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Buying private health insurance

One of the main ways of covering the cost of private health treatment is through private health insurance. There are several different types of health insurance policies, and you will need to decide which kind you want.

This page will help you think about whether to buy health insurance and what to look out for.

Top tips

When you buy insurance you should:

  • shop around
  • check the policy details to see what’s covered
  • be honest about your current health condition. By law you have to do this. It is called ‘disclosing all material facts’. If you don’t do this, the insurance company may not pay out
  • tell the insurance company of any change of circumstances which may affect your cover.

What to think about

Before taking out private health insurance, you should consider whether:

  • you can afford the premiums. The cost of premiums can be increased depending on things like your age, or if you smoke
  • there are any healthcare costs not covered by the policy
  • there is a limit on the amount the policy will pay out
  • you have to wait for a certain amount of time (a qualifying period) before you can make a claim on the policy
  • you have to pay for treatment up front and then claim the cost back from the insurance company. If so, think about whether you can afford to do this
  • you are already covered by a workplace health insurance scheme – check with your employers. You might also be included in your partner's workplace insurance scheme if they have one.

Telling the insurance provider about your health

When you take out private health insurance, you must tell the company about anything which may affect your insurance cover, for example, whether you smoke, or have an existing medical condition. This applies, even if there is no direct question about this on the application form.

If you don't give this information, the insurance company may refuse to cover the cost of treatment. You should also tell the company about any change in your circumstances.

When you have treatment

Before starting any treatment, check your policy and contact the insurance company to get their agreement on the treatment needed, the cost and where you will get the treatment. You need to get confirmation that they are happy with the arrangements and will pay for it. You should also get an estimate of the likely costs from the practitioner and send a copy to the insurance company.

Before you decide to have private treatment, talk to your GP and NHS doctors about what further treatment is available from the NHS, after the private treatment ends.

Keep a detailed record of all expenses involved in the treatment, including receipts and invoices.

Things your insurance policy won't cover

Check to see what’s covered under the insurance policy. Most health insurance policies won't cover:

  • a medical condition you had before taking out the policy
  • the cost of psychiatric treatment
  • chronic or long-term illnesses which can't be cured
  • health expenses abroad
  • fertility treatment
  • cosmetic surgery
  • experimental or unproven treatments
  • the cost of treating children.

If you have a disability

If you have a disability, you may have difficulty getting some types of insurance cover. Generally speaking, it is against the law for insurers to discriminate against disabled people. However, in some circumstances they may be allowed to take the fact that you're disabled into account when deciding whether or not to provide you with insurance and on the terms. An insurance broker or other independent intermediary should be able to find you a suitable policy.

If your insurance company refuses to pay out

Check the terms and conditions of your insurance policy. There may be several exclusions listed when the insurance company won’t pay out. These may include:

  • specific conditions, diseases or treatments
  • if the condition or disease was pre-existing. This means you had it before you took out the policy.

The company may also refuse to pay out the total amount if they think your practitioner is overcharging. In this case, you may have to meet the difference in costs yourself.

Your policy may require you to pay a fixed sum, for example the first £50, towards the cost of your treatment. This is called a policy excess.

Making a complaint

If you want to make a complaint about a private health insurance company, you should first take it up with the company. If you aren't satisfied after this, you can complain to the Financial Services Ombudsman. For more information, contact the Financial Services Ombudsman.

Financial Ombudsman Service
Exchange Tower
London
E14 9SR

Consumer helpline: 0800 023 4567 (free for people phoning from a landline) or 0300 123 9123 (free for mobile-phone users who pay a monthly charge for calls to numbers starting 01 or 02) (Monday to Friday from 8.00am to 8.00pm; Saturday from 9.00am to 1.00pm)
Email: complaint.info@financial-ombudsman.org.uk
Website: www.financial-ombudsman.org.uk