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Understanding Outpatient Limits on Private Health Insurance

Introduction

At WeCovr, we understand that navigating the world of private health insurance can be a daunting task. With so many options and variations in coverage, it's crucial to have a clear understanding of the different aspects of your policy. One area that often raises questions is outpatient limits, and in this comprehensive guide, we aim to demystify this aspect of private medical insurance.
As an independent insurance broking firm, our goal is to empower you with the knowledge and insights necessary to make informed decisions about your healthcare coverage. We believe that an educated consumer is better equipped to choose the policy that best suits their needs and budget.

What are Outpatient Limits?

Outpatient limits refer to the maximum amount your private health insurance policy will cover for outpatient treatments, consultations, tests, and scans within a given policy year. Once you reach this limit, your insurance provider will no longer cover any additional outpatient costs until the next policy year begins.
Insurers offer outpatient limits as an option to help reduce your premiums. However, you can also opt for unlimited outpatient coverage if your budget allows for it and you anticipate higher outpatient treatment needs.

Why Are Outpatient Limits Important?

Outpatient limits play a crucial role in determining the overall cost and coverage of your private health insurance policy. By understanding these limits, you can better assess your potential out-of-pocket expenses and make an informed decision about the level of coverage that aligns with your healthcare needs and financial circumstances.
Outpatient treatments can include a wide range of services, such as:
  • Consultations with specialists or consultants
  • Diagnostic tests (e.g., blood tests, X-rays, MRI scans)
  • Minor surgical procedures
  • Physiotherapy sessions
  • Complementary therapies (e.g., osteopathy, chiropractic care)
Without adequate outpatient coverage, you may find yourself facing significant out-of-pocket costs for these essential services, potentially hindering your ability to access timely and affordable healthcare.

How Outpatient Limits are Structured

Most private health insurance providers structure outpatient limits using a monetary value, such as £500, £1,000, or £1,500 per policy year. However, some insurers may set limits based on the number of consultations or treatments allowed within a specific period.
It's important to note that outpatient limits can vary significantly between different insurance providers and policy types. Some policies may offer comprehensive outpatient coverage with higher or unlimited limits, while others may have more restrictive limits to keep premiums lower.

Outpatient Coverage Across Major Health Insurers

To give you a better understanding of how outpatient limits work in practice, let's explore the outpatient coverage offered by some of the major private health insurance providers in the UK.

AXA Health

AXA Health Insurance is one of the largest health insurance providers in the UK. Their standard policy does not include outpatient cover as a default, but you can add it as an optional extra. AXA's outpatient cover includes:
  • Unlimited specialist fees for consultations
  • Unlimited diagnostic tests
  • Unlimited outpatient medical treatment
Please note that physiotherapy is not included in AXA's outpatient cover. If you require physiotherapy, you'll need to add their "Therapies Cover" as an additional option.

Aviva

Aviva's "Healthier Solutions" policy is a comprehensive plan that includes inpatient treatment, cancer care, and outpatient cover as standard. Their outpatient cover includes:
  • Tests
  • Scans
  • X-rays
If you've had specialist treatment from a consultant who then refers you for physiotherapy, it's included in the core coverage. However, if you require physiotherapy without a specialist referral, you'll need to add their "Therapies Cover" option.

Bupa

Bupa offers two policies with different approaches to outpatient cover:
  1. Treatment and Care policy: This lower-cost option includes outpatient therapies, such as physiotherapy, as standard. However, it does not cover specialist consultations, tests, or scans. This policy primarily covers private inpatient treatment if you need to stay in a hospital bed overnight or have major surgery.
  2. Comprehensive policy: Bupa's comprehensive policy includes outpatient cover for specialist appointments, tests, treatments, mental health support, and therapies. You can choose annual coverage limits of £500, £1,000, or unlimited to cover all your outpatient treatment. However, please note that the unlimited coverage option only applies if you receive treatment at a Bupa-approved hospital or treatment center.

Freedom Health Insurance

Freedom Health Insurance offers flexible private medical insurance with comprehensive inpatient care coverage. Their core policy pays for MRI, CT, and PET scans following a specialist referral, but not if your GP requests them. Specialist consultations and other tests, such as blood tests, are only available with Freedom's optional outpatient cover.
If you invest in their enhanced outpatient cover, you can access physiotherapy subject to overall policy limits. Freedom also offers cashback for treatments, including outpatient procedures, minor surgeries, and routine dental and optical care.

National Friendly

National Friendly offers four levels of coverage with increasing limits on inpatient care and outpatient treatments. It's essential to choose your policy carefully if mental health coverage is important to you, as not all policy levels include it.
National Friendly's outpatient cover includes MRI, CT, and PET scans, but these come out of your overall outpatient cover limits rather than being part of a separate diagnostic category. While some providers offer unlimited outpatient cover, National Friendly's maximum is £5,000, compared to up to £1 million for inpatient treatment at higher levels.

The Exeter

The Exeter's Health+ policy has comprehensive and guided options that offer flexible private medical insurance cover. Their core coverage includes outpatient surgical procedures, giving you quick access to treatment if you don't need inpatient care. Additionally, you can access CT, MRI, and PET scans, as well as up to three sessions of outpatient physiotherapy after surgery, if required.
The Exeter takes the same approach to optional extras as other insurers, with separate add-ons for outpatient and therapies cover. Their outpatient cover includes unlimited consultant appointments and tests, but you'll need separate therapies cover for physiotherapy, osteopathy, or chiropractic treatment.

Vitality

Vitality's private medical insurance focuses on helping its customers improve their health and well-being. They include outpatient surgical procedures in their core cover and were among the first insurers to do this. However, you'll need to add outpatient cover as an optional extra to access tests, scans, consultant appointments, and physiotherapy. There are two levels of outpatient cover:
  1. Limited: Offers unlimited cover for scans, but everything else is subject to a pre-agreed limit.
  2. Full: Provides unlimited coverage for all outpatient services.

WPA

WPA's Complete Health policy is highly flexible, allowing you to tailor your coverage to your needs. Their core coverage includes:
  • £250 towards outpatient consultations
  • £150 towards outpatient procedures
  • MRI, CT, and PET scans
Their optional extras include three categories of outpatient care:
  1. Consultations: You can skip this cover if the £250 provided by their core coverage will likely be enough for your needs.
  2. Therapy: If you're happy to pay for some physiotherapy, you may not need this cover.
  3. Tests: To ensure fast access to tests, you can choose this option with unlimited coverage.
WPA also offers other outpatient cover options for mental health care and cancer cover.

Choosing the Right Outpatient Cover

With so many variations in outpatient coverage across different insurance providers and policy types, it can be challenging to determine the right level of cover for your needs. At WeCovr, we understand that every individual's healthcare requirements are unique, and we're here to guide you through the process.
When evaluating your outpatient cover options, consider the following factors:
  1. Your anticipated healthcare needs: Reflect on your current and potential future healthcare needs. Do you have any existing conditions that may require frequent outpatient consultations or treatments? Are you prone to injuries or illnesses that could benefit from physiotherapy or complementary therapies?
  2. Your budget: Outpatient cover can significantly impact your overall insurance premiums. Determine how much you can comfortably allocate to your healthcare expenses and find a balance between your coverage needs and financial constraints.
  3. Your lifestyle and risk factors: Consider your lifestyle choices, family history, and potential risk factors that may influence your healthcare needs. For example, if you engage in high-impact sports or have a family history of certain conditions, you may benefit from higher outpatient limits.
  4. Your access to NHS services: While the National Health Service (NHS) provides excellent care, there may be instances where you require faster access to diagnostic tests or treatments. Adequate outpatient coverage can help expedite your healthcare journey.
  5. Your preferred healthcare providers: Some insurance providers may have preferred healthcare networks or approved facilities. If you have a preference for specific hospitals, clinics, or healthcare professionals, ensure that your chosen outpatient cover aligns with your preferences.
At WeCovr, our experienced team of insurance brokers is dedicated to understanding your unique circumstances and guiding you toward the most suitable outpatient cover options. We take the time to listen to your needs, concerns, and preferences, and we leverage our extensive knowledge of the insurance market to provide tailored recommendations.

Working with WeCovr: Your Partner in Healthcare Coverage

At WeCovr, we pride ourselves on being more than just an insurance broking firm. We strive to be your trusted partner in navigating the complexities of private health insurance, ensuring that you make informed decisions that align with your personal and financial objectives.
When you work with us, you can expect:
  1. Personalised Advice: Our brokers take a consultative approach, thoroughly assessing your specific requirements and providing tailored recommendations for outpatient cover and overall healthcare coverage.
  2. Comprehensive Market Analysis: We have in-depth knowledge of the insurance market and continuously evaluate the offerings from various providers. This allows us to present you with the most competitive and suitable options for your needs.
  3. Ongoing Support: Our commitment to you doesn't end with the initial policy purchase. We remain available to answer your questions, address any concerns, and assist you throughout the lifetime of your policy.
  4. Unbiased Guidance: As an independent broking firm, we have no affiliations with any particular insurance provider. Our sole focus is on finding the best solutions that meet your unique requirements, without any conflicts of interest.
  5. Transparent Communication: We believe in fostering a transparent and open dialogue with our clients. We strive to ensure that you fully understand the details of your outpatient cover, policy terms, and any potential limitations or exclusions.
At WeCovr, we understand that navigating the world of private health insurance can be daunting, but you don't have to go through it alone. Our team is here to be your trusted advisor, guiding you every step of the way and ensuring that you have the peace of mind that comes with comprehensive healthcare coverage.

Conclusion

Outpatient limits are an essential aspect of private health insurance that can significantly impact your access to essential healthcare services and your overall out-of-pocket expenses. By understanding how these limits work and the variations across different insurance providers, you can make an informed decision about the level of outpatient cover that best suits your needs and budget.
At WeCovr, we are committed to empowering you with the knowledge and support you need to navigate the complexities of private health insurance. Our team of experienced brokers is dedicated to providing personalised advice, comprehensive market analysis, and ongoing support to ensure that you have the right outpatient cover in place.
Don't hesitate to contact us today to schedule a consultation and take the first step towards securing a private health insurance policy that provides you with the peace of mind and healthcare access you deserve.
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Benefits offered by private health insurance

Private medical health insurance is an insurance policy that covers the costs of private healthcare, from diagnosis to treatment. You just pay an affordable monthly premium that covers all or some of the cost of treatment for acute conditions that develop after your health insurance policy has begun.

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Important Fact!

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👉 We insure our cars, houses, bicycles and even bags! Yet our health is one the most precious things we have.

People buy life, critical illness and private medical health insurance for a variety of reasons – easily one of the most important insurance purchases an individual or family can make in their lifetime. PMI insurance is still seen as a luxury in the UK. Indeed, only around 11% of the population has private medical insurance. However, an increasing number of people are taking out private medical insurance due to a number of reasons:
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Any questions?

Do I need Private Medical Insurance if I have Life Insurance?

Life Insurance and Private Medical Insurance cover you for two different purposes, so you will need to assess your needs but may wish to consider holding the two policies. Private Medical Insurance covers you if you get sick or need treatment and want or need to go privately. Life Insurance covers you in the case of death, giving a payout to family/those left behind.

Are Pre-existing Medical Conditions Covered?

Health insurance covers conditions that develop after your policy starts. Pre-existing conditions are typically not covered, and insurers may exclude related issues. Some policies may cover symptoms of pre-existing conditions under specific circumstances. Always review your policy's exclusions. Coverage for pre-existing medical conditions may be available if you currently hold a medical insurance policy or are transitioning from a company scheme. However, if you have never had medical insurance before or if your policy is not active at the moment, pre-existing conditions will not be covered. This limitation exists because health insurance is primarily intended to protect against unexpected health issues. To simplify, it's akin to getting into a car accident and then trying to obtain insurance coverage afterward to repair the vehicle — insurance companies typically do not cover such claims. Nevertheless, there is an option to gain coverage for pre-existing conditions after a two-year waiting period, subject to specific rules and conditions.

Why Do I Need Private Medical Insurance?

If you prefer to get straight into treatment in the private sector without the long waiting times with the NHS, or you just prefer the private sector anyway, without having to pay it all yourself, then you would need to have Private Medical Insurance to cover it. Sometimes treatments and drugs that are not covered by the NHS can be covered by Private Medical Insurance.

How Much Does It Really Cost?

It's free to use WeCovr to find health insurance - we never charge you for quotes. Health or private medical insurance is an investment that can pay for itself the first time you might need medical treatment.

Isn't NHS Treatment and Coverage Enough?

It depends on your personal choice and preferences. If you are prepared to limit yourself to NHS-covered treatments only and can or want to endure long waiting times to get into treatment, then yes, NHS might work for you. Your cover there is free. If you don't want to be exposed to long waiting times or if your treatment is not covered by the NHS, then you would benefit from Private Medical Insurance.

Why Do I Need to Speak to Someone?

Private Medical Insurance is an important financial product that insurance companies take a lot of care and diligence so speaking to real human beings ensures that they understand your requirements fully so that you can get the right cover.

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All of our partners are carefully vetted and authorised by the FCA, which means they are held to the highest standards that the FCA expects from them and treat all customers fairly!

How Do You Make Money If the Quotes Are Free to Get?

Our insurance partners give us a few pounds when you take out a policy with one of their experts.

How Much Is Private Health Insurance?

The cost of private health insurance depends on several factors, including your age, location, smoking status, and the type of policy you choose. Your health insurance policy is tailored to your needs, and the cost can vary based on the level of cover you require, such as the amount of excess and specific treatment allowances.

How Does Private Health Insurance Work?

Private health insurance covers you for conditions that arise after your policy begins. You pay a monthly fee and can make claims for private healthcare covered by your policy. One of the main benefits of private healthcare is quicker access to treatment compared to the NHS, along with access to new drugs or specialist treatments.

What Does Health Insurance Cover?

Most health insurance covers private hospital stays and may include outpatient treatments like scans, tests, or appointments. Policies vary in coverage, and exclusions often include emergency treatment, maternity care, cosmetic surgery, and ongoing conditions present before the policy started.

Can I Pay Extra to Have a Pre-existing Condition Covered?

Unfortunately, you cannot pay extra to have a pre-existing condition covered as part of your health insurance policy. However, you have access to support from a nurse or digital GP. If you have questions about what is covered under your policy, please contact us for clarification.

When Will My Health Insurance Policy Start?

Your health insurance policy begins once you've selected your policy and set up your payment. After setup, you'll receive your cover documents detailing what is and isn't covered. It's important to review these details carefully as policies differ.

Will I Need an Excess on My Private Health Insurance Policy?

An excess is the amount you contribute towards treatment when you make a claim. Choosing a higher excess can reduce your policy's monthly cost but requires a larger contribution when claiming. WeCovr's experts will offer you flexible excess options depending on your preferences.

How Can I Reduce the Cost of Health Insurance?

To reduce health insurance costs, consider choosing a higher excess, which lowers the monthly premium. However, ensure the plan still meets your needs. Other factors affecting cost include lifestyle choices like smoking and potential savings for couples or family plans.

Is There an Age Limit for Private Medical Insurance?

There is no age limit for taking out health insurance, but age influences the policy's cost. The benefits of health insurance are consistent regardless of age. If you're considering health insurance, you can get a quote from WeCovr's experts regardless of your age.

How Can I Compare Health Insurance Plans?

Let WeCovr's experts do the legwork for you and compare health insurance plans at no cost to you to find the best fit for your needs. Consider individual, couple, or family plans and review coverage details thoroughly before choosing. WeCovr provides transparent information on coverage options for easy comparison.

Can I Add Other People Onto My Health Insurance Policy?

Yes, you can add your partner (if you live at the same address) or dependents to your policy at any time. The cost of couple's or family health insurance depends on factors like location, age, health, and chosen excess. Contact WeCovr or your insurer for assistance in adding someone to your policy.

Can I Use Health Insurance Abroad?

While WeCovr's private health insurance plans are tailored for the UK, we offer global health insurance options for those living or working abroad. For holiday coverage, travel insurance is recommended.

What is Comprehensive Cover?

Comprehensive cover provides extensive benefits, including full outpatient services such as consultations, diagnostic tests, physiotherapy, and mental health therapies. Our team at WeCovr can assist in understanding the various coverage levels available.

Does Health Insurance Cover Dental Treatment?

Private health insurance typically does not cover dental treatment. However, WeCovr's experts can guide you to dental insurance policies offered by our partner insurers. Reach out to us to explore these options.

Does Health Insurance Cover Cancer?

Yes, private health insurance covers cancer treatment from diagnosis through treatment. At WeCovr, we can help you navigate the cancer cover options that suit your needs.

Can I Change My Cover Once I Have Signed Up?

At WeCovr, you have flexibility in adjusting your cover. Speak to our experts within 21 days of receiving your paperwork or at policy renewal to make changes.

How Quickly Can I Get an Appointment with a Private GP?

Accessing a private GP appointment is fast and convenient with WeCovr's services, available through your digital platform provided under your chosen insurance plan.

Can Each Person on My Policy Have Different Options of Cover?

Yes, family members on the same policy can potentially have different levels of cover tailored to their individual needs.

Are There Different Levels of Cover?

WeCovr works with insurers offering a range of cover levels to accommodate different budgets and needs. Our experts can discuss these options with you.

Where Can I Find Out More About Hospitals or Treatment Providers?

Discovering healthcare facilities and specialists is easy with WeCovr's resources. Contact us for personalised assistance by tapping one of the buttons above or below and filling in a few details for personalised assistance.

What Does Fee Assured Mean?

Fee-assured consultants provides transparency and no hidden costs for clients.

Does Health Insurance Cover Mental Health?

WeCovr prioritises mental health support with comprehensive coverage and access to specialist advice and services.

Can I Cover My Children as Well?

Children up to a certain age can be included in your policy, and we offer discounts for family coverage.

Will the Cost Go Up Every Year?

Like most health insurance plans, premiums may increase annually due to factors such as age and medical cost inflation.

How Much Does Health Insurance Cost?

The cost of health insurance varies based on several factors. Connect with our experts by tapping a button below and get your own personalised quote.

What's the Difference Between Health Insurance and NHS?

Private health insurance offers quicker access to consultations, treatments, and personalised care compared to the NHS.

Does Health Insurance Cover Physiotherapy?

Yes, WeCovr's experts can guide you which health insurance plans include coverage for physiotherapy treatments.

Can I Use My Cover Straight Away?

Immediate access to certain services like our digital GP app is available upon enrolment.

How Can I Get a Quote?

You can obtain a range of suitable quotes easily by tapping one of the buttons above or below and filling in a few details for personalised assistance.

What Does Health Insurance Cover and What Can't It Cover?

Health insurance covers new conditions that arise after the policy starts. Pre-existing conditions and certain exclusions may apply.

How Does Health Insurance Work?

WeCovr's experts help you arrange health insurance that simplifies access to private healthcare services, including consultations and treatments.

What is Outpatient Cover?

Outpatient cover includes consultations, physiotherapy, and mental health therapies outside hospital admissions.

Can I Use My Health Insurance Cover Immediately?

Yes, you can use your health insurance cover immediately. You have access to a nurse through your helpline and can consult with a GP using the digital GP app. If you need to make a claim right away, we may require a medical report from your GP. Health insurance is designed to cover new conditions that arise after the policy has started.

Does Health Insurance Cover A&E (Accident and Emergency)?

No, health insurance does not cover A&E (Accident and Emergency) visits. Private hospitals do not typically have the facilities for handling A&E cases. In case of an emergency, please dial 999 or use the NHS emergency services. However, if you require follow-up treatment after an emergency situation, your private medical insurance may be able to assist.

Are There Any Rewards for Being a PMI Plan Holder?

Yes, many insurers offer rewards in leisure, wellbeing, and health. Speak to WeCovr's experts or visit your insurer's website for more details on member rewards.

I'm Leaving My Job and Have Health Insurance with Them, What Do I Do?

You may continue your cover or get another own personal policy. If you continue your cover, existing or ongoing medical conditions might be covered depending on the level of cover you choose. Contact our friendly experts to discuss your options and find the right option for you.

How Do I Get a Quote After I've Left My Job?

You can tap one of the buttons above or below and fill in a quick form to arrange a call with us to discuss your options.

If I Continue My Health Insurance After I've Left My Job, Will My New Cover Be the Same as Before?

Your cover may be similar but not identical. We will help you find the right level of cover that suits your needs, and ongoing medical conditions may be covered. Contact our friendly advisers to explore all available options.

If I Continue My Health Insurance After I Left My Job, Will the Price for My New Cover Be the Same?

No, the price won't be the same as before since employers often contribute to the cost of employee cover. Additionally, different cover levels and medical histories may affect the price. Contact WeCovr's experts for detailed information.

How Long Do I Have After Leaving My Job to Decide to Stay with My Insurer?

You have a few weeks or months from leaving your job to decide to continue with your insurer or change to another one. Your policy may start the day after you left your work policy, and our experts can guide you through other available options.

What Do I Need Before Asking About Continuing My Cover After I've Left My Job?

After leaving your job, contact WeCovr's experts with your leave date to discuss available options.

I've Ongoing Treatment But I'm Leaving My Work Health Insurance Policy, Can I Still Have Treatment?

Yes, ongoing treatment may be covered on your new personal policy, although it could affect the price. Contact our experts for personalised advice on your options.

When And How Do I Pay My Excess?

Details on paying excess fees will be provided when you contact your insurer for treatment authorisation.

Do I Pay an Excess for Using Services Like Digital GP?

No, there is no excess fee for utilising these services.

Can I Change My Excess Partway Through the Year?

Excess adjustments can be made at specific intervals during your policy term.

What is a No Claims Discount?

No claims discounts can impact renewal costs based on claims history.

Can I Pay Extra to Have a Pre-existing Condition Covered?

Pre-existing conditions typically aren't covered but can be discussed with our healthcare specialists.

What is Full Medical Underwriting?

This involves health-related questions before policy enrolment to determine coverage.

What is Moratorium Underwriting?

Moratorium underwriting simplifies enrolment but may require health disclosures during claims.

Will My Claim Take Longer If I Have Moratorium Underwriting?

Claims may require additional information if under moratorium underwriting.

What is a Pre-existing Condition?

Pre-existing conditions refer to medical issues existing before policy inception.

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