How does health insurance work?
Health insurance works in the same way as any other insurance policy - you pay monthly or annually, and your insurer covers the cost of any treatment you need
There are two main elements to medical insurance:
treatment and diagnosis.
Treatment only cover is included with most policies. This protects you with cover for things like operations that you need to go into hospital for, or other treatment you receive while you’re there.
The diagnosis side of health insurance includes things like consultations with specialists, blood tests, MRIs and CTs that help to find out what’s wrong with you.
If you have treatment only cover, you’ll need to visit an NHS GP first for a diagnosis. Once you’re diagnosed, you can then be treated at a private facility.
If you have full or partial diagnosis cover, you can be diagnosed and treated privately.
Depending on your level of cover, your health insurance policy may cover just one aspect, or it may cover both.
What does private health insurance cover?
Health insurance covers the cost of any private healthcare you receive. But exactly what is covered depends on your policy.
Basic plans will cover you for things like operations and hospital stays, while more comprehensive private health insurance plans will cover whatever you need, from long-term cancer care to tests to find out what’s wrong with you.
We compare three tiers of cover to find the best deal for you:
- Basic - treatment only
- Medium - treatment and limited diagnosis
- Comprehensive - treatment and full diagnosis
Basic or treatment only covers the cost of any treatment you need while you’re in hospital, as well as the cost of your stay. Any testing you need will not be covered. You can still have tests done on the NHS, but private diagnosis and outpatient care, including things like consultations with specialists, will not be paid for.
Medium or treatment and limited diagnosis covers treatment, as well as some diagnostic testing. This can include blood tests at private hospitals, consultations with specialists and things like MRIs. These will usually be done quicker than they would be on the NHS. You’ll normally be given a set amount of cover for these tests, for example, £1000 worth over the course of a year.
Comprehensive or treatment and full diagnosis covers all your treatment, including any diagnostic testing you undergo at private facilities. Additional support like mental health care, physiotherapy and full dental work may also be covered.
I already have health insurance, can I switch insurers?
Yes. If you’ve held a health insurance policy for 12 months or more, switching cover is an option for you. If you’d like to move to a different insurer, you have two options:
- Switch policy
- Start a new policy
Switch policies. This means you can transfer your current policy to a new insurer, without a break in cover. Depending on the condition, your policy may continue to cover previous conditions under your new insurer. If you want to explore transferring any conditions, you'll need to answer any applicable questions during the switch process.
To switch insurers you’ll need to provide some extra information, such as your medical history. This will determine if the policy is right for you and if the insurer will accept the cover, including any existing conditions and exclusions.
The benefits of switching are:
- Cheaper insurance could be available.
- Access new products in the market.
- Tailored cover for your current needs.
- No break in cover. There may be a gap in cover if you start a new policy.
Start a new policy, also known as a moratorium policy. This means you end your previous cover and start a brand new policy. If you start a new policy, any medical conditions you’ve had in the past 5 years will be excluded until you’ve spent 2 years free of symptoms, treatment, medication or advice for that condition.
What our health insurance expert says
The high demand on the NHS can make it tricky to get the treatment you need when you need it. With shorter waiting lists and more control over when and where you’re treated, private healthcare lets you take control of your treatment. And health insurance can help you fund it.
Confused.com Health Insurance Expert
Need more help?
If you already have medical insurance, changing insurance companies is the easiest way to save. In July 2020, new customers saved £587 on average2 when switching cover with Assured Futures. Compare quotes today to see if you could save.
If you’re new to health insurance, there’s a few easy ways to cut the cost of your policy:
- Add an excess to cut the cost of your premiums, the more you can afford the cheaper your policy will be
- Look out for offers among your quotes, as providers may have sales on throughout the year
- Ponder the perks as some policies come with extras like discount gym memberships
- Get the right level of cover as you may not need the most comprehensive policy
- Consider family health insurance to insure all your loved ones under one, cheaper policy
2 During August 2021, Assured Futures clients saved an average 23% (£587.45) by switching insurers via Assured Futures. The average saving was £587.45 per year. These figures are based on a review of 100 clients that switched in August 2021, to a comparable or better policy.
Most private health insurance policies will not cover pre-existing conditions. These are normally health issues you’ve been treated for in the last five years, although some insurers may put a time limit at four years or less.
Asthma and diabetes are common examples of pre-existing conditions, and unless you’ve gone several years without being treated for them, they usually won’t be covered.
Chronic conditions are similar. These include things like high blood pressure, arthritis and diabetes that are likely to cause you issues for a long time. If you’ve recently received treatment for them, most insurers won’t cover you any further.
When getting a quote, have your medical history and details on any pre-existing conditions to hand to make it a bit easier.
While there’s a lot health insurance will cover, there are a few areas that your policy typically won’t cover.
These can include:
- Organ transplants
- Prescription drugs and dressings you receive as an outpatient
- Illnesses developed due to drug abuse
- Kidney dialysis
- Experimental, unproven treatment or drugs
- Cosmetic treatments
- Routine pregnancy procedures
- Mobility aids such as wheelchairs
- Deliberately self-inflicted injuries
Most of these will be covered by the NHS, but you may have to pay out of your own pocket if you want to be treated for them privately.
Basic health insurance policies usually won’t cover mental health care. More advanced policies that include full treatment and diagnosis cover will either cover mental health fully or provide this cover as an added extra. If it’s provided as an add-on, you may have to pay something towards it. Check your policy details to be sure.
You’ll need to be over 18 to take out a health insurance policy for yourself or your family. Children under 18 can still be covered via family health insurance cover, but the policy holder will need to be above the minimum age.As for an upper age bracket, this will depend on your provider but most health insurance companies will cover you up to any age. Be prepared to pay more however, as the older you are, the higher your premiums are likely to be.
Getting a quote is easy. All you need to do is fill in the form. There we’ll ask you for information that could affect your cover price, these include:
- Your age
- Whether or not you smoke
- Where you live
- Your general wellbeing
- Any pre-existing conditions you have
These will help determine whether you’ll be offered a quote, and how much you’re likely to pay for your health insurance.
Whether you need private medical insurance depends on what you want from your healthcare. Many treatments are available free of charge on the NHS, but often require you to wait to access them. Due to a lower demand on private healthcare facilities, health insurance allows you to get a diagnosis quicker, and avoid waiting lists for the treatment you need. You may even be able to access therapies that the NHS can’t fund.
Take a look at the benefits of private health care on this page for a rundown of the perks of going private and consider whether they’re for you.
No, you shouldn’t need to have a medical to get health insurance. You’ll normally just have to fill out a medical history form, and your provider will do the rest.