Westfield Health: health insurance, cover and claims

Westfield Health is a UK health insurer that sells private health insurance and health cash plans, and it also runs health schemes for employers. It trades under the names Westfield Health, UK Healthcare and Health365, and it was previously known as PatientChoice¹. Some plans include access to 6 free sessions of structured counselling in a 12 month period².

If you are looking at a plan, the two things that decide most of what happens later are what the plan includes and what it leaves out. Westfield Health does not cover treatment for heart conditions or cancer-related treatment on the plan examined by Which?³. Its maximum age for taking out a new policy is 79³. Everything else, from how a claim is paid to how a complaint is handled, follows from the policy wording rather than from the brand.

What Westfield Health plans offer

Westfield Health's products sit in two broad groups. The first is private health insurance, which pays for private medical treatment. The second is the health cash plan, which pays set amounts towards everyday health costs such as dental treatment, optical care and therapy, whether you are treated privately or not. The firm also sells cover to employers as a staff benefit, which is where the UK Healthcare and Health365 names are used¹.

Private health insurance in the UK generally comes in two shapes. Core cover includes inpatient and day-patient treatment, full cancer cover and virtual GP access. Comprehensive cover includes those features plus outpatient consultations and diagnostics⁴. That distinction matters more than any brand difference, because it decides whether a specialist appointment is paid for or whether only the treatment that follows a referral is.

Some plans go further and offer preventative services such as regular health assessments, mental health support and lifestyle advice⁵. These are usually add-ons or features of a higher tier rather than something every policy includes, so the plan summary is the place to check.

Health insurance is not the same as a cash plan, and the two are often confused. Insurance reimburses the cost of treatment, subject to the policy's limits and exclusions. A cash plan pays a fixed sum towards a cost you have already met, which is why cash plans are cheaper and why they do not depend on being treated privately. Westfield Health sells both, so the first question to settle is which one you are being quoted for.

For the wider market, see our guide to insurance and the directory of insurers.

What the plans do not cover

Every health insurance policy excludes some things, and the exclusions are where most disputes start. On the Westfield Health plan examined by Which?, treatment for heart conditions and cancer-related treatment are not covered³. That is a significant limit, because those are two of the conditions people most often assume private cover exists to deal with.

Across the market, chronic conditions are commonly excluded. The list that may not be covered includes:

• diabetes
• asthma
• Crohn's disease
• COPD
• arthritis
• multiple sclerosis
• heart disease
• hypertension
• epilepsy
• chronic kidney disease
• Parkinson's disease
• HIV/AIDS
• cystic fibrosis⁴

The logic is that insurance is designed for conditions that can be treated and resolved, not for long-term management.

Other standard exclusions include pregnancy, injuries from playing professional sport, cosmetic surgery, and certain jobs such as oil rig workers⁴. Life and protection policies have their own versions of this: possible exclusions include pre-existing conditions, dangerous activities, waiting periods, specific illnesses such as early-stage cancer or cancer diagnosed within the first 12 months, and self-inflicted injuries⁶.

Insurers are required to set these out clearly. A policy summary must give examples of exclusions or limitations, including deferred payment periods, exclusion of certain conditions, diseases or pre-existing medical conditions, moratorium periods, limits on the amounts of cover, limits on the period for which benefits will be paid, restrictions on eligibility to claim such as age, residence or employment status, and excesses⁷.

Pre-existing conditions: how the exclusion works

A pre-existing condition is any illness, symptom or treatment you had before the policy started, and how an insurer treats it depends on how the policy was underwritten. Where a policy is not individually underwritten, it carries a blanket exclusion for all claims caused by, or related to, a pre-existing medical condition⁹. That means no medical questions at the start, but also no cover for anything connected to your history.

Where a policy is individually underwritten, the insurer asks about your health and then decides. You will usually not be charged extra to add pre-existing conditions to a private health insurance policy; instead, the insurer will exclude the ones it cannot cover⁴. So the practical effect is usually an exclusion rather than a higher premium.

Insurers do not decide this alone. They may consult their Chief Medical Officer or other qualified experts, and they may request information from your GP or hospital doctor, always with your permission¹⁰. If you have a genetic condition, insurers' use of genetic test results is restricted by a voluntary agreement, and the rules are set out by the Genetic Alliance¹⁰.

The Financial Ombudsman Service sees complaints about exactly this. In one case, an insurer turned down a private health insurance claim on the grounds that the policy did not cover pre-existing medical conditions, and the ombudsman's case study records that the customer said they did not know¹¹. The ombudsman's consumer guidance on pre-existing medical conditions explains how it approaches these disputes⁹.

If you are unsure whether something counts as pre-existing, the safest course is to disclose it and get the insurer's answer in writing before you rely on the cover.

Counselling and mental health support

Mental health cover varies widely between plans, and it is one of the areas where a cash plan and an insurance policy behave differently. Some plans offer preventative services including mental health support⁵. Where a plan includes talking therapies, they are usually delivered through an approved network rather than by any therapist you choose.

Outside insurance, there is a substantial amount of free support:

• Mind provides confidential advice and support to anyone experiencing a mental health problem, on 0300 123 3393¹²
• Adferiad provides advice and support to individuals living in Wales who are experiencing a serious mental health illness¹²
• Citizens Advice is a free-to-use advice and support service with advisers trained to help those with mental health problems¹³
• The Mental Health and Money Advice service offers practical advice and support for mental health and money issues, covering welfare benefits and mental illness, managing your money, and paying for social care¹⁴, and can provide a supporting letter for a benefit application¹⁶
• The Mental Health and Money Toolkit from Mental Health UK can help with your financial and mental health¹⁷

If money problems are affecting your mental health, Stepchange has guidance on talking about debt¹⁸. If you are in work, Access to Work can provide support to manage your mental health at work, which might include a tailored plan to help you get or stay in work and one-to-one sessions with a mental health professional¹⁹. The Money and Pensions Service coordinates the UK Strategy for Financial Wellbeing, which sits behind much of this free help²⁰.

Adding children to a Westfield Health plan

Whether you can add a child to a Westfield Health plan, and what it costs, depends on the policy, so check the plan documents rather than assuming. What can be said generally is how children's cover works across the market.

Children are usually added to an adult's policy rather than holding their own, and the price is normally a fraction of the adult premium. A child with a long-term condition may face the same pre-existing condition exclusion as an adult, which is why it is worth checking before you rely on cover for a specific condition.

Where state support is concerned, the rules are separate and specific. The Healthy Start Scheme enables eligible pregnant women and families with children under the age of four who meet the qualifying criteria to get help, and eligibility includes Pension Credit, which includes the child addition²¹. The extended Healthy Start scheme is available to British children aged under 4 years old whose parent or guardian meets the financial eligibility criteria and is either subject to a no recourse to public funds condition or without any immigration status²².

For families with a disabled child, the disabled child addition can still be received for a third or subsequent child even if the child element is not available for that child²³. To keep getting the disabled child addition or premium, your child needs to get PIP and be under 16 or a qualifying young person²⁴. In Scotland, if your child receives the care part of Child Disability Payment and becomes eligible for the mobility part, Social Security Scotland will add this automatically, with no reapplication needed²⁵.

How to make a claim

Claims under a health policy normally start with treatment, so the order of events matters. If you are treated before the insurer has agreed to pay, you may find the cost is not reimbursed, which is why most policies ask you to contact them before booking private treatment.

The mechanics vary by product. Some schemes allow you to make a claim online²⁶. Others require paper forms and receipts. As an illustration of how much requirements differ between schemes, one family fund requires receipts for travel and accommodation claims but not for a flat-rate meal allowance²⁷.

Where a claim relates to a terminal illness, some schemes fast-track it: under the special rules for terminally ill people, your claim is fast-tracked²⁵. That is a feature of the benefits system rather than of private health insurance, but it shows the kind of provision that exists.

If a claim is turned down, the reason will normally be an exclusion, a pre-existing condition, or treatment that falls outside what the plan covers. The ombudsman's case study on a private health insurance claim refused for pre-existing conditions shows how these disputes are examined¹¹.

Using an approved practitioner

Health insurers usually pay for treatment from practitioners on their approved list, and going outside it can mean the cost is not covered. The same principle appears across financial services: NS&I, for example, accepts certification from a defined list of professionals, including a qualified individual currently practising in the legal, financial or teaching profession, a doctor, dentist or vet, a nurse (RGN or RMN), a minister of a recognised religion, a civil servant, a prison, police or customs officer, or an elected official such as a councillor, MP or Mayor²⁸.

Where a profession is monitored by a recognised professional body, that monitoring involves regular visits to practices and a requirement that regular reports are filed with the body²⁹. Insolvency practitioners work under a similar framework of recognised bodies²⁹.

For benefits claimants, there is a parallel set of rules about what work is permitted. You do not need a doctor's approval to do permitted work, but you must tell Jobcentre Plus³⁰. Apprenticeships have their own condition: the training must lead to a qualification accredited by a body recognised by the Office of Qualifications and Examinations Regulation or the Scottish Vocational Education Council³¹.

The practical point for a health policy is the same in each case: check that the practitioner is on the insurer's list before you book, and get the insurer's agreement in writing where the policy requires it.

Managing your plan in My Westfield

Westfield Health's online account, My Westfield, is where policyholders manage their plan, check what is covered and submit claims. The sources behind this page do not set out its features in detail, so the account itself and your policy documents are the place to look for what you can do there.

What can be said is what good practice looks like for any policyholder account:

1. Keep your contact details current, because insurers use them for renewal notices and for anything that affects cover.
2. Check the plan summary each year, since features and exclusions can change at renewal.
3. Keep receipts and treatment records together, because claims are easier to make when the paperwork is to hand.

If you are managing money alongside a health condition, free help exists. The Mental Health and Money Advice service covers welfare benefits and mental illness, managing your money, and paying for social care¹⁵. Citizens Advice advisers are trained to help those with mental health problems¹³. The Money and Pensions Service coordinates the UK Strategy for Financial Wellbeing²⁰, and Pension Wise Digital lets you start an appointment and pick it up again in your own time³².

Complaints and cancelling

If something goes wrong, the first step is a complaint to Westfield Health itself. Firms have a set period to give a final response, and if they do not resolve it, or you are unhappy with the answer, the complaint can go to the Financial Ombudsman Service. The ombudsman publishes its decisions and case studies, including one where a customer complained that a bank failed to cancel a direct debit and the ombudsman upheld the complaint³³, and another where a consumer complained about advice given by an independent financial adviser and the ombudsman upheld that too³⁴.

The volume of complaints gives a sense of scale. In the first quarter of 2025/26 the ombudsman opened 1,100 complaints about overdrafts³⁵, and across 2025/26 it opened 5,863³⁶. Those figures are about banking rather than health insurance, but they show how the service works in practice.

For comparison on timescales, some public schemes commit to sending a final response within 8 weeks (56 days) of receiving a complaint³⁷. That is a useful benchmark for how long a firm should take, though the statutory scheme for financial firms is what applies here.

Cancelling a policy is a separate matter from complaining about it. Check the policy documents for the notice period and for whether any refund is due, and remember that cancelling means you lose the cover from the date it ends.

How Westfield Health is regulated

Westfield Health is authorised by the Financial Conduct Authority under reference number 202609, with a status effective date of 01/12/2001¹. It appears on the Bank of England's list of insurers incorporated in the UK authorised to carry out contracts of insurance². The company behind the brand is an active company, number 00303523, incorporated on 1935-07-27⁴⁰.

Being authorised means the firm must follow the FCA's rules, including the requirement to set out exclusions and limitations clearly in a policy summary⁷. It also means complaints can go to the Financial Ombudsman Service once the firm has had its chance to respond.

Insurance is not a deposit, so the Financial Services Compensation Scheme does not protect a health insurance policy in the way it protects money in a bank account. What protects you instead is the insurer's own solvency, the regime it operates under, and the ombudsman if a dispute arises. Where a public scheme is not FCA-regulated, the body running it may still commit to treating non-regulated accounts with equivalent standards to FCA-regulated accounts⁴¹, but that is a voluntary commitment rather than a statutory protection.

For the wider picture, see our guides to insurance, protection and consumer protection.