Private Medical Insurance (PMI) in depth: how can I get the best from my policy?

There are many different private medical insurance (PMI) policies, so finding the right blend of cover, expertise and cost for your needs is essential. Here are some important choices to think about
PMI could give you faster access to medical care, consultations, procedures and operations than public health services. According to research from the Independent Health Providers Network in 2024, 45% of people who use private healthcare do so because they couldn’t get NHS appointments quickly enough.1
That means less disruption to your working, social and family life and less time worrying about your health. You can find out more about the benefits of PMI in our Essential Guide.
Am I already covered?
It seems like an odd question to ask, but before taking out a personal PMI policy it’s important to check whether you already have health cover. Some employers offer PMI as an employee benefit.
Even if you have PMI through work, taking out your own policy gives you more control over who and what is included. For example, you might look at coverage for your parents – but this is rarely available through a work arrangement.
And, of course, a PMI policy through your employer will only cover you for the time that you work for them. Having your own policy gives you the flexibility to continue the same protection, wherever you work.
- If you leave or retire, you might want to transfer the cover that you had at work (which may include any pre-existing conditions) to a personal policy. This is often possible – but you’ll need to act fast. The window to transfer across from one to the other is short, and can be as little as 30 days.
What can affect the cost of my PMI?
Some of the basics that determine your policy premium (i.e. the amount of money you pay for PMI each year) include your age, where you live, and who you want to include on the policy, such as children or partners.
But there are other design choices that can affect your policy premiums, so take some time to decide what’s most important to you. For example:
- Do you want to choose a particular hospital or consultant for your care, or are you happy to be guided by the insurer?
- Would you consider having some care on the NHS, depending on waiting times, alongside your private care?
- What are the absolute essentials that you want to include in your policy? For example, you might want to include all operations and hospital stays in your policy but set a maximum limit for consultant or out-patient costs.
- What level of excess do you want to include (i.e. the amount you pay towards the total cost of your claim)? A higher excess could mean a lower overall premium.
- Do you want cover to be UK only or include another location, to protect you in a second home overseas, for example.
These are just some of the factors that can affect your policy cover and premium. It’s essential to talk to an expert who can explain all of the choices and options available.
Is there anything that won’t be covered?
PMI is designed to cover acute conditions (i.e. short-term illnesses that respond quickly to treatment and injures such as a broken bone), rather than chronic conditions (i.e. a long-term illness, such as diabetes). One exception to this rule is cancer, which although a chronic condition, is included in full in most policies.
Often a policy will provide cover until you are diagnosed with a chronic condition. Once diagnosed, your insurer will let you know the date that routine monitoring and routine treatment will stop being covered. After this date you will usually only have cover for flare-ups of the condition where in or day-patient treatment is required.
If you have a pre-existing condition (i.e. something you’re already being treated for, had symptoms of or taken medication for) when you take out your policy, this may not be included in your cover.
PMI policies will also have an age cut-off point (typically 21, 25 or 30) for adult children. Beyond that point, they will need their own cover. You might, want to consider taking out a separate policy for each of your children once they are no longer eligible as a dependent until they are able to fund their own cover, or secure a policy through their employer.
When should I take out PMI cover?
The best time to buy PMI is when you don’t need it. Think about taking out a policy when you are fit and well, and don’t have any pre-existing conditions.
Mercer Marsh Benefits can help you to explore your policy and premium options. We'll talk to you to understand your needs, search the market and present you with choices, enabling you to make an informed decision. We will also be there to make sure that your PMI policy continues to be the best option for you at renewal, and any point in-between.
Contact us now to speak to one of the team who will be happy to help you on 0800 031 8152, personalhealthcare@mercermarshbenefits.com
- Head of Consumer Healthcare, Mercer Marsh Benefits