What is private medical insurance (PMI) and why choose it?

Private medical insurance is a type of insurance that is designed to cover all or most of the costs of diagnosis and treatment in a private hospital or clinic.  

PMI is designed to offer peace of mind that when treatment is needed, it can be carried out quickly. It may also offer the benefit of access to some approved drugs and treatments not widely available in the NHS.

PMI can be taken out by individuals or companies and the range of benefits and conditions covered may vary, so it’s important to read and understand all the details of your policy. Some policies keep their premiums lower by only covering a specific range of conditions and treatments – others offer fully comprehensive cover for even complex and expensive things like cancer treatment and heart problems.

The range of private medical insurance products available is very large, so it’s important to take time to choose carefully. Some policies offer a choice of hospitals you can use. Others may be restricted to a list offered by your insurer.

Even if you have comprehensive cover, there may be some restrictions on the amount an insurer will pay out – this is often true for consultations and things like physiotherapy. There may also be a policy excess in place. Either of these may leave you with a balance to pay yourself so again, it’s important to check the details of your cover.

If you’re covered through your employer, you will need to check the range of benefits available and also the process when you want to claim.

Whether you have personally paid PMI or company paid PMI it is important not to go ahead with treatment before you’ve had confirmation that your proposed care or treatment has been approved by your insurer.

Some forms of cover are designed to complement NHS care and offer rapid access to private care when you need it. Others may have restrictions related to the NHS waiting time for diagnosis or treatment, and some offer a cash benefit when you are treated within the NHS. This latter option may also be a feature of cash plans and lower cost medical benefits, which are discussed in the following section.

What if I don’t want to take out expensive PMI but I’d like some level of cover?

If you want to have some level of cover, for example for outpatient investigations or a range of other benefits, it’s worth looking at cash plans, sometimes known as medical cash plans or healthcare cash plans. These tend to be low cost and whilst they may not cover you for expensive inpatient treatment or cancer care, they offer a range of benefits including cover for things like tests and scans, physiotherapy and access to a GP helpline 24/7.

Some also offer inpatient treatment for a range of procedures if the NHS waiting time is over a certain limit. Cash plans or lower cost benefits are usually good value and are popular, particularly as many don’t penalise pre-existing conditions.

Many of the organisations providing cash plans or lower cost medical benefits are not-for-profit organisations and reinvest their surpluses for the benefit of members. They may also offer other service such as support and counselling for mental health problems and other benefits aimed at promoting wellbeing.

Find the price of treatments or tests

Can I get family cover?

Whether your choose PMI or lower cost benefits, there are usually options to cover family members.

Is there an upper age limit?

Many cash plans have no age restrictions on joining and may not require a medical. Others may have an upper age limit, for example, cover may not continue beyond the age of 75.

What’s the best way to find out more?

All PMI and cash plan providers have websites with lots of information. You may also find that your home or car insurer also offers health cover policies. There are also many expert brokers who can help you navigate the market and help you choose the best option for you.

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LaingBuisson is the chosen provider of independent sector healthcare market data
to the UK Government’s Office for National Statistics.