What core cover usually includes

Most private medical insurance policies are built around one core promise: if you need treatment that requires a hospital bed, the policy pays for it. That's the starting point before any add-on is considered, and it covers two related categories, in-patient treatment and day-patient treatment.

In-patient treatment

In-patient treatment is anything that needs at least one overnight stay in a hospital bed, typically for surgery, a procedure that needs close monitoring afterwards, or a recovery period. A hip replacement or a major operation on an internal organ are common examples. Core cover generally pays the consultant's fees, the cost of the hospital stay, the operating theatre, and any nursing care that goes with it.

Day-patient treatment

Day-patient treatment is admission to a hospital bed or a recovery area for the same kind of procedure, but without an overnight stay. A colonoscopy, many minor surgical procedures, and some chemotherapy sessions are usually dealt with this way. Policies that cover in-patient treatment almost always cover day-patient treatment on the same terms, because the distinction is about the length of the stay rather than the seriousness of the procedure.

Why the bed is the dividing line

The reason insurers group these two together is that both need a hospital bed, even if only for part of a day. Treatment that doesn't need a bed, such as a consultation, a scan or a course of physiotherapy, is usually classed differently and often sits outside core cover unless it's added separately. When you're reading a policy, that's the line to look for: does a treatment need a bed, or not.

Core cover of this kind applies to new conditions that arise after the policy starts. A condition that already existed when you took out the policy is judged differently, and the terms that govern that are worth checking on their own, as set out in our guide to pre-existing conditions.

Before you buy

The add-ons worth checking before you buy

These four extend cover beyond the core in-patient and day-patient treatment most policies start with. Each one changes what gets paid at a different stage of a claim, so it is worth knowing what each actually buys before deciding whether to add it.

  • Out-patient diagnosis

    Covers consultations, scans and tests needed to reach a diagnosis, which matters because core cover often only starts once treatment itself begins.

  • Therapies

    Covers physiotherapy, osteopathy or similar treatment, usually for a set number of sessions tied to a specific condition.

  • Mental health cover

    Covers psychiatric and psychological treatment, which many core policies exclude or cap unless this is added separately.

  • Extended cancer cover

    Covers categories a standard cancer benefit may leave out, such as take-home drugs, proton beam therapy or long-term hormone treatment.

  • How the add-on is priced

    Check whether each one is bundled into the premium, charged on top, or carries its own separate limits and exclusions.

Check against the policy document itself, not just the summary, since one insurer's "out-patient cover" can mean something narrower than another's.

How to read a policy's benefit schedule

The front of a policy tells you what is covered. The benefit schedule tells you how much of it you are actually paying for, and the two numbers are not the same thing. An insurer can list cancer treatment, physiotherapy or psychiatric care as included, and still cap what it pays out for each one within a single table set apart from the rest of the document.

Where the schedule sits

The benefit schedule is rarely on the page that sold you the policy. It usually appears as a separate table within the policy wording or the membership certificate, the document issued once you have bought cover. If you already hold a policy, that certificate is the thing to pull out and read line by line.

Overall limits and sub-limits

Two different kinds of limit sit side by side in most schedules. An overall annual limit caps the total the insurer will pay across every claim you make in a year. A sub-limit sits underneath that, capping one specific benefit on its own, regardless of how much of the overall limit remains unused.

  • A fixed number of physiotherapy or outpatient therapy sessions in a year
  • A separate cap on psychiatric or mental health treatment, often lower than the overall limit
  • A per-condition limit, applied once to a diagnosis
  • A lifetime limit on a specific treatment type, which does not renew at all

A policy that reads as generous at the top of the page can still leave you exposed on one line of the schedule. If you had, for example, a course of physiotherapy for a shoulder injury, the overall annual limit might comfortably cover it while a session-count sub-limit on physiotherapy specifically runs out first.

Reading a row correctly

Each row in the schedule is worth checking against three questions: what period the limit applies to, whether it resets each membership year or applies once per condition, and whether it sits inside the overall limit or is paid in addition to it. The wording that answers these questions is usually in the same document as the pre-existing condition definitions that govern whether a claim is admitted at all, so the two are worth reading together.

Core cover and add-ons: questions answered

Is out-patient treatment included as standard, or do I need to add it?

Out-patient treatment, meaning consultations, scans and tests you have without staying in hospital overnight, is usually sold as an optional add-on. Core cover tends to focus on in-patient and day-patient treatment, the kind that needs a hospital bed or a day case admission. If a referral for a scan or a specialist appointment matters to you, check the benefit schedule for an out-patient limit.

Does private medical insurance cover mental health treatment?

Mental health cover isn't a given on every policy. Some insurers include a level of psychiatric treatment as standard, others only offer it as an add-on, and some leave it out of the main plan altogether. The only way to know is to check the policy wording for a mental health section specifically.

What's the difference between in-patient and day-patient treatment?

In-patient treatment needs an overnight hospital stay. Day-patient treatment covers the same kind of procedure, a minor operation or investigation, done on the same day without an overnight bed. Both are usually part of core cover, but the distinction matters because add-ons such as out-patient diagnosis sit outside both categories and are priced separately.

Will cancer treatment be covered for as long as I need it?

Core cover usually includes cancer treatment, but the length and scope can vary between policies. Some cap certain treatments or limit cover to a set period, while an extended cancer cover add-on removes some of those limits. The detail sits in the benefit schedule under the cancer section, and it's worth reading before assuming unlimited cover is standard.

Where do I find the limits on what a policy actually pays for?

The limits sit in the benefit schedule, a table inside the policy documents that lists each type of treatment alongside what's covered and any cap on it. Some benefits carry a sub-limit, a separate cap within a wider category, such as a cap on physiotherapy sessions within out-patient cover. Reading the schedule line by line is the way to see where a limit applies.

Are therapies like physiotherapy covered automatically?

Therapies such as physiotherapy, osteopathy and acupuncture are usually treated as an add-on, and even where they're included, a cap on the number of sessions is common. They're often listed in their own section of the benefit schedule, separate from out-patient cover.