skip to Main Content

Private Medical Insurance explained

Private Medical Insurance is principally*designed to cover the costs of private medical treatment for short-term illnesses or injuries – commonly known as acute conditions. Most people buy this type of insurance to gain the reassurance of knowing that treatment is available promptly, should they become ill or injured. As a private patient you can usually choose where and when your treatment is to take place, the specialist who treats you and the hospital. You will usually have a private room with en-suite facilities, complete with TV, telephone and the freedom to entertain your visitors’ at all reasonable times.This allows you to plan your treatment around your personal and business life.

*One or two Insurers may be prepared to provide terms for cancer and chronic conditions.

Private Medical Insurance is designed to principally cover treatment for short-term illness or injuries. Some illnesses and treatments are not usually covered and these are common to most schemes. It is also important to remember that Private Medical Insurance is not designed to replace all the services offered by the NHS. These include accident and emergency treatment, which are beyond the scope of most private hospitals. The level of cover provided depends on your choice of insurance company and the type of plan selected.

Listed below are some very general guidelines. However it is important that you consult your Private Medical Insurance specialist...

      Usually included – treatment in the UK:

  • Hospital costs including:
  • Accommodation
  • Nursing care
  • Operating Theatre
  • Intensive Care and other ancillary charges

      Included only – in certain plans:

  • Out-patient tests
  • Out-patient consultations with a specialist
  • Overseas cover
  • Cash payment for treatment received as an NHS in-patient

      Usually not included:

  • Conditions you had before taking out the insurance (commonly known as pre-existing conditions)
  • GP services
  • Cover for long-term illnesses which cannot be cured (usually referred to as chronic conditions)
  • Accident and emergency admissions
  • Drug abuse, self-inflicted injuries, HIV/AIDS, infertility, normal pregnancy, cosmetic surgery, gender reassignment, preventive treatment, kidney dialysis, mobility aids, experimental treatment, experimental drugs, organ transplant, war risks, injuries arising from dangerous hobbies, and out-patient drugs and dressing.

Whichever plan you choose, it is likely that your premiums will rise above the rate of general inflation. This is because of factors which affect how healthcare is provided in all western economies.

Each year more people claim on their insurance cover for private medical treatment. the average cost of a hip replacement in London is £10600. As per Private Healthcare UK Self pay market study 2013, and is a common procedure, particularly for older patients.

The number and sophistication of treatments to improve quality of life is increasing steadily. Most Private Medical Insurance policies aim to cover these treatments as they become established medical practice and available privately.

Likewise, the sophistication and complexity of tests used to diagnose illness and injury is also increasing. Such tests are becoming far more widely available in private hospitals – for example, Magnetic Resonance Imaging (MRI) scans which costs around £750 each.

As people get older they are more likely to need and receive medical treatment, which means that Private Medical Insurance premiums will increase with age to reflect this.

This depends on the method of underwriting you choose.

Moratorium underwriting – details of your medical history is not required.
Medically underwritten – full details of your medical history is required.

This is when you are asked to fill in a form, but you are not asked to give details of your medical history. Instead, the insurance company does not cover any medical condition which existed for a stated period of time, usually in the last five years. These conditions may automatically become eligible for cover, but only when you do not have symptoms, or receive treatment, medication, test and advice (from your GP or a specialist) for that condition for the stated continuous period (usually two years), after your policy has started. If your insurance company offers a “moratorium” policy, they will give you printed information explaining how their particular moratorium works – you should always ask your Private Medical Insurance consultant to explain this for you.

You will be asked to fill in a form, giving details of your medical history. If necessary, the insurance company may write to your doctor for more information. It is essential that you give all the information you are asked for. If you don’t, it could affect your claim. If you are not sure whether or not to mention something, it is best to do so. If you have a medical condition which is likely to come back, it will probably be excluded, either indefinitely, or for a set period of time.

Insurance companies will not refuse to cover you because you are disabled. As with other pre-existing conditions, your insurance company may exclude cover for treatment arising directly from your disability.

Apart from emergency admissions to NHS hospitals, all medical treatment has to start with a referral by your GP to an appropriate specialist. At this point you should inform your GP that you have Private Medical Insurance. You should also then contact your insurance company to check that you are covered for the treatment that you will receive. In fact, some insurance companies insist that you do this. Your specialist will probably need to fill in and sign your claim form. Most insurance companies settle the hospital and specialist bills directly, but you should check this out with your Private Medical Insurance consultant before taking up a particular Private Medical Insurance plan. Some insurance companies make it a condition of the policy that you must pay all your bills for treatment and then reclaim the costs – this can cause serious cash flow problems.

We work with most of the well-known names in the UK as well as some dynamic lesser-known providers. We will research the marketplace on your behalf and make our recommendations based on your particular individual or corporate situation.

The disturbing facts of life are that in the UK

  • Each year over 150000 people suffer a stroke and 80% of these survive at least one year or more (source)
  • By 2020 almost half of Britons will get cancer in their life time. (source)
  • One in four Critical claims are from individuals in the UK under the age of 40,will have contracted a critical illness before age 65. For women, this is one in five and, of those who develop cancer, 40% will survive 5 years or longer (Data from Cover Magazine 22 April 2013 )
  • One in six healthy men will suffer a heart attack before they reach 65 yrs of age

The NHS offers an excellent service for emergencies. However, at June 2013 the figure reached 2.88 million (source NHS Regulator / Daily telegraph 15/8/2013) people today waiting for NHS treatment, many of whom have been waiting twelve months or more.

You could wait over 12 months for a non-urgent operation under the NHS and may think of going “private”. Some typical costs of treatment are outlined below, which could prove prohibitive if you do not carry insurance. Under private schemes, you can be operated on quickly (within days) and have nursing care at home whilst you recuperate. Additionally, if you carry Income Protection and Private Medical Insurance, your income will be protected for up to a year, for a prolonged illness or medical condition which prevents you working. Critical Illness Insurance would cover you if permanently incapacitated.

Average costs:

  • Heart £10600
  • HIP £7610 – £14980
  • Hysterectomy £1200 -£6903
  • Gall Bladder removal £4000 – £6895
  • Cataract £1200 – £3000
  • Hernia £1800 – 3500
  • Tonsillectomy £1640 – £2900

( Source Private Healthcare UK August 2014 )


The selling of Private Medical Insurance by Sherwood Healthcare comes under the Code of Practices of the following organisations:

Most insurance companies have their own complaints procedures in place; so if you have a problem with any part of your cover, speak to your insurance company first. If you are not satisfied with the way in which your complaint is handled, you can contact either The – Financial Ombudsman Service or the Personal Insurance Arbitration Service – depending on which one your insurance company uses.