What does health insurance cover?

8 min Read Published: 21 Jan 2021

What does health insurance cover?There are a number of well-established health insurance providers in the UK, offering private health insurance policies that range from basic to fully comprehensive. So what exactly does a health insurance policy cover? In this article we explain what is included as standard as well as what isn't covered. We also explain the optional benefits that can be added to a health insurance quote to ensure you get the best policy to suit your needs.

What is covered when you buy health insurance?

Health insurance policies vary from insurer to insurer, however, most health insurance policies include the following as standard:

  • Diagnostics/Outpatient Treatment- A health insurance policy will usually cover you for a number of tests, scans, x-rays and consultations. Some basic policies will have a limit on the amount of diagnostics you are covered for, whereas comprehensive policies usually have no limit. In addition, most policies will cover you for a limited number of outpatient procedures (treatment that does not require an overnight stay).
  • Inpatient Treatment - Health insurance will cover the cost of receiving inpatient care (treatment that requires an overnight stay). There are variations depending on the insurance company you choose and the level of cover, with some offering a choice of specialists and a wider network of hospitals.
  • Hospital Accommodation - The cost of your accommodation is covered with a health insurance policy. Some health insurance policies will provide overnight accommodation for family members and some even provide a cash benefit if you end up receiving treatment through the NHS.
  • Nursing Care - Health insurance policies cover the cost of nursing care while you are receiving treatment.
  • Medication - Medication costs are covered by health insurance and some policies may even grant you access to specialist drugs that are not available on the NHS
  • Additional Care - Some health insurance policies provide additional care as standard, such as advanced cancer cover, mental health cover and access to Virtual GP's. This varies from insurer to insurer and so it is best to speak to an independent specialist if you want to know the best way to maximise your cover. We explain more about seeking specialist advice below.

What isn't covered when you buy health insurance?

Most health insurance policies would exclude the following:

  • Pre-existing conditions - Most health insurance providers apply automatic exclusions for pre-existing conditions where you have sought advice or treatment in the past 2-5 years (depending on the health insurance provider)
  • Chronic illnesses - Chronic conditions are those that require long term care and in most cases are incurable. If you have a chronic condition before taking out health insurance it will not be covered. If you develop a chronic illness after you have taken out a health insurance policy you will be covered for the diagnosis and the initial stages of treatment. You will then be referred to the NHS in order to continue receiving treatment.
  • Elective treatment (Cosmetic surgery) - You will not be covered for elected cosmetic treatment on a standard health insurance policy. Some health insurance providers do offer enhancements that provide limited cosmetic surgery to remove birthmarks and correct prominent ears. These will come at an additional cost.
  • Treatment abroad - Health insurance policies do not cover you for treatment abroad and so you would need to refer to your travel insurance policy if this is required. Some insurance providers do offer a 'travel' option that grants access to treatment abroad but this will come at an additional cost.
  • Emergency treatment - Health insurance providers do not offer emergency care and so if you need to be seen as an emergency you will need to use the NHS (A&E)
  • Pregnancy - Health insurance does not provide support and assistance through pregnancy. Health insurance may however provide cover if complications arise and treatment is required.
  • Drug Abuse - Treatment for drug abuse and rehabilitation is not covered on a health insurance policy

Optional benefits that can be added to a health insurance policy

Health insurance providers such as Axa PPP, Bupa and Vitality all have 'optional' benefits that can be added to a health insurance policy to bolster the cover. Below we have listed a few of the optional benefits that can be purchased with most health insurance providers.

  • Access to an extended hospital network
  • Advanced cancer cover
  • Dental cover
  • Mental health cover
  • Worldwide cover

Summary

There are many different types of health insurance policy on the market making it difficult to understand exactly what is covered on a health insurance policy. It is worth remembering that for most people, the motivation for taking out health insurance is often born from a desire to skip the NHS queues and this is something that every health insurance policy provides. If you simply want an insurance policy that would enable you to have surgery privately if needed, then a basic plan is all you would need. If you are worried about having to wait to receive consultations or tests or wouldn't be able to afford to pay for those yourself, then a more comprehensive health insurance policy would be sensible. It is worth making a list of your priorities first and foremost and you may want to read our article 'How to compare the best health insurance policies in the UK'. Once you have an idea of the type of health insurance plan you may need, you should seek independent advice.

We have personally vetted the services of expert independent health insurance specialists Assured Futures*. Its team of qualified advisers have access to every health insurance provider on the market and so are best placed to find the policy that matches your specific requirements. As they are independent, they will have your best interests at heart and they promise to match the price of any like for like quote you receive elsewhere (or they will give you a £50 voucher).

 

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