Health Insurance Guides
What's not covered by private healthcare?
Key takeaways: What's not covered by PMI?
The treatments and conditions private health insurance doesn’t cover will vary depending on the insurer. However, there are some things, like pre-existing conditions or chronic conditions, that most insurers don’t usually cover. Some insurers may not cover conditions or treatments as standard, but will let you add them to your cover if you pay more. It’s best to check what’s covered before taking out private medical insurance.
What's in this article
Jump to sections:
What’s not covered by health insurance?
What won’t private health insurers usually cover?
Can I choose what not to have cover for?
How do I find the right private healthcare?
What do I need to consider if I’m thinking about private healthcare?
What’s not covered by health insurance?
Health insurance won’t cover every treatment or condition. It’s designed to cover conditions that start after you join, and you won’t usually be able to claim for chronic conditions. You may have to add extra options to your plan if you want cover for some conditions or treatments.
What is and isn’t covered by private health insurance will depend on your insurer and your individual plan. You can usually choose some parts of your cover when you set up your insurance. What one health insurer covers as standard may not be the same for another insurer. It’s always a good idea to make sure you understand what’s not covered before you buy private medical insurance, or renew your plan.
We’ve listed a few things here that most private health insurers usually don’t cover. You may want to check these in detail when looking at a new insurance plan.
What won’t private health insurers usually cover?
Pre-existing conditions
Health insurance is designed to cover new conditions, so conditions you’re already aware of when your health insurance starts – whether you’ve seen a doctor or not – aren’t usually covered.
Chronic conditions
Most health insurers count a chronic condition as one where any of these apply:
- It needs ongoing or long-term monitoring through checkups, tests, examinations or 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.
Treatment that could be carried out by a GP
Or in another primary care setting, such as by nurses based in a GP surgery.
Dentists’ or opticians’ fees
Some health insurers will offer cover for dentists’ or opticians’ fees as an added extra, often as a ‘cashback’ option where they’ll pay a percentage of the cost. However, most health insurance plans don’t cover dentists’ or opticians’ fees as standard.
Routine pregnancy and childbirth
Most health insurance doesn’t cover routine pregnancy or childbirth, as these don’t usually have waiting lists on the NHS (for obvious reasons). Health insurance plans may cover complications for you or the baby.
Emergency treatment
Most health insurers don’t cover emergency treatment, as the NHS is best placed to deliver this. Most private hospitals don’t have emergency departments.
Anything your health insurer tells you they don’t cover
You’ll find details of these in your plan’s handbook or other documents.
Can I choose what not to have cover for?
You may be able to choose your level of cover for some conditions or types of treatment.
Health insurers usually provide core cover. You can then pay extra to tailor the cover to your individual needs.
If you’re with AXA Health, you can choose options such as:
- Outpatient diagnosis and care
- Inpatient and day patient care
- Cancer care
- Mental health care
Some combinations of cover aren’t available. To learn more, see the AXA Health Plan.
If you haven’t added an option, you won’t be able to claim for this kind of treatment. For example, if you don’t choose Cancer care, you won’t have any cover for cancer treatment, so if you receive a cancer diagnosis, you’ll need to use the NHS or pay for treatment yourself.
By only choosing the options you need, you’re less likely to be paying for cover you don’t need.
How do I find the right private healthcare?
If you have private health insurance, your insurer will be able to help you find a specialist or hospital that can help you with your treatment.
If you’re self-funding, you can research specialists yourself, or you can find independent advice from The Private Healthcare Information Network. This gives you impartial, free information about specialists and hospitals.
What do I need to consider if I’m thinking about private healthcare?
If you’re self-funding: Make sure you know what you may need to pay. Private healthcare can be very expensive if you self-fund, so it’s worth doing some research. Before you commit to any treatment, ask your doctor or hospital for a full breakdown of the expected cost. You can ask different hospitals for quotes and compare. Make sure you know about any other possible costs – for example, if you need to stay overnight unexpectedly, need an extra follow-up appointment, or need to take medications home.
Some hospitals or private healthcare providers will offer you payment in instalments. Make sure you’re aware of the interest that may be added to your bill, how much this will cost over time, and what happens if you can’t keep up your repayments.
If you’re buying health insurance: If you’re considering taking out health insurance to pay for private healthcare, make sure you know what is and isn’t covered before buying your plan. Compare what different private health insurers provide to make sure you’re getting the best plan for your needs.
It’s also worth knowing that most health insurers don’t cover conditions or symptoms you have before your health insurance starts. These are sometimes called pre-existing conditions. If you need treatment for a pre-existing condition, you’ll either have to pay for it yourself, or have the treatment on the NHS.
There will also be some conditions and treatments your plan doesn’t cover, such as chronic conditions.
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.