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One of the first things you look at when buying health insurance is what inclusions do you have on your policy.

This essentially means what is included in your health insurance policy and what can you claim for if you get sick, injured or need treatment.

Whilst every insurer is different and will also take your personal history, health and age into consideration, there are some common inclusions and exclusions across all UK insurers.. 

To help guide you, Forces Compare have provided a list of common inclusions below.


What Are the Common Inclusions With Private Medical Insurance? 




  • Inpatient tests
  • Surgery as either an inpatient or a day patient
  • Nursing care and hospital accommodation (overnight stays)
  • Cash reimbursements for treatment provided by the NHS as an inpatient
  • Tests for outpatients
  • Consultations or treatment with a specialist as an outpatient
  • Physiotherapy or other forms of therapy

Private medical insurance is designed to treat short-term illnesses or injuries, otherwise known as ‘acute injuries.’ The purpose of PMI is supposed to help you use treatment to get you back to full recovery. Therefore, this covers things like diagnostics, treatment, consultations and staying in hospital (during the day or overnight).


What Affects Your Health Insurance Inclusions? 




  • The level of policy you purchase
  • The insurer that you use
  • Your age
  • Your current health
  • Any pre-existing medical conditions
  • Your condition – is it chronic or incurable?


What Are Common Exclusions? 




It is important to make yourself familiar with common health insurance exclusions. This includes having a chronic illness or something that is recurring or there is an unknown cure. This is not always likely to be covered by your private health insurance since it is difficult to get you back to full health.


This includes:


  • Pre-existing medical conditions
  • Cosmetic treatment
  • Certain cancers
  • AIDS
  • Pregnancy and menopausal treatment 
  • Sleeping problems
  • Certain allergies
  • Extreme sports
  • Injuries as a result of being intoxicated
  • Deafness
  • Ageing
  • Dialysis



Are Prescriptive Drugs Included in My Health Insurance Policy? 



Some prescriptive drugs are and are not covered by your health insurance. This will depend on the type of drug, how new it is and the condition that it treats. There are some drugs available for free on the NHS and some which you have to pay for. It is important to ask your insurance provider about a particular drug for confirmation.


A New Condition vs a Pre-Existing Medical Condition 




Most insurance providers will not insure you for a pre-existing medical condition. This is because you may need recurring or future treatment and since you are more likely to claim, the insurer will potentially lose money by insuring you.

However, if you have a new medical condition that emerges and requires treatment, this is something that may be covered provided that it is not a common exclusion.

Some insurers take different views on pre-existing medical conditions and may be willing to offer cover after a certain period of time e.g 1 to 3 years. 


Check the Terms of Your Policy for Exclusions 




It is always essential to check the terms and conditions of the policy you are thinking of purchasing. Whether you are speaking to a broker or the insurer directly, it is important to raise certain conditions that you have had in the last 3 years and whether you can receive cover for them in the future. 

Every insurer is different and some may be more flexible than others, or they have different inclusions and exclusions depending on the package that you purchase. Always speak to your insurer for more information.

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