Health insurance excess explained

A health insurance excess is the amount you pay towards eligible private treatment before your insurer pays the remaining covered costs. A per claim excess applies to each separate claim under the policy’s rules. A per year excess usually applies once per insured person in each policy year.

What a health insurance excess means

You agree your excess when you take out cover or change it under the policy’s terms. It appears in your policy documents. You pay it when you claim for treatment to which it applies.

Your regular payment keeps your insurance running. Your excess is a separate contribution towards a claim. Paying for cover doesn’t mean you’ve paid your excess. You don’t normally pay an excess in a year when you make no claims.

A higher excess usually means lower cover costs and more of the eligible treatment bill for you to pay. A lower excess means a smaller contribution when claiming and higher cover costs.

MoneyHelper explains insurance excesses, including why health insurance rules can differ between policies.

Per claim and per year excesses

Check the excess amount on your quote and when it becomes payable. Policies with the same excess can leave you paying different totals over a year.

Per claim excess

A per claim excess applies to each separate claim as the insurer defines it. If you need treatment for unrelated conditions, that may mean paying another excess.

A claim may include consultations, tests and treatment across several appointments and invoices. Check how the insurer groups related treatment and handles treatment restarting for the same condition.

Some policies refer to an excess per condition. Ask how that differs from a per claim excess on the policy you’re considering. Don’t assume they mean the same thing.

Per year excess

With an annual excess, each insured person usually contributes up to their excess across eligible claims in a policy year. Once you’ve met yours, further eligible claims that year have no further main excess.

Other policy limits still apply, and particular benefits may have separate excess rules. Check whether the year means a policy year, calendar year or another period.

Your excess doesn’t cap everything you pay for treatment.

How you pay the excess when claiming

Contact your insurer before booking private care under your policy. Follow its process to get treatment authorised and confirm which costs it covers, so you know what to pay before bills arrive.

1. The insurer checks whether the proposed care is covered and whether an excess applies.
2. It explains how much excess remains and how payment will work.
3. You pay your share as instructed, and the insurer settles the eligible balance under the policy’s terms.

Depending on the policy, you pay the hospital or consultant directly, or have the excess deducted from the insurer’s repayment of bills you’ve paid. Follow the insurer’s payment instructions for your particular claim.

If an eligible bill is smaller than your remaining excess, you usually pay it yourself. You don’t pay more than the bill just to use up the excess.

With an annual excess, later eligible bills may count towards the amount still outstanding.

Ask how to register smaller eligible bills even when the insurer owes you nothing. Costs paid privately without notifying the insurer may not count towards your excess.

What happens when your policy renews

An annual excess usually resets at the start of a new policy year.

This often falls on the anniversary of the policy’s start date. Don’t assume it happens in January.

If eligible treatment starts before renewal and continues afterwards, another annual excess may apply to care in the new policy year. That means contributing twice during one course of treatment.

Ask the insurer which dates determine how it applies your excess. Treatment dates can matter more than invoice dates. Don’t assume a late bill creates a new claim or belongs to the new policy year.

With a per claim excess, check the wording for ongoing claims at renewal. Paying once doesn’t automatically settle your contribution for every future year of care.

How an excess works on a family policy

Family cover often applies the excess separately to each person. If so, one adult meeting their annual excess leaves another adult or child’s contribution unchanged.

For example, you might meet your annual excess through several eligible claims in the same policy year. If your policy applies the excess separately, another family member claiming still has their own excess to pay.

Check the rules for every person covered, including children. Don’t assume your family has one shared excess or that children and adults have the same arrangements.

Allow for several family members claiming in the same year, including close together. What feels affordable for one person may become harder to meet across the family. Separate claims under a per claim arrangement bring further contributions.

Choosing an excess you can afford

Choose an excess you could pay comfortably soon after cover begins, alongside normal household spending. Relying on money you hope to save later risks leaving you short when a bill arrives.

Think about frequency as well as size. An annual excess sets your contribution for the year where its terms apply. A per claim excess can apply again for separate claims. Neither label explains all your potential treatment costs.

Ask the specialist to compare excess options with the rest of the cover unchanged. That shows the effect of the excess alone. Changes to outpatient cover or the hospital list make the comparison less clear.

The excess is only one factor affecting cover costs. Our guide to what affects private health insurance costs explains the others.

Check your excess alongside cover limits

Your excess is your contribution towards eligible treatment. A benefit limit is the amount of cover available for a particular type of care. Meeting your excess doesn’t remove that limit or make excluded treatment eligible.

Check outpatient cover carefully. Consultations and tests can mean several bills before hospital treatment is considered. An outpatient allowance also applies if specified in your policy.

Ask whether your excess uses up that allowance. Some policies count the full eligible treatment cost towards a benefit limit, including your contribution. Others calculate benefits differently. Our guide to outpatient cover explains how allowances affect access to consultations and tests.

Your excess doesn’t cap everything you pay yourself. Care outside your cover or charges above the insurer’s agreed limits may leave you with extra costs. Check hospital and consultant arrangements before committing to treatment.

Before choosing or changing your excess

Read the policy schedule alongside the claims and excess sections. The schedule usually records the amount. The wider policy wording explains when it applies. Keep both handy to check bills.

Before accepting cover, confirm the following with the specialist.

• How the policy defines a separate claim and when the excess resets.
• Which benefits have different excess rules.
• How the excess applies to each person covered.
• What happens to ongoing treatment at renewal.
• When you can change the excess and what restrictions apply.

Changing your excess at renewal depends on the insurer’s rules. Don’t assume you can reduce it after a claim starts and apply the change to existing bills.

If you’re considering another insurer, check cover and underwriting terms alongside the excess. Our guide to switching private health insurance explains what to review before ending your existing policy.

A health insurance specialist explains cover and gives quotes, including how different excess options work. You can compare private health insurance and talk through the details with the specialist.

Common questions

Last updated 8 November 2026