Health insurance
What does private health insurance cover?
The short answer
Private health insurance pays for eligible private treatment of new conditions that begin after your policy starts. Most policies cover diagnostic tests, specialist consultations and inpatient treatment; many exclude chronic conditions, pre-existing conditions, accident and emergency care, and routine pregnancy. Cover, limits and excesses vary by insurer, so the policy wording decides what is paid.
Written by Stuart Hendy. Reviewed by Parvoz Haydarov.
Published 2026-09-14. Last reviewed 2026-09-14. Next review due 2027-03-14.
What the cover is for
Private medical insurance is designed for acute conditions — problems that start after the policy begins and that respond to treatment. It is not a replacement for the NHS: emergency care, most long-term condition management and routine maternity care stay with the NHS. [1]
What most policies include
- Specialist consultations after a GP referral
- Diagnostic tests and scans, once the insurer has authorised them
- Inpatient and day-patient treatment in a private hospital
- Surgeons’, anaesthetists’ and hospital fees for eligible treatment
- A hospital cash benefit when you have eligible treatment on the NHS instead
What is usually excluded
| Exclusion | Why it applies |
|---|---|
| Pre-existing conditions | Underwriting decides which past conditions are covered; see how medical underwriting works. |
| Chronic conditions | Policies fund treatment that cures or stabilises, not ongoing management of a long-term condition. |
| Accident and emergency | Emergency care is an NHS service; private hospitals rarely run emergency departments. |
| Routine pregnancy and childbirth | Normally excluded, though some policies cover specified complications. |
| Cosmetic treatment | Excluded unless it follows an eligible accident or covered surgery. |
How limits change what you get back
Two policies with the same headline description can pay very differently. Outpatient cover may be unlimited, capped at a money amount, or excluded. Therapies, mental health cover and cancer cover are often modular. The hospital list attached to your policy also decides where you can be treated. [2]
Cover is now widely held. Association of British Insurers data published in January 2026 shows 6.5 million people in the UK were covered by private medical insurance in 2024, and that insurers processed a record £4 billion of individual and workplace claims that year — about £11 million a day. [2]
6.5 million — People in the UK covered by private medical insurance in 2024, according to the ABI [2]
Before you rely on a policy
- Read the policy wording, not the brochure The wording is the contract; the summary is not.
- Check the exclusions and any personal exclusions Underwriting can add exclusions specific to you.
- Check the hospital list Cover usually applies only at facilities the insurer recognises.
- Check the outpatient limit This is where most policies differ most.
Common questions
- Does private health insurance cover pre-existing conditions?
- Usually not. Medical underwriting decides which past conditions are excluded, either automatically under a moratorium or by listing them before you buy. Read how medical underwriting works for the detail.
- Does private health insurance cover A&E or emergencies?
- No. Emergency care in the UK is an NHS service and private hospitals rarely run emergency departments. If you need urgent help, call 999 or use NHS 111 — your insurance is for planned, eligible treatment that follows a referral.
- Can I use private health insurance instead of the NHS?
- You can use both. Private cover does not remove any NHS right, and many policies pay a cash benefit if you choose NHS treatment instead of claiming. See the NHS 18-week waiting time standard for what the NHS must offer you.
- How many people in the UK have private health insurance?
- The Association of British Insurers reported 6.5 million people covered by private medical insurance in 2024, with a record £4 billion of claims processed in that year — figures published in January 2026. [2]
Sources
- NHS. Guide to NHS waiting times in England. 2 December 2019 (primary source)
- Association of British Insurers. Insurers process record £4bn across individual and workplace health schemes (2024 data). 21 January 2026 (primary source)