What are chronic conditions?

A health insurance policy may not cover incurable or long-term conditions, such as arthritis or diabetes. These conditions are called chronic conditions. A chronic condition is a disease, illness or injury that has one or more of the following characteristics: It needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests. It needs ongoing or long-term control or relief of symptoms. It requires rehabilitation, or for you to be specially trained to cope with it. It continues indefinitely. It has no known cure. It comes back or is likely to come back.

What does private health insurance cost in the UK?

The cost of health insurance can vary depending on factors such as your age, your location, your excess and the level of cover you choose. You can find out more on our cost of private health insurance page.

Your excess is the amount you pay towards treatment if you make a claim. You can choose which level of excess you prefer, and it impacts the overall cost of your cover. If you choose a higher excess, your premiums would be less, but you’d have to pay more if you made a claim. If you have a lower excess, your monthly premiums would be higher, but you would pay less if you made a claim.

Your premium, sometimes called a subscription, is what you pay for your health insurance cover. This is usually paid monthly or annually.

Do I need to have a medical before I take out health insurance?

No, a medical is not usually required to purchase health insurance. You simply provide your personal details and typically answer some health questions. If you have any pre-existing or chronic conditions, you should talk to your insurer before purchasing to be clear on what is and isn’t covered. You can find an explanation of pre-existing and chronic conditions in this FAQ.

How does our AXA Health Plan work?

The AXA Health Plan takes some of the worry out of accessing healthcare. It covers private treatment for new conditions, and includes access to our online private GP service. You can see everything about what we do and don’t cover in the information we’ll give you before you buy. You pay a monthly or yearly cost, and then if you become ill or develop a health issue, you can choose to use private healthcare, so long as it’s covered by your membership. You usually start off by seeing a GP – that can be an NHS GP or a private one. Then if you need to see a specialist, you can get in touch with us and we’ll walk you through what you’re covered for. If you choose an option that covers seeing a specialist we can source or even book the appointment for you. If you have an option for hospital treatment this will usually be in a private hospital.

What does an AXA Health Plan cover?

Our AXA Health Plan covers private treatment for new medical conditions – it’s not designed to cover conditions you already have symptoms of when you join. The treatment that’s covered will depend on the cover you choose – we offer a range of options so you can select what matters to you. For example, you could choose to have cover for: seeing a specialist for a diagnosis, inpatient or day patient treatment, including operations, in a private hospital, cancer treatment if you ever get a cancer diagnosis, help with mental health conditions.

What does AXA health insurance not cover?

As with most insurance, there are some things we don’t cover under any of the care options with our AXA Health Plan: Chronic conditions - We don't cover treatment or monitoring of ongoing, recurring and long-term conditions (chronic conditions). Pregnancy and childbirth - We don't cover pregnancy or childbirth. Dental or optical treatment - We don't cover services that a dentist or optician would usually carry out. We don't cover dental procedures. Treatments, drugs and dressings - We don't cover fees for outpatient drugs, dressings and private prescriptions. We don't cover services that a GP practice would usually carry out. We don't cover preventative treatment or tests when there are no apparent symptoms. We don’t cover therapeutic vaccines, even if it's recommended as part of your treatment. We only cover treatment shown to be safe and effective by NICE, or by clinical trials that we recognise. We only cover the approved Advanced Therapeutic Medicinal Products (medicines based on genes or tissues) listed on our website.

What about conditions I already have when I join AXA Health?

Private health insurance covers private treatment for new medical conditions. It’s not designed to cover conditions you already have when you join. That includes conditions that start before you join, but which haven’t yet been diagnosed. This means your cover for any conditions you already have when you join is limited, and we may not cover the condition at all. If you have symptoms now that you’re worried about, we probably won’t cover that condition if you join, even if you haven’t seen a doctor about it. We’ll explain this cover before you buy, and you’ll see it on your membership certificate and handbook if you do buy.

What is a moratorium?

Most health insurance, from any insurer, is designed to cover new medical conditions, not those you have already. So your cover for conditions that started before you joined will be limited. For the AXA Health plan, a moratorium means that for most people joining the AXA Health Plan, we won’t cover any condition you had symptoms of in the three years before you joined. This includes if you had symptoms of a condition that hadn’t been diagnosed. This will last until you’ve had at least two years trouble-free from the condition after joining. Trouble-free means you haven’t gone to a medical practitioner, had any treatment or advice, followed a special diet, or taken medication, including over-the-counter medication. As well as this rule, we also have specific rules for some conditions too - including: chronic conditions – we'll only cover acute episodes, not long-term treatment; cancer - if you choose our cancer option, we'll only cover new cancer, not cancer that you had at any point before you joined. This includes if the previous cancer comes back or spreads; diabetes - we won’t cover diabetes or some other specified conditions; raised PSA (Prostate Specific Antigen) - if you've had a raised PSA that has led to investigation, monitoring or treatment, we won't cover any prostate conditions.

Will I need an excess on my AXA Health Plan?

You don't need to have an excess when you take out a plan, but you can choose to have one to help lower your premium. If you call us to make a claim, we’ll tell you what the excess is on your plan. When we receive an invoice for your treatment we’ll reduce the amount we’ll pay by your excess. With our AXA Health Plan, you’ll need to pay your total excess for each 12-month period in which you make at least one claim. The 12-month period starts on the date you first have treatment. We pay claims in the order they are sent to us, which means the first claim we pay might not be for the first treatment you had. We will confirm your excess start date on your membership documents. You’ll need to pay your excess again if you make a claim 12 months after your first treatment date, even if it’s for treatment of the same medical condition.

Can I add people to my AXA Health Plan?

Yes. You can add a partner, dependants, parents, grandparents, or even grandchildren to your policy, so you are able to provide peace of mind for yourself and your loved ones. Your family can be included on your plan even if they live at a different address and each family member can have the cover options to best suit their needs.

What types of health insurance does AXA Health provide?

We offer different types of health insurance to suit your needs: Individual health insurance – for individuals, couples and families; Small business health insurance – for self-employed/small businesses; Corporate health insurance – for larger businesses (250+ employees).

Are there restrictions on who can be covered by an AXA Health Plan?

We are unable to provide cover for people over 74 years of age. Additionally, we do not offer child only health insurance plans, although children can be covered on an adult relative's plan.

How can I contact AXA Health?

If you are thinking of joining AXA Health, simply start a quote – it doesn’t take long, and we won’t ask tricky medical questions. You can also give us a call on 0800 169 7593*. If you’re already with AXA Health, it’s easiest to contact us through your online account. *Lines are open 09:00 - 19:00 Mon - Fri. Closed Sat - Sun. We may record and/or monitor calls for quality assurance, training and as a record of our conversation.

How does health insurance work?

Key takeaways: How does health insurance work?

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What's in this article

Jump to sections:

Understanding private health insurance
Commonly used terms in private health insurance
How does private medical insurance work?
Key benefits of private medical insurance

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Understanding private health insurance

Private health insurance, also known as private medical insurance, covers the cost of private medical treatment when you need it. With private health insurance, you pay a monthly or a yearly subscription which covers the treatment that you need, as long as it’s covered by your plan.

With private health insurance, you can still use all the services offered by the NHS, but you will also have access to private healthcare. This can often provide you with access to quick diagnosis and treatment (depending on your cover). Private health insurance may also provide access to specialist treatments, or cancer drugs that may not be available on the NHS (depending on the cover you choose).

Generally, health insurance is designed to cover new acute conditions that develop after your policy has started. It doesn’t usually cover treatment for conditions and symptoms you’ve already experienced prior to joining, depending on the underwriting option chosen.

Commonly used terms in private health insurance

Premiums: This is what you pay for your health insurance cover. This can usually be paid monthly or annually. The cost of your premium can vary based on factors such as age, your location, and the level of cover you choose.
Excess: An excess is the amount you pay towards treatment if you make a claim. For instance, if your policy has a £500 excess, you'll need to pay the first £500 of your medical expenses, after which we will cover the cost of treatment according to your policy terms. When you take out a private health insurance policy, you’ll be able to choose which level of excess you prefer. The excess you choose will impact the overall cost of your cover.
Underwriting: Underwriting involves insurance companies deciding:
- What levels of cover it can offer you
- How much your premium should be
- How to cover any existing medical conditions you may have
Exclusions: As with most insurance, there are some things that aren’t covered. This can include:
- Chronic conditions
- Pregnancy and childbirth
- Dental or optical treatment
- Some treatments, drugs and dressings

How does private medical insurance work?

Here's a step-by-step overview of how private health insurance works:

Choose your cover options: Choose a policy that aligns with your healthcare needs and your budget.
If you need to seek treatment:
- If your GP recommends you see a specialist, tell them that you want to go private and ask for an open referral (this is where your GP states that treatment is necessary and which type of specialist you require that treatment from, but they do not specify the specialist’s name).
Making a claim:
- Call your insurance provider as soon as you’ve seen your GP, before you see a specialist/begin any treatment. This will mean that you won’t end up paying for treatment that you’re not covered for.
- Your cover will then be checked and you’ll be informed as to what happens next.

Key benefits of private medical insurance

Quick access to diagnosis and treatment: See a specialist quickly, at a time and place that suits you
Choice of specialists: Select from a choice of specialists
A choice of private hospitals and clinics: Benefit from private rooms and additional amenities during hospital stays.
Private healthcare: Access treatments and medications that may not be available through the NHS.

Considerations when choosing a policy

Assess your needs: Evaluate your health status, family medical history, and potential future healthcare requirements.
Understand the terms: Familiarise yourself with any exclusions, coverage limits, and the claims process.

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