BMA guidance

Guidance for patients thinking of taking out private medical insurance

The questions patients need to ask private medical insurance providers before making an informed decision.

Location: UK
Audience: Patients and public GPs
Updated: Monday 7 September 2020
Topics: Private practice
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Private medical insurers are insurance companies that provide particular health insurance policies that cover payments of benefits as a result of sickness or injury.

The purpose of private medical insurance (PMI), also known as private health insurance, is to assist patients in paying for private medical care and treatment for short term, curable conditions when they need it. The alternative being to pay for care themselves as the need arises.


What you'll get from this guidance

  • The different types of health insurance and what it typically will/won't cover.
  • The questions patients need to ask private medical insurance providers before making a decision.
  • Key considerations that will determine what level of cover patients should look for. 


Key information

It is crucial that the PMI cover ensures the following when patients need treatment:

  • That patients have insurance cover for the conditions for which they may require treatment.
  • That patients have, in conjunction with their GP, free choice of consultant with the right to top-up fees if they exceed the insurance reimbursement.
  • That patients have the option of choosing the hospital where they receive treatment and, if necessary, are able to top-up the charges if they require to use a hospital that charges more than their insurance cover.

Choosing the right plan will depend on budget and the level of cover selected to meet the individual's needs. Patients need to be confident that the cover they are buying will cater to these needs. The exact details of what is covered will vary considerably from policy to policy.

The PMI market is a large one, so it's important to shop around until the right cover is found.

  • Introduction
  • Reasons for taking out insurance
  • What benefits are included?
  • What are the different types of health insurance?
  • Does the policy have any exclusions?
  • What will the PMI cover/not cover
  • Key questions to ask before you make a decision