Workplace private health insurance - stay in or opt out?

MagicMoneyTree81

Can’t decide whether to opt out of workplace private health insurance. Wondering if anyone has any opinion as to its merits, especially based on the following?

It’s Freedom Health Elite FWIW. Includes private GP and round the clock phone consultations.

Underwriting type: Medical history disregarded (great, although the documentation talks about existing conditions not qualifying so it’s confusing)

Wife is on treatment for perimenopause and is frustrated with NHS, wants quicker response when a change in prescription is needed etc… Is private insurance likely to help much with this kind of thing?

She also has (possible) undiagnosed ADHD and would like to get diagnosed. I’m pretty sure the health insurance wouldn’t touch this due to being chronic not acute. Am I right?

Although I know it’s much cheaper than doing it outside of the work context, I’m not sure I can afford the premium plus benefit-in-kind tax at 40% rate (being a higher rate taxpayer in the UK in 2024 does not necessarily feel like affluence if you are main income earner with kids, but that is another story).

Thanks in advance!

Veteransaver

Depends how healthy you are! The BIk is quite a lot now so you do get taxed on it. Many have an excess (usually £100+).
But it does usually cover pre-existing so you may be able get your wife treated on it for something's at least
It often doesn't cover chronic or regular conditions, Eg if you need an annual checkup for something I've found annoyingly they don't cover you.
The trouble with private health care really is that they cherry pick what they will cover.
It's useful if you need a backop, knee op, hip op , hernia etc. As well as investigation scans etc.

Brie

I had a workplace scheme that meant after faffing about with the NHS for a year doe to a bad knee I was able to see a consultant within a week, knee scanned a day or 2 later, surgery booked for 2 months later.  I was already recovering from the surgery before I got the first offer of an initial appt on the NHS which was 6 months later.  Loved that and the fact I only had to pay tax on the benefit not the actual premium.

Downside is that if you get a prescription it will be private so you have to pay full price (not the £9+) unless you get your NHS doc to play along somehow. There's also an amount to pay each year which I only had to pay in full the year my knee was done .  £300 for treatment that was billed at £15k.

Mark_d

Do you need to buy the private medical insurance (eg. through a flexible benefit scheme) or is it simply part of your remuneration package?  Is your wife automatically included or would you need to pay for her?

Private medical insurance had been great for me.  It has been easy to arrange video consultation with private GP, so that I could be referred to a specialist.  You never when where you might start to suffer for certain medical episodes, so PMI is something I don't regret having.

My partner is independently cover under a separate PMI policy.  The private consultants were able to diagnose and treat a condition that the NHS consultants were unable to diagnose.  Private prescriptions can be useful in emergencies but do you have to pay the price of the medicine rather than the regular NHS prescription charge.  Some tablets my partner needed were shockingly expensive

DullGreyGuy

MagicMoneyTree81 said:

Can’t decide whether to opt out of workplace private health insurance. Wondering if anyone has any opinion as to its merits, especially based on the following?

It’s Freedom Health Elite FWIW. Includes private GP and round the clock phone consultations.

Underwriting type: Medical history disregarded (great, although the documentation talks about existing conditions not qualifying so it’s confusing)

Wife is on treatment for perimenopause and is frustrated with NHS, wants quicker response when a change in prescription is needed etc… Is private insurance likely to help much with this kind of thing?

She also has (possible) undiagnosed ADHD and would like to get diagnosed. I’m pretty sure the health insurance wouldn’t touch this due to being chronic not acute. Am I right?

Although I know it’s much cheaper than doing it outside of the work context, I’m not sure I can afford the premium plus benefit-in-kind tax at 40% rate (being a higher rate taxpayer in the UK in 2024 does not necessarily feel like affluence if you are main income earner with kids, but that is another story).

Thanks in advance!

Are you paying the premium and the BIK?  In most places I've worked you didnt pay the premium so it was only the BIK consideration, if you opted out you didnt get a pay rise you just saved the tax. One place with flexible benefits did take the premium. 

PMI generally covers the diagnosis and initial treatment of a chronic condition and may treat flareups but dont cover the day to day maintenance once you are on a steady path. You need to clarify the pre-existing aspect of your cover to determine if a claim is possible. 

When you dont pay the premiums then it's a bit of a no brainer unless you are really struggling, our last employers one cost £999 a year so £450 BIK. No longer being an employee our PMI now costs £3,600 a year with a higher excess. 

dunstonh

Can’t decide whether to opt out of workplace private health insurance. Wondering if anyone has any opinion as to its merits, especially based on the following?

In my 20s and 30s I probably wouldn't have cared too much.  In my 50s, I would jump at it if I had a chance.  Especially a group scheme that automatically covers existing conditions.

On-the-coast

I’m frugal in most respects, but quite happy to pay £1000 tax per year on company provided PMI - the BIK is approx £2500 for self & spouse. 

I’d recommend you phone them & clarify exactly what’s meant about pre-existing conditions.   Sometimes that applies when you don’t take up the offer from your employers when it’s first made, but subsequently try & join. 

MagicMoneyTree81

Thanks for your help everyone. Very useful. 

The company pays the premium for myself but not for the rest of my family. It's pretty damn cheap all things considered, but need to save every penny I can in the short term. Fortunately I discovered there is another enrollment window in July so I will opt out for now and reconsider in three months.

TELLIT01

I had private health cover through my employer and required knee surgery, followed by a lot of physio.  The wait for treatment on the NHS was 'unknown' according to my GP so it was done privately.  I couldn't have afforded to pay for it myself.  I was only in my 40's so not exactly a decrepit old git.