What Is Private Medical Insurance (PMI) in the UK? How It Works, What It Covers and What It Does Not

Private medical insurance, often shortened to PMI, is a type of health insurance that helps pay for private medical treatment in the UK. It is also commonly called private health insurance. For many people, PMI is attractive because it can offer faster access to consultations, diagnostic tests, scans, physiotherapy, mental health support and planned treatment for eligible conditions.

But PMI is often misunderstood. It is not a replacement for the NHS. It does not cover every illness, every test, every hospital bill or every medicine. It is usually designed for new, short-term, treatable medical problems, rather than long-term ongoing conditions or emergency care. Understanding this difference is essential before you buy a policy, rely on workplace cover or assume that private healthcare will solve every problem.

This guide explains how private medical insurance works in the UK, what it usually covers, what it commonly excludes, how claims work, how underwriting affects pre-existing conditions, and when PMI may or may not be worth considering.

What is private medical insurance?

Private medical insurance is an insurance policy that helps pay for private healthcare when you need eligible treatment. You pay a monthly or annual premium. In return, the insurer may pay some or all of the cost of approved private care, depending on your policy terms.

In simple terms, PMI helps you access private healthcare without having to pay the full private bill yourself each time. For example, if you develop a new knee problem, persistent abdominal symptoms or a suspected skin condition, your policy may cover a private specialist consultation, diagnostic tests and treatment if the claim is approved.

However, PMI is not an unlimited healthcare pass. It is a contract with conditions. The insurer decides whether a claim is eligible based on your policy, medical history, underwriting method, exclusions, benefit limits and whether the treatment is medically necessary.

If you are comparing private care with NHS care more broadly, you may also find this guide useful: NHS vs private healthcare in the UK.

PMI, private health insurance and health cash plans: are they the same?

The terms can be confusing, so it helps to separate them clearly.

Private medical insurance / private health insurance

These usually mean the same thing in the UK. They refer to insurance that may cover private diagnosis and treatment for eligible medical conditions. This can include specialist consultations, hospital treatment, surgery, scans and other healthcare services, depending on the level of cover.

Health cash plans

A health cash plan is different. It usually reimburses a fixed amount towards everyday healthcare costs such as dental check-ups, eye tests, glasses, physiotherapy or health screenings. It does not usually work like full private medical insurance and is not designed to pay for major surgery or hospital treatment.

Private GP subscriptions

Some services offer monthly subscriptions for private GP appointments, video consultations or same-day access. These can be useful, but they are not the same as PMI. A private GP subscription may help you speak to a doctor quickly, but it may not cover specialist treatment, scans, surgery or hospital bills. For more on this area, see Private GP services in the UK: costs and what to expect.

How does private medical insurance work in practice?

Although policies vary, the basic journey often looks like this:

1. You buy a policy as an individual, couple, family or through your employer.
2. You pay a premium monthly or annually.
3. You develop a new medical problem or symptoms that may need investigation or treatment.
4. You contact your insurer before arranging private care, unless your policy says otherwise.
5. The insurer checks whether the condition may be covered based on your policy and medical history.
6. You may be asked for a GP referral or allowed to self-refer for certain services, depending on the insurer and type of care.
7. You see an approved consultant, therapist, hospital or clinic.
8. The insurer pays the provider directly in many cases, or reimburses you if you have already paid and the claim is accepted.
9. You pay any excess, shortfall or non-covered costs.

The most important practical point is this: do not assume treatment is covered just because you have PMI. Many rejected claims happen because people book treatment first and ask the insurer later. In most cases, it is safer to contact your insurer before arranging a private consultation, scan, procedure or hospital admission.

What is PMI usually designed to cover?

Most UK private medical insurance policies are designed around acute conditions. An acute condition is usually a disease, illness or injury that is likely to respond quickly to treatment and return you to your previous state of health.

Examples might include:

• a new joint injury that needs assessment and treatment;
• a hernia that requires planned surgery;
• new digestive symptoms that need investigation;
• a cataract that needs private surgery;
• a new skin lesion that needs a specialist opinion;
• new mental health symptoms where your policy includes mental health cover;
• diagnostic tests or scans recommended by a specialist.

This does not mean every example will always be covered. It depends on your policy, medical history, underwriting, exclusions and whether the insurer authorises the claim.

Common things private medical insurance may cover

Different policies have different levels of cover, but many PMI policies may include some or all of the following.

Private specialist consultations

A policy may pay for you to see a private consultant, such as a cardiologist, orthopaedic surgeon, dermatologist, gastroenterologist, gynaecologist, ENT specialist or psychiatrist. Some policies require a GP referral first, while others offer direct access for certain conditions.

If you are unsure how referrals usually work, you may find this useful: How hospital referrals work in the UK.

Diagnostic tests and scans

PMI often covers diagnostic tests when they are part of an approved claim. This may include blood tests, X-rays, ultrasound, MRI, CT scans, ECGs, endoscopy or other investigations. Some policies are generous with outpatient diagnostics; others restrict them unless you add enhanced outpatient cover.

This is an area where policy design matters. A cheaper policy may cover hospital surgery but have limited outpatient diagnostics. That can be frustrating if your main reason for buying insurance is faster investigation of symptoms.

For related patient information, see How to understand medical test results and How to understand scan results.

Private hospital treatment

If a claim is approved, PMI may pay for private hospital treatment such as day-case procedures, planned surgery, hospital accommodation, theatre fees, nursing care, anaesthetist fees and consultant fees. The exact hospitals available depend on your policy and hospital list.

For example, someone with an eligible knee problem may be able to use PMI for private orthopaedic assessment and treatment. If you want background on private vs NHS orthopaedic care, see Knee replacement surgery in the UK: NHS vs private.

Cancer cover

Cancer cover is one of the most important parts of many PMI policies, but it varies widely. Some policies include extensive cancer cover, while others have limits on drugs, radiotherapy, chemotherapy, biological therapies, follow-up or access to certain hospitals.

When comparing policies, cancer cover deserves close attention. Look at whether the policy covers diagnosis, surgery, chemotherapy, radiotherapy, advanced drug treatments, ongoing monitoring and palliative care. Do not rely only on a headline phrase such as “comprehensive cancer cover”. Read the detail.

Mental health support

Some PMI policies include mental health cover, but not all do. Cover may include therapy sessions, psychiatric consultations or inpatient mental health treatment, often with annual limits. Other policies exclude mental health or offer it only as an optional add-on.

If mental health access is one of your main reasons for considering PMI, check the wording carefully. You may also find this existing guide helpful: Online therapy and counselling in the UK.

Physiotherapy and musculoskeletal care

Many policies include physiotherapy, osteopathy or chiropractic treatment, either after GP referral, consultant referral or direct insurer triage. Some insurers have dedicated musculoskeletal pathways where you can speak to a physiotherapist quickly without seeing a GP first.

This can be valuable because back pain, knee pain, shoulder problems and sports injuries are common reasons people seek private care. But limits may apply, such as a maximum number of sessions or a requirement to use an approved provider network.

Virtual GP or digital health services

Many modern PMI policies now include access to digital GP appointments, health helplines or remote support. These services can be useful for convenience, but they should not be confused with full NHS GP registration or emergency care.

If a digital GP identifies a problem that needs specialist care, you may still need insurer authorisation before using private diagnostics or treatment.

What private medical insurance usually does not cover

PMI exclusions are just as important as benefits. A policy can look attractive until you realise that the specific care you expected is not included.

Emergency care and A&E

Private medical insurance is generally not designed for medical emergencies. If you have chest pain, stroke symptoms, severe breathing difficulty, major trauma, heavy bleeding or a life-threatening problem, you should use emergency services, not try to arrange private treatment through an insurer.

In the UK, emergency and intensive care are mainly NHS services. Private hospitals are usually focused on planned care, diagnostics and elective treatment rather than major emergency medicine.

Pre-existing conditions

Most PMI policies do not automatically cover medical conditions you already had before the policy started. This includes symptoms, diagnoses, investigations or treatment that existed before the start date, even if the condition had not yet been formally diagnosed.

This is one of the most important PMI concepts. If you buy insurance after developing knee pain, abdominal symptoms, anxiety, high blood pressure or a suspicious lump, the insurer may treat that as pre-existing and exclude related claims.

Chronic and long-term conditions

PMI is usually aimed at acute conditions, not long-term management of chronic illness. Chronic conditions are ongoing problems that need monitoring, maintenance treatment or long-term care. Examples may include diabetes, asthma, epilepsy, hypertension, arthritis, inflammatory bowel disease or some long-term mental health conditions.

A policy may cover an acute flare-up or investigation in some circumstances, but it often will not cover routine ongoing management forever. This is where many people are disappointed, especially if they assume PMI works like a private version of the NHS.

Routine GP care and prescriptions

Standard PMI does not usually cover routine GP appointments, NHS prescriptions, repeat prescriptions, general health checks or everyday primary care. Some policies include digital GP services, but that is not the same as unlimited private GP care.

Pregnancy and childbirth

Normal pregnancy and childbirth are commonly excluded. Some complications may be covered under certain policies, but routine maternity care, birth costs and fertility-related care are usually restricted or excluded unless a policy specifically says otherwise.

Cosmetic treatment

Cosmetic surgery purely to improve appearance is usually excluded. Reconstructive treatment after an accident, cancer surgery or another medically necessary reason may be treated differently, but this depends on the policy.

If you are considering cosmetic procedures privately, it is important to treat PMI and cosmetic finance as separate subjects. For related patient safety considerations, see Thinking about cosmetic surgery abroad? A UK patient’s guide.

Dental and optical care

Dental and optical care are not usually included in standard PMI, although some policies offer add-ons or separate cash-plan style benefits. If you want dental cover, check whether the policy pays for routine check-ups, emergency dental care, hygienist appointments, crowns, implants or only a small contribution towards costs.

For private dental cost context, see Private dentist prices in the UK: what common treatments cost.

Experimental treatment

Insurers may refuse treatment they consider experimental, unproven or not established in UK clinical practice. This is especially relevant for some newer therapies, overseas treatments, regenerative medicine claims or treatments not approved through normal clinical routes.

Non-approved hospitals or consultants

Your policy may only cover certain hospitals, clinics, consultants or provider networks. If you choose a provider outside the insurer’s approved list, you may have to pay the difference or the full cost yourself.

Costs above insurer limits

Even when treatment is covered, the insurer may only pay up to a certain amount. If your consultant charges more than the insurer’s fee schedule, you may face a shortfall. This is one reason to ask about fees before treatment begins.

How underwriting works: why your medical history matters

When you apply for PMI, the insurer needs to decide how it will treat your previous medical history. This is called medical underwriting. It is one of the most important parts of private medical insurance.

The two common approaches are full medical underwriting and moratorium underwriting.

Full medical underwriting

With full medical underwriting, you answer detailed questions about your medical history when you apply. The insurer may exclude specific conditions from the start. For example, if you have a history of back pain, the insurer may exclude back-related claims.

The advantage is clarity. You may know upfront what is excluded. The disadvantage is that the application process can take more time and you must be careful to answer accurately.

Moratorium underwriting

With moratorium underwriting, you may not have to provide detailed medical history at the beginning. Instead, the insurer applies a general rule excluding recent pre-existing conditions for a set period. Claims are then assessed when you make them.

This can make the application process quicker, but it can also create uncertainty. You may not know whether a condition is covered until you claim.

Why disclosure matters

If you are asked medical questions, answer them fully and honestly. If you leave out symptoms, previous investigations, medication or a diagnosis, the insurer may later reduce or refuse a claim. In serious cases, the policy could be cancelled.

For many people with a more complicated medical history, it is worth speaking to a specialist broker or adviser before choosing a policy.

Does PMI cover pre-existing conditions?

Usually, not automatically. Most PMI policies are designed to cover new conditions that arise after the policy begins, not conditions you already had.

A pre-existing condition may include:

• a diagnosed illness you already know about;
• symptoms you had before the policy started;
• a condition you were waiting to have investigated;
• previous surgery or injury in the same body area;
• medication you were already taking;
• a condition that returns after a period of time.

Sometimes cover for a past condition may become available again under moratorium rules if you have been symptom-free, treatment-free and advice-free for a defined period. But the exact rules vary, so never assume.

This is why PMI is usually best bought before you develop a problem, not after you already need treatment.

Can you still use the NHS if you have private medical insurance?

Yes. Having PMI does not remove your right to NHS care. You can still use NHS GP services, NHS emergency care, NHS screening, NHS hospital care and NHS treatment pathways.

Many people use a mixture of NHS and private care. For example, they may see their NHS GP, use PMI for a private specialist consultation and scan, then return to the NHS for ongoing management. Others may use PMI for planned surgery while continuing to rely on the NHS for emergency care and chronic disease management.

However, NHS and private care usually need to be kept clearly separate. You cannot always mix and match parts of the same treatment episode in the way you might expect. For example, paying privately for one drug or test does not automatically mean the NHS must provide the rest of the private treatment pathway.

If NHS waiting times are one reason you are considering private options, see NHS waiting times and when treatment abroad may be considered.

How does a PMI claim work?

The claims process varies by insurer, but the general pattern is similar.

Step 1: You notice symptoms or receive a recommendation for treatment

You might develop symptoms, receive an NHS GP referral, or be advised that you need further investigation.

Step 2: You contact your insurer

Before booking private treatment, call the insurer or use its online claims portal. Explain your symptoms, when they started and what your doctor has advised.

Step 3: The insurer checks eligibility

The insurer may ask questions about your medical history, policy type, underwriting, referral and proposed treatment. They may ask for GP notes or a referral letter.

Step 4: You receive authorisation

If the claim appears eligible, the insurer may give you an authorisation code and tell you which hospitals, consultants or clinics you can use.

Step 5: You receive private care

You attend the consultation, test or treatment. The provider may bill the insurer directly.

Step 6: You pay any excess or shortfall

If your policy has an excess, you pay that amount. If a consultant or hospital charges more than the insurer will cover, you may also need to pay a shortfall.

What is an excess?

An excess is the amount you agree to pay towards a claim. For example, if your policy has a £250 excess and you make an eligible claim, you may need to pay the first £250 of costs.

Choosing a higher excess can reduce your premium, but it also means you pay more if you claim. This can work well for people who mainly want protection against large bills, but less well for people who expect frequent smaller claims.

What are benefit limits?

Benefit limits are caps on how much the insurer will pay for certain types of care. These limits may apply per year, per condition, per claim or per treatment type.

Examples include:

• a maximum number of physiotherapy sessions;
• a limit on outpatient consultations;
• a cap on mental health treatment;
• a hospital list restriction;
• a maximum consultant fee;
• a limit on cancer drugs or follow-up care.

Benefit limits are one of the biggest reasons two policies with similar names can offer very different value.

Types of private medical insurance policies

Individual PMI

This covers one person. It may suit self-employed people, freelancers, contractors or anyone who does not receive employer cover.

Couples PMI

This covers two adults on one policy. It may be cheaper or simpler than two separate policies, but the details vary.

Family PMI

This covers adults and children. It may be useful for families who want quicker access to private diagnosis or treatment, but you should check child-specific benefits carefully.

Corporate PMI

Employer-provided PMI can be a valuable workplace benefit. Corporate schemes may offer better terms than individual policies, sometimes including medical history disregarded terms for larger groups. But this is not guaranteed. You should still understand what is and is not covered.

Also remember that workplace PMI may be a taxable benefit and may end if you leave your employer.

What affects the cost of PMI?

The price of private medical insurance depends on many factors, including:

• your age;
• where you live;
• whether you smoke;
• your medical history;
• the level of outpatient cover;
• hospital list choice;
• cancer cover level;
• mental health cover;
• excess amount;
• whether you include family members;
• whether you choose guided consultant options;
• whether you add dental, optical or travel-related benefits.

PMI usually becomes more expensive with age because the risk of claiming increases. Premiums can also rise after claims, medical inflation or changes in insurer pricing.

Is private medical insurance worth it?

PMI can be worth it for some people, but not for everyone. It depends on your budget, health priorities, risk tolerance and expectations.

PMI may make sense if:

• you want faster access to private consultations and diagnostics;
• you want more choice over hospitals or consultants;
• you would struggle to pay a large private hospital bill yourself;
• you are self-employed and long waits could affect your income;
• you want private physiotherapy or mental health access, if included;
• you want cover for eligible planned private treatment.

PMI may be less useful if:

• your main concern is emergency care;
• you mainly want routine GP appointments;
• you already have symptoms and want them covered immediately;
• you have several chronic conditions requiring long-term management;
• you expect it to cover dental, optical, cosmetic or maternity care as standard;
• the premium would put pressure on your finances.

Some people prefer to self-pay for occasional private appointments instead of buying insurance. Others prefer PMI because it protects them against larger costs. There is no single right answer.

If you are weighing UK private care against overseas options, see Private healthcare UK vs treatment abroad: cost comparison.

How to compare PMI policies properly

When comparing policies, do not focus only on the monthly price. A cheaper policy may be cheaper because it excludes the things you care about most.

Check these areas carefully:

• Outpatient cover: Are specialist consultations and diagnostic tests included?
• Hospital list: Which hospitals can you use?
• Cancer cover: How broad is it, and are there limits?
• Mental health: Is it included or optional?
• Physiotherapy: How many sessions are covered?
• Underwriting: Full medical underwriting or moratorium?
• Pre-existing conditions: What is excluded?
• Excess: How much do you pay when you claim?
• Consultant choice: Can you choose freely or must you use a guided list?
• Claims process: Do you need GP referral, insurer triage or pre-authorisation?
• Renewal pricing: How might premiums increase later?

Common mistakes people make with PMI

Assuming everything private is covered

Private healthcare and insured private healthcare are not the same thing. You can pay privately for many services that an insurer will not cover.

Buying after symptoms start

If you already have symptoms, the insurer may treat them as pre-existing. PMI is not usually designed to cover a problem you already know about before buying the policy.

Choosing the cheapest policy without checking outpatient cover

Many claims start with consultations and diagnostics. If outpatient cover is limited, you may find that scans or specialist appointments are not covered as expected.

Not checking hospital access

Some policies exclude expensive central London hospitals or restrict you to a smaller provider network. This may be fine, but you should know before you buy.

Ignoring shortfalls

A consultant may charge more than the insurer’s recognised fee. Ask the insurer and provider about possible shortfalls before treatment.

Not telling the insurer before treatment

Pre-authorisation matters. If you arrange treatment without approval, the insurer may refuse to pay.

Questions to ask before buying PMI

• What exactly is covered as standard?
• What is excluded?
• How are pre-existing conditions handled?
• Is outpatient cover included or limited?
• Are scans and diagnostic tests covered?
• What cancer cover is included?
• Is mental health cover included?
• Can I choose my consultant?
• Which hospitals are included?
• What excess applies?
• Are there annual or condition-specific limits?
• Will I need a GP referral?
• How do claims work?
• What happens if a consultant charges more than the insurer pays?
• How might premiums change when I renew?

When should you use the NHS instead?

You should use NHS services for emergencies, urgent symptoms and many long-term conditions. PMI can be helpful, but it does not replace NHS care.

Use urgent or emergency NHS care if you have symptoms such as:

• chest pain or suspected heart attack;
• stroke symptoms, such as face drooping, arm weakness or speech problems;
• severe breathing difficulty;
• heavy bleeding;
• serious injury;
• loss of consciousness;
• severe allergic reaction;
• suicidal thoughts or immediate risk of harm.

For symptom-based guidance, you may also find these resources useful: Chest pain: when to worry, Shortness of breath: common causes and when to call 999, and Stroke symptoms and TIA.

So, what is PMI really for?

The simplest way to understand private medical insurance is this:

PMI is mainly designed to help you access private diagnosis and treatment for eligible new, treatable conditions, with more speed and choice than you may otherwise have.

It is not mainly designed for emergencies, routine GP care, chronic disease management, cosmetic treatment, normal pregnancy, everyday dental care or conditions you already had before joining.

The best PMI policy is not necessarily the cheapest or the most heavily advertised. It is the one that matches your real risks, budget, location, medical history and expectations. Before buying, read the exclusions, understand the underwriting, check outpatient and cancer cover, and make sure you know exactly how to claim.

FAQ: Private medical insurance in the UK

What does PMI stand for?

PMI stands for private medical insurance. It is health insurance that helps pay for eligible private medical treatment in the UK.

Is private medical insurance the same as private health insurance?

In the UK, the terms are often used to mean the same thing. Both usually refer to insurance that helps pay for private diagnosis and treatment, subject to policy terms.

Does PMI replace the NHS?

No. PMI does not replace the NHS. Most people with PMI still use NHS services for GP care, emergency treatment, screening, chronic disease management and services not covered by their policy.

Does PMI cover emergency treatment?

Usually not. Emergency medicine, A&E, ambulance care and intensive care are mainly provided by the NHS. If you have urgent or life-threatening symptoms, use NHS emergency services.

Does private medical insurance cover pre-existing conditions?

Usually, pre-existing conditions are excluded, at least initially. The exact rules depend on whether the policy uses full medical underwriting, moratorium underwriting or another underwriting method.

What is moratorium underwriting?

Moratorium underwriting is a method where the insurer does not fully assess your medical history at the start. Instead, it applies rules excluding recent pre-existing conditions for a set period. Whether a condition is covered may only become clear when you claim.

What is full medical underwriting?

Full medical underwriting means you provide detailed medical history when applying. The insurer then tells you which conditions are excluded. This can provide more clarity upfront.

Does PMI cover cancer treatment?

Many PMI policies include cancer cover, but the level varies. Check whether diagnosis, surgery, chemotherapy, radiotherapy, advanced drugs, follow-up and palliative care are included, and whether limits apply.

Does PMI cover mental health treatment?

Some policies include mental health cover, while others exclude it or offer it as an optional add-on. There may be limits on therapy sessions, psychiatric care or inpatient treatment.

Does PMI cover dental treatment?

Standard PMI usually does not cover routine dental treatment. Some policies offer dental add-ons or cash-plan-style benefits, but these are different from full medical insurance.

Do I need a GP referral to use PMI?

Often, yes, but not always. Some insurers allow direct access for certain services such as physiotherapy, mental health support or digital GP pathways. Check your policy before booking treatment.

Can I choose my private consultant?

It depends on your policy. Some policies allow more consultant choice, while others use guided consultant lists or approved networks. Choosing outside the list may lead to extra costs.

What is a hospital list?

A hospital list is the group of private hospitals and clinics your insurer allows you to use. Wider hospital lists usually cost more. Restricted lists may reduce premiums but limit choice.

What is an excess on PMI?

An excess is the amount you pay towards an eligible claim. A higher excess can reduce your premium, but you will pay more if you need treatment.

Can my insurer refuse a claim?

Yes. A claim may be refused if the condition is excluded, pre-existing, chronic, not medically necessary, outside policy limits, treated without authorisation or provided by a non-approved provider.

Can I use PMI and NHS care at the same time?

You can use both NHS and private care, but they usually need to be kept clearly separate. Paying privately for one part of care does not automatically mean the NHS will fund the rest of that private pathway.

Is PMI worth it for self-employed people?

It can be, especially if faster diagnosis or treatment could reduce time away from work. However, it depends on cost, exclusions, medical history and whether the policy covers the services you are most likely to need.

Can I buy PMI after I become ill?

You can apply, but the illness or symptoms you already have may be treated as pre-existing and excluded. PMI is generally more useful when arranged before health problems arise.

Will my premium increase every year?

It may. PMI premiums often increase with age, medical inflation, claims experience and insurer pricing changes. Always consider long-term affordability, not just the first-year price.

What should I read before buying a policy?

Read the policy summary, full policy wording, exclusions, underwriting terms, hospital list, excess rules, benefit limits and claims process. If anything is unclear, ask the insurer or a qualified broker before buying.