patient cover, a subset of inpatient cover, usually involves minor operations where you have a hospital room but are discharged the same day.
  • Outpatient treatment
    Depending on how comprehensive your Health Insurance cover is, outpatient treatment may be paid for in full, covered up to a set limit, or not covered at all. Outpatient treatment encompasses all medical care that does not require a hospital bed, such as diagnostic tests or treatment such as physiotherapy.

Why Outpatient Cover?

Some people choose inpatient-only Health Insurance coverage because they’re looking for a cheaper policy.

The advantage is that inpatient-only Health Insurance is a low cost option however the downfall of this is that you’ll need to use the NHS for outpatient care, which could delay your treatment.

What’s generally referred to as ‘Comprehensive Medical Insurance‘ will tend to cover both inpatient and outpatient care in full. Given you’re far more likely to need outpatient treatment than a serious inpatient medical intervention the level of outpatient cover has a significant impact on the cost of your Medical Insurance.

Health Insurance Covers Acute Conditions

Private Health Insurance policies are there to cover acute conditions rather than chronic ones.

Broadly speaking, the difference between chronic and acute conditions is that acute conditions can be cured with treatment, but chronic conditions remain with you forever.

Acute conditions include:

  • Joint pain treatable with arthroplasty (joint replacement)
  • Appendicitis requiring removal of your appendix
  • Broken bones
  • Cataracts
  • Hernias

Chronic conditions include:

  • Asthma
  • Arthritis
  • Heart failure
  • High blood pressure (hypotension)
  • Psoriasis

Acute conditions may lead to chronic conditions. For example, someone who has a heart attack might later go on to develop congestive heart failure due to damaged heart muscle. Heart failure is a chronic condition as it can’t be reversed.

Nadeem Farid Head of Employee Benefits at Drewberry

The difference between chronic and acute conditions isn’t severity – it’s the likely outlook for that condition with treatment.

For example, although one is far more severe than the other, both a cold and a heart attack are acute conditions because, assuming you receive the necessary medical care, both can respond to treatment and then pass.

Nadeem Farid
Head of Employee Benefits at Drewberry

Acute Flare Ups of Chronic Conditions

In some cases, the boundaries are blurred between what’s considered a chronic condition and what’s an acute condition.

For example, although asthma is a chronic condition, an asthma attack is deemed an acute phase of the illness.

This is because with medical intervention/hospitalisation, such as inhalers, steroids, oxygen and nebuliser treatment, the asthma attack can be treatable and you can be returned to your previous state of health, although you’ll still have the underlying chronic condition.

In this instance, admittance to hospital to treat a severe asthma attack may be covered by Private Health Insurance, but it’s best to check with your provider or ask an expert.

Diagnosis of Chronic Conditions

If you develop symptoms of a chronic condition, Health Insurance will cover you to see specialists and consultants up to the point of diagnosis of your chronic health condition.

However, at that point insurance providers won’t pay for the ongoing care for that chronic illness.

So while you’ll be covered to see a private consultant to get diagnosed with arthritis, if you require ongoing medication and GP reviews as a result, this won’t be covered by PMI.

Compare Top 10 UK Insurers
Takes approx. 60 seconds

Private Medical Add-Ons and Additional Cover

Depending on the provider, you may be able to get extra cover with a selection of policy ‘add-ons’. This could increase your entitlement to medical care under the policy.

Psychiatric Conditions

Some Health Insurance policies cover psychiatric treatment as standard, but for most it will be an optional add-on to the policy.

It’s worth noting that how much treatment you’re entitled to under any psychiatric element of your policy will vary from provider to provider and on a case-by-case basis.

This is because some psychiatric conditions may be deemed long-term and chronic, which could mean they’re not covered along with other chronic conditions.

Even if conditions are deemed chronic, some insurers may still pay for initial treatment but only up to a set limit.

This limit might be a cost limit, a limit on the number of days a patient can spend as an inpatient, or the number of outpatient consultant appointments available.

Dental and Optical Care

Whether or not your Health Insurance covers dental care will depend on your provider and the terms and conditions of the policy.

Most policies cover emergency dentistry, which might kick in if you’ve had a tooth knocked out or severely damaged. Another common dental cover is oral surgery, such as wisdom teeth extraction.

However, routine dental – which would cover you for everyday dentistry such as checkups, filings and crowns – is often an optional added extra to PMI.

The same is true for optical care. While surgery to remove cataracts would be covered by most PMI policies, everyday eye care (checkups and glasses etc.) are not typically covered unless you choose an add-on.

Therapies Cover

The main four therapies covered by Medical Insurance providers are:

  • Acupuncture
  • Chiropractic treatment
  • Osteopathy
  • Physiotherapy.

These will only be provided as standard by the best Health Insurance plans that offer a good level of outpatient cover.

Alternatively if it is not included by default some insurers will allow you to add therapies cover to your plan for an additional cost.

Exclusions: What Isn’t Covered by Health Insurance?

UK health insurance is not designed to provide all medical treatment. Some of the things PMI won’t cover include:

  • Emergency care
  • Ongoing management and treatment of chronic conditions
  • Kidney dialysis
  • Fertility treatment/IVF
  • Treatment required as a result of war, terrorism, contamination with radioactivity etc.
  • Normal pregnancy and childbirth
  • Treatment for alcoholism/other substance abuse issues.

This represents some of the most common exclusions from PMI policies but isn’t an exhaustive list. What’s covered will vary by provider and the type of cover you buy.

Need Medical Insurance Advice?

There’s so much to consider when you’re buying PMI in terms of what will and won’t be covered.

That’s why, given the complexity that comes with setting up the most suitable Health Insurance policy, it can be invaluable to speak to an expert who knows the market.

Why speak to us?

We started Drewberry because we were tired of being treated like a number and not getting the service we all deserve when it comes to things as important as protecting our health and our finances. Below are just a few reasons why it makes sense to talk to us.

  • There is no fee for our service
  • We are independent and impartial
    Drewberry isn’t tied to any insurance company, so we can provide completely impartial advice to make sure you get the most appropriate policy based solely on your needs.
  • We’ve got bargaining power on our side
    This allows us to negotiate better premiums for you than you going direct yourself.
  • You’ll speak to a dedicated expert from start to finish
    You will speak to a named expert with a direct telephone and email. No more automated machines and no more being sent from pillar to post – you’ll have someone to speak to who knows you.
  • Benefit from our 5-star service
    We pride ourselves on providing a 5-star service, as can be seen from our 2766 and growing independent client reviews rating us at 4.92 / 5.
  • Benefit from the protection of regulated advice
    You are protected. Where we provide a regulated advice service we are responsible for the policy we set-up for you. Doing it yourself or going direct to an insurer won’t provide this protection, so you won’t benefit from these securities.
  • Claims support when you need it the most
    You have support should you need to make a claim. The most important thing when it comes to insurance is that claims are paid and quickly. We are here to support you during the claims process and make sure it’s as smooth and stress free as possible.
Drew Nelson Health & Wellbeing Expert at Drewberry

We are here to offer impartial and, most importantly, fee-free Health Insurance advice.

If you want to talk through your options to make sure you are looking at the most suitable cover then don’t hesitate to  pop us a call on 02084327333.

Drew Nelson
Health & Wellbeing Expert at Drewberry

Great service assisting me obtain the right product. Would happily recommend Drewberry following their professional and efficient way of working.

Jonathan Chadwick
Compare Top 10 UK Insurers
Takes approx. 60 seconds

Or call us on 0208 432 7333

Compare Top UK Insurer Quotes Logos
Contact Us
Head Office & Pensions and Investments
Millennium Bridge House
2 Lambeth Hill
Personal Insurance & Accounts Payable
Telecom House
125-135 Preston Road
Drewberry London Office MapDrewberry Brighton Office Map
Our Core Principles
  • 1You Come FirstWe are a client focused business who always aim to put you first.
  • 2We are ExpertsTo provide you with the best advice, we need to know our stuff!
  • 3We are HumanWe are real people with feelings who are here to help you.
  • 4We are ProfessionalProviding a 5-star service requires a professional approach to everything we do.
  • 5We are here to EducateWe don't believe in sales, we are here to educate so you can make informed decisions.
Finalist - Moneyfacts AwardsFinalist - Cover Excellence AwardsHighly Commended - Protection Review Awards
Proud member of AMII (Association of Medical Insurers & Intermediaries)Proud member of Money Advice ServiceProud member of UnbiasedProud member of BIBA (British Insurance Brokers' Association)
Cookie Use

Drewberry™ uses cookies to offer you the best experience online. By continuing to use our website you agree to the use of cookies. If you would like to know more about cookies and how to manage them please view our privacycookie policy.