What it does
- Provides cover to employees, and sometimes their families, under scheme rules rather than an individual policy.
- In an insured scheme, an insurer carries the risk; in a trust, the employer funds claims and an administrator processes them.
- Sets its own eligibility, joining and leaving rules.
- Usually offers medical history disregarded terms on joining, which individual cover rarely matches.
How it is paid
- By the employer, sometimes with an employee contribution.
- Cover is normally a taxable benefit in kind for the employee.
- Trust arrangements pay an administration fee rather than a full insurance premium.
What it is regulated to do
- An insured scheme is a regulated insurance contract.
- A trust is not an insurance contract, so Financial Ombudsman Service access can differ — ask before you need it.
- Scheme rules, not a personal policy, decide what you get.
Anyone arranging or advising on insurance in the UK must be authorised by the Financial Conduct Authority or be an appointed representative of a firm that is, and you can check any firm or individual free of charge on the Financial Services Register. [1] The conduct rules that apply to insurance sit in the FCA’s insurance sourcebook. [2]
What protects you
- Ask the administrator how complaints are handled and who the final decision-maker is.
- Leaving the employer normally ends the cover; continuation terms must be arranged, often within a short window.
- Medical history disregarded terms are usually lost when you move to individual cover.
| The problem | Where it goes |
|---|---|
| An insurance sale, a policy decision or a declined claim | The firm’s complaints process first, then the Financial Ombudsman Service |
| A firm that has failed owing you money | The Financial Services Compensation Scheme |
| Care or safety at a hospital or clinic | The provider’s complaints process, then the health regulator for your nation |
| A doctor’s conduct or fitness to practise | The General Medical Council |
| Something we have published | Our own corrections route on the complaints page |
The Financial Ombudsman Service resolves complaints about regulated firms free of charge, [3] and the Financial Services Compensation Scheme can pay compensation where an authorised firm cannot. [4] Care regulators publish inspection reports for private hospitals as well as NHS ones, [5] and the medical register shows whether a doctor holds a licence to practise. [8]
Questions worth asking
Free and impartial guidance on any of this is available from MoneyHelper. [9] Private hospital and consultant performance and fee information is published by PHIN under the Competition and Markets Authority’s order. [6] [7]
Sources and methodology
- [1] Financial Conduct Authority. “The Financial Services Register”. View source(opens in a new tab)Primary source
- [2] Financial Conduct Authority. “Insurance: Conduct of Business Sourcebook (ICOBS)”. View source(opens in a new tab)Primary source
- [3] Financial Ombudsman Service. “Financial Ombudsman Service”. View source(opens in a new tab)Primary source
- [4] Financial Services Compensation Scheme. “Financial Services Compensation Scheme”. View source(opens in a new tab)Primary source
- [5] Care Quality Commission. “Find and compare care services”. View source(opens in a new tab)Primary source
- [6] Private Healthcare Information Network. “Private hospital and consultant performance and fee information”. View source(opens in a new tab)Primary source
- [7] Competition and Markets Authority. “Private healthcare market investigation”. View source(opens in a new tab)Primary source
- [8] General Medical Council. “The medical register”. View source(opens in a new tab)Primary source
- [9] MoneyHelper (Money and Pensions Service). “MoneyHelper — free and impartial money guidance”. View source(opens in a new tab)Primary source
We cite primary sources wherever possible. Read about our sourcing methodology.
Guides that explain this in full
Stuart Hendy
PMI Expert and Head of Publishing, PremierPMI
- 20 years in UK private medical insurance
- Underwriting and corporate placement specialist
Stuart brings over 20 years of experience advising on UK private medical insurance. He is a key member of the private medical insurance team and Head of the Publishing Team, gathering detailed client requirements, liaising with insurers on tailored quotes, and running training on insurer product changes and underwriting nuance.
Read full profile
Muhammad Junaid
Digital Marketing Executive, PremierPMI
- Digital marketing and search
- Financial promotions compliance review
Junaid leads digital marketing — search, content distribution and measurement — working with the editorial and advisory teams so that every campaign points to real, compliant guidance. He reviews anything published under the brand against the same fair, clear and not-misleading standard as the rest of the site.
Read full profile
