How does private health insurance work?
We know that health insurance isn’t the easiest thing to understand. So, we’ve answered some common questions about how it works.
Edited by Jordan Ayrey, health
insurance expert at Bupa
Last updated 28th May 2024
5 minute read
How does private health insurance work?
You’ll usually pay monthly or yearly for your cover. Then, if you become unwell or are injured, you can make a claim. Your insurer will then pay some or all of the cost of any private healthcare that you need.
You’ll usually be able to choose from a selection of private hospitals or clinics. And you’ll have a choice of specialists and consultants. You can usually see a specialist faster with private healthcare. And you may get access to new or advanced treatments.
You may have to pay an excess towards the cost of your treatment. There may also be limits to the amount you can claim. This depends on the policy you choose.
You’ll usually renew your policy each year, and your insurer will let you know how much this will cost.
Health insurance covers new conditions which begin after you’ve taken out your policy. You usually won’t be covered for conditions you had before your policy started.
What are the benefits of health insurance?
The main benefit of health insurance is that it gives you access to private healthcare. You can usually get treatment faster too.
Health insurance offers
- A choice of private hospitals and clinics.
- A choice of which specialists you see.
- Flexibility, so you can get the help you need in a way that works for you.
Some policies offer online appointments with GPs or other clinicians. This can include physiotherapists or mental health nurses. This means you can access support faster. You can also use these services to get a referral if you need more help.
Some policies also come with extra benefits. These can include free online meditation or fitness classes.
Tip
It’s a good idea to compare cover to find the benefits that are right for you.
What does health insurance cover?
Exactly what is and isn’t covered by a policy depends on the insurer and the policy you choose. Although most health insurance policies do agree on a few things.
Covered by most health insurance policies
- Physiotherapy
- Mental health
- Cancer
- Acute conditions. This includes any illness or injury that you can recover from.
Not covered by most health insurance policies
- Conditions that you had before your policy started.
- Ongoing conditions with no known cure. Such as arthritis or diabetes.
- Cosmetic treatments.
- Emergency treatment.
- Allergies and food intolerances.
- Life events like pregnancy, menopause, or ageing.
Some policies do cover long-term treatment for cancer or mental health, even if there is no cure.
Check any policy before you buy. Make sure you fully understand what’s covered and what’s excluded.
How do you make a claim on health insurance?
Every health insurer has their own process. Most ask you to visit your GP first to get a referral. Then they’ll help you find the private treatment you need.
Some health insurance providers offer online GP appointments, so you can get a referral faster. Some allow you to access specialists without a referral. In these cases, you can call or follow an online triage process to get access to specialists without a GP referral.
In most cases, you’ll need authorisation from your provider before you visit a specialist or get treatment. Your insurer will then pay the health care provider directly. If you have an excess or any limits on your cover, you may need to pay some of the cost of your treatment.
More health insurance guides
Our guides about the trickier aspects of health insurance can help you choose a policy that’s right for you.
Learn more about health insurance
- Health insurance excess
- Health insurance exclusions
- How to choose health insurance
- Do I need private health insurance?
- All health insurance guides
Watch our jargon buster videos
We’ll help make sense of some common health insurance terms.
Can I add family to my policy?
Yes, most insurers will allow you to add family members to your policy.
Insurers have different rules about what age counts as a child. For example, some will allow you to add a child up to the age of 21 if they are in full-time education.
For some policies everyone will need to live at the same address.
Tip
Some providers offer family discounts or couples' discounts for joint policies.
Will my health insurance policy renew each year?
Yes, most health insurance policies will renew every year.
Your provider will usually contact you when it’s time to renew. They may ask if there have been any changes to your circumstances. And they’ll let you know if the cost of your insurance has changed.
What if I leave a company health insurance scheme?
Some insurers will allow you to continue your cover with a personal policy. This means that any treatment you’re having can carry on.
You may be able to switch to a personal policy when your work scheme ends. This would continue your cover without interruption. How this works depends on your insurance provider and on the scheme you currently have.
There is usually a time limit on when you can switch. For example, you may need to move to a personal policy within six weeks of your company scheme ending.
If you have questions, ask your provider or your employer.
Leaving a Bupa company scheme?
If you have Bupa cover through your employer, and you’re leaving the scheme, you may be able to move to a personal Bupa policy.
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Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales with registration number 3956433. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Arranged and administered by Bupa Insurance Services Limited, which is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales with registration number 3829851. Registered office: 1 Angel Court, London, EC2R 7HJ.
