FREQUENTLY ASKED QUESTIONS

Private Medical Insurance

What is private medical insurance?

Health insurance pays all – or some – of your medical bills if you are treated privately. It gives you a choice in the level of care you get and how and when it is provided.

What does private medical insurance cover?

Like all insurance, the cover you get from private medical insurance depends on the policy you buy. Basic private medical insurance usually picks up the costs of most in-patient treatments (tests and surgery) and day-care surgery.

What does private medical insurance not cover?

Your insurance usually won’t cover private treatment for:

  • pre-existing medical conditions
  • chronic illnesses such as HIV/AIDs-related illnesses, diabetes, epilepsy, hypertension and related illnesses
  • normal pregnancy and childbirth costs
  • organ transplants
  • injuries relating to professional and semi-professional sports or arising from war or war-like hostilities
  • cosmetic surgery to improve your appearance

Note: other exclusions may apply.

What are the benefits of private medical insurance?

Note: all of this depends on the type of policy you buy.

  • Specialist referrals. You can ask your GP to refer you to an expert or specialist working privately to get a second opinion or specialist treatment.
  • Get the scans you need. If the NHS delays a scan, or won’t let you have one, you can use your cover to pay for it, provided that it is deemed to be medically necessary.
  • Reduce the waiting time. You can use your insurance to reduce the time you spend waiting for NHS treatment.
  • Choose your surgeon and hospital. You can (in theory) choose a surgeon and hospital to suit your time and place – which isn’t possible on the NHS.
  • Get a private room. You can use it to get a private room, rather than staying in an open ward which might be mixed-sex.
  • Specialist drugs and treatments may be available. Some specialist drugs and treatments aren’t always available on the NHS because they’re too expensive or not approved by the National Institute for Health and Clinical Excellence in England and Wales (NICE) or the Scottish Medicines Consortium (SMC).
  • Physiotherapy. You get quicker access to physiotherapy sessions if you have insurance than you would through NHS treatment.

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