What Does Health Insurance Cover?

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Published - 21 Jun 2023 | Updated - 29 Jan 2026

Health insurance in the UK, or private medical insurance (PMI), can offer faster access to treatment, more choice and added peace of mind.

But what exactly does it cover? In this guide, we break down what private medical insurance typically includes, what it doesn’t and how it works alongside the NHS.

Do you need private health insurance in the UK?

Private health insurance is not required by law. But if you choose to get it, you’ll pay regular premiums – just like you do for car insurance.

It can help cover the cost of and get you faster access to tests, scans, specialist appointments and treatment for new conditions. The level of cover depends on the plan you choose.

The NHS provides healthcare for free to UK residents. However, you might have to wait longer to see a doctor or get treatment.

What does private health insurance in the UK cover?

Cover varies depending on the provider, but it can include:

Treatment in a private hospital
NHS hospital cash benefits
Private consultation
Physiotherapy
Access to online services
Outpatient services including scans, tests and hospital appointments.

Learn more about what health insurance offers in our guide.

What is not covered by UK health insurance?

It’s important to understand what private health insurance covers – and what it doesn’t.

Some private health plans do not cover mental health care. Many also exclude long-term treatment for chronic conditions like diabetes.

Private health insurance may also not cover:

Emergency treatment
Cosmetic surgery
Routine dental treatment
Some alternative therapies.

Benefits of private medical insurance

There are many advantages of private medical insurance, including:

Shorter waiting times. A major benefit of PMI is that it allows you to avoid long NHS waiting lists. This means that you get seen by a doctor and get treatment sooner.
Choice of hospital. Many health insurance policies let you choose the doctor and hospital you want to go to for treatment. This isn’t always possible with the NHS.
Scans. Sometimes, the NHS will delay or refuse a scan, even though you think you need one. PMI allows you to get the scan you want and will cover the costs.
Physiotherapy. Health insurance helps you get faster access to a physiotherapist.
Private rooms. There’s a better chance you’ll be in a private room, rather than on a busy ward.
Specialist treatments and drugs. Sometimes, you can’t get specific treatments and medications on the NHS. This could be because they cost too much or that they aren’t approved by the National Institute for Health and Clinical Excellence in England and Wales (NICE) or the Scottish Medicines Consortium (SMC). You may get access to these with health insurance.

Choosing a health insurance plan

When choosing a health insurance plan, it’s important to know exactly what is and isn’t covered. That way, you can make sure it suits your needs.

Questions to ask when comparing PMI providers

Before picking a health insurance provider, think about what you really need. Always read the policy carefully to check what’s included and what’s not.

Here are some helpful questions to ask:

Will my health insurance cover family members?
Does the policy include mental health cover?
Am I covered for cancer treatment?
Can I choose which hospital I go to?
How much will my excess be?
How much can I claim on my health insurance each year?
How much outpatient cover do I get each year?
Is there cover for joint, muscle or bone problems?
Do I need a GP referral for private treatment?

Does UK PMI cover pre-existing conditions?

Most UK private health insurance plans, including Saga HealthPlans, are designed to cover new medical issues that start after you join.

Our policy book explains how we look at pre-existing conditions and the different types of underwriting we use.

When you buy new health insurance, we won’t cover the cost of treatment for any condition or symptoms you’ve had in the last three years. This applies to you and anyone else on your policy.

No matter which underwriting option you choose, you’ll be covered for any new eligible conditions that begin after your policy starts.

If you have a pre-existing medical condition, please call our friendly health insurance team on 0330 094 6361 to discuss your cover options.

Health insurance with Saga

Looking for flexible health insurance that suits your needs? We offer a range of plans designed to give you the right level of cover.

We have four Saga HealthPlans to choose from and a range of options for getting seen, tested and treated fast.

With our Saga GP Service, you can speak to a doctor anytime – 24/7, 365 days a year – by phone, from anywhere in the world.

And remember, you can only get Saga Health Insurance from us – it isn’t available anywhere else. It’s specifically for people over 50 and is underwritten by Bupa Insurance Limited.

Who underwrites Saga Health Insurance?

Saga Health Insurance is a unique product designed by us specifically for our customers and it is only available through us. Together with our underwriter, Bupa Insurance Limited, we are committed to providing high levels of quality, service and choice. That's why we offer a range of policies that can be tailored to suit your needs and budget.