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    Private Medical Insurance — Explained

What is inpatient cover?

Inpatient cover is one of the core components of a private medical insurance (PMI) policy. It funds your treatment when you are admitted to hospital and need to stay overnight — or for several days — to receive care.

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IN PLAIN ENGLISH

Inpatient cover pays for treatment when you are admitted to hospital and stay overnight, or longer. It is the foundation of almost every PMI policy and ensures you can access private facilities and consultants without waiting on NHS lists.

WHAT IS IT?

Inpatient cover at a glance

When a GP or specialist decides that a medical condition requires hospital admission — whether for surgery, investigation, or a course of treatment — inpatient cover steps in. It funds not just the procedure itself, but the full surrounding package: your hospital room and board, nursing care, theatre fees, anaesthetist costs, and any drugs or dressings administered during your stay.

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It is distinct from outpatient cover, which relates to consultations and diagnostics that do not require an overnight stay. Most insurers allow you to build a policy around inpatient-only cover as a lower-cost entry point, with outpatient and other modules added on top.

HOW DOES IT WORK?

The typical journey

  • You see your GP or a specialist and they recommend hospital treatment requiring an overnight admission.

  • You (or your adviser) contacts the insurer to obtain pre-authorisation — most insurers require this before treatment begins.

  • You are admitted to a private hospital or a private ward within an NHS facility.

  • Treatment takes place under the care of a named consultant of your choice.

  • On discharge, the insurer settles costs directly with the hospital, subject to any excess on your policy.

WORTH KNOWING

Most insurers operate a network of approved hospitals and consultants. Choosing a recognised specialist within this network helps avoid unexpected shortfalls. Your adviser can confirm which consultants are covered before you book.

WHAT'S COVERED?

Hospital accommodation and nursing care

  • Surgeon and anaesthetist fees

  • Theatre and recovery room costs

  • Drugs and dressings administered as an inpatient

  • Diagnostic tests ordered as part of the admission

  • Physiotherapy as part of a surgical episode

  • Intensive care or high-dependency unit (HDU/ICU)

  • Same-day (day-case) surgical procedures

  • Parental accommodation for children

  • Cancer treatment (where oncology module included)

Typically included under inpatient cover

USEFUL TO KNOW

Day-case procedures — surgery completed within a single day without overnight stay — are included under inpatient cover on most plans, not outpatient. This is an important distinction when comparing policy levels.

WHAT'S NOT COVERED?

Common exclusions to be aware of

  • Pre-existing conditions (unless the policy is underwritten on a medical history disregarded or switch basis)

  • Chronic, long-term conditions that require ongoing management rather than active treatment

  • Cosmetic or elective procedures with no clinical necessity

  • Accident and emergency treatment — this remains the domain of the NHS

  • Pregnancy and childbirth on standard plans (though complications of pregnancy are typically covered)

WHO IS IT FOR?

Is inpatient-only cover right for you?

An inpatient-only policy is well suited to someone who is happy to use NHS outpatient services for GP referrals and diagnostics, but wants the reassurance of fast-tracked private hospital treatment when surgery or a significant procedure is needed. It is generally the most cost-effective starting point and can always be extended later as circumstances change.

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