Guided Care in Private Health Insurance: How It Works

“Guided care” is a product option that can narrow how you access consultants and hospitals. The name and rules are insurer-specific, so do not assume every policy with this kind of option works the same way.

Bupa’s Guided Care example

Bupa’s Guided Care information describes using its Open Referral Network. After an eligible referral, Bupa offers a choice of consultants from that network, subject to the policy’s hospital network and authorisation requirements. The leaflet says the insurer may ask for an open referral, where the GP names the specialty rather than a particular consultant.

The Bupa leaflet also says consultant fees are covered under the option, but policy excesses and outpatient benefit allowances still apply. Therefore, “no consultant fee shortfall” does not necessarily mean every part of a claim is free of charge.

Questions to ask before choosing

• Which hospitals and consultants are available where you live?
• Do you need an open referral, and for which symptoms?
• Does the option change your choice of hospital or specialist?
• What excess, outpatient limit or other contribution still applies?
• Must the insurer approve each consultation, test and treatment?

Guided care may make the route clearer and help manage costs, but it can be less flexible than choosing a provider outside a defined network. Compare it with the policy’s standard referral route and read the policy guide and membership certificate together.

For the wider process, read our guides to private health insurance referrals and hospital lists.

Compare policy features before choosing: compare UK health insurance.

Sources checked 4 November 2026

• Bupa: Guided Care customer leaflet
• Bupa: How private health insurance works