How to actually choose an IPMI policy in 2026 — the 7 questions that matter

Most IPMI advice on the internet is written by people who've never run a claim.

I've handled 130+ of them across the major insurers in the last year alone. I look after 250+ clients in the book. And the pattern I see with many new clients at their renewal is depressingly consistent — the policy on the table doesn't fit the life of the person paying for it. Sometimes by a little. Often by £5,000, £10,000, £20,000 a year.

It's almost never the insurer's fault. It's almost always the questions that didn't get asked at the start.

These are the 7 I'd run through before signing any IPMI policy in 2026. Whether you're going direct, or through a broker. Whether you're buying for the first time, or sitting on a renewal letter you don't trust.

One thing first. The order matters as much as the questions. Get the order wrong and you optimise for the wrong thing — usually price, before you've worked out whether the cover even fits.

1. What's your area of cover — really?

This is the first question because it's the biggest single driver of premium, and the one most often answered on autopilot.

Most insurers offer three tiers — Europe, Worldwide excluding USA, Worldwide including USA. The price gaps are not small. Adding the US to a worldwide plan for a family of four often doubles the premium. Removing it almost always cuts the premium materially.

So the question isn't "which area gives me the most freedom." It's — where do you actually receive treatment? Where do you live? Where do you have a second home? Where might you go for elective treatment if your home country doesn't have the specialist you'd want?

Most families don't need US cover. The buyer who genuinely needs it is the one with a US property they spend serious time in, or the family split across the Atlantic. If neither applies, US cover is the most expensive thing you'll ever pay for and never use.

Real example. Last year a family came to me about cover for two parents - both in their seventies, relocating to the UK to be near family. They'd been quoted £132,000 a year. The most comprehensive plan on the market. Worldwide including US. Every benefit at maximum.

I asked the geography question.

The parents weren't going to the US. Ever. They weren't going to be travelling much at all. The treatment, if it ever happened, would happen in London. Or possibly back home.

Same insurer. Different plan. Worldwide excluding USA, sensible benefit levels for the actual life being insured. £65,000 a year for both.

The plan they'd been quoted wasn't bad. It was wrong. Different thing.

Get this question honest and the rest of the framework starts working in your favour.

2. Which underwriting basis are you on — Moratorium, FMU, or CPME?

This one matters because once it's set, it doesn't change.

Three options most insurers use:

Moratorium. The insurer doesn't ask about your medical history at the start. Anything you had treatment for, advice on, or symptoms of in the previous 2 years is excluded and stays excluded until you've gone two full years symptom-free, treatment-free, advice-free. Then it can come back into cover. Fast to apply for. Slower at claim, because every claim becomes a "did this exist before" investigation. Saying so, it’s still the most chosen option due to the fact that some previous conditions may become eligible again.

FMU — Full Medical Underwriting. You complete a detailed medical questionnaire upfront. The insurer reviews it and tells you exactly what's excluded, in writing. Slower to apply. Cleaner at claim time. You know what's covered before you need it, not when. The downside is that some conditions may reoccur and if you have an exclusion in place, this might be a painful error that you have made when taking the policy out.

CPME — Continued Personal Medical Exclusions. Used when you're transferring between IPMI insurers and want to carry over the underwriting position you already have, instead of starting from scratch.

The trap isn't the underwriting itself. It's choosing one because the application was easier, without understanding what it commits you to. A Moratorium client with a complicated history can spend years discovering at claim time that conditions they thought were covered, aren't. Yet.

In my view, FMU is the right answer for most clients with any meaningful medical history. The application takes longer. It's worth every minute of it. Because the answer you get back is in writing.

And once you're underwritten on a basis with an insurer, you don't move between bases on that policy. Switching insurer may trigger additional underwriting. So the time to get this right is at the start - not at year three when you've already developed the condition you didn't disclose.

3. What's your annual limit and does it actually matter?

The annual limit is what insurers love to put on the front page of the brochure.

£1m. £2m. Unlimited.

Almost no client ever hits it. In 130+ claims I've handled in 2025 across all the major insurers, exactly zero have hit £1m in a single year.

Real numbers from cases I see. A knee replacement, start to finish, sits around £20,000. Heart stents come in around £30,000. A full course of cancer treatment - surgery, chemotherapy, radiotherapy, the lot - runs £120,000 to £150,000 depending on the protocol and the country. Even the worst-case combination - both knees, heart stents, and a full cancer course in one calendar year – you are still well under any major insurer's annual cap.

So when an insurer waves an "unlimited" or "increased to £2 million" headline at you, the right question isn't "is it enough." It's - what did you give up to put that headline on the brochure?

Often the answer is sub-limits. The smaller caps inside the policy that actually decide what gets paid.

The headline number is marketing. The sub-limits are the cover. Don't confuse the two.

4. What are the sub-limits hidden inside the headline?

This is where most policies actually get won or lost.

The annual limit is one number. Inside the policy wording there are dozens of smaller ones - the limits the insurer doesn't put in the marketing. The ones that decide what you can actually claim when something happens.

The sub-limits worth checking on every IPMI policy:

• Mental health treatment — many policies have caps

• Outpatient consultations and tests — some plans cap outpatient at £5k or £15k, which sounds generous until you're three months into investigating something

• Oncology drugs — some policies cover surgery and radiotherapy in full but cap the drug element at a level that wouldn't fund a single cycle of newer immunotherapy

• Hospital accommodation — daily caps on private room costs that look fine until you're admitted to a London hospital where the actual room rate is double the cap

• Evacuation and repatriation — flat caps that don't reflect the real cost of an air ambulance from a remote location

• Routine maternity — separate cap, often modest, often misunderstood

• Dental and optical — small annual allowances that vary wildly between products

True story. A client of mine, a couple of years back. Polite woman. Didn't want to make a fuss about anything. We were on a renewal call. She mentioned, almost in passing, that she'd had a £4,800 outpatient bill the previous year. She'd paid it herself. I asked her why.

"Oh, I can’t be asked to do these little claims and I didn't want to bother you to help me with them."

It was covered. Comfortably inside the sub-limit she didn't know existed. £4,800 she could have got back. Money she'd quietly written off. Read the IPID. Read the policy wording. If you can't get a clear answer in plain English from the broker or the insurer, that itself is a signal.

5. Where does the insurer have a direct-settlement network - and is it where you actually live?

This is the question almost no client asks until the first big claim. By then it's late.

Quick clarification, because this gets confused all the time. IPMI is not UK private medical insurance. UK PMI has hospital tiers tied to your home address. Bupa, AXA, Vitality and others all do this. International cover doesn't work that way. Most IPMI insurers have a direct-settlement network, which is a list of hospitals and clinics around the world they have direct billing agreements with. If your treating facility is on that list, the insurer settles directly with the hospital. You don't see the bill. If it isn't, most likely they will ask you to pay first and claim back. For a £200 consultation, that's annoying. For a £40,000 inpatient stay, it's a cash-flow problem most families haven't planned for.

So the question isn't "is this insurer good." It's where do they have direct-settlement coverage in the country I actually live in, and in the country I'd most likely go to for serious treatment?

Live in central London? Every major IPMI insurer has solid coverage. Live in Lisbon, Limassol, Dubai, or São Paulo - the answer might be different. Worth asking this question. Most credible insurers will share their published facility list or your broker can pull it for you.

Check it before you sign. Not after.

6. If you're switching insurer — what's been declared, and what carries over?

This question only fires if you're moving from one IPMI insurer to another. Most clients who switch don't understand the mechanics. And most of the trouble at the first claim with a new insurer comes from this one paragraph.

Switching IPMI doesn't reset your underwriting clock from scratch. The new insurer accepts continuation cover from the old policy. Existing exclusions on your old policy carry over to the new one by default (although they can sometimes be reviewed and lifted if the underlying condition is old enough (typically 5+ years symptom-free, treatment-free, advice-free, with a fresh declaration to support it)).

The real trap is the switch declaration. Every transfer form has a small set of medical questions. They look brief. They are not. A "yes" on any of them - anything from a recent investigation to a flagged symptom - triggers either a fresh exclusion on the new policy or a loading on the premium. A "no" that turns out to be wrong becomes a non-disclosure issue that can cost you a major claim three years later, when the insurer cross-references your referral letters against what was disclosed at switch.

The honest answer to "what's been declared" is sometimes "I'm not sure." If that's the case, get hold of your GP records and your existing IPMI medical history before signing anything. The insurer will check at claim time, not at switch. The time to find any discrepancy is now.

One more thing. If a broker is selling you a switch on a discount alone - first-year price drop, "introductory rate," 25% off - be careful. Those discounts evaporate. The trajectory resets. The new insurer is buying your business at a loss in year one because they expect to recover in years two and three.

That's a tactic. Not a saving. And it's not the conversation about whether switching is right for you - it's a conversation about whose commission cheque is bigger.

7. Who actually runs the claim with you when it goes wrong?

Last question. The one most clients don't think about until it's too late.

October a year and a half ago. Saturday evening. I was at home with my family. Phone rings. A client. His mother had been at the hospital that morning. She'd just been told she had cancer that needed treatment urgently. Not next month, this week, and the consultant had recommended a specialist clinic in Germany. She wasn't on a UK NHS pathway. She was on the family's IPMI. The client had no idea what to do next.

I did. That's the point.

The 96 hours that followed were, in summary - a 40-minute call with the insurer's overseas claims team to set up the pathway, a few days of chasing the consultant for a written referral letter (the insurer needed the wording in a specific format, the consultant initially sent the wrong version, we went back twice), several rounds of pre-authorisation paperwork covering each phase of treatment, direct settlement set up with the German hospital before the family flew, and a logistics conversation about transport, accommodation for the family member travelling with her, and what would and wouldn't be claimable.

The client didn't see most of that.

She saw - Mum is being seen on Wednesday in Germany, the hospital won't ask us for money, here's the booking confirmation, here's who to call if anything changes. The treatment started on time.

That's the part of the broker job that doesn't appear on the invoice.

Now - if you bought your IPMI directly from the insurer with no broker, you're not without options at claim time. Most insurers will let you assign a broker to your existing policy after the fact, without switching insurer. That's the gateway. Not free ad-hoc claims help. A broker who works for nothing isn't a broker, it's a favour, and favours don't scale to the moment you actually need them.

The honest question - when something serious happens, who's making the calls, who's chasing the paperwork, who's negotiating with the claims team when there's a dispute? If the answer is "I will" and you've never done this before, that's the gap to think about now. Not at the moment your hand is shaking and you're trying to read a denial letter.

Want a second pair of eyes on your specific situation? Current policy, family setup, where you live, what you're actually worried about. That's what an introductory call is for. No fee. No obligation. No pitch dressed up as advice.

Arrange a consultation here or message me directly on WhatsApp on 02045772274.

Kirill Alba is the Director of Albatross Healthcare Ltd, an FCA-authorised IPMI brokerage based in the UK (FCA No. 1024739). This article is for information only and is not personal advice. Policy terms vary by insurer.