Private Medical Insurance UK

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What Is Private Medical Insurance?

Private medical insurance (PMI), sometimes called private health insurance, is a policy that pays for private healthcare when you get ill or injured. Instead of waiting on an NHS list for diagnostics, a specialist consultation, or non-urgent surgery, you go private, and the insurer picks up the bill within the limits of your policy.

PMI does not replace the NHS. A&E, maternity, GP services, and chronic long-term conditions stay inside the NHS. What PMI does is buy you speed and choice for the acute, treatable, one-off stuff: the knee scan, the hernia repair, the suspected cancer pathway, the physio block, the mental health referral.

Knox Mortgages advises on PMI as part of personal and business protection planning. We do not sell PMI in isolation. We look at it alongside life insurance, critical illness, and income protection so the whole package actually holds up if something goes wrong. For limited company directors and the self-employed, PMI usually lands in the conversation at the same time as income protection and relevant life insurance.

What Private Medical Insurance Typically Covers

PMI policies are modular. The core cover is in-patient and day-patient treatment. Out-patient cover, cancer cover, mental health cover, and extras are layered on top at different tiers.

The four core cover areas you will see on almost every UK policy:

In-patient and day-patient treatment. Private hospital admission, surgery, anaesthetist fees, consultant fees, hospital accommodation, diagnostic scans (MRI, CT, ultrasound) done as part of the admission. This is the bit every policy includes.

Out-patient treatment. Consultations, diagnostics, tests, and therapies done without being admitted. Usually tiered: a basic policy might give you £500 a year of out-patient cover, a mid-tier policy £1,500, a full policy unlimited. This is often the most-used part of the policy and the place most clients under-buy.

Cancer cover. Full cancer pathways including chemotherapy, radiotherapy, targeted therapy, and increasingly biological treatments not always available on the NHS at the same speed. Most mid-tier and above policies include full cancer cover. Some budget policies exclude it or limit it. Read the schedule.

Mental health cover. Out-patient and in-patient mental health treatment. Cover levels vary widely in 2026. Some insurers now include talking therapies and psychiatric consultations on standard policies; others treat it as an add-on. If mental health cover matters to you, compare this line specifically.

On top of the core four, most providers offer extras: dental, optical, physiotherapy blocks, digital GP services, health screening, worldwide cover, and access to private hospitals in London (London is often a separate hospital list at higher premium).

What Private Medical Insurance Doesn’t Cover

PMI is designed to treat acute, curable conditions. It is not a total replacement for the NHS. The standard exclusions on most UK policies:

Chronic conditions. Diabetes, asthma, long-term back pain, MS, lifelong autoimmune conditions. PMI will usually cover an acute flare-up but not the ongoing management of a chronic disease.
Pre-existing conditions. Anything you had diagnosed or symptomatic before the policy started, depending on the underwriting type (covered further down).
A&E and emergency care. Go to NHS A&E for emergencies. PMI does not replace emergency medicine.
Pregnancy and childbirth. Routine maternity is an NHS service. Some top-tier policies cover complications of pregnancy; none cover routine antenatal care, delivery, or postnatal care.
Fertility treatment. Almost never covered.
Cosmetic surgery unless medically necessary following an accident or cancer treatment.
Experimental or unproven treatments not approved by NICE or the relevant authority.
Self-inflicted injury, drug or alcohol-related illness in most policies.
War, terrorism, and professional sport in most policies.

Two things people get wrong. PMI will not cover something you already know about when you apply. And PMI will not turn a chronic condition into a curable one just because you pay a premium.

PMI vs NHS: Honest 2026 Comparison

Both systems work. They do different jobs. The table below is how Knox frames the trade-off with clients.

Factor	NHS	Private Medical Insurance
Cost at point of use	Free	Covered by premium, often with excess
Waiting times for non-urgent care	Weeks to over a year depending on speciality	Days to weeks
Waiting times for diagnostics	Weeks to months	Usually within 1 to 2 weeks
Emergency and A&E care	Full access, world-class	Not covered
Cancer treatment access	Excellent, subject to NICE approval	Broader access, sometimes faster, some non-NICE drugs
Mental health	Strong crisis care, long talking therapy waits	Faster access to talking therapy, variable in-patient cover
Chronic conditions	Ongoing management included	Usually excluded
Choice of consultant and hospital	Limited	Full choice within policy hospital list
Maternity	Full access	Not routine maternity, some complications cover
Typical cost	Paid via tax	£40 to £250+ per month per person depending on age and cover

PMI is a speed and choice product for acute care. The NHS remains the backbone for emergencies, chronic conditions, maternity, and serious trauma. Most Knox clients who take PMI keep using the NHS for routine GP and A&E and use the private policy for everything in the middle: diagnostics, consultants, electives, and treatment where NHS waits are a problem.

How Much Does Private Medical Insurance Cost in the UK?

Cost depends on age, postcode, cover level, excess, hospital list, smoker status, and any underwriting loading. The table below is an indicative monthly premium for a healthy non-smoker on a mid-tier policy with £250 excess, covering in-patient and moderate out-patient, standard UK hospital list (excluding central London).

Age at start	Individual (monthly)	Couple (monthly)	Family of 4 (monthly)
30	£40 to £65	£75 to £125	£120 to £190
35	£50 to £80	£95 to £150	£140 to £220
40	£60 to £100	£115 to £180	£165 to £260
45	£75 to £125	£145 to £230	£210 to £330
50	£95 to £160	£185 to £290	£260 to £410
55	£125 to £210	£240 to £380	£330 to £520
60	£165 to £280	£320 to £510	£420 to £670
65	£220 to £380	£430 to £700	N/A

Family of 4 assumes two adults plus two children under 18. Children are usually cheap to add: often £15 to £40 per child per month depending on cover level.

These are 2026 indicative figures for new policies taken out on moratorium underwriting with a standard hospital list. Full medical underwriting tends to run 5 to 15% cheaper for healthy applicants because the insurer has a clearer view of risk from day one. Central London hospital lists often add 15 to 30%.

Factors That Move Your Premium

Seven things move a PMI quote more than anything else:

Age. The biggest single driver. Premiums typically rise 5 to 10% each year at renewal even without a claim.
Excess. The amount you pay per claim year before the insurer starts paying. Moving from £0 excess to £500 excess often cuts premiums by 20 to 35%.
Out-patient tier. The difference between £500 out-patient cover and unlimited out-patient is often the single biggest cover decision after in-patient.
Hospital list. Standard UK list, extended list including some central London hospitals, or full London list. Each step up adds cost.
Underwriting type. Moratorium (faster, cheaper to set up, pre-existing excluded for a period) vs full medical underwriting (slower, more certainty from day one). Covered below.
Claim history. Some insurers apply a no-claims discount structure similar to motor insurance. Claiming moves you down the scale.
Smoker status and BMI. Smokers and applicants outside standard BMI ranges usually pay more.

Postcode has a smaller effect on PMI than on some other insurance products, but London and specific South East postcodes do price higher.

Family Private Medical Insurance: What’s Different

Family policies cover two adults plus children on a single plan. Two things change versus an individual policy.

Pricing. Children almost always price significantly below adults. The per-head cost of adding a second adult and two children to an existing policy is usually cheaper per person than four separate policies. A family of four will typically cost 2.2 to 2.8 times the cost of a single adult at the same age, not 4 times.

Underwriting. Each person on the family policy is underwritten separately. One family member’s health history does not affect another’s terms. If one adult has a chronic condition, their cover can be structured differently (sometimes excluded, sometimes loaded) without pushing up the premium for the rest of the family.

Children’s cover is where family PMI earns its keep. Paediatric out-patient appointments, ENT referrals, orthodontics (depending on the policy), mental health support for teenagers, and specialist diagnostics are often the most-used benefits on a family plan. A £4,000 a year family policy that gets a child seen by a paediatric specialist in a week rather than six months is doing its job.

Knox usually recommends mid-tier cover with unlimited out-patient for families rather than a budget plan with limited out-patient. The claims pattern on family cover skews heavily towards out-patient consultations and diagnostics, and the cheaper policies run out of out-patient budget mid-year.

PMI for the Self-Employed: Tax Treatment and Why SE Clients Specifically Benefit

For self-employed people and limited company directors, PMI is one of the clearer wins in a protection portfolio. If you cannot work, you do not earn. NHS waiting times for a diagnostic scan or a consultant appointment that would get you back to earning are a direct cost. A £90 a month PMI policy that gets you in front of a specialist in 10 days instead of 10 months can protect thousands of pounds of billable income.

There are two ways a self-employed client typically buys PMI:

Sole trader or personal policy. Paid for from taxed income. No tax relief on the premium. Simple, portable, and works for anyone.

Limited company director on a company-paid policy. The company pays the premium, and the premium is a taxable benefit in kind (BIK) for the director. The director pays income tax on the BIK value at their marginal rate; the company pays Class 1A National Insurance. The company can deduct the premium as a business expense against Corporation Tax. The net position for a higher-rate director is often meaningfully cheaper than paying for the same cover out of net personal income, depending on your personal tax position.

PMI is not the same structure as relevant life insurance. Relevant life premiums are tax-deductible with no BIK. PMI premiums are a BIK. Some directors still run PMI through the company because the Corporation Tax deduction outweighs the personal tax hit; others pay personally. This is a tax planning conversation, not a one-size-fits-all answer. Knox works alongside your accountant on the structure.

If you are self-employed or a director and income protection, life insurance, or a mortgage is on the table, PMI often fits into the same conversation. Cross-reference our freelancer mortgage guide and company director mortgage guide for how Knox approaches the rest of the picture.

How to Compare Private Medical Insurance Providers

Three big decisions drive a PMI comparison: underwriting type, cover level, and hospital list. Get these right and the rest is detail.

Moratorium vs full medical underwriting

Factor	Moratorium underwriting	Full medical underwriting
Application speed	Minutes (no medical declaration)	Days to weeks (full medical history)
Pre-existing conditions	Excluded for typically 2 years symptom-free, then automatically covered	Disclosed at application, permanently accepted, excluded, or loaded
Premium	Usually higher for healthy clients, lower for those with history	Usually lower for healthy clients
Certainty at claim	Insurer assesses pre-existing at claim stage	Clear position from day one
Best for	Healthy clients who want speed, or clients with mixed minor history	Clients with significant medical history, or anyone wanting certainty

Moratorium is the default in the UK and the faster setup. Full medical underwriting gives more certainty but takes longer and often needs GP report requests. For most straightforward cases, moratorium is fine.

Cover level comparison

The honest shortlist of questions when comparing UK providers:

In-patient cover: usually unlimited on all mainstream providers. Confirm the hospital list.
Out-patient cover: is it £500, £1,000, £1,500, or unlimited? This is the most variable line.
Cancer cover: full, or limited? Any restrictions on non-NICE drugs?
Mental health cover: out-patient sessions, in-patient admission, or excluded?
Therapies: physio, chiropractic, osteopathy. Often tied to out-patient limits.
Digital GP: included as standard on most mainstream providers in 2026.
Excess structure: per claim, per year, or per condition? Per year is usually better value.

The main UK PMI providers

Bupa, AXA Health, Vitality, Aviva, WPA, The Exeter, Freedom Health, and Health-on-Line are the providers most frequently quoted. Each has a different hospital list, different cover tier structure, different strength on mental health, and different pricing model. No single provider wins on every dimension. The right provider depends on what you actually want covered and who will underwrite you at the best terms.

How Knox’s Protection Team Helps Match Clients to Providers

Knox advises on PMI as part of a whole protection picture, not as a one-off sale. What that looks like:

Understand the full protection gap. PMI sits alongside life insurance, critical illness, income protection, and (for directors) relevant life. We map what you already have, including employer-provided schemes, and identify the real gaps.
Agree cover priorities. Speed of diagnostics? Mental health cover for a teenager? Full cancer cover? Hospital list that includes a specific London consultant? The priorities change the provider shortlist.
Compare providers on your actual profile. Two healthy 35-year-old clients will not get identical quotes from the same insurer. We quote across providers, not against a single panel.
Set up underwriting properly. Moratorium or full medical underwriting, family structure, excess level, hospital list.
Keep the policy under review. Renewal premiums rise. We review at year 2 and year 3 to check the cover still fits, and we can re-broke mid-term if circumstances change (new child, business sale, diagnosis of a chronic condition, move to a limited company structure).

PMI is commission-paid to the broker. There is no upfront fee for Knox’s protection advice. We disclose commission on request.

Knox’s protection pages cover the rest of the picture. For the other products usually considered alongside PMI, see:

Frequently Asked Questions

Is private medical insurance worth it in the UK in 2026?

It depends on what you value and what NHS waits look like for you. If your income depends on being able to work (self-employed, commission, contractor, director), fast access to diagnostics and consultants has a direct financial value, and PMI is usually worth it. For salaried employees with strong sick pay, the value is more about speed, choice, and peace of mind. It is not a universally good buy for everyone.

Does PMI replace the NHS?

No. PMI does not cover A&E, routine maternity, GP services, chronic long-term conditions, or most mental health crisis care. It covers acute, curable conditions where private treatment is faster or offers more choice. Most clients keep using the NHS for emergencies and GP care and use PMI for diagnostics, consultants, and electives.

Can I get PMI with pre-existing conditions?

Usually yes, but the condition itself will either be excluded, loaded, or temporarily excluded depending on the underwriting type. Moratorium underwriting excludes pre-existing conditions for a period (typically 2 years symptom-free) then automatically covers them. Full medical underwriting makes the decision at application. Some conditions (well-controlled asthma, historical minor issues) often cover normally; chronic conditions are typically permanently excluded.

How much does private medical insurance cost per month?

Indicative range for a healthy non-smoker: £40 to £100 per month for a 30-year-old individual on a mid-tier plan, rising to £125 to £280 at age 60. Family of four at age 40 is typically £165 to £260 a month. Premiums rise each year at renewal regardless of claims, usually 5 to 10%. See the cost table above for a fuller breakdown.

Can I claim PMI premiums against my business as a company director?

Yes, but treat it as a benefit in kind. The premium is a deductible business expense against Corporation Tax; the director pays income tax on the BIK value, and the company pays Class 1A NI. Whether this beats paying personally depends on your marginal tax position. It is not the same structure as relevant life insurance. Knox works with your accountant on the decision.

What’s the difference between moratorium and full medical underwriting?

Moratorium is faster, no medical declaration at application, and pre-existing conditions are excluded for a period (typically 2 years symptom-free) before automatically being covered. Full medical underwriting means disclosing your full medical history upfront; the insurer then accepts, excludes, or loads specific conditions permanently. Moratorium suits healthy applicants wanting speed; full medical underwriting suits anyone with meaningful history who wants certainty.

Does PMI cover mental health?

Most mainstream UK PMI policies cover out-patient mental health in 2026, including talking therapies and psychiatric consultations, often subject to an annual session limit or an out-patient cap. In-patient mental health cover is more variable and often tiered. If mental health matters, compare this line specifically between providers, because cover levels differ materially.

What happens to my PMI if I change jobs?

Personal PMI policies stay with you when you change jobs. Employer-provided PMI ends when you leave, and you usually have a 30 to 90-day window to take over the policy personally on continuing personal medical exclusions terms (which preserve cover for conditions you had while on the group scheme). Missing this window typically means re-underwriting from scratch. If you have employer PMI, check the continuation terms before you leave.

Can I pay for PMI annually instead of monthly?

Yes. Most UK insurers offer a 4 to 8% discount for annual premium payment rather than monthly. If cash flow allows, annual is cheaper.

Can I switch PMI providers without losing cover for existing conditions?

Sometimes. This is called “continued personal medical exclusions” (CPME) switching. The new insurer accepts your existing policy’s exclusions rather than re-underwriting you from scratch. Not every provider offers CPME on every policy, and there are conditions. Knox handles switches carefully: the wrong move can reset your underwriting and expose conditions you thought were covered.

Speak to a Protection Adviser

Knox Mortgages advises on private medical insurance alongside life insurance, critical illness, and income protection, built around what you actually need rather than what any single insurer happens to sell. Whole of market, FCA regulated, no tied panels.

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Knox Mortgages is a trading style of Fort Advice Bureau which is regulated and authorised by the FCA to conduct Mortgage and Protection business, FRN: 972730