A private medical insurance excess is the first part of the cost of your treatment that you pay yourself; the policy pays what is above it. You choose the amount when you take the policy out, it is on your certificate or schedule, and it is charged only when you claim, so a year with no treatment is a year with no excess. Private healthcare excess, medical insurance excess, UK health insurance excess: the phrasings all mean this one thing, though the word carries different baggage in America and Australia, which the questions at the end cover.

The decision behind the search is usually whether to take an excess, and at what level. That is a quote rather than a rule, because the premium is what moves when the excess does, and seeing the movement means having each level priced. A broker can do that across several insurers in one conversation; fill in the form on this page to be put in touch with one that is FCA-authorised. It is free and takes a few minutes. This page explains what you are choosing; its sister page, how much excess should you choose, works through how each insurer applies it.

What a private health insurance excess is

Every insurer writes the definition in its own words, but the parts are the same. WPA's product information document has it in one sentence:

"Where an excess is chosen, you must pay your excess for eligible treatment up to your chosen level per Policy year before we provide benefit."

— WPA, Complete Health Insurance Product Information Document (November 2025), page 2, read 4 September 2026.

Four things are in that sentence, and they are what an excess is. It is chosen: a level you select, not a charge imposed on you. It attaches to eligible treatment: it comes off bills the policy would otherwise pay, so an excluded treatment is simply not covered and the excess never arises. It has a ceiling: once you have paid "up to your chosen level", the excess is spent and the policy pays for the rest of the period it runs over, subject to its own limits. And it comes "before we provide benefit": the insurer's money starts where yours stops.

The level is a fixed sum, not a percentage, and on the wording we hold it is personal to each insured person:

"Benefits covered under this policy will be subject to an excess payable for each member every policy year."

— Aviva, Healthier Solutions terms and conditions (April 2025 issue), page 11, read 4 September 2026.

On a family policy with that wording, each person carries their own excess rather than the household sharing one. Aviva lists six levels on the same page, from £100 to £5,000; each insurer sets its own range, so there is no single maximum, and your certificate states yours. A £500 excess means you pay the first £500 of covered treatment in the period the excess runs over, and the policy pays what is above it.

Why policies have an excess

Two reasons, and the first explains the second. The premium is the price of the risk the insurer takes on. With an excess, the first part of every eligible claim is yours, so the insurer carries less of the risk and prices accordingly: a higher excess usually means a lower premium, and a lower excess a higher one. That is the shape of the market, not a figure; we hold no premium data, and what the gap between two levels comes to is something only a quote can tell you.

The second reason is what an excess does to small bills. A single consultation may cost less than your level, in which case you pay it even though it was covered, and on a wording where the excess runs for the policy year what you paid counts towards it. That is the bargain: you take the small, predictable bills in exchange for a lower price on cover for the large, unpredictable ones. Whether it suits you turns on how you expect to use the policy, and on what the trade is worth on your own quote at more than one level; a broker can ask several insurers for that at once, and there is no charge for asking.

When you pay the excess, and who you pay it to

Not when you buy. On the wordings we hold, no excess is collected with the premium, and nothing is refunded if you do not claim, because nothing was taken. The excess is triggered by a claim and settled against the treatment bill rather than paid to the insurer. Bupa's policy guide shows the split:

"Helen has some physiotherapy which costs £250. We pay Helen's physiotherapist £150 and we'll let Helen know that she needs to pay the physiotherapist £100 (which is the policy excess)."

— Bupa, Bupa By You policy guide (BINS 14718, 2024), page 10, read 4 September 2026.

One bill, two payers. The insurer pays the practitioner the part above the excess, the member pays the practitioner the excess itself, and the insurer tells her what she owes rather than invoicing her. Freedom's guide describes the same arrangement from the insurer's side: the excess is deducted "from the first valid invoice we receive and from any subsequent valid invoices until the excess has been fully applied", after which "you will then need to pay the excess amount to the relevant provider" (Freedom Health Insurance, Freedom Elite Policyholder's Guide to Cover, April 2025, page 31, read 4 September 2026). The hospital or clinic, not the insurer, is who you settle up with.

The practical point is that the excess is money you need at the point of treatment, not something spread across the year with the premium; if finding a high level at short notice would be awkward, that is a reason to choose a lower one. These are extracts, not the market, so ask any insurer that quotes you to confirm it collects the excess the same way.

An excess is not a co-payment, and not a limit

Three different mechanisms in a policy can leave you paying towards treatment, and quotes do not always label them. Keep them apart.

A co-payment is a share of each bill rather than a fixed first slice. WPA offers one as an alternative to its excess:

"Where Shared Responsibility (co-payment) has been selected, you must pay 25% of claims for eligible treatment up to your chosen level of Shared Responsibility."

— WPA, Complete Health Insurance Product Information Document (November 2025), page 2, read 4 September 2026.

With an excess, you pay the whole of each bill until your level is reached, and then nothing. With this co-payment, you pay a quarter of every bill from the first pound, until your contributions reach the ceiling you chose. A small bill therefore costs you less under the co-payment; what a large one costs you depends on where that ceiling sits against the excess you would otherwise have chosen. The clause does not say what period the ceiling runs over, so if you are offered one, ask. It is the only percentage co-payment in the documents we hold, and we have not established whether other insurers offer one.

A benefit limit caps what the insurer will pay for a category of treatment, most often out-patient consultations and tests, over a policy year. It works from the other end: an excess sets where the insurer's money starts, a limit sets where it stops, and once a limit is used up the rest of that year's bills in that category are yours whatever excess you chose. Bupa's wording shows the two as separate things:

"If you have a Direct Access phone or video assessment you won't need to pay an excess for it and the cost won't be subtracted from your outpatient benefit allowance (if either of these apply to your policy)."

— Bupa, Bupa By You policy guide (BINS 14718, 2024), page 7, read 4 September 2026.

"Either of these": a policy may have an excess, an out-patient allowance, both or neither, and each is counted separately. The clause also shows that not every use of a policy starts the excess; this assessment, on Bupa's wording, touches neither. Limits have their own page, private health insurance benefit limits explained; the point here is that a low excess and a low out-patient limit are different dials, and they do not cancel out.

What to understand before you choose a level

The level is the least of it. Before the number means anything, you need four things from the policy wording, and they are the four things that differ between insurers.

  • How often it is charged. Once a policy year, or once per claim, and some wordings count per condition; two claims in a year cost one excess under the first and two under the second. The Aviva and WPA sentences above say policy year, and Bupa's example goes on to say Helen pays no second excess that year. The sister page sets out each insurer's basis.
  • Whether it is per person. Aviva's "for each member" means a family of four carries four excesses.
  • What sits outside it. Some services do not start the excess at all, as Bupa's Direct Access assessment shows; a digital GP service or helpline may or may not, and the wording says.
  • How it is collected. Against the bill, paid to the provider, on the wordings we hold. Check that yours does the same.

Then the one thing no wording can tell you: what each level does to the premium. That is a quote, and worth having at two or three levels so the trade is in front of you. How much excess should you choose walks through the four insurers' wording in detail; a broker can put current quotes at several levels beside it for your circumstances, and the conversation costs nothing.

Common questions

Can you have private health insurance with no excess?

On the wordings we hold the excess is chosen rather than imposed, and Freedom's guide opens its clause with "If this policy does have an excess", so a policy written without one is contemplated. No excess means the policy pays eligible bills from the first pound, and a higher premium is the usual price of that. It does not mean the policy pays everything: benefit limits and exclusions apply as before.

Is there such a thing as excess protection or an excess waiver on health insurance?

Not in any policy document we hold. Excess protection and excess waiver are products sold alongside motor, travel and car-hire insurance, where a third party refunds the excess you pay. We have not found an equivalent for private medical insurance; if one is offered, ask for the wording and the cost before counting on it.

What is the six-week option, and is it a kind of excess?

It is not an excess. The usual shape of a six-week option is that the policy pays for in-patient or day-patient treatment only if the NHS cannot provide it within six weeks of the date your specialist says you need it. It lowers the premium by limiting when the policy responds rather than how much of a bill you pay first; we hold no clause on it, so ask the insurer for its exact wording.

Is a UK excess the same as an American deductible or an Australian hospital excess?

The American deductible is the same idea: an amount you pay before the insurer pays. The Australian hospital excess, which is what searches for Qantas, AIA or Defence Health are about, is broadly the same mechanism inside a system with its own tax rules, which is why "excess reduction on a tax return" comes up; nothing like that attaches to a UK policy. The UK wordings we hold apply the excess to covered treatment generally, not only to hospital stays.

Does health insurance cover excess skin removal?

This is a different "excess": loose skin, usually after weight loss, rather than the policy term. Whether surgery to remove it is covered is a question of what the policy includes, and we hold no clause on it. Policies commonly exclude treatment they class as cosmetic, and where the line falls depends on the insurer's wording, so ask for the exact clause before assuming either way.

Should I choose a high or a low excess?

That depends on how often you expect to claim, how the insurer counts the excess, and what each level does to the premium on your own quote, which is why it is a quote and not a rule. How much excess should you choose goes through the trade-offs insurer by insurer, with each one's wording quoted.

If you now know what the word on the quote means, the next step is to see what it does to the price for you. Fill in the form on this page, and an FCA-authorised broker will set out current quotes from several insurers at the excess levels you are weighing.