Private health insurance excess explained
An excess is the amount you agree to pay towards a claim before your insurer pays the rest. Choose a higher excess and your premium falls; choose a lower one and you pay less at claim time. The detail that catches people out is how often you pay it — some policies charge the excess once per membership year, others on every separate claim. Here is how a private medical insurance excess works in the UK in 2026, the typical amounts, and how it changes what you actually pay.
The essentials in 30 seconds
- What it is: the excess is the fixed amount you pay towards eligible treatment before your policy starts paying — the private-medical equivalent of a car-insurance excess.
- Higher excess, lower premium: raising your excess reduces your monthly cost, because you carry more of any small claim yourself.
- Per year or per claim: the big variable. Many insurers charge the excess only on your first claim each membership year; others apply it to every separate condition or claim, which can mean paying it more than once in a year.
- Common options: excesses are typically offered from £0 up to around £500, with some insurers going to £1,000–£5,000 for the lowest premiums.
- You usually pay the hospital or insurer, not upfront: the excess is normally settled after treatment, either deducted from what the insurer pays or invoiced to you.
Excess options and the trade-off with your premium
| Excess level | Effect on premium | Who it tends to suit | What to watch |
|---|---|---|---|
| £0 (nil excess) | Highest premium | Those who want nothing to pay at claim time and prefer a predictable monthly cost | You pay more every month whether or not you ever claim |
| £100–£250 | Moderate premium reduction | A common middle ground — a noticeable premium saving for a manageable claim contribution | Check whether it applies once a year or per claim |
| £500 | Larger premium reduction | People comfortable self-funding smaller costs to cut the monthly price | You’d absorb most of a minor claim yourself |
| £1,000–£5,000 | Lowest premiums | Those primarily insuring against major, high-cost treatment | Small claims may cost less than the excess — effectively self-insured for minor issues |
Indicative options for orientation only — not a quote and not a statement of any specific policy. The excess levels offered, the size of the premium saving at each step, and whether the excess is charged per year or per claim all vary by insurer and plan. Always confirm the terms in your policy documents.
How a private health insurance excess actually works
An excess is the slice of an eligible claim you agree to cover yourself. If your policy has a £200 excess and you have treatment that costs £1,200, you pay £200 and your insurer settles the remaining £1,000 — provided the treatment is covered and has been authorised. In return for taking on that first slice, you pay a lower premium than you would on an otherwise identical nil-excess policy. It is the same principle as a motor or home excess: the more of the risk you shoulder, the cheaper the cover.
In practice you rarely hand money over before treatment. The usual flow is that the hospital or consultant invoices your insurer, the insurer applies your excess, and either the insurer bills you for that amount or the hospital collects it directly — so the excess is settled once the claim is processed, not paid upfront at the door. If your policy also carries an outpatient limit or other caps, the excess is separate from those: it is the first-pound contribution, while limits cap the insurer’s side. For the wider picture of what plans do and don’t pay for, see what private health insurance covers, or start at the private health insurance hub.
Per policy year vs per claim — the difference that decides what you pay
This is the part most worth checking before you buy. Insurers apply the excess in one of two ways:
- Once per membership year (“first claim only”): you pay the excess on the first eligible claim of the year and nothing more towards the excess for the rest of that year, however many further claims you make. This is the more common and more predictable approach.
- Per claim or per condition: the excess applies each time you start a new claim or are treated for a separate condition. On this basis a £200 excess could cost you £400 across two unrelated claims in the same year.
There is a further wrinkle to know about: if a course of treatment spans two membership years — for example it starts in March and continues past your renewal date — some policies apply the excess again in the new year, even though it feels like one continuous claim. When you compare policies, treat “how and how often is the excess charged?” as a headline question, not fine print. The way underwriting is set up also shapes your claims experience; the two main approaches are compared in moratorium vs full medical underwriting.
Choosing an excess — and other ways it affects your premium
There is no universally “right” excess — it is a trade-off between a lower monthly cost and how much you are willing to pay if you need treatment. A higher excess makes most sense if you have savings you could comfortably use at claim time and mainly want protection against large, unexpected costs. A lower or nil excess suits people who prefer certainty and want as little as possible to find when they claim. The excess is only one of several levers on price, though: your hospital list, whether you add outpatient cover, any six-week or NHS-wait option, and voluntary co-payments all move the premium too.
If your goal is a lower monthly cost, raising the excess is one of the most effective levers — but it is not the only one. For the full set of options, see how to reduce private health insurance premiums, and for what cover typically costs overall, private health insurance cost UK 2026. If you are still weighing up whether a policy is worthwhile at all, is private health insurance worth it? works through the decision.
Private health insurance excess — FAQs
Information only — not financial or medical advice. This page explains in general terms how a private medical insurance excess typically works; it is not a statement of any specific policy, and the excess levels, premium effect and whether the excess is charged per year or per claim are defined by your insurer’s policy wording. Figures shown are indicative and not quotes. My Insurance Expert is not an FCA-authorised intermediary and does not arrange or sell policies. Last updated: 2026-07-12
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