The essential guide to Private Medical Insurance 

UK private medical insurance (PMI), sometimes known as private health insurance, is a type of insurance policy that covers you for medical expenses such as operations and health consultancy, using private medical care or facilities. 

Having to wait to see a GP when you feel unwell, then endure a delayed diagnosis and join the back of a long queue for treatment is extremely worrying for anyone. In addition to health concerns, the uncertainty can upset carefully laid plans such as family events, or stop you living life to the full - whether that’s working, socialising or spending time with loved ones. 

PMI could help. It might give you wider treatment options¹, shorter waiting times for operations, more flexible access to GPs or specialists, and more detailed diagnostic tools². You could be seen more quickly, in a private hospital and with technologies, techniques and treatments that might not even be available on the NHS. 

You’ll also have the comfort of knowing that if you need treatment, it’ll be in your own private hospital room, with medical experts who can spend time with you, shape the best treatment plan for you, and answer your questions. 

 

PMI policies vary depending on the insurance provider and the options you’ve chosen. But you can usually be confident, subject to any exclusions, that you’re covered from the moment you see a GP (NHS or privately, in person, by phone or virtual call), and they confirm you need diagnostic tests, treatment or a specialist appointment to further explore your condition or symptoms.   

If it’s included with your policy, you might even be able to go directly to a specialist without seeing a GP.

Once you’ve seen your GP or specialist, you should call your insurer to let them know you’ve had a referral and would like to make a claim. Your insurer will discuss the coverage your policy provides and, in some cases, can even help you to book treatment with a consultant or specialist.

From there, the insurer will usually pay your hospital or specialist directly (subject to any excesses in your policy) and reimburse any agreed costs with you. So, all you need to do is focus on getting better. 

A typical PMI policy may cover services such as:

• In or day patient treatment (e.g. an operation such as a knee or hip replacement)
• Hospital stays
• Virtual and/or private GP consultations
• Consultations with a specialist
• Diagnostic tests such as blood tests, MRI, CT & PET scans
• Cancer treatment
• Mental health treatment
• Dental treatment
• Physiotherapy

Many PMI policies also give you online knowledge resources and tools to help you keep well and prevent future illness. 

PMI is designed to cover acute conditions rather than chronic conditions. An important exception to this rule is cancer, which can be a chronic condition but is usually covered by policies.    

• An acute condition is a disease, illness or injury that responds quickly to treatment. That could include a broken bone, or a torn ligament.
• A chronic condition is a disease, illness or injury that has no known cure, needs long term treatment or monitoring, or requires rehabilitation. Arthritis or diabetes are examples. 

The cost and design of a policy depends on factors such as:

• Your age
• Who you want to insure (for example, just yourself or family members as well)
• Your medical history
• Where you live
• The level of cover you are looking for.

Beyond these basics, everyone will have different priorities for their healthcare, so finding the policy that best suits you is essential. For example, you might want to be able to choose the hospital where you’re treated or include extras such as travel insurance or optical coverage.

Mercer Marsh Benefits (MMB) can do all the hard work to understand your needs, search the PMI market, then share information and quotations from a range of insurers.

We’ll provide you with a dedicated PMI expert with the knowledge and insight to help you choose the right policy. That person will be on hand to answer any questions you might have at sign-up, during your policy year and when it comes to renewal. 

Contact us now to speak to one of the team who will be happy to help you on 0800 031 8152 or email us at Personalhealthcare@mercermarshbenefits.com. 

Footnotes

1. https://www.nice.org.uk/about/nice-communities/nice-and-the-public/making-decisions-about-your-care/information-for-the-public-on-medicines

2. https://www.laingbuissonnews.com/healthcare-markets-content/news-healthcare-markets-content/nuffield-among-first-to-offer-new-scanning-technology/