Private medical insurance does not replace the NHS


When you buy a private medical insurance policy in the UK this is not the end of the road with the services provided by the NHS.

Private medical insurance does not replace the NHS but actually works brilliantly alongside it.

Your UK health insurance policy will generally not cover you for things such as:

  • A & E (accidents and emergencies)
  • The routine treatment and monitoring of chronic conditions
  • Private GP consultations *
  • Pre-existing medical conditions**

*Some insurers will offer virtual GP appointments and with the advancement of technology, more and more are beginning to review their offering in relation to primary care.

There is one UK provider who will cover private GP appointments at a vastly reduced cost if you have chosen the cover limit to include this and at least one other who offer an add-on benefit which includes private GP appointments up to a specific annual limit.

** medical conditions that you have prior to taking out your private medical insurance policy are often excluded from your cover and therefore you would still need to use the NHS for treatment or medication should you ever need it.

You will need a GP referral to make a claim on your private medical insurance

When you want to make a claim on your health insurance, your insurance provider will need a referral from your GP (or a private GP) in the majority of cases. As most private GP services are not covered under UK private medical insurance policies then the most cost effective option is to continue to use your NHS GP.

Continuing to use the NHS can help to contain the cost of your health insurance for the future.

If you can access the treatment you need quickly via the NHS and choose not to claim on your private medical insurance, this will reduce the claims value allocated to your membership.

As an example, if you have been advised you need a blood test and your local NHS facility can do this for you within a day or so – why not go this route rather than claim on your insurance? The same applies to any treatment, if you can access any diagnostic tests in a timely manner via the NHS, why not save your insurance policy for when you really need it.

In many cases the specialists and consultants work for both the NHS and private sector so you could end up under the care of the same specialist whichever route you choose to take.

NHS Cash back on your private medical insurance

Most health insurance providers will offer their members a cash back value for treatment they have on the NHS. This ordinarily applies to in-patient and day–patient cases and could be anywhere between £100 and £250 per night. There is usually an annual benefit maximum and this varies by insurance provider.

When it comes to the treatment of cancer, the annual limit may be removed and could also include out-patient treatment or chemotherapy received at home.

If you are having treatment via the NHS but have a private medical insurance policy in place, make sure you know whether you are eligible for any cash back from your policy.

If you would like to know more about private medical insurance policies in the UK or receive further information about how the two systems work together, please do not hesitate to contact us. One of the SMP Healthcare team will be happy to help you.

Telephone 01245 929129

Freephone 0800 047 0127