You pay a premium — averaging around £80 a month per UK adult — and when a new health problem appears, your insurer funds private care: consultation typically within days, diagnostics in 1–2 weeks, routine surgery in 2–6 weeks. It covers acute, treatable conditions; emergencies and chronic disease management stay with the NHS.
- ✓The journey: GP referral, insurer authorisation, treatment, insurer pays the hospital directly.
- ✓Cover is for acute conditions — chronic illness and A&E stay with the NHS.
- ✓Pre-existing conditions are excluded at joining, via moratorium or full underwriting.
The claim journey, step by step
Using private health insurance follows the same basic path with every UK insurer, whether you're with Bupa, AXA Health, Aviva, Vitality, WPA or The Exeter. It starts, slightly counterintuitively, with your GP — private cover picks up the journey at the specialist stage, not before.
- See a GP and get a referral. When a new symptom appears, you see a GP — your NHS GP or, on many policies, a private digital GP the same day. If specialist care is needed, they write a referral. Most insurers require this before anything else.
- Call your insurer for authorisation. Before booking anything, you contact your insurer (phone or app) with the referral. They confirm the condition is covered, agree the specialist or give you a shortlist, and issue a pre-authorisation number.
- Have your consultation and tests. You see the consultant privately — typically within days — and any scans or diagnostics follow in 1–2 weeks. Each new stage of treatment is authorised the same way.
- Treatment goes ahead and the insurer pays. Routine surgery typically happens 2–6 weeks from referral. The hospital and consultant bill the insurer directly — you don't pay and claim back. You only pay your excess, plus anything above your policy's benefit limits.
What's covered — and what never is
Private health insurance covers acute conditions: new problems that respond to treatment and can be cured or substantially resolved — a knee injury, a hernia, cataracts, many cancers. It does not cover chronic conditions: long-term illnesses that need ongoing management rather than a cure, such as diabetes, asthma or arthritis (though acute flare-ups of a chronic condition are often covered). This acute-versus-chronic line is the single most important concept in UK health insurance — it explains most claim disputes and most disappointed expectations, so it's worth understanding before you buy rather than at claim time.
| Typically covered | Not covered |
|---|---|
| Specialist consultations and diagnostics for new symptoms | A&E and emergency care — always NHS |
| Surgery, hospital stays, day-case procedures | Chronic condition management (diabetes, asthma) |
| Cancer diagnosis and treatment (varies by plan) | Pre-existing conditions (excluded at joining) |
| Physio and mental health care (on many plans) | Pregnancy and routine childbirth, cosmetic surgery |
| Acute flare-ups of chronic conditions (often) | GP services, vaccinations, routine dental and optical |
How the excess works
The excess is what you contribute when you claim — typically £0 to £500, chosen when you buy. With most large insurers it applies once per person per policy year, not per claim: if you have a £250 excess and your treatment involves a consultation, an MRI and surgery across several months, you pay £250 once and the insurer covers the rest of that year's claims in full. In practice the insurer usually settles the hospital directly and either collects the excess from you or the hospital bills you for it.
A higher excess is the cleanest way to cut your premium — typically 10–20% off for moving to £250 — because it reduces small-claim costs without removing any benefit. What you're choosing is the point where cover kicks in, not what's covered. The excess isn't the only cost-sharing mechanism to check: some policies also cap specific benefits (outpatient cover limited to £500 or £1,000 a year is common on cheaper plans), and a few use co-payments where you pay a percentage of certain treatment. Benefit limits do more to shape what a policy is actually worth than the headline premium does.
Ready to see what cover looks like for you?
Underwriting in 60 seconds
When you apply, the insurer decides how to treat your medical history. Almost all individual policies use one of two methods. Moratorium: nothing to declare up front; conditions from the last five years are automatically excluded, but can become covered again after (typically) two trouble-free, treatment-free years on the policy. Full medical underwriting: you declare your history at application and get a definitive list of any exclusions in writing from day one. Neither method charges you more for your history — underwriting decides what's excluded, not your price.
New conditions that appear after you join are covered on either method (if they're acute and within your benefits). The full trade-offs are in our moratorium vs full medical underwriting guide, and what counts as pre-existing is covered in our pre-existing conditions guide.
Renewals, and how policies age with you
Policies renew annually. There's no re-underwriting at renewal — your medical history isn't reassessed, and the insurer can't drop you or add exclusions because you claimed. What does change is price: expect renewals to rise most years with medical inflation and age, typically by 8–15%. You can adjust your excess or cover at renewal, or switch insurers — including on switch terms that preserve your underwriting position. From there, the practical questions are what cover costs (our cost guide) and which insurer fits (our best UK insurers comparison of Bupa, AXA Health, Aviva, Vitality, WPA and The Exeter).
Frequently asked questions
Do I need a GP referral to use private health insurance?
With most UK insurers, yes — a GP referral is the standard entry point before specialist care is authorised. It doesn't have to slow you down: many policies include a private digital GP with same-day appointments who can make the referral, and some insurers accept self-referral for physio and mental health.
Can I choose my own hospital and consultant?
Within your policy's hospital list, yes — that's a core advantage of going private. Your list depends on the tier you chose: full lists include most UK private hospitals, while guided or restricted options trade choice for a lower premium. Insurers must approve (or shortlist) the consultant when they authorise the claim.
When does private health insurance cover start?
Cover typically begins on your policy start date, often the day you buy — there's usually no general waiting period for new acute conditions. The real limits are that pre-existing conditions are excluded under your underwriting terms, and some benefits on some policies carry specific waiting periods, so check the schedule.
Does private health insurance cover A&E and emergencies?
No. Emergency and urgent care — 999 calls, ambulances, A&E — is always handled by the NHS, whatever policy you hold, because private hospitals aren't set up for emergency admissions. Insurance can fund eligible follow-up treatment privately once you're stabilised, but the emergency itself is NHS care.
What's the difference between acute and chronic conditions in insurance?
Acute means a condition that responds to treatment and can be cured or substantially resolved — that's what insurance covers. Chronic means long-term and requiring ongoing management, like diabetes or arthritis — that's excluded, though many policies cover acute flare-ups of chronic conditions and the initial diagnosis phase before a condition is classed chronic.
Do I contact my insurer or the hospital first when something is wrong?
Your GP first, then your insurer. The order matters: see a GP (in person or via your digital GP service), get an open referral, then call your insurer to authorise before booking anything. Hospitals and consultants are the last step — our claims guide walks through the full sequence.
Do I pay for private treatment upfront and claim it back?
Usually not. UK insurers settle authorised bills directly with the hospital and consultant, so no money passes through you apart from your excess and anything above your benefit limits. Occasionally a consultant charges above the insurer's fee schedule — you'd be told of any shortfall before treatment.
Can I use the NHS and private health insurance together?
Yes, and most people do — mixing is normal and allowed. Common patterns: NHS GP and A&E with private diagnostics and surgery, or an NHS diagnosis followed by insured private treatment. Some insurers even pay you a cash benefit per night if you choose NHS treatment for a covered condition.
What is an open referral?
A GP referral naming the specialty needed — say, orthopaedics — rather than a specific consultant, with the insurer then offering you a shortlist of approved specialists. Insurers like it for cost control, and some policies require it. You still choose from the shortlist; you just don't hand-pick any consultant in the country.
Do I have to redo medical underwriting at renewal each year?
No. Underwriting happens once, when you take the policy out; renewal is automatic and your medical history isn't reassessed. The insurer can't add exclusions or refuse renewal because you claimed or your health changed. Re-underwriting only happens if you apply for a genuinely new policy.
What happens if a condition I'm being treated for becomes chronic?
The insurer funds the acute phase — diagnosis, and treatment aimed at resolving the condition — but once it's classed as chronic, ongoing management transfers to the NHS. You'd be told before funding stops, and acute flare-ups may still be covered. It's the most contested boundary in health insurance, so read your policy's chronic conditions wording.