What Does Private Health Insurance Cover in the UK?

UK private medical insurance is designed for acute, treatable conditions that arise after your policy starts. That means new problems; short-term illnesses or injuries that can be cured or substantially improved with treatment. Long-term, chronic, or pre-existing conditions are generally not covered.

Within that scope, here’s what a typical comprehensive policy actually pays for.

Inpatient treatment

The original purpose of PMI. If you need surgery or a hospital stay, your policy covers:

• The operation itself, including the surgeon’s and anaesthetist’s fees
• Hospital accommodation (usually a private room)
• Diagnostic tests during the stay
• Drugs and dressings
• Nursing care

Day-patient treatment

Procedures that need a hospital but not an overnight stay; endoscopies, minor surgery, certain investigations.

Outpatient consultations and diagnostics

Specialist appointments, MRI/CT/ultrasound scans, blood tests, X-rays. The amount of outpatient cover varies by tier; core plans often have a low limit or none, comprehensive plans typically have a high limit or no limit.

Cancer cover

UK PMI usually includes full cancer cover as standard, including diagnostics, surgery, chemotherapy, radiotherapy, and increasingly advanced treatments like targeted therapy and immunotherapy. Some insurers offer cancer treatment with no annual limit.

Mental health treatment

Most modern policies include mental health cover for new conditions. Typically this means:

• A set number of outpatient therapy sessions per year (often 10-28)
• Inpatient psychiatric treatment up to a defined limit
• Cover for conditions including anxiety, depression, eating disorders, and OCD

Pre-existing mental health conditions are usually excluded under standard underwriting.

Physiotherapy

Almost always included, often with a specified number of sessions per year, sometimes accessible without a GP referral.

Virtual GP and digital health

Many insurers include unlimited virtual GP appointments; typically same-day video consultations with a UK-licensed doctor, with prescriptions and referrals issued through the app.

Add-ons available on most policies

These aren’t always included as standard but can be added:

• Dental and optical cover
• Travel insurance
• International treatment
• Higher mental health limits
• Outpatient maternity-related cover (limited)
• Health screens and check-ups

What it doesn’t cover

Standard UK PMI typically excludes:

• Pre-existing conditions
• Chronic, ongoing conditions (diabetes, asthma, heart conditions)
• Routine GP appointments
• Routine pregnancy and childbirth
• Cosmetic surgery
• Fertility treatment
• A&E (handled by the NHS)
• Self-inflicted injuries and substance abuse-related treatment

For full detail on exclusions, see our guide to what private health insurance doesn’t cover.

Frequently asked questions

Is cancer always covered? Yes for new cancers diagnosed after your policy starts. Pre-existing cancers are usually excluded. The level of advanced treatment covered varies by insurer and tier.

Are children’s conditions covered the same way? Yes. Children on a family policy get the same range of cover, with the same underwriting principles around pre-existing conditions.

Does my policy cover treatment overseas? Standard UK policies cover emergency-only treatment on holidays up to 60-180 days a year. For ongoing overseas treatment, you need international cover.

What if my condition becomes chronic? If a condition you’re being treated for is reclassified as chronic, the insurer typically continues to fund stabilisation but stops funding ongoing maintenance. We can help you understand exactly where the line falls on each policy.

Want a clear list of what’s covered for your situation? Call 0800 131 0400 or email info@insuredhealth.co.uk.