Private Health Insurance (PHI) refers to an insurance policy designed to meet some or all of the costs of private medical treatment. It is also known as Private Medical Insurance. Simply put, you pay a monthly sum to an insurer and they pay for your treatment in a private medical facility when you need care, although there are some exceptions (noted below) which are not funded by private health insurance.
Usually PHI is provided by way of an indemnity policy – that is, it pays out to cover the cost of private treatment for an acute illness or injury on a short-term basis. This could include a private room in a hospital, surgeons’ and other specialists’ fees, or outpatient treatments like physiotherapy or diagnostic procedures.
There are three main types of private health insurance policy;
- Fully underwritten policies
If you choose fully underwritten private health insurance, you will need to give your provider a full, detailed breakdown of your medical history. It is important to disclose everything as failure to do so can cause you to lose cover at a time you most need it.
- Moratorium policies
To be covered by a moratorium plan, you only need to give limited information about your medical history to your insurer.
These policies are therefore more convenient and quicker to apply for, however moratorium plans are usually more expensive as the insurer cannot be as sure what medical treatment you are likely to need in the future.
With fully underwritten policies, you will know from day one which conditions you’re covered for, and which you’re not.
- Specialist policies
Some insurers also have specialist policies which will, for example, cover you only in the event that you have to wait longer than six weeks for NHS treatment. Other policies are designed specifically for the over 55s, or have a special focus on one disease, such as cancer or heart disease.
Some pick-and-mix style policies are now becoming available too.
These policies allow you to tailor make your cover to suit your needs and give you peace of mind over those areas of treatment you would most like to be covered.
Private medical care is designed to complement rather than completely replace services provided by the NHS. There are many types of care including emergency care and pregnancy and birth services which are not covered by private medical insurance. However, having PHI has many significant advantages including less waiting time for diagnosis and treatment of serious life-threatening illnesses, better facilities, access to life-saving drugs not available on the NHS, and more comfortable, tailored care.
What does health insurance cover?
There are many different types of health insurance plan to choose from. Some plans cover only basic treatments, whilst others offer more comprehensive cover that may include more specialist and costly therapies.
All types of health insurance cover you for the cost of receiving medical treatment in a private medical facility, including scans and surgical procedures as an in-patient and as an out-patient. Most also provide you with cover for radiotherapy and chemotherapy to treat cancer and provide access to a GP or other medical specialist when the need arises.
However, the type of cover you buy will determine the level of cover you receive.
For example, access to a GP can vary from access to a 24 hour helpline or a Skype appointment, through to an immediate face-to-face consultation with a private GP. You may prefer online appointments as they are easier than leaving the house or taking time off work, but you may not like the sound of this type of care, in which case, it’s best to check with your provider what exactly is covered in each of their policies, before purchasing.
It’s important to note that there are some things that are never covered by private health insurance. These include; any pre-existing condition you have, any chronic conditions that require long-term, ongoing treatment and Accident and Emergency care.
If you are unsure whether your particular health concerns count as ‘pre-existing’ conditions, consult your insurance broker or provider for more information on your specific queries.
The Benefits of Private Health Insurance
There are many benefits to private health insurance. They include;
Shorter waiting times
Everyone hates waiting and never does the wait seem longer than when it involves your health.
For most people, this is the single most valuable part of having private medical insurance. With NHS waiting times as long as they are, and growing, waiting can mean the difference between getting a problem diagnosed and resolved early enough to stop it in its tracks, and missing that golden window of opportunity.
PHI allows you, and your loved ones, if your plan covers your partner and children, to skip straight to front of the queue and get instant on-demand access to care.
If you require treatment, it can start straight away.
You can therefore receive the essential medical attention you need without having to go through that long, nervous wait for an appointment.
Sometimes, on being diagnosed with an illness, patients decide to ‘go private’ as a way of avoiding the very long waiting lists they encounter within the NHS. However, choosing to pay in this way, at the point of need, can make it unaffordable for most people, as this table below shows.
|Treatment||Cost of private treatment||Average wait time on NHS|
|CT scan||Up to £870||2.2 weeks|
|MRI scan||Up to £1,298||2.6 weeks|
|Cataract surgery||£2,140||12.4 weeks|
|Skin lesion removal||£940||6.5 weeks|
|Knee replacement||£11,814||13.5 weeks|
|Hip replacement||£10,776||13.5 weeks|
Average wait times are for NHS patients in England whose treatment started in Dec 2018.
Scan costs depend on the complexity of scan.
Having private health insurance in place, in advance, before medical emergencies happen is a far better way to pay for care and means that whatever your need, if it’s covered by your plan, you don’t need to worry about costs at all.
PHI is therefore the best way to fast-track lengthy NHS waiting lists without having to have thousands of pounds available to spend on treatment.
Choosing your own doctor
NHS wait times can be very long, especially for rarer conditions that require specialist care.
Another benefit of PHI is that you can choose which doctor you would like to see. This not only means access to top consultants and specialists but that you are also able to build up a relationship of trust with your healthcare professional that means they know you and your health inside out.
Unlike NHS services where you may see a different doctor every time you attend a clinic, and often that doctor will not be familiar with your case and your concerns, with private medical insurance, you can choose any doctor within the network or even outside of it.
With private health insurance, the choice is yours, and you are free to request doctors at the top of their field.
With better hospitals comes better facilities. Private health care facilities are usually less crowded, more luxurious and better equipped than most public healthcare facilities, with the highest quality treatment options available to ensure your medical care is the best it can be, and your visits and your stays are as pleasant and comfortable as they can be.
When you use private health care services, you are assured of excellent, modern, state-of-the-art facilities and as a result, a better experience of care.
Unrestricted visiting hours
This is one of those points that you can only appreciate if you have ever been a patient or had a loved one admitted into hospital. Hospitals can be very strict on opening hours, and the number of visitors you are allowed by your bedside.
This can be especially frustrating when you want to be with your loved one for longer periods than the allocated visiting time.
With private health insurance, visiting hours are a thing of the past. In-patients are allowed access to their friends and family at all times, with no-one telling them to leave.
Privacy is a basic human right, and something we all value, especially at the times in our lives when we feel unwell, vulnerable and emotional.
Busy, noisy, crowded public hospital wards can leave patients wanting for privacy, and the necessary peace and quiet needed to rest and recover.
Private conversations can be overheard by those in the beds next to you and the noisy conversations of others around you can impede your ability to rest.
With private health insurance, you are guaranteed your own private room if a hospital stay becomes necessary. You can have as much privacy as you need, conversations are not overheard by others, and examinations happen behind closed doors, and not just a pulled curtain.
Better customer care
Have you ever called your insurance company and struggled to get someone to respond straight away to your enquiry? We’ve all been there, and know how frustrating it can be. With private health insurance, there are no worries about not being able to get through to someone when you need to speak to them.
As part of your policy you can have access to your own customer care rep, who will be following your progress, and even visit you if you are in hospital to check everything is to your satisfaction, and that you are comfortable, and all your needs are being taken care of.
Access to drugs not provided by the NHS
Some private health insurance policies are designed to cover the cost of specialist drugs that are licensed in the UK but which aren’t available under the NHS.
These types of drugs are only available to those with private medical insurance and cannot be bought as a stand-alone item if the need arises.
There may be caps on drugs spend even with private medical treatment though so it’s best to check on each provider’s policies and plans if this point is of specific concern to you.
However, there is no doubt that, as Cancer Research UK themselves say, “[private] treatment could increase the chance of curing your cancer or controlling it for a long time” because of the speed at which treatment can be obtained and the possible access to life-saving therapies that aren’t available in publicly-funded hospitals.
Cover for Children
Family healthcare policies allow you to tailor your cover to include children if needed.
Some insurers include free cover for children under the age of 18, and some include cover for children up to the age of 25 if they are in further or higher education.
These policies allow for parents to stay with children when overnight hospital stays are required, which matters to many parents who hate the thought of leaving their child alone in a hospital.
Some insurers provide policies separately for children’s care.
Child health insurance provides tailored cover for your children’s healthcare needs as they grow, meaning you have peace of mind that their health care is protected.
One-to-One telephone, online and home support
Under private medical insurance, one-to-one telephone support and online support are commonplace additional benefits of the cover.
Some policies even provide for specialist nurses to visit you to ensure you are receiving all the care and support you need.
Treatment at home for chemotherapy and other therapies
Some policies allow you the choice of whether to receive therapies in a clinic, or in the comfort of your own home, or even at work.
Patients are given the opportunity to receive treatments such as chemotherapy, intravenous antibiotics, blood transfusions, and rehabilitation therapies such as physiotherapy and occupational therapy at home where you may feel significantly more relaxed, private and comfortable.
Specialist nurses are committed to providing exceptional clinical services, worked around your life and your needs.
At present in the UK, private medical care is designed to complement rather than completely replace services provided by the NHS.
There are many types of care including emergency care and pregnancy and birth services which are not covered by private medical insurance. However, having PHI has many significant advantages including less waiting time for diagnosis and treatment of serious life-threatening illnesses, better facilities, access to life-saving drugs not available on the NHS, and more comfortable, tailored care, which means that if you are able to afford cover, it is worth it just for the peace of mind alone.
Private medical insurance can be expensive, but there are cheaper plans available which can make private health cover affordable but give you peace of mind you will be well looked after in the event you become ill.