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Individual Health Insurance

Mehdi Punjwani
Written by  Mehdi Punjwani
Donna McConnell
Reviewed by  Donna McConnell
8 min read
Updated: 02 May 2024

Private individual health insurance is a useful policy that gives you access to a range of extra benefits you may not get through the NHS. Here’s what you need to know about taking out individual cover.

What is individual health insurance? 

Individual health insurance is a private health plan you can take out to supplement or replace the care you get from the NHS. It can give you access to shorter waiting periods, private facilities, and additional services or treatments unavailable through public healthcare. They’re designed to cover one person only. 


How does individual health insurance work? 

When you take out an individual health insurance policy, you’ll pay a monthly premium and in return, if you need medical treatment you’ll be able to claim on your policy and take advantage of the range of benefits on offer. 

You can buy individual health insurance tailored to specific conditions or requirements, even pre-existing medical conditions. Most providers offer different levels of cover, whether you just want to supplement NHS care with essential treatment coverage or take out a comprehensive plan that covers a range of services. 

How do I get private treatment and claim on health insurance? 

If you have a private health insurance plan, first ensure you have the required coverage for the treatment you think you’ll need. Then you’ll need to do the following:  

  1. See your GP: As with any medical issues, the first step should be to see your GP, who’ll be able to assess and decide what treatment is required. Ensure they know you have private cover so they can keep this in mind when recommending treatment 

  2. Get a referral: Your GP will refer you to a specialist if necessary, one that is suitable for the level of cover you have 

  3. Authorise treatment with your provider: Before proceeding with treatment you should contact your insurer and get their approval so you know for sure you’ll be covered. You’ll likely need to provide details of the condition and treatment, as well as the referral details from your doctor and an estimated cost if possible 

  4. Make preferred choices if required: At this point you may be given the option of choosing a private specialist or hospital, a perk of private health insurance  

  5. Undergo treatment: Keep all documentation and receipts for treatment you undergo as this is important for your insurance claim 

  6. Make a claim: You’ll need to submit a claim to your insurer, usually using a claim form. You will also likely need to pay an excess fee, and depending on the nature of your policy you’ll either pay up front for the treatment and get reimbursed, or arrange for your insurer to pay directly 

What are the benefits of individual health insurance? 

The main benefits of taking out a private health insurance plan are: 

  • Reduced waiting times: You’ll often get quicker access to tests, treatments and other procedures compared to those using the NHS 

  • Private facilities: Many insurance policies also give you access to private hospitals or private rooms within public hospitals, with potentially more comfortable surroundings  

  • Choice of healthcare professionals: You may even be able to choose your own consultants or specialists if you have a preferred doctor or expert in mind 

  • Additional services: Some medications or treatments may not be available on the NHS, especially if they are particularly new or innovative, but private care is more likely to offer these 

What should I watch out for when taking out health insurance? 

As with any insurance policy there are always certain things to bear in mind - when you take out individual health insurance, ensure you consider: 

  • Limitations: Different policies and providers will have different limitations on the cover they offer, such as treatments you’ll have access to or facilities you can check in to and for how long 

  • Exclusions: Individual health insurance plans may also come with exclusions for certain conditions such as pre-existing medical conditions  

  • Lifestyle choices: Your policy is likely to be affected by things like smoking, drinking, or having a high-risk job 

What is usually covered by individual health insurance? 

The coverage you get with individual health insurance policies can vary hugely, depending on the level of protection you take out. You’ll generally only be covered for basic hospital treatment or emergency treatment on a standard plan, while higher-tier plans can offer extra coverage for:  

  • Consultations with specialists 

  • Examinations, scans and diagnostic tests 

  • Surgical procedures 

  • Physiotherapy 

  • Mental health treatment 

  • Treatment at a dentist or optometrist  

  • Maternity care 

  • Hospital stays, including private facilities or rooms at public hospitals 

What does individual health insurance typically exclude from cover? 

Individual health insurance policies do come with some exclusions and limitations you should be aware of: 

  • Pre-existing conditions: If you have a pre-existing medical condition before you take out cover, you won’t be able to claim for treatment for it. Examples of such conditions include diabetes or heart disease 

  • Cosmetic surgery: You also won’t be able to claim for cosmetic surgery unless it’s medically required 

  • Drug abuse or self-harm: Most policies won’t cover you for injuries or illnesses related to drug abuse or self-harm 

  • Organ transplants: Private health insurance won’t generally pay for organ transplants  

  • Infertility treatment: You won’t be covered for the cost of infertility treatments like IVF on most policies   

  • Mobility aids: Insurance won’t pay for mobility aids such as mobility scooters and stair lifts 

How much does individual health insurance cost? 

The cost of individual health insurance will vary depending on a range of factors, and you can expect to pay anywhere from £20 a month to over £100. 

What affects the cost of individual health insurance? 

Your premiums for individual health insurance will depend on the following: 

  • Your age: The older you are, the higher your risk of developing a health condition, so coverage will generally be more expensive  

  • Your medical history: If you have a history of health issues and any pre-existing conditions, these are likely to raise your premiums 

  • Your level of cover: Opting for premium policies that include many or all of the features we listed above will generally cost more than basic coverage 

  • Your lifestyle: If you smoke or you have any particularly risky hobbies, these increase your risk factor and therefore your overall insurance costs 

Alternatives to individual health insurance 

Individual health insurance plans are ideal if you only need to cover one person, however depending on your needs you may also want to consider one of the following. 

Joint health insurance 

A joint health insurance policy lets you cover a couple under a single plan, and this can be more cost-effective than taking out two single policies, as well as being easier to manage. Just consider whether it may be more beneficial to take out tailored individual policies if your needs are different. 

Family health insurance 

Family policies expand the benefits of joint health insurance to the whole household, it's useful for families and usually even more cost-effective. 

Children’s health insurance 

Children’s health insurance offers cover tailored specifically for children such as paediatric services or specialised children’s hospitals. 

Am I already getting health insurance? 

Before taking out an individual health insurance policy, check whether you’re already receiving coverage through other means - some premium bank accounts offer health insurance alongside, while your employer may also have a company plan available.  

Can I get individual health insurance with a pre-existing medical condition? 

Having a pre-existing medical condition isn’t necessarily a barrier to getting cover. However, you’ll likely find that most insurers won’t cover you for treatment relating specifically to that condition - and if they do, it’s likely to come with certain limitations or conditions. If you can get health insurance, which you should still be able to, it will likely cost extra - even if coverage for your actual condition isn’t offered.  

How do I apply for individual health insurance? 

To get a quote for individual health insurance, you’ll just need to provide information about yourself and the cover you need. You’ll also need to provide a medical history, and some providers may even ask you to pass a medical. 

Remember to always be honest about yourself and your medical history, as lying or withholding information can lead to your claims or coverage being invalidated.  

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