Private Medical Insurance
Private Medical Insurance Advice for Individuals, Families and Business Owners
Your health is one of the most important things you have, but getting access to medical treatment can sometimes mean waiting for appointments, tests or procedures.
Private Medical Insurance (PMI) can provide access to private healthcare for eligible conditions and treatments covered by your policy, subject to the policy terms, exclusions and underwriting.
At Cambs Ely Mortgages, we provide protection advice for individuals, families, self-employed people and business owners across Ely, Cambridge, Cambridgeshire and throughout England.
We can help you understand how Private Medical Insurance works, what different policies can offer and whether it could be appropriate for your circumstances.
What Is Private Medical Insurance?
Private Medical Insurance is designed to help cover the cost of eligible private medical treatment.
Depending on the policy you choose, this can include access to private hospitals, consultants, diagnostic tests and treatment for conditions covered by the policy.
The exact level of cover varies between providers.
Some policies offer a wider choice of hospitals and consultants, while others may restrict treatment to particular hospital networks.
The important thing is understanding what you're paying for and what the policy does — and does not — cover.
Why Consider Private Medical Insurance?
One of the main reasons people consider PMI is access to private healthcare.
Depending on your policy, PMI can potentially provide:
Access to private hospitals
Choice of consultant or specialist
Diagnostic tests
Private treatment for eligible conditions
Different levels of hospital cover
Options for outpatient treatment
Cancer treatment options
Mental health benefits on some policies
Physiotherapy and other therapies on some policies
The benefits available depend entirely on the policy selected.
PMI is not designed to replace the NHS. Instead, it can provide an additional option for accessing private healthcare where treatment is covered by your policy.
How Does Private Medical Insurance Work?
You normally pay a monthly or annual premium for your policy.
If you develop a medical condition and need treatment, you would normally contact your insurer before arranging private treatment.
The insurer will assess whether the condition and proposed treatment are covered under your policy.
If approved, the insurer can then arrange or authorise treatment through its network.
You should always check with your insurer before proceeding with treatment, as arranging treatment without authorisation could affect what the policy will pay.
What Does PMI Cover?
The precise benefits depend on the insurer and level of cover.
A policy may include some combination of:
Inpatient Treatment
Cover for eligible treatment where you need to be admitted to hospital.
Day-Patient Treatment
Treatment where you may need to attend hospital but don't necessarily stay overnight.
Outpatient Treatment
Depending on the policy, this can include consultations, diagnostic tests and specialist appointments.
Cancer Treatment
Some PMI policies include private cancer treatment, although the exact level of cover and exclusions vary.
Mental Health Support
Some policies offer mental health treatment and support, subject to their specific terms and limits.
Therapies
Physiotherapy, osteopathy and other therapies may be included or available as additional options.
It is important to check the policy details rather than assuming every PMI policy provides the same benefits.
What Isn't Usually Covered?
Private Medical Insurance isn't designed to cover every medical condition or every type of treatment.
Policies commonly have exclusions and limitations.
For example, depending on the policy, exclusions can relate to:
Pre-existing medical conditions
Chronic conditions
Certain treatments
Cosmetic procedures
Experimental treatments
Routine or preventative treatment
The precise exclusions vary between insurers and policies.
Some insurers may offer different underwriting options for pre-existing conditions, while others may exclude them.
Understanding the underwriting method is therefore an important part of comparing PMI.
Moratorium vs Full Medical Underwriting
When applying for PMI, the insurer may use different approaches to underwriting.
Moratorium Underwriting
Under a moratorium approach, certain pre-existing medical conditions may be excluded for a period based on your medical history.
If you haven't experienced symptoms or treatment for a specified period, the condition may potentially become eligible for cover, depending on the policy.
Full Medical Underwriting
With full medical underwriting, the insurer asks for detailed information about your medical history when you apply.
The insurer then decides what conditions, if any, will be excluded or accepted.
The underwriting method can affect the policy you receive, so it is important to understand the difference.
Choosing a Hospital List
Your choice of hospital list can affect both the level of cover and the premium.
A wider hospital list may provide access to more private hospitals and consultants.
A restricted list may cost less but give you fewer options.
Some insurers also offer different levels of hospital cover depending on where you live.
When comparing policies, it is therefore worth considering which hospitals and specialists are realistically available in your area.
PMI for Families
Private Medical Insurance can be arranged for individuals, couples and families.
For parents, having access to private healthcare can be particularly attractive where waiting for diagnosis or treatment could affect family life and work commitments.
Family policies can cover multiple people, although the cost and underwriting will depend on the individuals being insured.
Children's cover and available benefits vary between providers.
PMI for Self-Employed People
For self-employed people, being unable to work can have a direct impact on income and business activity.
While Income Protection is designed to address the financial impact of being unable to work, PMI addresses a different issue: access to private healthcare.
Being able to access eligible diagnosis or treatment privately may help some self-employed people manage health issues while reducing disruption to their working life.
PMI and Income Protection can therefore complement each other, but they are designed for different purposes.
PMI for Business Owners
Private Medical Insurance can also be provided as an employee benefit.
For business owners, it may form part of a wider employee benefits package.
Some businesses use private healthcare as part of their overall approach to attracting and retaining employees.
Business owners may also consider PMI for themselves and other key people within the business.
The tax treatment of employer-provided medical insurance can vary depending on the circumstances, so appropriate tax advice should be obtained where necessary.
Individual vs Business PMI
PMI can generally be arranged on an individual basis or through a business.
The appropriate option depends on factors such as:
Number of people being insured
Employee benefits
Business structure
Budget
Desired level of cover
Underwriting requirements
Whether dependants are included
For business owners, we can help explain the protection options available, while specialist tax advice may be appropriate regarding the tax treatment.
How Much Does PMI Cost?
There is no standard PMI price.
Premiums can be affected by factors including:
Age
Location
Number of people insured
Level of cover
Hospital list
Excess
Underwriting
Optional benefits
Claims history for some business schemes
Increasing the excess can sometimes reduce the premium, but it also means you would need to contribute more towards eligible claims.
A lower premium isn't automatically the most suitable policy.
The aim should be to balance the level of cover you want with a premium that fits your budget.
Reviewing Existing Private Medical Insurance
If you already have PMI, it's worth reviewing the policy periodically.
Your circumstances may have changed since you originally arranged the cover.
You may have:
Changed employer
Started your own business
Had children
Moved home
Changed your budget
Added or removed dependants
Changed your healthcare preferences
A review can help you understand whether your current policy still provides the level of cover you want.
It doesn't automatically mean changing provider. Existing medical underwriting can be an important consideration, so replacing a policy should be considered carefully.
Private Medical Insurance Advice in Ely and Cambridgeshire
At Cambs Ely Mortgages, protection advice goes beyond mortgages.
We can help you look at the different areas of financial protection that may be relevant to your circumstances, including Life Insurance, Critical Illness Cover, Income Protection and Private Medical Insurance.
Whether you're a first-time buyer in Ely, a homeowner in Cambridge, self-employed in Cambridgeshire or a business owner, we can help you understand your options.
With access to a wide range of providers, we can compare suitable protection solutions based on your circumstances.
Looking at Private Medical Insurance?
PMI isn't right for everyone, and the cheapest policy isn't necessarily the most appropriate.
If you want to understand what Private Medical Insurance could offer, we can explain the options, compare suitable policies and help you understand the important differences between them.
Cambs Ely Mortgages — Building Blocks for a Brighter Future.