How does private health insurance work?

Private health insurance, also referred to as private medical insurance, is an insurance policy which complements the NHS.

Anyone with health insurance can still use all the services offered by the NHS but you will also have access to private healthcare, which can often provide you with quick diagnosis and treatment (depending on your cover).

Private medical 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).

You will usually pay a monthly subscription and you can claim for the costs of private healthcare you receive which is covered by your policy.

Most health insurance plans are designed to cover you for new and unforeseen medical issues and don’t cover treatment for conditions and symptoms you’re already suffering from when you join. These medical conditions are known as pre-existing 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.

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.

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 within this FAQ.

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 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 our Outpatient diagnosis and care option we can source or even book the appointment for you. If you choose an option that covers you for hospital treatment, this will usually be in a private hospital.

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

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.

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.

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.

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

Yes. You can include a partner, dependants, parents, grandparents, or even grandchildren on 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.

See…

• Couples health insurance
• Child health insurance
• Family health insurance

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)

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.

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.