What is Private Health Insurance? Do I need it? How much does it cost?

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13-04-2020

Private Medical Insurance provides access to private healthcare facilities so you can receive fast treatment of the highest standard when you need it most.

  • Receive treatment at a time convenient to you avoiding potentially lengthy NHS waiting list.
  • You’ll get more choice over your treatment, such as where it takes place and the specialist who treats you.
  • Access the latest drugs and treatments, even those not yet routinely available on the NHS.

What Does Private Health Insurance Cover?

Firstly Private Medical Insurance will only cover the cost of treatment for acute conditions, it is not designed to treat chronic conditions.

  • Acute Condition
    A short term condition which is curable with treatment.
  • Chronic Condition
    Is a long term condition which is persistent and cannot be cured.

Cover is defined by the use of a hospital bed. The most basic health insurance will only cover inpatient treatment while more comprehensive policies cover outpatient treatment in full or up to a monetary limit often set at £500, £1,000 or £1,500.

  • Inpatient Cover
    Covers the cost of any treatment where a hospital bed is needed, this can either be over night or as a day-patient.
  • Outpatient Cover
    Covers the cost of diagnostics, consultations and treatment of conditions where a hospital bed is not required.

All policies cover the full cost of treating curable (acute) medical conditions that require an overnight stay in hospital (inpatient treatment) or require a period of time in a hospital bed (day-patient treatment).

Example Treatment & Cover
Suppose an individual needed a joint replacement. The basic inpatient and day-patient cover would pay for consultations leading up to the operation and the operation itself.

Prior to needing a joint replacement the individual suffered a bout of joint pain. Should this individual have outpatient cover it would have paid for all tests, scans and consultations that diagnosed that the joint needed replacing.

The level of cover and type of treatment required will determine the exact process and interaction between the NHS and your Medical Insurance but the main variation depends on whether the policy includes outpatient cover.

No Outpatient Cover

Private Health Insurance No Outpatient Process

With Outpatient Cover

Private Medical Insurance Outpatient Process

Without any outpatient cover you run the risk of having to go through the NHS outpatient waiting list for diagnostic testing and initial consultations, potentially delaying your care.

Extensive Cancer Cover

Taking out Health Insurance provides you with access to cutting-edge cancer treatment, including drugs and procedures that don’t tend to be available on the NHS because the cost is prohibitive.

Other benefits of private cancer care can include:

  • Choice of having chemotherapy at home rather than in a clinical setting
  • Cover for the cost of wigs and prostheses that are required as a result of cancer treatment / surgery
  • Money to pay for scalp cooling, to reduce hair loss from chemotherapy
  • Donations to a hospice should you need to stay in one to receive palliative care
  • Access to home nursing for a certain number of days, where a dedicated private nurse will come to your home to check up on you during your treatment.

What is not covered by Medical Insurance?

Where each insurer has their own policy wording we cannot say for sure but there are a number of exclusions which are reasonably consistent across all UK Health Insurance policies.

  • Pre-existing Medical Conditions
  • Chronic Conditions
  • GP Services
  • Emergency Services
  • Normal Pregnancy
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Do I Need Private Medical Insurance?

No one can deny that the NHS does a fantastic job but, especially recently, funding and resources have been stretched. This has resulted in delays to care.

According to NHS statistics…

  • At the end of March 2018, an approximate total of 3.84 million patients were waiting to start treatment.
  • Of those 3.84 million people, 2,755 patients waiting to start treatment after a referral had been waiting for more than 52 weeks.
  • In 2017/18, the median wait for admitted treatments was 10 weeks.
  • Roughly 13% of patients had to wait more than 18 weeks to receive treatment as of March 2018.

Private healthcare can help you skip these waiting lists for all eligible treatment, i.e. an acute condition that you didn’t have before you took the policy out.

How Much Does Private Health Insurance Cost?

How much Private Health Insurance Costs depends on a variety of factors, including:

  • Age
    The older we are, the more likely we are to need medical treatment and so the more a policy costs.
  • Outpatient cover
    Whether you opt for full outpatient cover, outpatient cover up to a set limit or no outpatient cover at all.
  • Location
    Where you’re based in the UK will impact your policy; if you live near expensive hospitals, such as in Central London, you’ll pay more for your cover.
  • Hospital lists
    The list of hospitals you’re eligible for treatment in will affect the cost of your Health Insurance, with more expensive hospitals meaning higher premiums.
  • Excess 
    How much you’re willing to pay upfront for your treatment before the insurance policy takes over, e.g. the first £100 towards your care.
  • Additional extras
    Optional extras on your policy, such as dental and optical cover, will increase the cost of your premiums.

To work out the average cost of Health Insurance below, we’ve searched all the major players in the UK market and assumed:

  • All the individuals are in good health
  • They’re non-smokers
  • They’re looking for a mid-range policy with a mid-range hospital list
  • They’re willing to pay a £100 excess
  • They’ll be underwritten on a moratorium basis
  • They don’t want any additional extras on their policy
  • They’re based in the same postcode as our Brighton office.

Examples of the Cost of Health Insurance

With these assumptions we have calculated pricing of a Mid-Range Health Insurance policy for different age groups as well as for individuals, couples and families.

Cost of Health Insurance for Single Individuals

25 Year Old
50 Year Old
£63 per month
£113 per month

Cost of Private Health Insurance for Couples

30 Year Old Couple
£125 per month

Cost of Private Medical Insurance for Families

Family with 35 Year Old Parents
13 and 11 year old children
£200 per month

Health Insurance Underwriting Options

One of the most important decisions to make when setting up your Private Medical Insurance is the type of medical underwriting you choose. When taking out a personal policy you have a couple of options:

Moratorium Underwriting
The most common type of medical underwriting for Health Insurance. Rather than asking about your medical history in full it simply excludes most pre-existing medical conditions you’ve suffered from over a set period, usually the past 5 years.

Full Medical Underwriting
You will need to disclose your entire medical history to the insurer from the start. As a result the insurer will take your health into consideration and any exclusions due to pre-existing medical conditions will be set out from the inception of the policy.

Which Medical Underwriting Is Best?

There is no hard and fast rule whether moratorium or full medical underwriting will be the best option for you, so much depends on your personal circumstances and your state of health.

To ensure you choose the most appropriate underwriting speaking to an expert can really help, if you need any support please do hesitate to pop us a call on 02074425880 or email help@drewberry.co.uk.

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Common Health Insurance Questions

  • Is Health Insurance Worth it?

    This depends on your stance.

    Obviously, we’re very fortunate in the UK to have the NHS for our healthcare needs, which is free at the point of use. This ‘cradle to grave’ health service means that you never have to pay out of pocket for healthcare in the UK if you don’t want to.

    However, the NHS has come under increasing strain in recent years thanks to an older, sicker population. As the population ages and faces other health problems, such as obesity and type 2 diabetes, you may find your care under the NHS is slower than you’d prefer.

    You can face waits of weeks for outpatient consultant appointments before you even get near to having inpatient surgical treatment.

    Private Health Insurance, while it won’t replace the NHS entirely in areas such as cover for emergencies and chronic conditions, is designed to supplement the NHS and speed up your care for eligible acute conditions.

    Whether this is worth it or not depends on whether you value faster, more efficient care and can afford to pay the premiums to skip the NHS waiting lists.

  • Why is Private Healthcare Better?

    Private healthcare isn’t necessarily ‘better’ than the NHS. In many cases, the same consultants and surgeons will work for both the NHS and the private sector.

    The NHS does a fantastic job with the resources it has, but there has been a funding squeeze in recent years that has made it harder for it to provide all the services that patients require in a timeframe to suit them.

    For instance, the NHS may ration world-leading drugs for cancer because of their high cost, either declining to fund them or only doing so on a case-by-case or ‘postcode lottery’ basis. Private Health Insurance, on the other hand, will typically cover all available cancer drugs in full.

    The difference between private healthcare and the NHS is largely the speed at which you’ll be seen and the choice you have over your treatment in terms of facilities you can visit and consultants you can see.

    The facilities you visit may be superior to the NHS in that you’ll typically have a private, ensuite room and friends and family can enjoy round-the-clock visiting hours. There’ll also typically be a better quality of the dreaded hospital food! However, these are generally ‘nice to haves’ rather than essential healthcare services.

  • Can You Go to a Private Hospital Without Private Health Insurance?

    No, you don’t have to have Private Health Insurance to go to a private hospital. There are a number of hospitals that allow you to self-fund treatment.

    However, this can be an expensive option. A surgical procedure such as a hip or knee replacement can cost more than £10,000 just for the procedure, without any additional costs associated, such as x-rays, scans and outpatient followup appointments.

    So, while self-funding private healthcare is possible, it’s only really an option for wealthier people. Private Health Insurance, on the other hand, spreads this cost out into what could be more affordable monthly payments.

  • What is a Pre-Existing Health Condition?

    A pre-existing condition is any condition you suffer from prior to taking out the policy. It will typically be excluded either for a set period or indefinitely from your policy.

    How pre-existing conditions are treated when it comes to Private Health Insurance and whether or not they’ll be covered depends on the type of underwriting you choose.

    Moratorium Underwriting

    Moratorium underwriting excludes most pre-existing medical conditions you’ve suffered from over a set period, usually the past 5 years.

    Moratorium underwriting is the most common type of medical underwriting for Health Insurance is divided into plans underwritten on a rolling moratorium or a fixed moratorium basis.

    Rolling Moratorium Medical Underwriting

    The vast majority of Health Insurance is written on a rolling moratorium basis.

    Rolling moratorium underwriting means the insurer will consider any claims for medical conditions that you’ve suffered from in the 5 years before taking out the policy, providing you’ve served 2 years on the policy without any advice, medication or treatment for that condition.

    This includes both self-funded private treatment or NHS treatment.

    Fixed Moratorium Medical Underwriting

    Fixed moratorium underwriting is a more lenient type of underwriting that rolling moratorium underwriting.

    It still excludes any medical conditions you’ve suffered from in the 5 years leading up to the policy start date.

    However, once you’ve served 2 years on the policy, the insurer will then consider covering you for that condition, regardless of whether you’ve received treatment for that condition or not over those 2 years.

    It’s important to realise that often the most serious conditions — such as cardiac and cancer cases — are unlikely to be eligible for fixed moratorium underwriting.

    Only one insurer still uses fixed moratorium underwriting for its Medical Insurance, however.

    Full Medical Underwriting Health Insurance

    Buying fully medically underwritten Health Insurance means you disclose your entire medical history to the insurer from the start.

    This lets your insurer take your health into consideration when deciding how to provide you with cover.

    You provide your medical history through a health declaration form, which will ask a set of questions about your health and previous medical conditions.

    Depending on what comes up on the form, the insurer might write to your GP for further evidence of your medical history to back up the underwriting.

    Any disclosures on the health declaration form or that later come up if the insurer decides to write out for your medical history will result in an exclusion for that condition.

    With full medical underwriting, any serious condition you’ve suffered from in the past will likely be excluded, even if it occurred more than 5 years ago.

    This exclusion will usually be permanent, although it may be possible to get it lifted at a later date with medical evidence from your GP.

    For more minor conditions, however, you may be able to negotiate coverage with your insurer, particularly if that condition occurred a number of years ago.

  • Do I Have to Renew My Health Insurance Every Year?

    Private Health Insurance does go through a renewal process every year like car insurance. This means that every year there’s an opportunity for you to revisit the market and ensure you’re still getting the best deal.

    Many Health Insurance providers auto-renew policies, which means that your policy will roll over at the end of each year and automatically continue with the same provider. There is the potential that this could lead to more expensive insurance over time, so it always pays to revisit the market periodically to ensure you’re getting the best deal.

  • How Can I Reduce the Cost of Private Health Insurance?

    There are many ways to reduce the cost of Private Health Insurance.

    The main options to consider are:

    • Adding an excess
      An excess refers to how much you’ll have to pay upfront for private medical treatment. It’s usually per person on the policy per policy year. So if you had a £100 excess, you’d need to pay for the first £100 of treatment you have in any given policy year. The larger your excess, the cheaper your premiums will be.
    • Adding the 6 Week NHS Wait
      With this option, if the treatment you need is available on the NHS with a wait of less than 6 weeks, you’d need to use the NHS for your treatment. It’s only if the treatment you need either isn’t available on the NHS or the wait is longer than 6 weeks for treatment that your Health Insurance kicks in.
    • Reducing Outpatient Cover
      Outpatient cover refers to all treatment that doesn’t require the use of a hospital bed, such as tests, consultant appointments, x-rays and scans. You can limit the amount of outpatient cover you receive per policy year to reduce the cost of premiums.
    • Review Your Hospital List
      You have multiple ‘tiers’ of hospitals available to you when you take out a Private Health Insurance policy. The best hospitals and facilities are those in Central London; they’re also the most expensive facilities in the country and you therefore pay a premium for having access to them. A lower tier of hospitals might exclude Central London but still give you access to a range of national private facilities.
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Compare Best 5 UK Health Insurance Providers

Below are the top 5 Health Insurance companies in the UK. To read more about them, check out our Health Insurance review pages here >>

aviva

Aviva

Aviva is the largest insurer in the UK. Aviva’s PMI offering is their Healthier Solutions product, which you can tailor to your own budget.

  • Underwriting
    Full Medical Underwriting / Moratorium / Continued Personal Medical Exclusions
  • Excess
    £100 / £200 / £500 / £1,000 / £3,000 / £5,000 per year
  • Core Cover
    Inpatient and day-patient / cancer cover
  • Outpatient Cover
    £0 / Reduced (limited to £500 or £1,000) / Full outpatient cover
axa ppp healthcare

AXA PPP Healthcare

Based in Tunbridge Wells, AXA PPP Healthcare has helped people to access healthcare services since 1940.

  • Underwriting
    Full Medical Underwriting / Moratorium
  • Excess
    £100 / £250 / £500 / £1,000* / £2,500* / £5,000*
  • Core Cover
    Inpatient and day-patient / radio/chemotherapy** / Optional mental health cover
  • Outpatient Cover
    Standard or Full
bupa

Bupa

Established over 60 years ago, Bupa is a UK household name. Bupa Health Insurance has two tiers of over: Comprehensive (full inpatient and outpatient care) and Treatment & Care (inpatient-only). Both options include mental health cover as standard.

  • Underwriting
    Full Medical Underwriting / Moratorium
  • Excess
    £0-£500
  • Core Cover
    Inpatient and day-patient / radio/chemotherapy / Mental health cover
  • Outpatient Cover
    Paid in full or with optional limits of £500 / £750 / £1,000
The Exeter

The Exeter

Founded in 1927, Exeter Family Friendly is a mutual Friendly Society with over 60,000 members. The Exeter’s Health Insurance policy is known as The Exeter Health+, which includes mental health cover as standard.

  • Underwriting
    Full Medical Underwriting / Fixed moratorium / Rolling moratorium / Continued personal medical exclusions
  • Excess
    £0 / £100 / £250 / £500 / £1000 / £3,000 / £5,000
  • Core Cover
    Inpatient and day-patient / cancer cover
  • Outpatient Cover
    Paid in full or with optional limits of £500 / £1,000
vitality

Vitality

Vitality (formerly PruHealth) launched in October 2004 as a joint venture between Prudential and South African health insurance provider Discovery. Vitality has an innovative approach to health insurance in their Vitality plan, rewarding you with points and reduced premiums for healthy living.

  • Underwriting
    Full Medical Underwriting / Moratorium / Continued personal medical exclusions
  • Excess
    £0 / £100 / £250 / £500 / £1,000 once a year or once per claim
  • Core Cover
    Inpatient and day-patient / cancer cover
  • Outpatient Cover
    Paid in full or with optional limits of £500 / £750 / £1,000 / £1,250 / £1,500

Get Private Health Insurance Quotes & Expert Advice

Being health insurance brokers we can talk you through your options to ensure you gain the cover you want, without any unexpected limitations.

If you have a pre-existing medical condition we are also able to speak to the underwriters at each insurer to try and gain you the most favourable terms available in 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 2872 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.

I had a great experience with Drewberry, they have a lot of knowledge and expertise with life insurance and income protection and were able to advise me and arrange suitable products. Highly recommend.

Lachlan Mellings
12/08/2020
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Drewberry Ltd registered office: Telecom House, Preston Road, Brighton, England, BN1 6AF. Telephone 0208 432 7333

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