What does private medical insurance cover?

Having Private Medical Insurance or Private Health Insurance as it is also known, is like having cover for your finances and health at the same time.

If your employment benefits do not cover health insurance, and you can afford to pay for the premium. There is no reason why you should not have a health insurance policy.

What is Health Insurance?

The National Health Services (NHS) entitles British citizens to receive free medical care at the point of use.

It pays for all your medical bills in an NHS hospital or clinic. However, if you wish to use a private facility, you need Private Medical Insurance

Once you have this insurance in place. It will cover the costs of all the tests, treatments, diagnosis, and consultations received in a private practice, during the term of cover. 

In order to access Private Medical Insurance you need to pay monthly fees to an insurance provider. These monthly fees are known as premiums. During the term when the policy is active you can use this insurance to pay-off all the medical expenses that the policy covers. 

Private medical insurance is in addition to the NHS and can be used to pay for treatments that the NHS doesn’t cover.

Here are the benefits of having Private medical Insurance:

  • No delays in accessing treatment
  • The choice of where to get treatment
  • Access to more advanced and wider range of treatments
  • Better facilities such as a private rooms

What does a Private Medical Insurance cover?

Private medical Insurance is primarily for treatments which are acute and can be cured.

Here are the treatments that it covers:

Inpatient care

These are patients who have to stay in the hospital for treatment overnight. 

Outpatient care

Where patients visit the hospital for tests, diagnosis, and specialist consultations and do not have to stay overnight.

Day patient care

Patients who visit the hospital for day appointments but do not stay overnight.

Possible additions to your Private Medical Insurance

The type of cover you get depends upon the clauses of the specific policy you buy. Basic medical insurance plans cover the expenses of in-patients and day patients who visit hospitals for tests and surgery.

Other extended medical insurance policies are designed to cover the costs incurred by outpatients in visiting specialists and getting tests done too. 

Here are some additional options from which your insurance provider will let you pick. Usually for an additional cost to your basic medical insurance policy:

  • Medical treatments at nursing homes
  • Physiotherapy
  • Dental treatments
  • Psychiatric treatments
  •  Optical Appointments
  • More targeted treatments of diseases like cancer

What does Private Medical Insurance not cover?

While your private medical insurance covers acute and curable illnesses, there are many health issues that it will not cover.

These include:

  • Incurable medical conditions, such as HIV, which last long term and have no known cure.
  • Elective treatments which are not required for health reasons, but you choose to undergo without any obligation. Such as cosmetic surgeries and fertility treatments.
  • Emergency treatments, as these are covered by the NHS.
  • Spending time in rehabilitation centres or any other treatments due to drug abuse.
  • If you are getting a treatment done abroad. 
  • There are times when emergencies and complications during pregnancy are covered by health insurance, but overall pregnancy is not covered.
  • Importantly, if you have a pre-existing medical condition, for example diabetes, at the time of purchasing medical cover, it will not be covered.

Limitations to private medical insurance cover

Also, according to the type of insurance you are opting for, the cover limit will vary.

There can be annual limits on:

  • The percentage or amount you can claim on total expenditure.
  • Total cost amount the insurance will cover per condition.
  • The amount that you can claim per visit.
  • The percentage or amount the insurance company is willing to cover for each treatment such as physiotherapy.

There are some medical policies that come with a clause that they will only cover the cost of treatment if you have to wait on an NHS waiting list for 6 months or longer. 

When do you need a Private Health Insurance policy?

It is a personal choice whether to obtain Private Medical Insurance or not. Therefore whether you need it is a personal choice as well.

Here are the reasons why you might want to have medical insurance:

  • When you do not want to wait for your treatment from the NHS. Or there are long waiting lists which you feel will affect your chances of treatment working.
  • You feel that private care is better than the NHS.
  • There are specialist treatments. Such as those for sports injuries. Which are not covered by the NHS and you want the treatments available for them.

When do you not need Private Health Insurance?

You don’t need private medical insurance when:

  • You find the NHS dependable and are satisfied with it for your medical care.
  • Your employment benefits package already has your medical bills covered. 
  • When you have children. You might prefer the NHS because your children get immediate priority there.
  • When you cannot afford the premiums for private health care and only have enough to pay for car, home and other important bills.
  • When you have debts to repay and little disposable income. 
  • Instead of paying regular insurance premiums. Which might only be useful if a medical condition arises. You can choose to pay for your treatments privately. This could prove more cost-effective in the long run. However, it could also prove far more costly in the long run too if you have a costly condition to treat.

In summary, if you want on-demand access to the best facilities, treatments and specialist medical care. Private medicine should be a priority for you.

If you don’t want to wait on long NHS waiting lists for treatment. Or you want access to drugs and tests that are not currently available on the NHS. Then private medical insurance is your best option.  

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