What's an outpatient limit with health insurance?
Adding out-patient cover to your health insurance gives you access to diagnostic tests, treatments, and therapies. This guide explains how out-patient cover limits work and how leading insurance providers differ in their coverage.
What is out-patient treatment?
Out-patient treatment typically doesn’t require hospital admission, meaning an out-patient receives treatments and returns home. Out-patient treatment can include minor surgeries, diagnostic tests, consultant appointments or therapies such as physiotherapy.
For example, if you need to stay overnight in a hospital bed to undergo major surgery, your care is classed as inpatient treatment. There is also day patient treatment where you might need to stay in a day patient unit for several hours but return home afterwards. Core health insurance cover typically includes inpatient treatment as standard. However, you’ll often need to pay more for out-patient cover.
How does out-patient cover work?
Health insurance policies include some forms of treatment as standard. You’ll typically get inpatient cover and cancer treatment even with the most basic health insurance policies. Health insurance policies also offer various optional extras so you can choose the cover that meets your needs.
Optional extras usually include out-patient cover, enhanced mental health support and optical and dental cover. However, it’s worth considering what out-patient treatments you’ll likely need when obtaining health insurance quotes. Most policies now include some out-patient services in their core cover but offer others at an additional cost.
Is any out-patient treatment included in core coverage?
The short answer is yes; you’ll find some out-patient cover included in health insurance providers’ core coverage. While standard health insurance policies used only to include inpatient treatment and exclude out-patient treatments, many now include minor diagnostic tests, scans, and even some out-patient surgical procedures.
We recommend adding out-patient cover to your health insurance policy because it can give you faster access to diagnostic tests. However, many policies now offer tests and scans in their core cover.
The out-patient services offered vary between insurers, so you should carefully compare quotes and insurance policy documents before buying.
Coverage limits
When a health insurance policy mentions coverage limits, it refers to the amount your policy will pay out each year. There are different coverage limits for each type of cover. For example, there will likely be a set figure to cover private inpatient care costs and a separate one for out-patient cover. When you’ve hit your annual limit, your insurance won’t cover more private healthcare.
Some private health insurance companies offer different levels of coverage, so you can pick the one that fits your budget.
Major health insurers’ out-patient coverage
To give you an idea of the types of out-patient cover included in each private health insurance plan, we decided to review what each major health insurance provider offers. In our view, the insurance companies below are the nine best health insurance providers in the UK.
While this article focuses on the out-patient cover included in each policy, you must consider what each policy offers in a broader sense before buying. Speaking with a health insurance broker can help you understand what coverage level you’ll likely need and how to get the best coverage for your budget.
AXA Health
AXA Health Insurance is one of the UK’s largest health insurance plan providers. You’ll need to add out-patient cover as it isn’t included in their standard policy. While you’ll need to see an NHS consultant for your initial appointment, AXA Health Insurance includes diagnostic surgery and scans in its core cover, which could help speed things up compared to NHS waiting lists.
AXA’s out-patient cover includes unlimited specialist fees for consultations, diagnostic tests, and out-patient medical treatment. AXA doesn’t include physiotherapy in their out-patient cover, meaning you’ll need to add therapies cover if you want out-patient treatment and physiotherapy.
Aviva
Aviva’s health insurance plan, “Healthier Solutions”, is a comprehensive policy which includes inpatient treatment, cancer care and out-patient cover as standard. Out-patient cover includes tests, scans and X-rays.
If you’ve had specialist treatment from a consultant who then refers you for physiotherapy, it’s included in core coverage. However, you’ll need to add therapies cover to access physiotherapy with a GP referral.
Bupa
Bupa offers two policies with different approaches to out-patient cover. Their lower-cost Treatment and Care policy includes out-patient therapies such as physiotherapy as standard, but not specialist consultations, tests and scans. Beyond that, the policy covers private inpatient treatment if you must stay in a hospital bed overnight or have major surgery.
Bupa’s comprehensive policy includes out-patient cover for specialist appointments, tests, and treatments, including mental health support and therapies. You can choose annual coverage limits of £500, £1000 or unlimited to cover all your out-patient treatment. Unlimited coverage only applies if you receive treatment at a Bupa-approved hospital or treatment centre.
Freedom
Freedom Health Insurance offers its customers flexible private medical insurance with comprehensive inpatient care coverage. Their core policy pays for MRI, CT and PET scans following a specialist referral, although not if your GP requests them. Specialist consultations and other tests, such as blood tests, are only available with Freedom’s optional out-patient cover.
If you invest in enhanced out-patient cover, you can access physiotherapy subject to overall policy limits. Freedom also pays cashback for treatments, including out-patient 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 out-patient treatments. Choose your policy carefully if mental health coverage is important to you, as not all policy levels include it. National Friendly’s out-patient cover includes MRI, CT, and PET scans, but they come out of your overall out-patient cover limits rather than being part of a separate diagnostic category.
While some providers offer unlimited out-patient cover, National Friendly’s maximum is only £5,000 compared to up to £1 million for inpatient treatment at higher levels. Level 1 supports customers who want their healthcare plan to provide a quick diagnosis, so it includes out-patient consultations, tests, and scans. Physiotherapy is typically only available after inpatient treatment, although some minor surgical procedures, such as carpal tunnel release, are covered.
The Exeter
The Exeter’s Health+ policy has comprehensive and guided options that offer flexible private medical insurance cover. Their core coverage is excellent and includes out-patient surgical procedures to give you quick access to treatment if you don’t need inpatient care. You can also access CT, MRI and PET scans and up to three sessions of out-patient physiotherapy after surgery if required.
The Exeter take the same approach to optional extras as other insurers, with separate add-ons for out-patient and therapies cover. Their out-patient 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 out-patient surgical procedures in their core cover and were among the first insurers to do this. You’ll need to add out-patient cover as an optional extra to access tests, scans, consultant appointments and physiotherapy. There are two levels of out-patient cover; limited offers unlimited cover for scans, but everything else is subject to a pre-agreed limit. Full cover is unlimited for all out-patient services.
WPA
WPA’s Complete Health policy is highly flexible, letting you tailor your coverage to your needs. Their core coverage includes £250 towards out-patient consultations and £150 towards out-patient procedures and MRI, CT and PET scans.
Their optional extras include three categories of out-patient care: consultations, therapy and tests. You can skip the consultation cover if the £250 provided by their core coverage will likely be enough for your needs. Equally, if you’re happy to pay for some physiotherapy, you may not need therapy cover. However, to ensure fast access to tests, you can choose the tests option with unlimited coverage. WPA also offer other out-patient cover options for mental health care and cancer cover.
Getting professional advice
MyTribe guides help you learn more about health insurance and understand your options. However, the best way to find the right medical insurance cover for your needs is to speak with a regulated broker. Contact us for a comparison quote, and we’ll put you in touch with a specialist broker for tailored advice.
Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.
