How Does Health Insurance Work?

Health insurance is an agreement: you agree to pay premiums and in return, your insurer agrees to pay for eligible treatments. Every policy is different, but every type of private medical insurance or health insurance works on the same four principles:

1. Set up a policy

Decide which benefits are right for your situation. If you’re not sure, talk to a regulated adviser who can make a firm recommendation on the policy that’s right for you.

Every policy starts with a basic, core package of benefits. Most health insurance policies let you add on extra services in return for a higher premium.

This might include things like physiotherapy, psychiatry, home nurses, dental treatment, opticians’ appointments, and other specialised treatments.

2. Start paying your premiums

The cost of your premium will depend on a number of things. Your age, your lifestyle – your unique personal medical history – the benefits you’d like, and the amount of excess you’re willing to pay.

As soon as you start paying your premiums, you can use any extra health benefits that come with your policy. Things like lifestyle trackers, free health tests, health videos or even phone-lines to help you deal with stress or basic aches and pains.

Get medical care when you need it

If you’re feeling ill, then you seek help from a medical professional. That’s likely to be a visit to your local GP but it may be over the phone. Some insurers offer 24-hour helplines.

When it’s clear you need treatment, or if you need more tests to get a firm diagnosis, then you’ll be referred to a specialist for private medical care.

If it’s an eligible treatment then you’ll start to make a claim.

Get peace of mind, 365 days a year

Private health insurers have teams of people who are reviewing care, constantly. They want to make sure you’ll get the right treatment for your situation.

That might include drugs you can’t get yet on the NHS, or treatment plans with alternative therapies. It could also include things like specialised aftercare and ongoing rehabilitation.

In every case, the insurer will pay for eligible treatment up to approved limits (less any excess you’ve agreed to pay, of course. We explain health insurance excesses here.)

There’s a great deal of peace of mind in knowing you can be seen where and when it suits you. You won’t have to wait for an appointment. You’ll get the treatment you need.

Health insurance gives you more freedom to choose when and where you’re treated in private care facilities, and by whom. You’ll avoid any NHS waiting times when you need to see a specialist or get a diagnosis.

Every policy explains which private hospitals you can use, and which benefits you’ll have access to on top of those hospitals and their specialists.

And – if you’ve taken out a policy that we recommend – we can make sure you’re getting maximum value from it too.

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