How Private Medical Insurance Works

Arranging cover starts with understanding your needs, choosing suitable benefits and deciding how your medical history will be assessed. Once WPA accepts your application, your Policy documents explain the cover available and any exclusions.

When you need treatment, contact WPA before making arrangements so it can confirm eligibility and any authorisation requirements. This guide explains the process from your first conversation with Shield through to claims and annual renewal.

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Private Cover That Complements the NHS

Private Medical Insurance is designed to complement the NHS rather than replace it. It may give you another route to eligible consultations, diagnosis and treatment while NHS services remain available for care outside your Policy.

What you can claim for depends on the product, benefits, limits, underwriting and exclusions agreed when the Policy begins. The Benefits of Private Medical Insurance guide explains the main areas of cover.

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From First Conversation to Ongoing Cover

The exact journey depends on your circumstances, but most personal applications follow these stages.

Step 1

Discuss Your Needs

Explain what you want from your cover, who needs protection and the budget you have in mind.

Step 2

Choose Your Benefits

Consider the core cover and any Optional Extras that reflect your priorities, needs and budget.

Step 3

Select Underwriting

Choose how your medical history and any pre-existing conditions will be assessed when applying.

Step 4

Apply to WPA

Review the recommendation, complete the application accurately and wait for WPA's acceptance.

Step 5

Use Your Cover

Contact WPA through the app, My WPA or customer service before arranging eligible treatment.

Step 6

Review at Renewal

Review the renewal terms each year, with Shield available to explain any changes and options.

Four Parts That Shape Your Cover

Core Cover and Optional Extras

Core benefits form the Policy foundation, while Optional Extras extend selected areas to suit your healthcare priorities.

How Underwriting Works

Underwriting determines how your medical history and any pre-existing conditions will be assessed when you apply.

Premiums and Excesses

Your premium reflects factors including age, location, underwriting and selected benefits. An excess may help adjust the cost.

Authorisation and Claims

Most treatment needs WPA's authorisation before it begins. The WPA Health app and My WPA help you manage claims.

Important to Know Before You Apply

Health insurance does not cover every condition or treatment. Pre-existing and chronic conditions, deferment periods, exclusions and benefit limits may affect what is eligible. The exact position depends on the Policy terms and underwriting agreed with WPA.

Do not cancel existing health insurance until you have reviewed the new terms, understood any differences and received confirmation that the replacement cover is in place.

Questions About How PMI Works

Does Private Medical Insurance replace the NHS?

No. Private Medical Insurance is designed to complement the NHS. NHS services remain important for treatment outside the Policy or better provided through public care.