What it does
- Writes the policy wording that decides everything you are and are not covered for.
- Prices the risk using age, location, cover level, excess and medical history.
- Authorises treatment in advance and pays hospitals and consultants directly in most cases.
- Decides claims against the wording and handles complaints about those decisions.
How it is paid
- From your premiums, less the claims it pays and the costs of running the business.
- Renewal pricing reflects claims across the book as well as your own history.
- Commission paid to intermediaries comes out of the premium you pay.
What it is regulated to do
- Authorised and regulated by the Financial Conduct Authority, and prudentially regulated by the Prudential Regulation Authority.
- Required to treat customers fairly, handle claims promptly and give clear information.
- Required to provide an insurance product information document summarising cover.
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
- A complaint to the insurer, then to the Financial Ombudsman Service, costs you nothing.
- The Financial Services Compensation Scheme covers insurance if the insurer fails.
- You have a statutory cooling-off period on new policies.
| 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
Parvoz Haydarov
Founder, PremierPMI
- Founder of PremierPMI
- Whole-of-market private medical insurance
Parvoz founded PremierPMI as a specialist private medical insurance brokerage. He sets the direction of the firm — insurer relationships, service standards, compliance culture and the editorial bar for everything published under the PremierPMI name — and personally reviews the largest corporate and family cases before they go to market.
Read full profile
