Private Medical Insurance (Part 1) - Understanding General Exclusion Lists

When managing a private medical insurance (PMI) policy for yourself, your family, or your company, understanding what is and isn’t covered is essential. One of the most important aspects to understand is the general exclusion list, which outlines the treatments, conditions, and circumstances that are not covered, regardless of your chosen underwriting terms. Since each insurer has its own general exclusion list, it’s important to understand these details. They help outline the boundaries of your policy and ensure you’re not caught off guard when making a claim or considering a change of provider.

This article is the first in a three-part series designed to help you better understand eligibility when it comes to making claims on private medical insurance. In this part, we’ll focus on general exclusion lists, including some of the common general exclusions you’ll find across the industry, how these lists can vary from one insurer to another, and we’ll also touch on underwriting terms.

By the end of this article, you’ll hopefully have a clearer understanding of general exclusion lists, setting you up perfectly for the next part of the series – “Understanding The Different Types of Underwriting Terms”. Which can be found on our blog page of the website.

Differences Between General Exclusion Lists

It’s worth noting that each insurer typically has its own unique general exclusion list. While there are often similarities between these lists, differences do exist – which means no two insurers are exactly the same. That’s why it’s important to review and understand the specific general exclusions of any provider you're considering. If you're thinking about switching insurers, it's a good idea to compare both your current provider’s list and the new provider’s list to see how they differ. General exclusion lists are usually included in the insurer’s policy wording. If you’re having trouble finding them, you can always get in touch with the insurer directly or speak to a regulated broker for guidance.

Common General Exclusions Across the Industry

While every insurer's list is different, there are some exclusions that are commonly found across the board. These include:

• Chronic conditions, such as asthma or diabetes.

  
  

• Childbirth or Pregnancy.

  
  

• Complementary or ‘alternative’ therapies (although some policies may now offer limited coverage for these).

  
  

• Cosmetic procedures like nose reshaping or facelifts.

  
  

• Emergency care for sudden or unexpected illnesses or injuries. This is usually covered by the NHS, rather than PMI.

  
  

These examples are for illustrative purposes only and should not be relied upon as a substitute for your insurer’s official general exclusion list. For information specific to your policy, please refer to your insurer’s policy wording or contact the insurer directly.

General Exclusions and Underwriting Terms

Getting to grips with your insurer’s general exclusion list is just one part of understanding your private medical insurance. Underwriting terms are just as important when it comes to figuring out what’s actually covered. For a claim to be accepted, it usually needs to tick two boxes: it must meet the eligibility criteria set out in your policy’s underwriting terms and not fall under any general exclusions. That’s why it’s a good idea to get familiar with both.

If you’d like to learn more about underwriting, our article “Understanding the Different Types of Underwriting Terms” takes a closer look at the main types and how they work—you can find it over on our blog.

In Summary

Understanding both the general exclusion list and the underwriting terms of your policy is key to managing your private medical insurance effectively. The exclusion list outlines what isn’t covered, while the underwriting terms explain the conditions under which a claim may be accepted—within the scope of what your insurer covers. Getting to know both can help you avoid any surprises down the line when you need to use your insurance.

If you’re unsure about whether a particular treatment or condition is covered under a private medical insurance policy, a regulated insurance broker can help explain how general exclusions and underwriting terms may apply. It’s always a good idea to check directly with your insurer or seek guidance from a broker if you have questions about what may or may not be included in your policy.

Disclaimers:

Disclaimer 1: The information provided in this article is accurate as of April 13, 2025. However, all details are subject to change in the future based on updates to insurer terms, market conditions, or regulatory changes. For the most up-to-date information, please contact a broker or your insurer directly.

Disclaimer 2: The information provided in this article is intended for educational purposes only and should not be used as specific advice for any individual insurer or policy. For details regarding your specific policy, always refer to your insurer’s policy documents or contact a broker or your insurer directly for personalised assistance.