What Does Private Health Insurance Cover in the UK? A Clear Guide to What’s Included

Private health insurance in the UK offers a range of benefits beyond what’s available on the NHS — from faster diagnoses and shorter waiting times to more choice over where and how you're treated. But not all policies are the same, and it’s important to know what is actually covered before signing up.

This guide explains exactly what private medical insurance includes (and what it doesn’t), how coverage varies between policy types, and how to make sure you get the right level of protection for your health and budget.

What Is Private Health Insurance?

Private health insurance (or private medical insurance, PMI) is a policy that covers some or all of the cost of private healthcare. It’s designed to complement, not replace, the NHS. While emergency care and general GP services remain under the NHS, private insurance can fast-track access to consultants, scans, surgery, and recovery care.

Most policies are modular, meaning you start with basic inpatient cover and then add options like outpatient treatment, mental health support, or dental care.

Read our guide on: Health Insurance Policy Types Explained

What Does Private Health Insurance Typically Cover?

Let’s break down the main types of treatment and services that most UK private health insurance policies include — depending on the level of cover you choose.

1. Inpatient and Day-Patient Treatment

Included:

• Hospital stays (overnight or same-day)

• Surgery and specialist procedures

• Anaesthetics and nursing care

• Diagnostic tests carried out while admitted (e.g. blood tests, X-rays)

This is the core of most private health insurance policies. Even the most basic plans typically include it.

2. Outpatient Treatment (if added)

Included (with outpatient cover):

• Consultations with specialists

• Diagnostic scans (MRI, CT, ultrasound)

• Blood tests and follow-up appointments

• Pre-hospital assessments and post-treatment care

Outpatient treatment is often excluded from cheaper plans but can be added as an optional extra. Some policies offer capped outpatient cover (e.g. £1,000 per year) to balance cost and coverage.

3. Cancer Care

Most comprehensive health insurance policies now include extensive cancer cover, which may provide:

• Private consultations with oncologists

• Diagnostic tests and scans

• Radiotherapy and chemotherapy

• Access to specialist drugs not always available on the NHS

• Support services (e.g. counselling, nutritional advice)

Tip: Always read the cancer cover section carefully. Some providers exclude experimental or non-NICE-approved treatments.

4. Mental Health Support

Included (on selected plans):

• Inpatient psychiatric treatment

• Therapy or counselling sessions (subject to limits)

• Access to private mental health clinics or specialists

Mental health cover is often included in mid- to high-tier policies or available as a module. Lower-tier plans may exclude it entirely or restrict the number of sessions.

5. Virtual GP and Digital Health Services

Many insurers now offer:

• 24/7 access to private GPs via phone or video call

• Prescription delivery or pick-up from local pharmacies

• Digital tools to manage symptoms or track appointments

These services are increasingly standard even on budget policies, and they’re a major advantage for convenience and early access to care.

6. Therapies and Complementary Treatment

Optional or included with some plans:

• Physiotherapy

• Osteopathy

• Acupuncture

• Chiropractic treatment

Often covered only if recommended by a consultant. Some policies require pre-authorisation before starting treatment.

7. Private Hospital Accommodation

Even basic plans typically cover:

• A private room with en-suite bathroom

• Meals, Wi-Fi, and more comfortable surroundings

• Flexible visiting hours

While not a health benefit per se, private accommodation can significantly improve your treatment experience.

What Is NOT Covered by Most Private Health Insurance Policies?

Even comprehensive cover has limits. Standard exclusions usually include:

1. Pre-Existing Conditions

Unless your insurer agrees otherwise, conditions diagnosed or treated before the policy start date are excluded.

• Some policies allow cover after a “symptom-free” period (often 2–5 years)

• Full medical underwriting may provide more clarity upfront

2. Chronic Conditions

Private insurance does not usually cover long-term management of ongoing conditions such as:

• Diabetes

• Asthma

• Epilepsy

• Hypertension

These remain under NHS care in most cases.

3. Accident and Emergency Treatment

• Emergency services (A&E)

• Ambulances

• Life-threatening situations

These are always handled by the NHS.

4. Pregnancy and Fertility Treatment

Most policies do not cover:

• Routine pregnancy care

• IVF or fertility services

• Elective Caesarean sections unless medically necessary

Some high-tier policies offer limited maternity cover, but this is rare.

5. Cosmetic Surgery

Unless it's medically required (e.g. breast reconstruction post-cancer), cosmetic procedures are excluded.

6. Routine Dental and Optical Care

These are typically excluded unless added via optional modules. Even then, cover may be limited to:

• Annual check-ups

• A set contribution towards glasses or lenses

• Emergency dental treatment

How Coverage Varies Between Policies

Coverage depends on:

• Policy type (comprehensive vs inpatient-only)

• Level of outpatient benefit

• Hospital network access

• Modules you choose to add

• Whether the policy uses moratorium or full underwriting

Read our guide on: How to Find the Best Health Insurance in the UK

Extra Benefits to Look For

Some providers include perks that add value even if you rarely claim:

• No-claims discounts or cashback for staying claim-free

• Gym discounts or wellness rewards (e.g. with Vitality)

• Second medical opinion services

• NHS cash benefit — a cash payment if you’re treated by the NHS instead of claiming privately

Unique Insight:

Some insurers pay a fixed cash amount if you choose to be treated on the NHS even when your policy would have covered private care. This can offset your premium and let you keep cover as a safety net.

Who Needs Which Level of Cover?

Basic inpatient-only cover is best for:

• Younger, healthy individuals

• Those mainly seeking faster surgery access

Mid-level cover with outpatient benefits suits:

• People managing minor but recurring issues (e.g. joint problems)

• Those needing regular diagnostics or therapy

Comprehensive plans are ideal for:

• Self-employed or those who can’t afford time off for NHS waiting lists

• Those wanting full cancer, mental health, and diagnostic cover

• Families looking for all-inclusive protection

FAQs: What Private Health Insurance Covers in the UK

Does private health insurance cover GP visits?

Not usually for in-person GPs, but many providers now offer 24/7 virtual GP services as standard.

Are scans like MRIs covered?

Yes — if you have outpatient cover. Inpatient-only policies will cover scans carried out during a hospital stay, but not standalone diagnostics.

Can I get dental and optical cover?

Yes, but usually only with a policy add-on. Some providers offer cash back towards check-ups, glasses, or emergency treatment.

Is cancer treatment fully covered?

It depends on the policy. Most comprehensive plans include cancer cover, but limits may apply to certain drugs or experimental treatments.

Will I need to pay for treatment upfront?

In most cases, insurers pay the hospital directly. However, you may need to pre-authorise treatment and cover any excess or uncovered costs yourself.

Final Thoughts

Private health insurance offers real value when it comes to faster, more personalised care — but only if you understand what your policy includes. By knowing exactly what is and isn’t covered, you can choose a plan that fits your health needs and budget without overpaying for extras you won’t use.

Before committing to any provider, compare policies side-by-side, read the exclusions thoroughly, and consider modular plans if you want more control over cost. Used wisely, private health insurance can complement the NHS and give you peace of mind — particularly when it comes to timely diagnosis and treatment.

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