An excess on private health insurance is the part of a treatment bill you pay yourself before the policy pays the rest. People search for it as a health insurance excess fee, but on the policy wordings quoted below it is not a fee the insurer collects from you up front: it comes off your first treatment bill, and you settle it with the hospital or clinician. What catches people out is not the amount, which you choose when you buy, but how often it is charged, once a policy year, once per claim or once per condition, and each insurer writes that into its policy in its own way.
If you are choosing an excess level, or working out what the one on your certificate means in practice, a broker can set several insurers' excess wordings side by side for your circumstances and show you how each level changes the quote. Fill in the form on this page to be put in touch with an FCA-authorised broker. It is free and takes a few minutes.
Per policy year, per claim or per condition
Three bases exist. Per policy year: the excess is paid once, against the first bill or bills of the year, and further treatment that year attracts no more. Per claim: it is paid each time a new claim is opened. Per condition: it is paid once for each condition claimed for, however many bills that condition produces. The level on a quote tells you nothing about which applies, and the basis is what decides the cost over a year: two claims under a per-claim wording cost two excesses; under a per-policy-year wording they cost one.
Which basis applies is in the policy wording, not on the quote summary. The clauses below are the ones we hold on this question for four insurers, read on 4 September 2026. Each is one extract, not the whole document, and nothing here should be read across to a policy you have not seen. If you want the basic definition first, what a health insurance excess means covers it in plain English.
What four insurers' own wording says
Aviva: six levels, per member, every policy year
"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. The excess options listed on the same page are £100, £200, £500, £1,000, £3,000 and £5,000.
Two things are in that sentence: the basis is the policy year, and the excess is "for each member", so on a family policy each person carries it each year rather than one excess being shared across everyone. The copy we read is hosted in a broker's document library rather than on Aviva's own site; the terms that came with your policy are the ones that bind.
Bupa: once a policy year, paid to the practitioner, with a worked example
"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). If Helen needs other treatment during the policy year, she doesn't need to pay another excess."
— Bupa, Bupa By You policy guide (BINS 14718, 2024), page 10, read 4 September 2026.
The £100 excess comes off the first bill; Bupa pays the physiotherapist the balance; Helen pays the £100 to the physiotherapist, not to Bupa; and "other treatment during the policy year", with no qualification about what it is for, attracts no second excess. It is a worked example, not a list of Bupa's excess levels, and we are not inferring those from it.
The same guide also keeps one thing outside the excess altogether:
"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)."
— same guide, page 7.
So on Bupa's wording not every use of the policy starts the excess, and this one does not touch the out-patient allowance either.
Freedom Health Insurance: deducted invoice by invoice, then paid to the provider
"If this policy does have an excess, we will deduct this amount from the first valid invoice we receive and from any subsequent valid invoices until the excess has been fully applied. We will tell you when we have done this and 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.
Freedom's clause is about collection, and it answers what the other clauses we hold leave open: what happens when the first bill is smaller than the excess. The excess is one amount, worked off against invoice after invoice "until the excess has been fully applied"; Freedom then tells you what has been deducted, and you pay it to the provider, not to Freedom. What the clause does not say is the period that amount runs over. It does not use the words "policy year", and we have not established from this extract whether Freedom's excess resets at renewal, so do not read that across from Aviva or Bupa.
WPA: a per-policy-year excess, or a 25% co-payment instead
"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. 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.
Two arrangements, not one. The excess is conventional: a chosen level, per policy year, paid "before we provide benefit". Shared Responsibility is a co-payment rather than an excess: 25% of claims for eligible treatment, up to a ceiling you choose. The clause does not say whether that ceiling runs per claim or per policy year, so we assume neither. None of the other three clauses here describes a percentage co-payment; if a quote offers one, ask what period the ceiling is counted over before comparing it with a flat excess.
| Clause we hold | Basis the clause states | Who you pay the excess to |
|---|---|---|
| Aviva, Healthier Solutions terms, page 11 | Per member, every policy year; six levels from £100 to £5,000 | Not stated in this clause |
| Bupa, Bupa By You guide, page 10 | Once per policy year ("doesn't need to pay another excess") | The practitioner, in the worked example |
| Freedom, Elite guide, page 31 | One amount deducted across invoices until fully applied; period not stated | The provider, once Freedom confirms the deduction |
| WPA, Complete Health IPID, page 2 | Excess per policy year; or Shared Responsibility, 25% of claims up to a chosen level, period of the ceiling not stated | Not stated in this clause |
When you get quotes, ask for the basis and the collection mechanism in writing for each, not just the level. A broker can gather that from several insurers in one conversation and show you each quote at more than one excess level; there is no charge for asking.
An excess is not the only cost-sharing dial
A higher excess usually means a lower premium; that is the shape of the market. It is not the only lever a quote may offer, and the other common one, a reduced out-patient limit, works differently: on the wording we hold it removes cover rather than deferring part of a bill to you.
"If you have chosen a reduced out-patient limit of £500 or £1,000 you are not covered as an in-patient, day-patient, or out-patient for treatment for: complications of pregnancy and childbirth, or surgical procedures on the teeth performed in a hospital"
— Aviva, Healthier Solutions terms and conditions (April 2025 issue), page 8, read 4 September 2026.
On Aviva's wording the reduced limit does not just cap out-patient spending: it takes two kinds of treatment out of the policy in every setting, in-patient included. WPA's Complete Health document builds a cap in as standard instead, "Out-patient Treatment Consultations with a Specialist – £250 (increase with the Extra Out-patient Consultations Optional Extra)" (same WPA document, page 1), and sells the way to raise it. None of the four excess clauses above removes a category of cover; an excess changes who pays first, not what is covered. Keep the two apart when a quote offers both.
Common questions
How much is the excess on private health insurance?
There is no standard figure: the excess is a level you choose when you buy, from whatever options the insurer offers. Aviva's terms list six, from £100 to £5,000, each applying per member every policy year; other insurers set their own range in their own documents. If you already hold a policy, the level that applies to you is on your certificate or schedule.
What is the difference between the excess and the premium?
The premium is what you pay for the policy; the excess is what you pay towards treatment before the policy pays. The two move against each other, in that a higher excess usually means a lower premium. We hold no premium data, so we cannot say by how much for any insurer; ask for the quote at more than one excess level and the difference is in front of you.
Is the excess paid in advance with the premium, and is it repaid if you do not claim?
Not on the wordings we hold. Freedom deducts the excess from your treatment invoices and then asks you to pay it to the provider, and Bupa's worked example has the member paying her physiotherapist. Nothing we have read collects an excess alongside the premium or repays one; on these clauses a year with no treatment is a year in which no excess is taken. Your own policy wording binds, so check it before relying on this.
Which level to choose turns on the basis your insurer applies and on how you expect to use the policy, and that is a quote rather than a rule. Fill in the form on this page, and an FCA-authorised broker will set out the current excess options and wording from several insurers for your circumstances.