Health Insurance

Health insurance deals with acute conditions, meaning ones that respond to treatment and are expected to resolve. A hip that needs replacing, a hernia repair, a suspicious lump that needs investigating quickly, a cartilage tear, cancer treatment, physiotherapy after an accident.

You are seen faster, you have a say in the consultant and the hospital, and you normally get a private room. Most plans cover the consultation, the diagnostics, the surgery, the stay and the aftercare linked to it. Many now include mental health support, cancer drugs not routinely funded by the NHS, and direct access to physiotherapy or talking therapies without a GP referral. The real gain is time: months on a waiting list often becomes weeks privately, which for anyone self employed is a financial matter as well as a medical one.

The exclusions matter more than the benefits, because this is where expectations go wrong.

• Chronic conditions. Anything long term needing ongoing management rather than a cure, such as diabetes, asthma or arthritis, is excluded once it becomes chronic. A policy typically funds the investigation and an acute flare up, then hands ongoing care back to the NHS.
• Accident and emergency. If you are seriously injured you go to an NHS emergency department, because private hospitals mostly do not run one.
• Pre-existing conditions, in nearly all cases.
• Normal pregnancy and childbirth, cosmetic surgery, fertility treatment, self inflicted injury, and anything experimental or unproven.
• Routine dental and optical treatment, unless you add an extension or a cash plan.

Organ transplants, dialysis and long term rehabilitation also sit outside most personal policies.

Every insurer needs your medical history before it takes you on, and there are two routes.

Moratorium underwriting

You answer no medical questions at outset. The insurer automatically excludes anything you have had symptoms, treatment, medication or advice for during a look back period, usually five years. That exclusion can fall away: typically, once you go a continuous period, commonly two years, clear of symptoms, treatment, medication and advice for it. Quick to set up and it suits people in good general health, though you do not know exactly what is excluded until you claim.

Full medical underwriting

You complete a health questionnaire and the insurer tells you at outset precisely what is excluded and on what terms. It takes longer and can produce permanent exclusions, but you know where you stand from day one, which is usually worth having if your history is significant.

If you already hold cover, continued personal medical exclusions, sometimes called switch underwriting, lets you change insurer while keeping your existing terms. Leaving an employer scheme is the common trigger and the window is often short. Never cancel an existing policy before the replacement is agreed.

Two quotations for the same person can differ enormously depending on how the plan is built. The excess is what you pay per policy year before the insurer contributes, often between 100 and £1,000, and raising it is the simplest way to cut the cost. Outpatient cover, which pays for consultations, scans and tests without an overnight stay, is the most used and most expensive part, so plans offer it in full, capped at say £1,500, or removed. The hospital list decides where you can be treated, and a local list costs less than a national one including central London. A six week option funds treatment only where the NHS wait exceeds six weeks, which cuts the premium while keeping cover for the delays that matter.

Age is the driver you cannot change, and premiums rise each year on top of medical inflation, so review the structure at renewal rather than accept the increase. Being independent, we can compare the market and tell you when moving would cost you underwriting terms worth keeping.

Holding private cover does not remove your entitlement to NHS care, and you will still use it. The emergency department, your GP, the ambulance service, chronic disease management and anything your policy excludes all stay with the NHS.

What you are buying is the ability to skip a waiting list for planned treatment and choose the consultant and the timing. People take it out because they have waited before and did not want to again, because they cannot afford to be out of action, or because the odds of needing something are rising. Any of those is a fair reason. Expecting it to replace the NHS entirely is not.