Health Insurance Guides
Does health insurance cover emergency care?
Key takeaways: Does health insurance cover emergency care?
Private health insurance doesn't usually cover emergency care, but you may be able to go private if you need follow-up consultations, tests or treatment.
You won’t usually be covered for follow-up care if the emergency treatment was for a pre-existing condition. If you needed the emergency care for a chronic condition, the amount of cover you can get for follow-up treatment may be limited.
Does health insurance cover emergency care?
Health insurance doesn’t usually cover accident and emergency treatment, but if you need follow-up care or treatment to help you recover, private health insurance may cover it.
If you have an accident or health emergency, call an ambulance on 999, or go to A&E immediately. Don’t call your health insurer.
The NHS should always be your first choice for emergency treatment, as they have dedicated A&E departments and staff experienced in emergency treatment.
Private health insurance doesn’t usually cover emergency care, and private hospitals don’t usually have emergency departments, as they’re set up for planned treatment only.
However, if you need follow-up treatment after the NHS has treated the initial emergency, private health insurance may cover it.
What could health insurance cover after I’ve had emergency care?
Quick access to a specialist
If you need follow-up consultations or treatment with a specialist, you can usually see one quickly with private health insurance. Depending on how your plan is set up, there may be rules about which hospitals or specialists you can use.
Follow-up tests and scans
You may need follow-up tests and scans after the initial emergency treatment. These could be as an outpatient, or as a day patient or inpatient. You’ll usually need a specialist to refer you for tests and scans.
The way different insurers cover these varies. Some insurers may include them in their core cover, but with others you may have to pay extra to add them as a separate option. There may be a limit on the number of tests and scans you can have.
With AXA Health, if you choose to add our Outpatient diagnosis and care option you’ll get as many scans and tests as you need if a specialist refers you. If you’ve chosen our Inpatient and day patient option, you’ll be covered for diagnostic tests and scans you have as an inpatient or as a day patient.
Access to other health practitioners and support
Depending on your insurer and your plan, you may be able to access mental health support or see other health practitioners such as physiotherapists quickly.
Access to private GP appointments
You’ll probably be referred to your NHS GP when you’re discharged from emergency care. Private health insurance also often offers a private online or phone GP service so, if you need a follow-up GP appointment, you’ll be able to get it quickly. AXA Health has a 24/7 online GP service where you can choose appointments by video or phone 24 hours a day, subject to appointment availability.
What won’t health insurance cover after I’ve had emergency treatment?
Pre-existing conditions
Health insurance is designed to cover new conditions, so conditions, symptoms or signs you’re already aware of when your health insurance starts – whether you’ve seen a doctor or not – aren’t usually covered, even if you need unexpected, emergency treatment for them.
Find out more in our guide to pre-existing conditions: Can I get health insurance to cover a pre-existing condition?
Chronic conditions
If it’s a chronic condition that has flared up, a private health insurer may cover short-term treatment of the condition. However, they may not cover any further treatment.
The way health insurers cover chronic conditions will vary, so it’s always worth checking with them before arranging private treatment.
Most health insurers define a chronic condition as one where any of these apply:
· It needs ongoing or long-term monitoring through check-ups, tests, examinations and consultations.
· It needs long term control or relief of symptoms.
· It needs you to have long term rehabilitation or special training to cope with the illness.
· It continues indefinitely.
· It has no known cure.
· It comes back or is likely to come back.
Individual insurers might have a different definition, so it’s worth checking your membership documents for their definition of a chronic medical condition.
Find out more about chronic conditions in our guide on what are chronic conditions?
Reviewed by Dr. Nikita Patel
Dr Nikita Patel is Head of Propositions at AXA Health and an NHS GP. In her role at AXA Health, she leads development of our products and propositions, shaping innovative solutions that deliver meaningful value for our members. Nikita previously worked in consulting at Deloitte, advising organisations across healthcare and life sciences. She is passionate about creating sustainable, person-centred propositions that bridge clinical insight and commercial innovation to deliver lasting impact.