8th August 2019

Private medical insurance (PMI)…Another expense or a beneficial must-have?

By Jolanta Okereke
Account Handler
Woman in private doctors examination room

You might think Private Medical Insurance (PMI) is an unnecessary expense or even an insurance ploy. After all, we are fortunate to receive medical care, free at the point of use on the NHS. PMI means paying a monthly or annual premium for insurance you hope you may never use. It also doesn’t cover chronic illnesses like diabetes and asthma. If you have a stroke or cancer you will probably get admitted to A&E, and will likely receive priority care. So why exactly should you add another expense to your already expensive life? 

It may come as a surprise that PMI is designed to work alongside NHS care. In fact, the two complement each other. Once you know how it works, you may not simply see it as another expense but more as a missing piece of the puzzle.

Here are some reasons why PMI is worth considering:

Reduce the waiting time

You can use your insurance to reduce the time you spend waiting for NHS treatment if your wait time is more than six weeks. According to current NHS waiting times in England, the maximum waiting time for non-urgent consultant-led treatments is 18 weeks from the day your appointment is booked, or when the hospital or service receives your referral letter1. Imagine the time spent in discomfort because the NHS cannot see you straight away. It can lead to frustrations and has implications for your quality of life while you wait to be treated.

Specialist referrals

Are you tired of your GP prescribing you some medication and sending you on your way? You are entitled to ask your GP for a referral for specialist treatment on the NHS. But, according to the NHS website, whether you'll get the referral depends on what your GP feels is clinically necessary in your case2. With PMI, you can request a referral to see an expert or specialist working privately to get a second opinion or specialist treatment.

Specialist drugs and treatments

Some specialist drugs and treatments aren’t available on the NHS because they’re too expensive or not approved by the National Institute for Health and Clinical Excellence in England and Wales (NICE).  With PMI, you are more likely to obtain a wider scope of drugs and treatment not available on the NHS due to the cost. For example, the breast cancer drug Palbociclib was previously rejected by (NICE) for the use on the NHS due to its substantial price tag, estimated around £140 a pill3. Now imagine if your loved ones could not receive the best treatment available because the drug is deemed too expensive. You would want to try every avenue to make sure your loved one had the best possible chance. Palbociclib is now available via the NHS but there are a range of other drugs which are not available.  

So, here’s a quick summary

PMI can be good value if you need a specialist, want to avoid NHS waiting times or have access to what the NHS deems ‘expensive’ drugs and treatment.

Even if you get PMI, you’ll keep your right to use the NHS. It remains a safety net that may pick up the tab for anything that isn’t covered by your insurance policy.

We can help discuss the right PMI product that suits your individual needs and will be able to tailor an insurance plan to fit your budget and benefit criteria, so you can enjoy the peace of mind PMI cover brings, without the worry about it being an unnecessary expense.


NHS waiting times  

Referrals for specialist care 

Drugs not avaialble on NHS due to price