Private medical cover and health cash plans

Private health insurance covers the cost of investigating and treating medical or dental conditions, and it is arranged as an individual policy, a group policy through an employer, or one of several related products including cash plans, dental policies, six-week plans and international policies¹. It is not the same thing as a health cash plan, which is a low-cost insurance package that pays cashback towards everyday healthcare bills and towards the unexpected, such as a stay in hospital².

The two are often confused because both are sold as "health cover". The practical difference is what the money does. Private medical insurance pays a hospital or clinic for treatment. A cash plan pays you back, up to annual limits, for costs you have already paid, such as a trip to the optician, dentist or physiotherapist³.

Cost is the other dividing line. Premiums for private medical insurance are typically much higher than premiums for health cash plans, and many policies carry an excess to pay². Sample quotes analysed for Which? by LifeSearch in June 2026 ranged from £32.81 a month for core cover for a 30 year old to £280.11 a month for comprehensive cover at age 80⁴.

Private medical insurance or a health cash plan: what each one pays for

Private medical insurance covers the cost of investigating and treating medical or dental conditions¹. Policies come in several shapes: individual policies paid for by an annual or monthly premium, group policies arranged by an employer, cash plans, dental policies, six-week plans and international private medical insurance policies¹. The Financial Ombudsman Service lists these as the main types a consumer is likely to meet¹.

A health cash plan works on a different principle. You pay a monthly premium and then claim back the cost of everyday healthcare visits, up to your annual payment limits³. Medicash describes it as a low-cost insurance package providing cashback towards everyday healthcare bills as well as cover towards the unexpected, such as a stay in hospital². Medicash itself offers two main types: individual health cash plans, for individuals and their family members paying for their own cover, and corporate health cash plans².

The two can sit alongside each other. Employers can offer both private medical insurance and health cash plans together as part of an employee benefits package³. For an individual buying cover, the choice usually comes down to whether the priority is access to private treatment or help with routine bills.

Core or comprehensive cover: what the premium buys

Most private medical insurance policies are sold at one of two levels. Core cover includes inpatient and day-patient treatment, full cancer cover and virtual GP access⁴. Comprehensive cover includes those features plus outpatient consultations and diagnostics⁴. The gap between the two is largely about where treatment happens: inpatient and day-patient care on one side, consultations and tests before or after a hospital stay on the other.

Some providers build their own structure on top of that split. The Exeter's Health+ policies are described as having core cover at the heart of every policy, including unlimited cancer cover and full in-patient cover, with benefit add-ons and policy choices giving flexibility⁷. The same core cover applies to both its traditional and guided options⁸.

It is worth knowing where health insurance sits among protection products generally. Critical illness cover, which pays a lump sum on diagnosis of a specified serious illness, can be added to a life insurance policy or bought separately, and it does a different job from private medical insurance⁹. Private medical insurance pays for treatment; critical illness cover pays you money. Some people hold both, and the protection insurance guide sets out how the illness and life products fit together.

What private health insurance costs: from about £33 a month at age 30

The cost of private health insurance is based on your age, where you live and your chosen level of cover⁴. Sample quotes analysed for Which? by LifeSearch in June 2026, for a single non-smoking customer in an OX postcode with a standard excess typically £250 and a guided hospital list, give a clear picture of how those factors move the price⁴.

All figures are from the June 2026 sample quotes⁴. The age 80 comprehensive average is based only on insurers that returned quotes, so it reflects a smaller group than the younger ages⁴. The two age 30 figures are not a conflict: they are core cover and comprehensive cover at the same age, and the difference between them is what the extra cover buys⁴.

Age is not the only lever. Where you live and the level of cover chosen both feed into the premium⁴. A higher excess reduces what the insurer expects to pay out, and the excess range across policies runs from £0 to more than £1,000⁵. The guide to how insurance premiums are calculated explains the general mechanics, including Insurance Premium Tax.

Excess, cover limits and what claiming does to your premium

An excess is the amount you pay towards a claim before the insurer pays the rest. On private medical insurance, excesses can vary between £0 and more than £1,000⁵. Some cash plans build a private medical insurance excess benefit into their own structure: Health Shield's PMI Excess is provided by Health Shield and paid from, and up to a maximum value of, the "Specialist Consultation and Scanning" benefit limit on the plan¹⁰.

Cover limits matter as much as the excess. Limits may be per-condition, per-year, or over the lifetime of the policy, and costs above those limits are the customer's responsibility⁵. All but the most high-end policies carry limits of some kind⁵. A policy that looks generous on the headline benefit can still leave a long course of treatment partly unfunded.

Claims history is one of the factors insurers take into account when calculating premiums⁵. Claiming may push premiums up at renewal, and you may lose any no-claims discount⁵. That is a different arrangement from the pricing rules that apply to home and motor cover, where the ban on price walking stops insurers raising a renewal price for existing customers simply because they did not shop around.

What private health insurance will not cover

The exclusions are the part of the policy that decides whether it is useful to you. It is likely that treatment for some illnesses, including pre-existing conditions, will not be covered by an individual private medical insurance policy¹¹. Most long-term conditions that require ongoing treatment, such as diabetes or asthma, are generally not covered as standard⁶. Cancer is a notable exception to that rule⁶.

Chronic conditions that may not be covered include diabetes, asthma, Crohn's disease, COPD, arthritis, multiple sclerosis, heart disease, hypertension, epilepsy, chronic kidney disease, Parkinson's disease, HIV/AIDS and cystic fibrosis⁴. Pregnancy is excluded, as are injuries from playing professional sport and cosmetic surgery, and certain jobs such as oil rig workers may fall outside cover⁴.

There is a separate point about age. Being retired does not in itself prevent you from taking out private health insurance, although normal eligibility and underwriting rules still apply⁶. None of the providers Which? analysed in its review of private health insurance providers place age limits on their cover for existing customers⁶.

If you have a chronic condition, the honest position is that private medical insurance may not do much for it. A health cash plan is a different proposition, because it reimburses everyday costs rather than treating the condition itself. For conditions such as diabetes, the guidance on life cover is to seek professional advice and expect to buy from a specialist provider, which indicates how underwriting treats long-term conditions generally¹².

Full medical underwriting or moratorium underwriting

Individual policies commonly use either full medical underwriting or moratorium underwriting⁴. The choice affects what happens at the start of the policy and what happens later.

With full medical underwriting, you disclose your medical history and the insurer decides what it will cover. With moratorium underwriting, the insurer may cover a condition in future if you have had no symptoms, treatment, medication or advice relating to it for a set period, usually two years after the policy starts³. Which? describes the same period as typically lasting two years, requiring no treatment, medication or follow-up⁴.

The practical difference is timing. Full underwriting gives certainty from day one, because the insurer has already assessed your history. Moratorium underwriting gives a route to cover for conditions that may otherwise be excluded, but only after the waiting period has passed without symptoms or treatment.

If you have any pre-existing medical conditions, you will usually not be charged extra to add them to your policy, and the insurer will exclude those it cannot cover⁴. That is worth knowing when comparing quotes, because a higher premium is not automatically the price of a pre-existing condition.

Switching insurer, and what happens to conditions you already have

Switching is possible but not automatic. You can switch on continuation of underwriting terms if the new insurer agrees, which means it will continue covering the conditions that were covered on the prior policy⁴. The new insurer has to accept those terms.

Some insurers might not cover illnesses or injuries you have experienced recently, or any conditions you currently have, even if these are covered by your existing insurer¹³. That is the risk in switching: a condition that is covered today can become an exclusion tomorrow if the new insurer will not take it on.

The sequence matters. Arranging new cover before cancelling the old policy avoids a gap, and it is worth checking the new insurer's position on your existing conditions in writing before you act. For Westfield Health private health insurance, cancellation queries are handled by calling the customer helpline¹⁴. The general rules on cooling-off periods, refunds and fees are set out in the guide to cancelling insurance.

Making a claim: GP referral, hospital lists and paying the provider

Medical treatment usually starts with a referral by your GP for specialist treatment, and insurers ask that cover is checked before any private treatment is arranged¹³. In most cases a GP appointment comes before a claim can be initiated⁵. There are two types of referral a GP can provide: an open referral and a named referral⁵.

Some insurers make exceptions to the GP referral rule for certain conditions⁵. Those exceptions can cover muscle or joint conditions, mental health conditions where they are covered, and cancer symptoms⁵. The ABI publishes guidance on mental health and health insurance for anyone checking how a policy treats those conditions¹⁵.

Westfield Health's process is typical: an appointment with your GP, and at the point they refer you to a specialist, a call to the dedicated team to discuss options¹⁶. On payment, in most cases nothing is paid to the healthcare provider, because the provider invoices the insurer directly⁵.

The same source states that you are entitled to talk with your GP or hospital doctor before medical reports are sent to the insurance company¹⁷. Those two rights matter if your medical history is being assessed for underwriting or a claim.

A private medical insurance claim normally runs from GP referral to insurer approval, with the provider billing the insurer.

Health cash plans: how they work and how to claim

A health cash plan pays money back on everyday healthcare bills, such as trips to the optician, dentist or physiotherapist, up to annual limits³. You pay a monthly premium and then claim back the cost of those visits, up to your annual payment limits³. The claim is about the receipt, not a referral: with Simplyhealth, for example, you do not need to have had a GP referral to claim for a treatment³.

Claiming is usually done through an app or a website. Medicash plans can be claimed on through the free My Medicash app, or by visiting the Make a Claim page on its website². Health Shield's Flexible Health Cash Plan includes additional benefits such as GP Anytime, a 24/7 counselling and support helpline, mental wellbeing support, PERKS, SkinVision, MyGymDiscounts and Home Assistance¹⁸.

Partner cover is an add-on rather than a discount. On Health Shield's Select Health Cash Plan, partners can be added for an additional charge¹⁰, and the same applies to the Flexible plan¹⁸. Medicash asks anyone who wishes to cover a partner, including same sex partnerships, to select its Dual Plan, with both plans available in a range of levels¹⁹. For comparison, joint term life insurance is usually slightly cheaper than each partner buying an individual policy, but the price difference is often very small²⁰.

Where protection stops

Private medical insurance is not a substitute for the NHS in an emergency. It covers planned investigation and treatment, and most claims begin with a GP referral⁵. Emergency care is not what the policy is for.

Travel cover is a separate matter again, and the boundaries are worth knowing. The UK Global Health Insurance Card will not cover private healthcare²¹, and it cannot be used for any medical treatment at a private hospital or clinic, repatriation to the UK, rescue, cancelling or cutting short a holiday, luggage going missing or being stolen, or state-provided healthcare in non-EU countries such as the US and Australia¹. The guide to travel cover and the GHIC sets out how the card and a travel policy work together.

If something goes wrong with a health insurance policy, the Financial Ombudsman Service handles complaints about medical insurance, including private medical insurance¹. The guide to complaining about an insurer explains the process and the ombudsman's role. If an insurer fails financially, the guide to what happens when an insurer goes bust covers FSCS protection.