For high-net-worth individuals, private healthcare usually means a fully comprehensive policy on a Central London hospital list including HCA facilities, often paired with a private GP retainer at £2,000–£10,000 a year and international cover for time spent abroad. Comprehensive London-list cover typically runs £150–£400+ a month per adult depending on age — and for many, insuring still beats self-insuring.
- ✓Full outpatient cover plus a London or HCA hospital list is the standard HNW configuration.
- ✓Private GP retainers typically run £2,000–£10,000 a year for same-day, unhurried access.
- ✓Cancer treatment can run well into six figures — the strongest argument against pure self-insurance.
What full cover actually means
Most UK health insurance is sold with limits — capped outpatient cover, restricted hospital lists, excesses to trim the premium. The HNW configuration strips those out. A fully comprehensive policy typically means unlimited outpatient cover (consultations, diagnostics, follow-ups without a cap), full cancer cover including newer drugs not routinely NHS-funded, mental health cover, and a free choice of recognised consultant.
The practical difference isn't just generosity — it's the absence of friction. No checking whether you've hit an outpatient cap mid-diagnosis, no negotiating a shortfall between what a Harley Street consultant charges and what a budget policy reimburses. If discretion and speed are the point, the policy shouldn't be the bottleneck.
- Outpatient benefit: unlimited. Capped outpatient cover is where mid-market policies quietly run out mid-diagnosis — the first thing to strip.
- Cancer cover: full, including drugs. Check the policy funds licensed drugs your oncologist recommends, not a restricted formulary.
- Consultant choice: open. Guided-referral options discount the premium by choosing your specialist for you — the opposite of what this configuration is for.
- Underwriting: considered. Full medical underwriting gives certainty in writing; at this level, certainty usually beats the moratorium's ambiguity.
London hospital lists and HCA access
The hospital list is where HNW policies genuinely differ from standard ones. Extended or Central London lists bring in HCA Healthcare facilities — The Wellington, The Princess Grace, London Bridge Hospital, The Lister — alongside the likes of Cleveland Clinic London and King Edward VII's. These are where many of the most in-demand consultants practise privately, and several are excluded from standard mid-market lists precisely because they're expensive.
| Configuration | Indicative monthly cost (per adult) |
|---|---|
| Standard comprehensive, national hospital list | £80–£150 |
| Comprehensive with Central London / HCA list | £150–£400+ |
| International plan with worldwide (ex- or incl. US) cover | £300–£800+ |
Beyond insurance: retainers and concierge medicine
Insurance funds treatment; it doesn't give you a doctor who knows you. That's the gap private GP retainers fill. A retained or membership-based private GP — common in Mayfair, Chelsea, and increasingly outside London — typically costs £2,000–£10,000 a year depending on the practice and what's bundled: same-day appointments, longer consultations, home visits, annual health MOTs and direct referral into the specialist network.
Above that sits the concierge-medicine layer: firms that coordinate everything — sourcing the right specialist globally, managing records across countries, arranging second opinions and travel for treatment. The landscape ranges from physician-led practices to membership services attached to family offices; pricing is bespoke and rarely published. For most people the combination that earns its keep is a retained GP for access plus a comprehensive policy for funding — the concierge layer makes sense mainly for complex, multi-country lives.
- Retained GP. Continuity, same-day access, unhurried medicine — £2,000–£10,000 a year, typically.
- Comprehensive PMI. Funds diagnostics, surgery and cancer care at full-list hospitals without negotiation.
- Concierge layer. Coordination and global sourcing for genuinely complex needs — bespoke pricing.
Full cover, configured properly
International cover
If you split time between countries, a UK-only policy leaves gaps. Two routes close them. Some UK insurers offer worldwide or overseas treatment options as add-ons — useful for planned treatment abroad or cover while travelling. Alternatively, full international PMI (Bupa Global, AXA's international arm and similar) covers you across regions as standard, with the US either included or excluded — including it is what pushes premiums towards the top of the range.
The honest trade-off: iPMI is significantly more expensive than domestic cover and most of the extra buys treatment you may never seek abroad. For someone primarily UK-based, a comprehensive UK policy plus travel insurance for emergencies is often the more rational structure — iPMI earns its premium when you genuinely live across borders.
If you're weighing planned treatment abroad — a specific surgeon in the US, proton therapy in Europe — check whether a UK policy's overseas option covers elective referral or only emergencies. The wording differs materially between insurers, and it's the detail that decides whether the add-on is worth having.
Self-insure or insure?
The reasonable HNW question: with liquid assets, why pay premiums at all? Self-paying works well for predictable one-offs — a £12,000–£15,000 hip replacement is not a financial event at this level, and self-pay keeps things simple and private.
Most wealthy individuals we see land on a hybrid: insure the tail (a comprehensive policy, sometimes with a large excess to trim cost, since small claims are irrelevant anyway), self-pay the trivial, and buy access through a retained GP. Speed and discretion drive the choices more than money — which is exactly why the policy details, not the price, deserve the attention.
It's also worth being clear-eyed about what a policy adds beyond funding. Insured patients get pre-authorised pathways, an insurer advocating on fees, and — on the best policies — cover for licensed cancer drugs long before routine NHS adoption. Self-payers get invoices. For family cover the same logic compounds: insuring children and a spouse comprehensively costs relatively little against the adult premiums, and it means the whole household runs through one fast, familiar system when something goes wrong.
Frequently asked questions
What is the best private health insurance for high-net-worth individuals?
There's no single answer, but the configuration matters more than the brand: fully comprehensive cover, unlimited outpatient benefit, full cancer cover and a Central London or HCA hospital list. Bupa, AXA Health and Aviva all offer this level; the right choice usually turns on hospital-list detail, consultant access and underwriting terms rather than headline price.
Does health insurance cover HCA hospitals like The Wellington and The Princess Grace?
Only on the right hospital list. HCA facilities — The Wellington, The Princess Grace, London Bridge Hospital, The Lister — are typically excluded from standard national lists and included on extended or Central London lists, which generally add roughly 15–30% to a comprehensive premium. Check the specific list document, as inclusion varies by insurer and plan.
How much does a private GP retainer cost in the UK?
Typically £2,000–£10,000 a year, depending on the practice and what's included — same-day appointments, longer consultations, home visits, annual health assessments and direct specialist referral. Some practices charge per appointment (roughly £100–£300) instead of a retainer. London membership practices sit at the upper end; regional ones are often materially cheaper.
What is concierge medicine and is it worth it in the UK?
Concierge medicine is coordinated, membership-based private healthcare: a service that sources specialists globally, manages your records, arranges second opinions and handles logistics. Pricing is bespoke and rarely published. It tends to earn its cost for complex, multi-country medical lives; for most UK-based people, a retained private GP plus comprehensive insurance covers the same ground.
Should high-net-worth individuals self-insure instead of buying health insurance?
Self-paying suits predictable one-offs — routine surgery at £12,000–£15,000 is easily absorbed. The case for insuring is the tail: extended cancer treatment can run well into six figures, and insurers bring negotiated rates and case management. Many wealthy individuals insure comprehensively with a large excess, self-pay small items, and keep the open-ended risk covered.
How much does high-end health insurance cost in London?
Comprehensive cover on a Central London or HCA hospital list typically runs £150–£400+ a month per adult, against £80–£150 for standard comprehensive cover on a national list — age is the biggest single driver. Full international plans run higher still, roughly £300–£800+ a month depending on regions covered and whether the US is included.
Can I get international private medical insurance while living in the UK?
Yes. International PMI from the likes of Bupa Global and AXA's international arm covers treatment across chosen regions, with US cover optional and expensive. Some UK domestic policies also offer overseas treatment add-ons, which can be a cheaper middle route. iPMI generally makes financial sense only if you genuinely live or work across borders.
Do private hospitals offer discretion for high-profile patients?
Generally yes — private facilities are accustomed to high-profile patients, and several London hospitals offer discreet admission arrangements and private entrances. Discretion ultimately rests with the hospital rather than the insurer, but a policy with a Central London list gives you access to the facilities where such arrangements are routine. Raise specific needs directly with the hospital.
Is a health insurance excess worth having if you're wealthy?
Often, yes. A large excess — say £500–£1,000 — trims the premium meaningfully, and at this wealth level small claims were never worth making anyway. You keep the policy for what it's genuinely for: the open-ended six-figure risks like extended cancer treatment. It's the insurance equivalent of self-paying the trivial and insuring the tail.