Choosing private medical insurance PMI cover levels
It's important to pay attention to policy exclusions
PMI covers the cost of being treated privately, either at a private hospital or in a private NHS bed. It is designed to cover short-term, curable medical problems. Anything that isn't short-term or curable is likely to be excluded – however each policy is different, so check carefully what is and isn't included before you buy.
Exclusions
Your policy won't pay for longer-term treatment such as kidney dialysis, or illnesses such as asthma. Other common exclusions include substance abuse, normal pregnancy and non-essential cosmetic treatments.
Private medical insurers typically offer a variety of policies with different levels of cover. Most offer at least one top-level comprehensive policy, a medium-level standard policy and a lower-level budget policy.
Some insurers also have specialist policies. For example, some policies cover you only when you have to wait longer than six weeks for treatment on the NHS. Other policies are designed specifically for the over-55s, or have a special focus on one disease, such as cancer.
Modular policies are becoming increasingly common. These cover you for in-patient treatments but also allow you to add cover for different things so that you tailor-make your insurance package.
In-patient vs out-patient treatment
Most policies cover all the costs of in-patient treatment (tests and surgery) and daycare surgery. Cover for out-patient treatment (diagnostic tests, scans, physiotherapy, consultations and chemotherapy and radiotherapy) varies. Comprehensive policies usually cover all out-patient treatments, although annual limits may apply.
Standard policies cover most out-patient treatments but may limit the cost of treatment covered. Budget policies cover fewer types of out-patient treatment and have lower financial limits on the amount of treatment covered.
With budget policies, out-patient treatment may also be covered if it directly relates to in-patient treatment, for example, follow-up physiotherapy after a stroke.
Extra cover
Cover for psychiatric treatment varies between insurers. This is a difficult area for insurers to categorise as it blurs the line between curable illness (which is covered by PMI) and long-term care (which isn't covered). Comprehensive policies are more likely to include psychiatric treatment, but not all do, so you have to check.
Some policies also offer extra cover, for example, for complementary therapies, a private ambulance, home nursing, a 24-hour advice line and parental accommodation if your child is in hospital. Again, the higher grade the policy is, the more likely it is to cover these areas.
Switching insurers
Health problems can tie you to your insurer. Switching health insurer to take advantage of more competitive premiums can mean that you lose cover for any conditions you've developed since you started your policy.
However, some insurers may allow you to switch policy without losing cover for pre-existing conditions. Others will agree to cover you for these conditions after a set period if you remain free of the conditions in that time. Check this carefully with the insurer before you buy the policy.
If you're moving from a policy you've had as a perk through your employer, check whether it allows you to switch to its individual policy without losing any cover.
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