What private medical insurance is
Private medical insurance — PMI, also sold as private health insurance — is an insurance policy that pays for eligible private treatment of conditions arising after the policy starts. You pay a monthly or annual premium, and the insurer pays for treatment that falls within the policy terms, normally at a facility the insurer recognises.
It is a general insurance product rather than a long-term protection contract. Most policies run for twelve months at a time and are renewed annually, which means the premium, and sometimes the terms, can change at each renewal.
The point to understand early is that PMI is built around acute conditions — ones that respond to treatment and can be resolved. It is not designed to fund the ongoing management of long-term conditions.
How it works alongside the NHS
Private medical insurance does not replace the NHS and is not intended to. Accident and emergency, urgent and emergency care, maternity care and the treatment of chronic conditions remain NHS services, and a private policy is generally not written to cover them.
In practice most private treatment still starts with an NHS GP. The usual route is a GP referral for a specialist opinion, which you take to your insurer to authorise before anything is booked. Insurers differ on whether a GP referral is required first and on what they will authorise, so the order you do things in matters.
People generally hold PMI alongside NHS care for choice over the timing and setting of planned treatment for eligible conditions — not as a way of stepping outside the health service.
What a policy can generally cover
- Inpatient treatment — Hospital admission, surgery, accommodation and associated costs where both the condition and the treatment are eligible. This is the core of almost every policy.
- Day-patient treatment — Procedures needing a hospital bed for part of a day without an overnight stay.
- Outpatient cover — Consultations, diagnostics and scans without admission. This is normally where policies differ most — it may be full, capped at a monetary limit, or restricted to certain stages.
- Optional extras — Benefits such as therapies, mental health cover, or dental and optical are commonly available at additional cost. They are rarely included as standard.
What is actually included varies considerably between providers, and between tiers from the same provider. Two policies at a similar premium can behave quite differently at the point of claim.
What it generally does not cover
Exclusions commonly seen across the market include chronic or long-term conditions, emergency treatment, pre-existing conditions (subject to the underwriting basis below), cosmetic treatment, and in most cases routine pregnancy and childbirth.
Exclusions are not standardised. Each insurer writes its own definitions — particularly around what counts as chronic rather than acute — and that definition does a great deal of work when a claim is assessed.
Cover for one person
An individual policy covers one named person. Price is normally driven by age, where you live, the excess you accept, the hospital list attached to the policy and how outpatient cover is structured.
Because the policy is renewed annually, premiums generally rise with age and with claims experience across the book. Switching provider later is possible but is not automatic — a new insurer will apply its own underwriting, so anything that has happened in the meantime becomes relevant.
Cover for a family
A family policy puts partners and children on a single plan with one renewal date. Many providers price children considerably more cheaply than adults, and some include them at no additional premium on certain plans, but this is a provider-by-provider matter rather than a market rule.
Each adult is normally underwritten in their own right, so one person’s medical history does not necessarily affect the other’s terms. Where a family is covered, the hospital list matters more than it does for a single adult, because it has to work for several people at different ages.
If you are self-employed
There is no employer scheme to fall back on, so private medical cover for a self-employed person is normally arranged and paid for personally, or through the business where one exists.
It is worth being clear about what PMI does and does not solve. Private medical insurance pays for treatment. It does not replace the earnings you lose while you are unable to work — that is what income protection is for. For a self-employed household the two address genuinely different problems, and which matters more depends on how quickly lost income would be felt.
If you are a company director
Cover can usually be arranged either personally or through the company. The two routes are treated differently for tax: premiums paid by a company are generally a business expense but are normally treated as a benefit in kind for the individual, with the detail depending on how the company and the individual are taxed.
We are not tax advisers and this page does not give tax advice. The tax position of a director’s policy should be confirmed with your accountant before you decide how to hold it, because getting that wrong is more expensive than the premium difference.
Health insurance through a business
Employer-arranged schemes cover a defined group of employees, and are generally administered as an employee benefit with a single renewal and a scheme-level agreement rather than individual policies.
Underwriting at scheme level can work differently from an individual application. On schemes above a certain size some insurers will offer bases that do not require each member to declare a medical history. What is available depends on the size of the group and the insurer, so this is a conversation rather than something that can be stated as a rule.
Hospital access and insurer networks
Every private medical policy is attached to a list of facilities the insurer will authorise treatment at. Lists are set by the insurer, vary between tiers of the same product, and change over time. A broader list generally costs more.
A facility being physically near you does not mean it is on your policy’s list, and this catches people out more than any other feature of the product.
We do not publish insurer hospital lists on this page. They change, and a list that was accurate when it was written becomes a liability once it is not. The current list for any policy you are considering should be checked against that insurer’s own published directory at the time you apply.
Where you live in Scotland changes the picture
This is the part of private medical insurance where geography genuinely matters, in a way it does not for life cover or income protection. For those products a policyholder in Oban and one in Glasgow are in much the same position. For PMI they are not.
Participating facilities in Scotland are concentrated in and around the Central Belt. If you are based in or near Glasgow or Edinburgh, the hospital list on most policies is likely to include options within a reasonable distance, and the choice between a broader and a narrower list is largely a question of cost.
If you are in Inverness, Oban, Fort William or further north and west, the practical question is a different one: not which list is broadest, but whether anything on the list is within a distance you would actually travel for planned treatment, and for follow-up appointments afterwards. A policy that reads well is worth less if using it means a long journey each time.
None of that makes private medical insurance unsuitable outside the Central Belt. It does mean the hospital list, and any travel or accommodation benefits a policy includes, deserve more weight in the decision than they would for someone in the central belt — and that some providers suit some postcodes better than others.
How underwriting generally works
- Moratorium — The insurer does not ask for your medical history up front. Conditions you have had within a defined recent period are excluded, and some may become eligible later if you go a defined period without symptoms, treatment or advice for them. The periods differ by insurer.
- Full medical underwriting — You declare your medical history at application and the insurer confirms in writing what is excluded. You know where you stand at the outset rather than at claim stage.
- Medical history disregarded — Generally only offered on business schemes above a certain size, where the insurer agrees to disregard existing conditions for the group.
Which basis suits you depends on your own history and on how much certainty you want before you need to claim. It is one of the decisions on this product most worth taking advice on.
Pre-existing conditions
As a general rule private medical insurance is designed for conditions that arise after cover starts, so something you already have is unlikely to be covered from the outset.
That is not the same as being uninsurable. Depending on the underwriting basis, an existing condition may be permanently excluded, excluded for a period, or capable of becoming eligible later. The outcome depends on the insurer’s terms and on your own history.
We do not ask for medical details at enquiry stage. Health information belongs in the application to the insurer, not in a website form.
Why policy terms and provider options differ
There is no standard private medical insurance product. Each insurer defines what it treats as chronic rather than acute, sets its own hospital lists, structures outpatient cover in its own way, prices by postcode and age on its own basis, and behaves differently at renewal.
Judging two policies on premium alone is therefore misleading. The meaningful comparison is between what each one would actually authorise for the kind of treatment you are most likely to need, at a facility you could realistically get to.
How getting support works
Speak to us about your private medical insurance options and we will go through what you are trying to achieve, who needs to be covered, and the practical questions on this page — hospital access where you live, how outpatient cover is structured, and which underwriting basis makes sense for your history.
We will confirm at the outset how the private medical insurance service is provided and by whom, so you know what you are dealing with before anything else happens.
Appointments are normally carried out by telephone, wherever you are in Scotland. Initial enquiries are always free, and we do not ask health questions at this stage.