Frequently Asked Questions

Private Medical Insurance, often referred to as PMI or Health Insurance, is designed to cover the cost of private medical treatment for ‘acute conditions’ that start after your policy begins. It is available at a range of different levels of cover at various premiums designed to meet the needs and budgets of different customers.

Having private healthcare does not mean you have to use it – you have the choice to use your cover or be treated by the NHS, just like those without cover.

Outpatient cover pays for diagnostic tests and consultations that do not require a hospital bed overnight, such as blood tests, X-rays, MRI and CT scans. Many providers also cover minor procedures such as endoscopies and wart removals under an outpatient option. If you have e.g. £500 cover, after you pay any excess on your policy, this is the amount your insurer will put towards your treatment. If you have 'unlimited or full refund' outpatiemnt cover, then all outpatient treatment is paid by your insurer.

You don't have to have an excess, but an excess is the amount you will have to pay when you make a claim on your health insurance policy. Having an excess means that you have to pay part of your treatment costs up to the amount of your excess. Your excess amount can generally be e.g. £0, £100, £200, £500, £1000.

Having an excess will reduce you monthly premium.

Most health insurance plans are not designed to cover pre-existing medical conditions. Pre-existing conditions are illnesses for which you had symptoms, consultations, medication, surgery or other treatment in the past.

You can still get private medical insurance even if you have pre-existing conditions. However, depending on the condition(s) or their severity, insurers may not pay for their treatment and apply medical exclusions to your policy.

Typically, there are general exclusions found in most private medical health insurance policies, these include but are not limited to:

• Chronic conditions.
• Pre-existing conditions.
• Drug or substance abuse.
• Sex change.
• Organ transplants.
• Prescribed drugs.
• Fertility treatment.
• Cosmetic surgery or treatments.
• Trial or experimental drugs or treatments.

Insurers do not typically pay for treatment towards chronic conditions. However, they may provide cover if there is an acute flare up of the condition.

This very much depends on the hospital list you have chosen with your insurer. Generally there are 3 types of hospital lists you can choose from (this can vary depending on the insurer):

• Guided Option - Your insurer will recommend on average 3 or 4 consultants you can see from their standard network of facilities in your area. The selection will depend on your postcode, their feedback and other metrics. This is generally the most cost effective option
• Standard List - This will be the insurers standard network of hospitals and facilities and you we will be able to select where you wish to visit.
• Extended/London - This will be an insurers standard list, but with the addition of more expensive/specialist facilities as well as additional Central London hospitals. This option will be the most expensive.

Most policies will either automatically include GP appointments, or it will be an optional add-on. Appointments could be either online or face to face and can be made quickly. You should check individual policies to see what is offered.