Health Insurance Guides
What does health insurance cover?
Key takeaways: What does health insurance cover?
Health insurance is designed to give you fast access to private medical treatment. You can usually tailor your health insurance to fit your individual needs, and you’ll often get additional services such as access to an online GP service or health support line.
It’s designed to cover new health conditions, so won’t cover anything you’re already aware of. It’s best to check what’s covered for before taking out health insurance.
What's in this article
Jump to sections:
What does health insurance cover?
Can I choose what my health insurance covers?
How do I know what my health insurance covers?
What does health insurance usually not cover?
Are there limits on what I can claim on my health insurance?
What does health insurance cover?
Health insurance is designed to give you fast access to private medical treatment for new conditions that start after you join. You’ll usually have the option to tailor your plan to cover your individual needs. However, there are some conditions and treatments that health insurers don’t typically cover.
What your health insurance covers will depend on the options you chose when you set it up. For example, some plans might cover you for outpatient consultations with a specialist, while others won’t cover this.
Health insurance usually covers treatment for medical conditions that start after your plan starts. There are some things you won’t be covered for – you can see the types of treatment most health insurance plans don’t typically cover below.
As well as covering you for treatment, you often get additional services with your health insurance to support your health and wellbeing.
Can I choose what my health insurance covers?
With most health insurance plans, you can tailor what your health insurance covers so that it works best for your needs. As with most health insurance, pre-existing conditions are not covered.
At AXA Health we have options such as but not limited to:
- Cancer care
- Inpatient and day patient care
- Outpatient diagnosis and care
- Mental health care
How do I know what my health insurance covers?
Your membership documents will tell you what you’re covered for. It’s a good idea to check them – you can often do this online, in your online account.
Before you start any private treatment, contact your health insurer to make sure your plan will pay for your treatment, and if you’ll need to pay anything, such as an excess.
What does health insurance usually not cover?
Here are some of the things most health insurers won’t usually cover.
Pre-existing conditions
Health insurance is designed to cover new conditions. If you have symptoms already – whether you’ve seen a doctor or not – your health insurance won’t usually cover these.
This includes:
· If you’ve taken any medicine for the problem – including painkillers or other medicine you bought in a shop.
· If you see your GP after joining, but the problem started before you joined. Health insurers will usually check this in your medical history.
· If you haven’t yet had any diagnosis for the problem.
It’s always best to check the rules for your health insurance provider carefully.
Chronic conditions
Most health insurers won’t cover long-term treatment of chronic conditions. These are conditions that need long-term treatment or monitoring, have no known cure, or are likely to come back. However, your health insurance may cover treatment of a flare-up of the condition.
Treatment that could be carried out by a GP
Health insurance doesn’t usually cover primary care, such as:
· Treatment in a GP surgery (although you may have access to a private online GP through your health insurance)
· Optician’s fees – unless you’ve chosen an option that covers this
· Dentist’s fees – unless you’ve chosen an option that covers this.
Pregnancy and childbirth
Health insurance doesn’t usually cover routine pregnancy and childbirth, as the NHS is best placed for this kind of care. However, your health insurance may cover any treatment of any complications.
Emergency treatment
In the UK, the NHS is based placed for emergency care. Private hospitals don’t usually have A&E departments. This means that health insurance doesn’t usually cover any kind of emergency treatment. If you go on to need further treatment after your emergency, your health insurance may cover this.
Anything your health insurer tells you they don’t cover
You’ll find details of these in your plan’s handbook or other documents.
Are there limits on what I can claim on my health insurance?
Depending on how your plan is set up, there could be limits on some of the things your health insurance covers. For example:
- You may need to use specific specialists and hospitals.
- You may need to ask your insurer to set up appointments for you.
- There may be a limit on the number of outpatient consultations or the amount of outpatient treatment you’re covered for.
- There may be an overall limit on how much you can claim in a year.
Find out more about our AXA Health Plan or start a quote
Reviewed by Dr Corné Hurter
I was appointed Medical Director for Services and Delivery at AXA Health in January 2026. Before then, I spent 10 years working at HCA UK in roles such as Medical Director for Care Transformation and Director of Medical Services.
During my time at HCA UK, I was part of the first cohort of doctors to complete a Medical Management and Leadership Master’s degree.
I’m passionate about patient care and innovation that supports care delivery to patients in a manner which is sustainable and value-driven.
I’m excited to be using my experience to make a real difference to members and the service we provide.