What Conditions or Treatments Does Private Health Insurance Not Cover?

This will vary from provider but as a general guide most private health insurance policies do not include certain conditions such as:

Non-emergency treatment outside the UK

Often if you are travelling abroad for a medical procedure it is a cosmetic one anyway, but it may be that you are travelling abroad for a new procedure not yet clinically trialled in the UK. Most insurers will not cover this as they are unable to approve the procedure and it may cost a vast amount of money.

Drug abuse

The NHS works with local councils to offer a wide range of support for drug users to try and fight their addiction. Because this condition is usually self-inflicted though a private insurer will not cover you against it (which is not to say that there are not plenty of private clinics you can attend).

Alcohol abuse

As Above.

Self inflicted injuries

Again the intention of the victim to cause harm to themselves is what prevents insurers from covering the cost, but the NHS can provide both physical and psychological care and there are many privately working psychiatric professionals if you wish to avoid the NHS.

HIV/AIDS

This is sometimes covered by insurers but if you are HIV positive you will need to give a full history of the details of your condition and you may face a much higher premium.

Cosmetic surgery

Since this is not to correct a medical condition in the majority of cases an insurer will not cover it. This is treatment which is also difficult to get covered on the NHS since it is not seen as necessary for your health but if you have a medical need for it (or a psychological need for it ) for example a breast reduction to correct back pain the NHS may pay.

Cosmetic dentistry

Again this is cosmetic and not medical but you may be able to receive this on the NHS if your cosmetic dental procedure also fills a medical need, such as correcting an exposed nerve with a dental veneer.

Fertility/infertility

Most insurers will not cover the cost of fertility treatments because while the inability to have children when you want them can be extremely difficult psychologically it does not pose a threat to your health or medical wellbeing.

Sex changes

Again this is something which the NHS could help with, and with which you could receive private treatment, but an insurer will not cover you for sex change surgery. Often this is one of the medical procedures people choose to have abroad as the waiting time on the NHS can be long and the cost of the procedure privately very high in the UK.

Organ transplant

Although this is an unpredictable operation and failure to get an organ transplant can result in death many insurers will not cover you. The NHS has access to far more organs and it is likely you will receive treatment much more quickly if you go through them.

Kidney dialysis

People with kidney failure are not usually covered by insurance. If you develop kidney failure during the time your policy is running you may not be covered either, so read your policy carefully especially if there is a family history of kidney failure.

Outpatient drugs and dressings

Chances are, if you need drugs and dressings as an outpatient the procedure is not one which you would think to claim for on your insurance, or it is a trip to the A&E. The cost of prescriptions is fixed by the NHS so that it is unlikely the cost of drugs and dressings will cost more than the amount your insurance would increase by making a claim anyway.

Mobility aids

These are not medical procedures but instruments to make life easier for people with poor mobility, such as mobility scooters or wheelchairs. These can be bought privately but you will need to pay for them yourself.

Experimental treatment and drugs

Although you are more likely to be able to get experimental treatment and drugs privately (because private clinics do not need to wait for full clinical trialling to be complete) you may need to pay for these yourself. This is not always the case, and some insurers may cover the latest treatments for some conditions.

War risks

If you are injured in an act of war your recovery and treatment may not be covered by your health insurer.


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