How does private health insurance work in the UK?

Looking for private health insurance can feel overwhelming when you're trying to make sense of different policies, cover options, and costs involved. Yet you're not alone in considering this option. The Financial Conduct Authority have calculated that 7.6 million people in the UK have private health insurance, an increase of nearly one million since 2020¹.

Knowing how private health insurance works is important for choosing the right policy for you and your family. This guide breaks down everything you need to know about private health insurance in the UK.

How does private health insurance work?

Setting up your policy

Step 1: Choose your cover

At Vitality, all our plans start with Core Cover, which includes:

• Virtual GP consultations
• In-patient and day-patient treatment (hospital fees, consultant fees and scans)
• Advanced Cancer Cover
• Mental health support
• Physiotherapy sessions
• Out-patient surgical procedures
• Plus, other benefits like NHS hospital cash benefit, childbirth cash benefit, home nursing, and private ambulance

Step 2: Customise your plan

At Vitality, you can decide if you want to add any of the following Cover Options:

• Out-patient cover – gives you access to out-patient consultations, diagnostics- plus physiotherapy outside of our network
• Mental health cover – includes full cover for Talking Therapies, additional cover for in-patient and day-patient treatment and extended out-patient treatment.
• Therapies cover - includes chiropractic, osteopathy, acupuncture, podiatry, and two consultations with a dietician following a GP referral
• Optical, dental and hearing cover – contributes towards routine and emergency care
• Worldwide travel cover – pays for emergency medical expenses, travel disruptions, vaccinations, and more 

Step 3: Decide your hospital options

This allows you to choose your consultant or the hospital where you want to be treated.

At Vitality, you can choose from:

• London care – access to all private hospitals in the UK, and NHS hospitals with private facilities
• Countrywide hospital list - access to all the private hospitals in the UK’s largest hospital groups 
• Consultant select - a digital tool that recommends the right high-performing consultant for your needs

Step 4: Choose your excess

An excess is an amount that you pay towards your medical treatment before your insurance picks up the rest of the cost. Choosing to pay higher excess will reduce the cost of your policy.

You can set your excess at different levels, £0, £100, £250, £500 or £1,000. 

Excess can be applied once each plan year, or each time you make a claim.

Read more: What is health insurance excess?

Step 5: Choose your underwriting type

Underwriting is the process insurers use to assess your medical history, and past claims before offering a health insurance quote. The type of underwriting you choose can affect what is covered and how much you pay for your policy.

You can choose:

• Full Medical Underwriting (FMU)
• Moratorium Underwriting (Mori)
• Continued Personal Medical Exclusions (CPME)

With Full Medical Underwriting you disclose your full medical history upfront. With Moratorium Underwriting, you don’t need to tell us your medical history until you make a claim. Then we’ll let you know whether you’re insured for that condition. Continued Personal Medical Exclusions let you carry over the underwriting terms from your previous insurance plan when you switch to us. This means any health conditions that weren’t covered before may still be excluded, and we might add new exclusions based on your health questionnaire.

Read more: The different types of medical underwriting explained

Step 6: Submit your application

Complete your application form and sign the declaration. Once your application is accepted, you’ll receive your policy documents confirming your cover. If you’ve applied with Full Medical Underwriting, we’ll also let you know if any health conditions are excluded from your cover.

As a Vitality member, you’ll also be set up with access to the Care Hub—your digital hub for managing your health insurance. Use it to track claims, book GP appointments, and access your benefits with ease.

When you need treatment

Step 1: Initial Consultation with a GP

The first step is usually to see a doctor about your symptoms. This can be your NHS GP or a private GP. If you have insurance with us, you can use the Vitality GP app for a virtual consultation.

The GP will assess your condition and, if they believe you need to see a specialist, they will provide you with a referral letter. This is a crucial document for your insurance claim.

It's often recommended to ask for an "open referral." This means your GP refers you to a general specialist rather than a named one. This gives you more flexibility to choose from your insurer's list of approved specialists and hospitals.

For private physiotherapy and mental health treatments, you can usually refer yourself without needing to see a GP first.

Read more: How does a virtual GP appointment work?

Step 2: Contacting your insurer to start a claim

Once you have your referral letter, it’s important to contact your insurer before booking any treatment—this process is called pre-authorisation. With Vitality, you can do this quickly via Care Hub, which shows what treatments are covered and which hospitals and consultants are available to you.

To get started, you’ll need your policy number, a copy of your referral letter, and a brief description of your symptoms. Once approved, you’ll receive an authorisation number—this confirms your claim and should be given to your consultant so they can bill Vitality directly.

Read more: How do health insurance claims work?

Step 3: Choosing a Hospital and Specialist

With your authorisation number, you can now choose a hospital and specialist from your insurer's approved network.

Most policies have a list of hospitals and clinics you can use. You might have a basic list, or you may have paid for a more extensive one that includes more expensive hospitals, such as those in central London.

The fees for consultants and specialists are often separate from hospital costs. Your insurer will confirm whether the consultant you want to see is within their fee guidelines.

Step 4: Receiving treatment

You can now book your initial outpatient consultation with the chosen specialist. During this appointment, the specialist may recommend further diagnostic tests (like an MRI or X-ray) or a course of treatment (such as physiotherapy or surgery).

If the specialist recommends any additional tests or treatment, you will need to contact your insurer again to get further pre-authorisation. It is vital to do this before you proceed to avoid having to pay for the costs yourself.

Payment

This is where the insurance steps in. When the insurer approves your treatment, they’ll usually pay the consultant or the hospital directly.

If there’s an excess on your policy, the insurance company will let you know how much to pay when you make your claim. Some insurance companies will ask you to pay it straightaway, others when they settle the bill for treatment.

If you use a hospital or consultant not covered by your plan, you may be responsible for a portion of the costs.

How to choose the right private health insurance plan?

Assessing your needs

• Consider your medical history. Your medical history is an important consideration when deciding which provider to choose. Try to find an insurer who can offer you the treatments you think you may need in the future. If you already have a medical condition, it’s unlikely to be covered by your private health insurance.
• Prioritise cover options. Different providers will offer different levels of cover. So, choosing the cover options that are right for you, and your family is important. Companies that offer comprehensive core cover can sometimes be more cost effective if you need to make multiple claims.
• Weigh up the costs. Most medical care is free in the UK, so you’ll want to make sure you’re getting private medical insurance that is worth the cost. Understand exactly what level of cover you’re getting for your money. Also find out if there are any costs that you’ll need to pay yourself, such as an excess.

Compare health insurance providers

• Don’t focus solely on the cost. Some providers may appear more expensive but offer better cover in their core plan.
• Check hospital lists. Make sure you can access a hospital that’s local to you and consultants who are specialists in their field.
• Understand underwriting. Underwriting affects what’s covered. Providers may offer different underwriting options.
• Look at excess options. Some providers let you choose how often excess is applied.
• Review optional cover. Compare what extras are available.
• Consider wider benefits. For example, when you sign up with Vitality, you get access to Vitality Rewards.

Next steps: how to get private health insurance?

Step 1: Research providers

• Explore the major health insurance providers and compare what each one offers. Most insurers provide detailed information online, including downloadable brochures outlining their cover options.
• For tailored guidance, consider speaking to a specialist health insurance adviser who can help you compare health insurance plans across the market and find one that suits your needs.

Read more: How to compare health insurance plans?

Step 2: Get quotes

• When you have your list of preferred providers, get a quote from each of them. Be open and honest about all your medical history so you can make sure you’re getting the right cover.

Step 3: Set up your plan

• When you’ve chosen your provider, set up your plan with your chosen cover options.
• You’ll also need to agree the policy excess and type of underwriting.
• You can add your partner or family to the cover too.
• Make sure you’re happy with your choices and understand what you’re buying before you sign the policy terms. 

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