How Does an Excess Work in Private Health Insurance?
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When you take out private health insurance you'll usually be given a variety of different excess options to choose from. It's important to understand exactly how an excess works and the implications it can have for both you and your policy.
We've put together this guide to answer some of the most common health insurance excess questions so you are equipped with the knowledge you need to determine which level of excess is right for you.
What is an insurance excess?
An insurance excess is the amount you agree to pay towards your treatment if you make a claim on your health insurance policy.
Excess options in 2026 typically range from £0 to £5,000, though the specific 'bands' vary by provider. Leading insurers like Bupa and AXA Health commonly offer tiers at £0, £100, £250, £500, and £1,000. For those looking to significantly reduce their premiums, Aviva and Vitality continue to offer higher 'safety net' excess levels of £3,000 and £5,000. Choosing a higher excess can lower your monthly cost by up to 40%, but it is essential to ensure you have these funds readily available in a savings account should you need to open a claim.
Why pay an excess?
Choosing to pay an excess gives you a degree of control over your policy premiums (the amount you pay per month or year for your cover). The higher the excess you choose to pay when you make a claim, the lower the cost your cover will be.
Remember to read your policy documents carefully, though. The terms and conditions of an excess will differ from insurer to insurer, and it's important to be aware of and understand what this means for you when it comes to settling your bill.
Your excess level is one of many factors that can affect your premiums—read our handy guide to find out what else can increase or decrease the amount you pay here.
How does an excess work?
Crucially, you will only need to pay an excess when you make a claim on your private health insurance. Your insurance provider will explain how and when to pay your excess when you first make the claim, and will always be hand on to answer any questions you may have.
When it comes to settling the bill, you will be required to pay any excess amount you agreed to when you first took out your plan. Your insurer will then cover the rest providing the costs are within any agreed limits.
More often than not your insurer will require you to pay your excess (if applicable) on your first eligible claim of each membership year. This means you will only need to pay the total amount of your excess once per policy year, even if you make multiple claims for a condition.
Note: if you receive treatment that starts in one membership year and carries on into the next, your excess may be applied twice even though it's technically only one claim.
Some other providers may charge an excess every time you make a claim—be very mindful of this, as it could result in being a far more expensive option for you if you make multiple claims.
Health insurance excess example:
Suppose you have a £250 annual excess and require a private MRI scan and specialist follow-up, which in 2026 typically costs around £1,500.
- You would pay: £250
- Your insurer would pay: £1,250
Once this excess is paid, any further eligible treatment within the same policy year—such as physiotherapy or minor surgery—would usually be covered in full by your insurer without you needing to pay another penny."
How to make a claim on private health insurance
- 1. Secure a Referral (Digital or Traditional): If you are unwell, your first step is to obtain a medical referral. In 2026, most policies include 'Digital GP' services via apps like My Bupa or Vitality GP, which often provide video appointments within 24 hours. These virtual GPs can issue 'open referrals' (referring you to a specialty rather than a named doctor), which are instantly uploaded to your insurer's system. Alternatively, you can still use a traditional NHS GP, though you will need to ask them for a private referral letter.
- 2. Get Digital Pre-Authorisation: Once you have your referral, you must notify your insurer to get a claim authorisation code. In 2026, this is most efficiently done through your provider’s mobile app or online portal. You simply upload a photo of your referral letter (if not already issued by their digital GP) and answer a few automated questions about your symptoms. In many cases, the system will grant instant pre-authorisation, confirming your coverage and reminding you of any remaining excess before you even book your specialist appointment. Your insurer will then assess your claim and determine whether this is covered by your plan. If it is, you may be required to pay your excess amount before you see your specialist.
- 3. See your specialist: if your insurer accepts your claim you can then see your specialist. Depending on the insurer and plan you have opted for you may need to arrange your treatment directly through your provider. At your first appointment you'll need to give your specialist details such as your claims number and any other documents you have received from your insurer. It's good practice to keep your insurer updated throughout this process, and they will be on hand to give advice and answer any questions you may have.
- 4. Settling your bill: your insurer will typically settle any bills directly with the hospital or specialist who has treated you though in some cases they may contact you for further information. In any case, your insurer will always let you know whether there is an excess to pay. Once your provider has received the invoice for your treatment they will then cover this (minus any excess you are liable to pay) and will let you know how and when to pay your excess. You may need to pay this upfront before you see your specialist with your insurer settling the rest of the bill later on.
How do I know which excess amount is right for me?
The most important thing to consider when choosing your excess amount is what is affordable for you. Remember, private health insurance is designed to cover unexpected illness and injury. If this does happen you will need to be able to pay your excess fee at relatively short notice so it's important to be realistic about your finances.
Whilst opting for a higher excess amount may seem appealing, given it will reduce your overall premium, you should never put yourself in a position where you would struggle to afford this.