Individual Private Medical Insurance
Individual Private Medical Insurance (PMI) covers the costs of private medical treatment for curable medical conditions, referred to frequently as 'acute conditions'. PMI includes the costs of surgery, specialists, accommodation and nursing at a private hospital or in a private ward of an NHS hospital.
A Standard Private Medical Insurance Plan covers hospital or emergency treatment. It will include 'in-patient' and 'day-care' treatment only. Comprehensive Plans may offer additional coverage including such care as 'outpatient treatment', dental treatment, complementary medicine, maternity, travel and personal accident cover.
In general, Private Medical Insurance Plans do not cover chronic or critical illness which cannot be cured, for example multiple sclerosis, asthma or diabetes. However, in a crisis, most PMI policies will pay the cost of treatment for stabilising a patient and returning them to their previous level of health when possible.
We can provide a comprehensive search of the marketplace, and provide unbiased advice based on our sourcing.
What isn't covered?
- You can't take out cover now for treatment you know you're going to need.
- If you've had health problems in the past (pre–existing conditions), your insurer may also exclude those conditions from your cover. If you are asked to disclose these when applying for the insurance you must do so, or you could invalidate your policy, which means the insurance company won't pay out if you make a claim.
- It does not cover the treatment of chronic medical conditions. There are various definitions of chronic conditions depending on the policy, but broadly it is a long–term medical condition which is likely to continue to need regular or periodic treatment.
- Some exclude certain types of treatments such as out–patient treatments, routine treatments (such as health checks), dental care or experimental treatments.
- Most also exclude routine pregnancy, HIV/AIDS, fertility treatment, mental or psychiatric conditions, and elective treatments you may choose to have, such as cosmetic surgery.
Keeping costs down;
Shop around: it's a competitive market out there and both cover and costs vary from company to company. You could choose:
- to pay a larger excess, which means you agree to pay more of the bill; or
- cover that only kicks in if NHS services are not available within a certain timeframe.
Be clear about what you need. You may not want the highest level of cover. Always compare what's covered by a policy, not just the price. Some might be cheaper than others, but they may not offer the same level of protection.
Top tips
1. Read the paperwork and ask questions if you don't understand anything.
2. Make sure you check what you're covered or not covered for.
3. Tell the insurance company if you have any existing medical conditions.
4. Find out if your employer provides health insurance as part of your benefits package.