International health insurance in the UK

The UK has the NHS, free at the point of use for residents, so international health insurance is bought for a different reason: private access, choice of hospital and cover beyond the UK. IPMIEMEA explains who buys it, what it changes and how to compare.

How healthcare works for expats in the UK

The National Health Service provides care to residents of the UK, free at the point of use for most services. You register with a GP practice, which is the gateway to specialist referral and hospital treatment. Emergency care is available to everyone. The NHS is comprehensive, but demand is high, and waiting times for non-urgent specialist appointments and elective surgery are the usual reason people look at private options.

The private sector in the UK is well developed and sits alongside the NHS rather than replacing it. People reach it in one of three ways: a domestic private medical insurance policy, often provided by an employer; paying for treatment directly; or international private medical insurance (IPMI). Domestic policies cover treatment in the UK only and are typically built around inpatient and day-patient care, with outpatient and other benefits as options. International plans cover you across an area that can be Europe, worldwide excluding the USA or worldwide.

For a resident who will never leave, a domestic policy is the natural fit. This page is for the people in between: expats arriving in the UK, people leaving it, and international families who want one plan wherever they are.

Visas, the health surcharge and the NHS, in general terms

There is no general requirement to hold private health insurance in the UK. For people coming from abroad on most longer visas, the application generally includes an immigration health surcharge, paid up front, which gives access to the NHS on broadly the same basis as a resident for the duration of the visa. Some short-term visitors and some visa categories are instead charged for NHS treatment. Confirm the current rule for your visa with the official guidance or your immigration adviser; the categories and the surcharge have changed over time.

Two points follow for anyone comparing plans:

• International cover does not replace the surcharge. Holding a private plan does not normally exempt you from paying it, and the plan is not accepted in place of it.
• The NHS is your baseline. Once you have NHS access, international cover is a choice about speed, choice and travel, not a necessity for care.

If you are leaving the UK, the position reverses: your NHS entitlement generally depends on being ordinarily resident, and it may lapse when you move abroad. That is one of the main reasons people leaving the UK take international cover before they go.

Who buys international cover in the UK, and why

• Expats arriving in the UK. People who already hold an international plan from a previous posting keep it, because it covers private treatment in the UK, cover when they travel, and continuity of underwriting.
• People leaving the UK. Those moving to the Gulf, to Spain or Portugal, or further afield take a plan before they leave, often with a worldwide excluding USA area, so that they are covered from the day they arrive.
• International families. Households split between the UK and another country want one plan, one set of terms and one claims team.
• Frequent travellers. People who spend a large part of the year outside the UK find that domestic policies and travel insurance leave gaps that an international plan closes.
• People who want private access in the UK. For some, an international plan with a European area is simply the way they buy private treatment in the UK, with the travel cover as a bonus.

Our guide to international health insurance in EMEA compares international, local and travel cover in more detail, and our Europe-only versus worldwide guide covers the area decision.

The decisions that change your cover

These are the choices that move the price and decide whether the plan suits you. Make them first.

Our guide to inpatient versus outpatient cover explains what each part adds and costs.

Pre-existing conditions and underwriting

The NHS does not underwrite. Private insurance, domestic or international, does. Domestic UK policies commonly exclude pre-existing conditions and may exclude chronic conditions altogether. International plans vary more: some cover chronic conditions that arise after the start date, and all of them look at your history before they accept you.

The routes are full medical underwriting, where you declare your history and get a written decision, and a moratorium, where recent conditions are excluded automatically for a period and may return to cover if they stay quiet. If you are moving from a domestic policy or another international plan, ask whether the new insurer will continue your existing terms. Some will consider it.

Our guide to pre-existing conditions explains each route and the terms you will see on the form.

Insurers worth reading about first

Nomi quotes the insurers on our insurer pages for UK residents where the insurer offers cover there. Useful first reads:

• Bupa Global publishes its plan limits in pounds sterling, which suits UK readers directly. Its area options include worldwide and worldwide excluding the USA; the option that excludes Europe and the UK is for people living elsewhere.
• AXA Global Healthcare offers five cover levels, the choice to include or exclude the USA and a per-person excess.
• Cigna Global and Allianz Care are modular plans often chosen by people leaving the UK for the Gulf. Our Cigna versus Allianz page sets them side by side.

If you are leaving the UK, tell each insurer your destination. The premium and the available options are set by your country of residence, not by where you buy.

How to prepare a comparison

1. Whether you are arriving, staying or leaving, and when.
2. Who is to be covered, with dates of birth and nationalities.
3. Where you will live and where you will travel in the next year.
4. Your medical history.
5. Whether you want full outpatient cover, limited cover or none, and what excess suits you.

Our cost guide explains what drives the premium, and the HealthiNomad Premium Index publishes a country table for context.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to a regulated broker.