Private health and protection insurance expert and editor
Investing in health insurance gives you access to private healthcare, but your coverage will vary depending on whether you choose a basic or comprehensive plan. In this guide, we look at the differences between basic and comprehensive policies so you can choose the right plan.
When you take out private medical insurance, you choose a policy that offers the coverage you need. You can opt for a basic or comprehensive health insurance policy for more extensive coverage.
You can also tailor your policy by adding optional extras to a basic plan. You're covered as soon as you start paying premiums and can contact your insurance company to claim when you need treatment.
Every health insurance plan includes certain types of coverage as standard. Even if you want to avoid adding optional extras to create a more comprehensive health insurance plan, a basic policy will let you access private healthcare and membership benefits.
Here are a few treatments and services you can expect your health insurance plan to cover as standard.
All health insurance policies cover inpatient treatment, including surgery, meaning you can avoid NHS waiting lists if you need a hospital stay. You'll also have a private room and may benefit from facilities such as an ensuite bathroom and chef-prepared meals.
Your treatment is also covered if you're treated in a day-patient unit.
Cancer will likely affect 50% of us during our lifetime, so cancer treatment forms an essential part of every health insurance plan. Health insurance typically covers the costs of surgery, radiotherapy and chemotherapy. Some insurers offer other therapies and services such as nutritionist appointments, wigs, prosthetics and reconstructive surgeries.
It's worth shopping around for the best deal as insurers differ in the levels of coverage they offer. Paying an additional premium can give you extended coverage.
All health insurance plans offer some form of mental health support. This varies by health insurance company but typically includes access to counselling and CBT. Some allow you to self-refer for a limited number of sessions without seeing your GP. There are also mental health helplines for advice about your or your children's emotional health.
Insurers vary in the number of mental health conditions they cover, so it's a good idea to check what's included before you choose your policy.
Virtual or digital GP services let you book an online GP consultation 24/7. It's great news if you struggle to get an appointment with your NHS GP at a convenient time. Some virtual services offer video appointments. Others let you enter your symptoms into an app, and a doctor will call you back.
Virtual or telephone appointments aren't usually suitable for patients with complex medical needs. However, they can be ideal for straightforward issues that require a private prescription or consultant referral.
Private medical insurance lets you choose your hospital and consultant, like the NHS. Depending on your chosen insurer, you can choose from a list of private hospitals or a private hospital bed in an NHS hospital.
Each insurer has several hospital lists and includes their standard list on all health insurance policies. You can choose your hospital and consultant based on the facilities and whether it's close to home. You can also select a consultant who's an expert in the procedure you need. Your consultant choice may be limited if you've opted for guided consultant choice, where your insurer gives you a shortlist of consultants.
A health insurance plan can offer perks and discounts, such as free coffee or discounted cinema tickets and gym memberships. Some plans provide discounts to all members, while others offer you the chance to earn enhanced rewards.
For example, Vitality's rewards program lets you set health and activity goals and earn rewards for hitting them.
A comprehensive health insurance plan gives you more coverage and access to a broader range of treatments. Some insurers offer pre-designed comprehensive health insurance plans, or you can add optional extras to their standard health insurance plans.
Here are some features you'll find with a comprehensive health insurance plan.
All comprehensive health insurance plans cover outpatient treatment, basically anything that doesn't require a hospital stay. Outpatient care includes consultant appointments, physiotherapy treatment and diagnostic tests and scans.
It's well worth including outpatient coverage on your health insurance policy as it means you won't have to wait for a diagnosis and can start treatment more quickly. If you need physiotherapy, your comprehensive health insurance will likely cover it; you may be able to refer yourself for a limited number of sessions.
Private medical insurance typically gives you access to cutting-edge treatments and new drugs that aren't yet available on the NHS. A comprehensive health insurance policy can also provide alternative treatment options and therapies, such as acupuncture, homoeopathy or osteopathy, that standard health insurance plans don't cover.
All health insurance plans include financial limits or specify the number of treatment sessions available. Opting for a comprehensive medical insurance plan will cover more sessions or higher treatment costs. You can also pay more to increase the limits on specific treatments.
A comprehensive health insurance plan can also include different types of treatment. For example, some of the most comprehensive health plans include genetic testing, stem cell therapy, and other treatments and support services.
All medical insurance plans offer some mental health support, from counselling to telephone helplines or online resources. However, comprehensive health insurance plans provide extended coverage for more serious mental health conditions.
While all medical insurance includes inpatient care, this often doesn't apply to psychiatric treatment. You'll need comprehensive health insurance to access inpatient or day-patient treatment.
The NHS provides free dental treatment and free eye tests in some circumstances. However, more of us now pay for our routine dental and optical care. Adding optical and dental coverage to your comprehensive health insurance could save you money if you already pay for private treatment.
Depending on your chosen policy, your comprehensive medical insurance could pay for your routine check-ups, treatments, glasses, and contact lenses if needed. However, glasses and contact lenses are only usually covered if you need them for the first time or if your prescription has changed.
As mentioned, standard health insurance plans only include an insurer's basic hospital list. However, insurers also offer extended lists at an extra cost. Extended hospital lists reflect that private healthcare costs more in some locations because of higher wages or facility costs.
You'll typically pay more for treatment in most major cities. Unsurprisingly, Central London has the highest costs. Most insurers offer an extended list and an extended plus Central London list. These are ideal if you live in London or another major city and want to ensure you can have treatment close to home.
Even the most comprehensive medical insurance still has exclusions. Health insurance coverage is only available for acute conditions that arise after you buy your health insurance policy. Acute conditions are illnesses or injuries that can be cured with treatment, such as hip replacements, surgery for broken bones, or cancer treatment.
Your health plan won't cover chronic conditions such as diabetes, asthma or angina that can't be cured but can be monitored and controlled long-term.
Medical insurance also comes with standard exclusions. For example, plans don't cover treatment for addiction, cosmetic surgery or fertility treatment, among other things. Some insurers have longer exclusion lists, so always check the small print.
Other exclusions depend on your medical history and whether you have any pre-existing conditions. If you saw a doctor for advice or treatment for any illness during the five years before you bought your policy, that condition will be excluded from coverage for the first two years. If it doesn't reoccur, you can add it to your policy.
MyTribe guides help you understand how medical insurance works and how to find the right coverage for your needs. Contact us for a comparison quote, and we'll put you in touch with a specialist, regulated broker for advice tailored to your circumstances.
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
Chris Steele is myTribe’s resident expert in private health insurance and healthcare, with over a decade of experience in the field. As a Chartered Insurance Institute (CII) qualified professional, he has helped countless consumers navigate private medical insurance. Regularly quoted by national media, Chris is a trusted voice in the UK insurance industry, with his insights featured in leading consumer finance publications.
The main difference is in the level of coverage each plan offers. Basic health plans provide access to some private medical treatment and support services. Comprehensive coverage offers a broader range of care options and more treatment sessions, depending on your chosen policy.
Yes. Diagnostic tests are covered by outpatient coverage, which is usually only available as an optional extra. You can opt for a comprehensive policy or pay to add outpatient care to a basic plan.
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