What am I covered for? What does my cover not include? - Private health Insurance

This is a very important part of the process. After all, you don’t want to be paying for something you either don’t need or doesn’t apply to you.

Your insurer will make a decision on the type of policy available to you based upon your medical history.

Private health insurance covers short term illnesses, diseases or injuries which are known as ‘acute conditions’. It will also cover:

  • In patient costs
  • Surgery as an in patient
  • Day surgery
  • Hospital costs such as theatre time, nursing care, accommodation etc.
  • Consultations
  • Diagnostic tests

There may be a few other services which will differ between providers.

If you have opted for a personalised policy then you will be able to add to this depending on your requirements.

What does my policy not cover? (H3) A7. This is why we stress the importance of reading your policy very carefully. There is a list of exclusions which insurers will not cover which include chronic or pre-existing conditions and those which are termed ‘self-afflicted’.

Why is this? Insurance companies have a finite amount of money with which to pay out on claims and someone with a long term condition is likely to make more demands upon this than someone with a one-off illness. If they allowed chronic or long term conditions then the money would soon run out which would exclude a large number of people. In an ideal world, they would cover any type of medical expense but because money is finite is has to be allocated according to need and where it will have the most benefit.

There is also the fact we have an ageing population who are also living longer. Plus we are seeing the emergence of new, technologically advanced forms of treatment which are also costly and that combined with our increased demands mean that the cost of health care is rising all the time.

So, what is not covered in a health insurance policy?

This includes:

  • Pre-existing conditions: this means any medical condition you had before taking out a policy.
  • Chronic or long term illnesses such as diabetes and arthritis: these are diseases or illnesses which can be eased but not cured.
  • Self-afflicted conditions such as drug and alcohol abuse, dangerous sports, HIV/AIDS, cosmetic surgery, fertility treatment, organ transplants, pregnancy and gender reassignment surgery.
  • GP services
  • Accident & Emergency (A & E) admission
  • NHS prescriptions

In regard to pre-existing or chronic conditions: you may find that your insurance provider offers a ‘health cash plan’ which would enable you to pay for daily medical treatment. This is a low cost option which can be done as a monthly direct debit and pays a cash sum for treatment.

Other similar examples include critical illness cover, sickness & accident cover, income protection insurance and paying directly for treatment.

Private Medical Insurance Guide:



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