Investing in health insurance gives you access to private healthcare, but your coverage will vary depending on whether you choose a basic or comprehensive plan. In this guide, we look at the differences between basic and comprehensive policies so you can choose the right plan for you.
How does private health insurance work?
When you take out private health insurance, you choose a policy that offers the coverage you need. You can opt for a basic or comprehensive health insurance policy for more extensive coverage.
You can also customize your policy by adding optional extras to the basic plan. You are covered as soon as you start paying premiums and can contact your insurance company to make a claim when you need treatment.
What does basic health insurance cover?
Every health insurance plan includes certain types of coverage as standard. Even if you want to avoid adding optional extras to create a more comprehensive health insurance plan, a basic policy will give you access to private health care and membership benefits.
Here are a few treatments and services you can expect your health insurance plan to cover as standard.
Inpatient and day treatment
All health insurance policies cover hospital treatment, including surgery, meaning you can avoid NHS waiting lists if you need a hospital stay. You will also have a private room and may benefit from amenities such as your own bathroom and meals prepared by a chef.
Your treatment is also covered if you are treated in a day unit.
Cancer care
Cancer is likely to affect 50% of us in our lifetime, so cancer treatment is an essential part of any health insurance plan. Health insurance usually covers the cost of surgery, radiotherapy and chemotherapy. Some insurers offer other therapies and services such as nutritionist exams, wigs, prosthetic and reconstructive surgeries.
It’s worth shopping around for the best deal as insurers vary in the levels of cover they offer. Paying an additional premium can give you extended coverage.
Mental health support
All health insurance plans offer some form of mental health support. This varies by health insurance company, but usually includes access to counseling and CBT. Some allow you to self-refer to a limited number of sessions without seeing a GP. There are also mental health helplines for advice about your or your children’s emotional health.
Insurers vary in the number of mental illnesses they cover, so it’s a good idea to check what’s included before choosing a policy.
Virtual services of general practitioners
Virtual or digital GP services allow you to book online GP consultations 24/7. That’s great news if you’re struggling to get an appointment with your NHS GP at a convenient time. Some virtual services offer video meetings. Others allow you to enter your symptoms into an app and the doctor will call you.
Virtual or phone appointments are usually not appropriate for patients with complex medical needs. However, they can be ideal for simple problems that require a private prescription or referral from a consultant.
Choice of consultant and hospital
Private health insurance allows you to choose your hospital and adviser, like the NHS. Depending on your chosen insurer, you can choose from a list of private hospitals or a private hospital bed in an NHS hospital.
Each insurer has several hospital lists and includes their standard list on all health insurance policies. You can choose your hospital and consultant based on the facilities and whether it is close to home. You can also choose a consultant who is an expert in the procedure you need. Your choice of consultant may be limited if you have opted for guided consultant selection, where the insurer gives you a shortlist of consultants.
Member benefits and discounts
A health insurance plan may offer perks and discounts, such as free coffee or discounted movie tickets and gym memberships. Some plans give discounts to all members, while others offer you the chance to earn enhanced rewards.
For example, Vitality’s rewards program lets you set health and activity goals and earn rewards if you reach them.
What do comprehensive health insurance policies cover?
A comprehensive health insurance plan gives you more coverage and access to a wider range of treatments. Some insurers offer pre-designed comprehensive health insurance plans, or you can add optional add-ons to their standard health insurance plans.
Here are some of the features you will find with a comprehensive health insurance plan.
Outpatient treatment
All comprehensive health insurance plans cover outpatient treatment, basically anything that doesn’t require a hospital stay. Outpatient care includes consultations, physiotherapy treatment and diagnostic tests and scans.
It pays to include outpatient insurance in your health insurance policy because it means you won’t have to wait for a diagnosis and can start treatment more quickly. If you need physiotherapy, your comprehensive health insurance will probably cover it; you may be able to be referred for a limited number of sessions.
Alternative therapies
Private medical insurance usually gives you access to the latest treatments and new medicines not yet available on the NHS. A comprehensive health insurance policy may also provide alternative treatment and therapy options, such as acupuncture, homeopathy or osteopathy, that standard health insurance plans do not cover.
Additional treatments or more extensive coverage
All health insurance plans include financial limits or set the number of treatments available. Choosing a comprehensive health insurance plan will cover more sessions or higher treatment costs. You can also pay more to increase the limits for certain treatments.
A comprehensive health insurance plan can also include different types of treatment. For example, some of the most comprehensive health plans include genetic testing, stem cell therapy, and other treatments and support services.
More comprehensive mental health coverage
All health insurance plans offer some mental health support, from counseling to helplines or online resources. However, comprehensive health insurance plans provide extended coverage for more serious mental health conditions.
Although all health insurance covers hospital care, it often does not cover psychiatric treatment. You will need comprehensive health insurance to access hospital or day care.
Dental and optical cover
The NHS offers free dental treatment and free eye examinations in some circumstances. However, more of us are now paying for our routine dental and optical care. Adding optical and dental coverage to your comprehensive health insurance could save you money if you’re already paying for private treatment.
Depending on the policy you choose, your comprehensive health insurance may pay for your routine check-ups, treatments, glasses and contact lenses as needed. However, glasses and contact lenses are usually only covered if you need them for the first time or if your prescription has changed.
A wider choice of hospitals
As mentioned, standard health insurance plans only include a basic hospital list of insurers. However, insurers also offer extended lists at an additional cost. Expanded lists of hospitals show that private health care is more expensive in some locations because of higher wages or facility costs.
You will usually pay more for treatment in most major cities. Not surprisingly, central London has the highest costs. Most insurers offer an extended list and an extended plus central London list. They are ideal if you live in London or another major city and want to be sure you can have treatment close to home.
What is excluded from coverage?
Even the most comprehensive health insurance still has exclusions. Health insurance is only available for acute conditions that arise after purchasing a health insurance policy. Acute conditions are illnesses or injuries that can be cured with treatment, such as hip replacements, broken bones surgery, or cancer treatment.
Your health plan won’t cover chronic conditions like diabetes, asthma or angina that can’t be cured but can be monitored and managed over the long term.
Medical insurance also comes with standard exclusions. For example, plans do not cover addiction treatment, cosmetic surgery or fertility treatment, among others. Some insurers have longer exclusion lists, so always check the fine print.
Other exclusions depend on your medical history and whether you have pre-existing conditions. If you have seen a doctor for advice or treatment for any ailment during the five years before you bought the policy, that condition will be excluded from cover for the first two years. If it doesn’t happen again, you can add it to your shelf.
Get in touch
MyTribe guides help you understand how health insurance works and how to find the right coverage for your needs. Contact us for a comparative quote and we’ll put you in touch with a specialist, regulated broker for advice tailored to your circumstances.
