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A guide to private health insurance

In this guide we'll explore what is health insurance and is private health insurance worth it? We look at how private medical insurance works, what it does and doesn't cover, and what factors affect its cost. 

What is health insurance?

Health insurance provides access to private healthcare and helps cover the cost. It’s also known as private health insurance or private medical insurance (PMI). It covers seeing a private GP, physiotherapist, or mental health professional. It also covers treatment in private hospitals. As well as access to specialist drugs and ongoing care

One of the main advantages of private health insurance is that it gives you quicker access to diagnosis and treatment. Private medical insurance can help you and your family get the treatment you need when you need it. 

How does private health insurance work?

Private medical insurance helps pay for a range of medical treatments, tests, surgeries and medication as long as you have a health insurance policy in place. When you set up the health insurance plan, you decide the type of cover you need. Insurance companies often offer a standard level of cover. They also offer additional cover for an extra cost.

You pay your premiums each month or year. When you need treatment, you can check with your insurance company to see if you can have that treatment at a private hospital. This means you can often choose when and where to have the treatment. You can sometimes choose from a list of approved practitioners.

With some physiotherapy and mental health treatment, you may be able to refer yourself for treatment without needing to see a GP first.

The cost of your treatment will be covered by the insurance company. In some instances, you may need to pay an excess. An excess is an amount that you pay towards your medical treatment before your insurance company picks up the rest of the cost.

What does private health insurance cover?

Private health insurance differs between insurance companies. So it’s a good idea to shop around to get the best type of cover for you and your family. But most health insurance cover includes:

Private GP consultations

Access to video consultations and 24-hour health advice lines. Vitality also offer up to £100 per plan year towards private prescriptions and minor diagnostic tests.

Hospital treatment

The insurance covers in-patient and day-patient hospital and consultant fees. In-patient and day-patient diagnostic tests including pathology, radiology, and CT, MRI and PET sans are also usually covered in full. However, out-patient diagnostic tests are not covered as standard. A separate out-patient benefit limit is required. Surgical out-patient procedures are also covered. Some insurers cover treatment you can have at home, such as chemotherapy.

Vitality provides a cash benefit for eligible in-patient and day-patient treatment if a member chooses to have treatment at an NHS hospital. The benefit provides £250 per night (max £2,000) for eligible in-patient treatment and £125 per day (max £500) for eligible day-patient treatment.

Cancer care

Your private health insurance can cover cancer care and support. This includes early risk assessments, discounted screenings and treatment.

Mental health support

Access to early intervention therapies such as CBT, and counselling through talking therapies. At Vitality, we cover up to 8 sessions of talking therapies. As a member, you can self-refer for talking therapies, meaning you don’t need a GP referral.


Health insurance plans usually cover a set number of physiotherapy sessions. Vitality covers up to 6 sessions of physiotherapy, no GP referral needed. You can choose a physiotherapist from an approved list.

Optional extras

Many health insurance plans also offer extra options. These include out-patient cover, dental insurance, and sight and hearing tests. It may also offer travel insurance and even weight loss surgery.

What does private health insurance not cover?

Most private health insurance won’t cover routine treatment. They also won't cover long-term conditions like diabetes or asthma. They’ll only cover treatments for conditions that you’re likely to recover from.

Quite often, they’ll also exclude any conditions you had before taking out the insurance.

The following are usually excluded by private health insurance: 

  • Emergency and cosmetic treatments. 
  • Childbirth. 
  • Treatment for alcohol and drug abuse.  
  • Any treatment that takes place outside the UK.  

Each provider has different exclusions. So, be sure to read their terms and conditions with care. 


What are the benefits of private health insurance?

Fast access to specialist healthcare

With private medical insurance, you can see a GP or specialist without having to wait long. And you’ll get fast access to treatment if you need it. Shorter waiting times can lead to earlier diagnosis and quicker treatment. 

Manage your health on your terms

With private medical cover, you can talk to a GP at a time that suits you. You can make appointments that fit your schedule and choose where to have your treatment. Some insurers even let you choose a consultant from a list of qualified doctors.    

Comfortable private surroundings  

Treatment at a private hospital or practice can be a comfortable experience. Because you get your own room and a private bathroom. 

Access to a wide range of treatments

With private medical insurance, you'll have access to many treatment options. This may include treatment that you might currently pay for, like physiotherapy and mental health support.

Peace of mind

Private health insurance takes away the frustration of waiting to see a specialist. It provides peace of mind when it comes to your or your family's health. 

Can I still use the NHS if I have private health insurance?

All UK citizens can get free NHS care even if they have private health insurance. The NHS provides healthcare based on a person’s needs, not their ability to pay.  

If you need treatment and have private health insurance you can choose to use the NHS or get private treatment. Or do both.

If you choose to get private treatment, you can switch back to the NHS for care at any time. 

Is private health insurance worth it?

Let’s take a look at the pros and cons of having a private health insurance.


  • Quick access to healthcare
  • Access to specialist drugs or treatment
  • Private room and ensuite facilities if you go into hospital. 
  • Choose to have treatment at a time and place that suits you. 


  • Some insurance policies have a list of approved consultants and specialists. So, you may not always get to choose your preferred one.  
  • Long-term chronic conditions such as diabetes and asthma aren’t usually covered.  
  • Pre-existing conditions may be excluded from cover. This may depend on the underwriting terms you select. 
  • The NHS is a free service, whereas you need to pay a regular premium to have private medical insurance. 


How much does private health insurance cost?

The cost of your private health insurance depends on several factors:  

  • Who’s included on your policy: You can take out cover for just yourself, you and your partner or your family. The number of people on the policy, their ages and medical histories can all affect the price of your cover.  
  • Your age: As you age, you’re more likely to need medical treatment.   
  • Your medical history: You may need to provide full details about your medical history and disclose whether you have any pre-existing conditions. You and your family's past medical history may result in personal medical exclusions on your policy and you will not be able to claim for these conditions. Different types of underwriting are available and the type of underwriting you choose will affect the price of your policy. 
  • Your lifestyle: How much you weigh, and whether you smoke may affect your future health. This may influence the cost of your cover.   
  • The level of cover you choose: If you choose to add extras to your policy, like dental insurance, optical and hearing cover, you’ll usually pay a bit more for them.   
  • Your excess: You can reduce your premium by paying an excess on your policy. You pay this amount for your medical treatment and your insurance covers the rest.  Your premium will change each year based on your age and whether you’ve made a claim. It will also change based on the increase in the cost of medical care, which we call medical inflation.   
  • Claims made: The amount you’ve claimed also affects your premium. If you don’t make any insurance claims, your premium should only rise in line with age and medical inflation.

Private medical insurance – things to consider

Choose your provider wisely  

Different providers offer different levels of cover. So, choosing the right options for you and your family is important. 

There's often a standard level of cover. But, it will have limitations, such as a cap on how much the insurance will pay for some treatments. Companies then tend to offer access to extra treatments. They also have more generous limits if you choose optional extras.

Weigh up the costs  

You'll want private medical insurance that is worth the cost, so it's important to 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. Or shortfall on consultant fees.  

Consider your medical history  

You may need to give details about your medical history when you apply for health insurance. That depends on the type of underwriting. You must be as honest and open as can be. If you already have a medical condition, it's likely that your private insurance won't cover it. 

Take advice  

Speak to a specialist adviser or one of our private health insurance team. 

Vitality private health insurance

Want to know more about health insurance or thinking about taking out a policy? Here are some of the benefits of taking out health insurance with Vitality:

  • See a private GP within 48 hours 
  • Avoid lengthy hospital waiting lists 
  • Get specialist drugs and treatments 
  • See a consultant fast 
  • Refer yourself for physiotherapy 
  • Get mental support fast and without a GP referral
  • Discounts from top brands. And rewards for getting healthy.
Get your health insurance quote today

Published: 29 May 2024

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