What Exactly Is Private Medical Insurance?

If you do not know about private medical insurance, this article is for you.

What Exactly Is Private Medical Insurance?

We will learn everything about private medical insurance, what it covers, what does not, what are the benefits, and what are the cons of this insurance.

The NHS provides free care to the majority of UK citizens. If you receive private care, health insurance will cover all or a portion of your medical expenses. It allows you control over the type, timing, and level of care you receive. Even though it’s not required, paying for private treatment without insurance may be hard if you don’t want to use the NHS. This is especially true for serious conditions.

What is covered by it?

Private medical insurance is insurance, and how much coverage you get depends on the policy you buy. Most tests, surgeries, and day surgeries are done in a hospital are often covered by basic private health insurance. Some insurance plans cover outpatient procedures (like those done by specialists and consultants) and may give you a small set payment for each night you stay in an NHS facility.

What does private medical insurance leave out?

Typically, private healthcare is not covered by health insurance for:

  • Existing medical problems and organ transplants
  • Costs of regular pregnancy and childbirth, cosmetic surgery to enhance your beauty, injuries from dangerous sports, war, or hostilities resembling a war, and chronic illnesses like diabetes, epilepsy, hypertension, and illnesses linked to HIV/AIDS.
  • Though these aren’t always covered, you may be able to select coverage that includes mental health, depression, and sports injuries.

Would you like it?

It’s largely a matter of preference.

You don’t actually need private medical insurance if you:

  • You would rather receive care outside of the NHS.
  • Simply put, you prefer to go to private hospitals instead of the NHS whenever you can.
  • You wish to be covered for medications and medical care that the NHS does not provide, such as specialized surgery for sports-related injuries (check that the treatment is included in your policy before you buy).

Who wouldn’t require private medical insurance protection?

You don’t require personal health insurance if

  • You have health insurance through your employer’s benefits program, so you’re content to rely on the NHS for your medical care.
  • You’re concerned that your child may become ill because they receive fast attention from the NHS, but you only have enough money for the most basic types of insurance, like home and auto insurance (and life insurance if you have dependants)
  • Instead of paying for private health insurance, you should use your money to pay off your bills as you have no savings.
  • You can pay for individual therapies; if you have enough resources, doing so can be more economical than paying regular insurance premiums for whatever therapy you might require.

Cons and benefits of private medical insurance

Remember that everything depends on the kind of coverage you purchase.


  • Referrals from experts. To obtain a second opinion or specialized care, you can ask your general practitioner to refer you to an expert or specialist who practices privately.
  • Obtain the scans you desire. You can use your insurance to cover the cost of a scan if the NHS delays or refuses to allow you to get one.
  • Shorten the wait time. If your wait time for NHS treatment is longer than six weeks, you can use your insurance to shorten the time you must wait.
  • Select the surgeon and the facility. In contrast to the NHS, you can (theoretically) select a doctor and facility that work with your schedule.
  • Reserve a private room. Instead of staying in a mixed-sex open ward, you can use it to get a private room.
  • There may be specialized medications and therapies available. Because they are too expensive or have not received approval from the Scottish Medicines Consortium or in England and Wales (NICE), several specialized medications and therapies are not offered by the NHS (SMC).
  • Physiotherapy. If you have insurance, you can schedule physiotherapy appointments more quickly than if you were using the NHS.


  • On the NHS, you might receive superior care. You will receive priority NHS care if you have a serious condition like cancer, heart disease, or a stroke.
  • It is pricey, and the cost will increase. Two parents in their 40s and two kids under 10 make up the usual family premium, which can range from £700 to £1,800 annually. By the time you’re older and more likely to need hospital treatment, you might not be able to pay it because premiums increase both annually and with age.
  • Usually, chronic illnesses are not covered. Most policies do not provide coverage for chronic, fatal diseases like diabetes and some malignancies.
  • There may not be any available treatments close by. If you select insurance with an approved list of hospitals and consultants, this may not include the specialist consultant or convenient treatment location you want to see

Is private health insurance cost-effective?

If you think you could need pricey, specialized care, it might be a good value.

If you enjoy sports, for instance, you might desire access to specialized private care that isn’t provided by the NHS, such as surgeons and specialists who exclusively perform private work.

  • You would require insurance that covers the kind of care you would require.
  • Private medical insurance would probably save you money if you had to file multiple claims.
  • Even if you purchase private health insurance, you will still be able to access the NHS.
  • It still serves as a backup plan that will pay for any expenses not covered by your insurance.

If you wish to go private, you have other options.

One out of every five private patients uses savings to pay for all or part of their medical expenses. The typical cost of a hip or knee replacement is £10,000, while an MRI scan starts at £500. Your doctor can assist you in comparison shopping for scan costs.

If you want a professional or second opinion, just pay for a private session. Then, if required, your doctor will recommend that you return for treatment to the NHS.

Consider other insurance options

It could be difficult for you to keep up with mortgage payments or handle the bills if you become ill or hurt and can’t work, especially if you don’t have enough funds or sick leave from your workplace.

Insurance that keeps you out of debt, like income protection, should be your top focus.


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