Adding outpatient coverage to your UK Health Insurance gives you access to diagnostic tests, treatments and therapies. This guide explains how outpatient coverage limits work and how leading insurance providers differ in their coverage.
What is outpatient treatment?
Outpatient treatment usually does not require hospital admission, which means that the outpatient receives treatment and returns home. Outpatient treatment may include minor surgical procedures, diagnostic tests, consultations or therapies such as physiotherapy.
For example, if you need to stay overnight in a hospital bed to undergo major surgery, your care is classified as inpatient treatment. There is also day treatment where you may have to stay in the day unit for a few hours but return home afterwards. Basic health insurance usually includes hospital treatment as standard. However, you will often have to pay more for outpatient insurance.
How does outpatient coverage work?
Health insurance policies include some forms of treatment as standard. You will usually get hospital cover and cancer treatment with even the most basic health insurance policies. Health insurance policies also offer a variety of add-ons so you can choose the coverage that suits your needs.
Optional extras usually include outpatient cover, enhanced mental health support and optical and dental cover. However, it’s worth thinking about what outpatient treatments you’re likely to need when you get your health insurance quotes. Most policies now include some outpatient services in their basic coverage, but offer others at an additional cost.
Is any outpatient treatment included in the basic insurance?
The short answer is yes; you’ll find some outpatient coverage included in a health insurance provider’s basic coverage. While standard health insurance policies used to include only inpatient treatment and exclude outpatient treatment, many now include minor diagnostic tests, scans and even some outpatient surgical procedures.
We recommend that you add outpatient coverage to your health insurance policy as this can give you faster access to diagnostic tests. However, many policies now offer tests and scans in their core cover.
Outpatient services offered vary from insurer to insurer, so you should carefully compare quotes and policy documents before purchasing.
Coverage Limits
When a health insurance policy mentions coverage limits, it refers to the amount your policy will pay out each year. There are different coverage limits for each type of coverage. For example, there is likely to be a specific figure to cover the private costs of hospital care and a separate figure for out-of-hospital insurance. When you reach your annual limit, your insurance will no longer cover private health services.
Some private health insurance companies offer different levels of coverage, so you can choose one that fits your budget.
Outpatient coverage from major health insurers
To give you an idea of the types of outpatient coverage included in each private health insurance plan, we decided to review what each major health insurance provider offers. In our opinion, the insurance companies below are the nine best health insurance providers in the UK.
While this article focuses on the outpatient coverage included in each policy, you need to consider what each policy offers more broadly before purchasing. Talking to a health insurance broker can help you understand what level of coverage you’re likely to need and how to get the best coverage for your budget.
AXA health
AXA Health Insurance is one of the largest providers of health insurance plans in the UK. You will need to add outpatient insurance as it is not included in their standard policies. Although you will need to see an NHS consultant for your first appointment, AXA health insurance includes diagnostic surgery and scans in its basic cover, which could speed things up compared to NHS waiting lists.
AXA’s outpatient treatment cover includes unlimited specialist fees for consultations, diagnostic tests and outpatient treatment. AXA does not include physiotherapy in its outpatient services cover, which means you will need to add therapy cover if you want outpatient treatment and physiotherapy.
Aviva
Aviva’s health insurance plan, “Healthier Solutions”, is a comprehensive policy that includes hospital treatment, cancer care and outpatient insurance as standard. Outpatient insurance includes tests, scans and x-rays.
If you have had specialist treatment from a consultant who then refers you to physiotherapy, this is included in the basic cover. However, you will need to add therapy cover to access physiotherapy with a GP referral.
Bupa
Bupa offers two policies with different approaches to outpatient cover. Their lower cost treatment and care policy includes out-of-hospital therapies such as physiotherapy as standard, but not specialist consultations, tests and scans. In addition, the policy covers private hospital treatment if you need to stay in a hospital bed overnight or have major surgery.
Bupa’s comprehensive policy includes outpatient cover for specialist examinations, tests and treatments, including mental health support and therapies. You can choose annual cover limits of £500, £1,000 or unlimited to cover all your outpatient treatment. Unlimited cover is only valid if you are being treated at a Bupa-approved hospital or treatment centre.
Freedom
Freedom Health Insurance offers its clients flexible private health insurance with comprehensive hospital care coverage. Their core policy pays for MRI, CT and PET scans after a specialist referral, but not if your GP asks for it. Specialist consultations and other tests, such as blood tests, are only available with Freedom’s additional outpatient treatment cover.
If you invest in extended outpatient coverage, you can access physiotherapy as per the general policy limits. Freedom also pays reimbursement for treatments, including outpatient procedures, minor surgeries, and routine dental and optical care.
National friendly
National Friendly offers four levels of coverage with increasing limits on hospital care and outpatient treatment. Choose your policy carefully if mental health cover is important to you, as not all policy levels include it. National Friendly’s outpatient coverage includes MRI, CT and PET scans, but these come out of your overall outpatient coverage limits rather than being part of a separate diagnostic category.
While some providers offer unlimited out-of-hospital cover, National Friendly’s maximum is just £5,000 compared to up to £1 million for hospital treatment at higher levels. Level 1 supports clients who want their healthcare plan to provide them with a quick diagnosis by including outpatient consultations, tests and scans. Physiotherapy is usually only available after hospital treatment, although some minor surgical procedures, such as carpal tunnel release, are covered.
Exeter
Exeter’s Health+ policy has comprehensive and guided options offering flexible private health cover. Their basic cover is excellent and includes outpatient surgical procedures to give you quick access to treatment if you don’t need hospital care. You can also access CT, MRI and PET scans and up to three sessions of outpatient physiotherapy after surgery, if required.
Exeter has the same approach to optional extras as other insurance companies, with separate extras for out-patient and therapy cover. Their outpatient cover includes unlimited consultation appointments and tests, but you will need separate cover for physiotherapy, osteopathy or chiropractic therapy.
Vitality
Vitality Private Health Insurance is focused on helping its customers improve their health and well-being. They include outpatient surgical procedures in their core coverage and were among the first insurers to do so. You will need to add outpatient cover as an extra to access tests, scans, consultation appointments and physiotherapy. There are two levels of outpatient coverage; limited offers unlimited scan coverage, but everything else is subject to a pre-agreed limit. Full coverage is unlimited for all outpatient services.
WPA
The WPA Complete Health policy is very flexible and allows you to tailor your coverage to meet your needs. Their basic cover includes £250 for outpatient consultations and £150 for outpatient procedures and MRI, CT and PET scans.
Their optional supplement includes three categories of outpatient care: consultation, therapy and tests. You can skip the consultation cover if the £250 offered by their basic cover is likely to be sufficient for your needs. Equally, if you are happy to pay for physiotherapy, you may not need cover for the therapy. However, to ensure quick access to the tests, you can choose the option of tests with unlimited coverage. WPA also offers other coverage options for outpatient mental health care and cancer coverage.
Getting professional advice
MyTribe guides help you learn more about health insurance and understand your options. However, the best way to find the right health insurance coverage for your needs is to speak to a regulated broker. Contact us for a comparative quote and we will connect you with a specialist broker for tailored advice.
Waiver: This information is general and what is best for you will depend on your personal circumstances. Talk to a financial advisor or do your own research before making a decision.
