What does private health insurance cover?

Private health insurance helps pay for private medical treatment. It is an option for people who want more control over their healthcare, and to be treated in more comfortable surroundings.

There are many policies available, with different options from different insurers, which can be overwhelming. It helps to know what is usually covered, so you can make an informed decision. In this article, we explain what is typically covered and not covered.

What does private health insurance usually cover?

Private health insurance is designed to cover the cost of treatment for acute conditions that first start while your policy is active. An acute condition is an illness or injury that is likely to respond quickly to short-term treatment, restoring you to your previous state of health.

Health insurance does not usually cover conditions you had before your policy started, known as pre-existing conditions. It also does not usually cover chronic conditions, which are long term and need ongoing management.

Understanding acute, chronic and pre-existing conditions helps you understand your cover. With this in mind, most health insurance policies can cover:

• private treatment when you are admitted to hospital as an inpatient or day-patient
• outpatient treatment
• therapies such as osteopathy and chiropractic
• dental surgery
• mental health care
• private GP costs
• cancer treatment

Cover varies a great deal between insurers and policies. Many of these benefits may have a financial limit, and some may only be available as optional extras for an additional premium.

What are inpatient, day-patient and outpatient treatment?

These terms describe whether you need a hospital bed and how long you stay. They are used in private hospitals and in the NHS.

Inpatient treatment

Inpatient treatment is when you are admitted to hospital and stay for at least one night. Most private health insurance policies cover inpatient treatment as standard, as long as the condition and treatment are eligible. Benefit limits may apply.

Inpatient cover can include:

• hospital accommodation, meals and nursing care
• surgery and anaesthetics
• medication given while you are in hospital
• diagnostic tests and scans
• specialist fees

Day-patient treatment

Day-patient treatment is when you are admitted to hospital and need a bed, but you do not stay overnight and go home the same day. It may need more recovery time than outpatient treatment, an anaesthetic, and hospital facilities such as a bed, supervision and food.

Day-patient treatment is usually included in the inpatient cover of a health insurance policy. This means any inpatient limits and exclusions also apply. Examples can include some eye surgery, dental surgery, hernia repair and arthroscopy.

Outpatient treatment

Outpatient treatment is when you visit a hospital, clinic or other medical facility for treatment, without being admitted and without staying overnight.

Not all policies cover outpatient treatment as standard. Many insurers offer it as an optional benefit for an extra premium. Outpatient cover can include:

• consultations with a specialist
• diagnostic tests and scans
• minor procedures that can be done without a hospital admission, such as removing skin lesions or taking biopsies
• physiotherapy
• other treatments, such as chiropractic, acupuncture and podiatry

Always check your policy documents to understand what is covered.

What does private health insurance usually not cover?

Health insurance policies list the conditions and situations they do not cover, known as exclusions. If you claim for something on this list, your claim is likely to be declined.

Exclusions vary between policies and insurers, but a typical UK health insurance policy does not usually cover:

• pre-existing conditions
• chronic conditions
• emergency treatment
• treatment received outside the UK
• cosmetic treatment
• drug, alcohol or substance misuse
• fertility treatment
• maternity

Does private health insurance cover you abroad?

UK private health insurance does not usually cover treatment abroad. You will usually have a list of UK hospitals you can use.

If you plan to live and work outside the UK for a long period, usually more than 12 months, international health insurance may help.

International health insurance is different from travel insurance. International health insurance is for people relocating abroad to live, study or work, and covers their long-term healthcare needs. Travel insurance covers unexpected events on shorter trips, such as medical emergencies, lost luggage and cancellations. Read more about international health insurance and travel insurance.

Why get private health insurance?

Private medical insurance means you can benefit from private healthcare without paying large medical bills yourself. Its advantages include:

• treatment without waiting for an NHS referral, subject to the terms of your policy
• more choice over where, when and by whom you are treated
• more comfort in a private hospital room
• access to treatments and drugs that may not be available on the NHS, depending on your cover

Read more about whether private health insurance is worth it.

How much does private health insurance cost?

The cost depends on several factors, but you can usually adjust your cover to fit your budget.

Your age has a big influence, and premiums usually rise as you get older. Other factors include your excess, your claims history, Insurance Premium Tax and the cost of private healthcare. Read more about what affects the cost of health insurance.

What does Freedom Health Insurance cover?

We offer two UK health insurance plans for individuals and families. Freedom Elite is also available for businesses as a group scheme.

Freedom Elite

Freedom Elite core cover includes:

• hospital and specialist fees for inpatient and day-patient treatment
• cancer cover
• MRI, CT and PET scans, on specialist referral
• certain pregnancy complications
• certain dental surgery
• home nursing
• private road ambulance
• NHS cash benefit, if you choose to have eligible treatment as an NHS patient
• maternity cash benefit, after you have been covered for at least 10 months

You can add optional cover, including:

• outpatient treatment, with a limit of £1,500 or a full refund
• therapies, with a limit of £750 or £1,500
• mental health care
• dental, optical and private GP costs
• the London Plus hospital list extension

Freedom Essentials

Freedom Essentials core cover pays a fixed cash benefit towards eligible inpatient and day-patient treatment. It also includes:

• a fixed cash benefit for certain pregnancy complications and dental surgery
• MRI, CT and PET scans, on specialist referral
• NHS cash benefit
• a cancer cash benefit, as Freedom Essentials does not include cover for cancer treatment

You can add an optional outpatient package. It includes specialist fees, diagnostic tests and physiotherapy, along with routine dental and optical costs and a maternity cash benefit.

Limits and exclusions apply to all these benefits. Full details are in your Guide to Cover or policy document, which you can find in the Freedom Health Insurance Claims Portal.