Your excess is the amount you pay towards private treatment before the insurer pays the rest. On most UK policies it applies once per policy year, not per claim — though a minority of plans differ, so check the wording. Raising it from £0 towards £500 typically saves around 10–20% per step on the premium.
- ✓On most policies the excess applies once per policy year — not to every claim.
- ✓Each step up the excess ladder (£0 → £100 → £250 → £500) typically saves 10–20%.
- ✓Beyond £500, extra excess usually buys less saving than it costs in risk.
What the excess is — and when you actually pay it
The excess is your contribution to a claim: if you have a £250 excess and claim for treatment costing £4,000, you pay £250 and the insurer pays £3,750. In practice you usually pay it to the hospital or consultant directly, or the insurer collects it and settles the rest of the bill behind the scenes — you're never asked to fund the whole treatment and claim it back.
The crucial mechanic is how often it applies. On most UK health insurance policies, the excess is charged once per person, per policy year — so if your knee claim in March uses your excess, further eligible treatment for you that policy year (including for an unrelated condition) is typically covered in full. A minority of insurers apply it per claim or per condition instead, which is a materially worse deal for anyone who claims more than once.
When a high excess stops making sense
The excess ladder has a top. Insurers' discounts shrink at each step — the jump from £500 to £1,000 usually saves far less than the jump from £0 to £500 — while your exposure keeps growing pound for pound. At some point you're accepting £500 of extra risk for £40 of annual saving.
- Diminishing discounts. If doubling your excess saves less than 5%, the trade is rarely worth it — you've found your ceiling.
- Small claims stop being worth making. With a £750+ excess, outpatient-scale claims (a £300–£500 MRI, a few consultations) fall entirely on you, and the policy only really works for big inpatient events.
- Couples and families multiply it. Where the excess applies per person, a family with a £500 excess could pay it several times in one bad year.
- Cash flow is real. An excess you'd struggle to pay at short notice defeats the point of insurance — set it at a level you could pay tomorrow without wincing.
Price your cover at every excess level
Excess vs the six-week option — two different discounts
The excess is often confused with the other big money-saver, the six-week option. They cut the premium in completely different ways and can be combined.
| Excess | Six-week option | |
|---|---|---|
| What you give up | First £X of each year's claims | Private treatment when the NHS wait is under 6 weeks |
| Typical saving | 10–30% depending on level | 15–25% |
| Who it suits | Anyone comfortable self-funding small amounts | People mainly insuring against long NHS waits |
| Downside | You pay it even on serious claims | You may wait up to 6 weeks on the NHS for some treatment |
A common, well-balanced structure is a £250 excess plus the six-week option: the premium drops substantially, you still get fast private treatment whenever NHS waits are long — which, with a 12.4-week median NHS wait, is most of the time for surgery — and your worst-case out-of-pocket cost is a known £250.
Choosing your number
No excess level is universally right, but there is a right process. Get the same quote at £0, £100, £250 and £500 and look at the actual pound savings, not percentages. Then ask two questions: could I pay this excess tomorrow without difficulty, and does the annual saving exceed roughly what I'd expect to hand back in claim years?
For most working-age adults the answer lands at £250–£500 — enough to earn a real discount, small enough that no sensible claim is ever deterred. People who want first-pound cover for every consultation sit at £0–£100 and pay for the privilege; people using insurance purely as big-event protection can justify £1,000 if the discount is still meaningful. And remember you can usually change your excess at renewal, so this year's choice isn't forever — though lowering it may involve new underwriting on some policies.
Finally, keep the excess in proportion. It's the easiest dial to turn, but it's not the biggest: the hospital list and outpatient limit often move the premium further. Set the excess once, sensibly, then spend your comparison energy on the structural choices — and on making sure the insurer's wording says 'per policy year' before you sign anything.
Frequently asked questions
Is a health insurance excess per claim or per year?
On most UK policies, per person per policy year: you pay it on your first claim of the year, and further eligible claims that year are covered in full. A minority of insurers charge it per claim or per condition instead, which costs you more if you claim twice — check the policy wording before comparing quotes.
How much does increasing my health insurance excess save?
Typically 10–20% per step. Moving from £0 to £250 often trims 10–20% off the premium, and £0 to £500 can save 20–30%. The exact discount varies by insurer and age, so get the same quote at several excess levels and compare the pound savings directly.
What excess should I choose on health insurance?
For most people, £250–£500: big enough to earn a meaningful discount, small enough to pay comfortably if you claim. Go lower if you want first-pound cover for frequent outpatient use; go higher only if the extra discount stays above roughly 5% per step and you could absorb the cost easily.
Do I pay the health insurance excess if my claim is for cancer?
Generally yes — the excess applies to eligible claims of all kinds, including cancer and other serious inpatient treatment, unless your policy specifically waives it. That's worth remembering when choosing a high excess: you won't only pay it on optional, elective claims.
Do I pay the excess again if I claim for two different conditions in one year?
Usually not — on per-policy-year policies the excess is charged once per person per year regardless of how many conditions you claim for. On the minority of per-claim or per-condition policies you would pay it again, which is exactly why the wording matters more than the headline number.
Is a £1,000 excess on health insurance worth it?
Only sometimes. Discounts shrink at each step, so £500 to £1,000 often saves just a few percent while doubling your exposure. It can suit people using insurance purely for big-event protection, but if the extra saving is under about 5%, most people are better off stopping at £500.
Should I choose a higher excess or the six-week option to cut my premium?
They save in different ways and combine well. The excess (10–30% saving) means self-funding the first part of any claim; the six-week option (15–25%) means using the NHS when its wait is short. A £250 excess plus six-week option is a popular balanced structure.
How do I actually pay my health insurance excess when I claim?
Usually to the hospital or consultant directly — the insurer authorises treatment, tells the provider your excess amount, and the provider invoices you for it while billing the insurer for the rest. You're never expected to pay the full treatment cost upfront and reclaim it.
Can I change my health insurance excess after taking out the policy?
Usually at renewal, yes. Raising the excess is straightforward and cuts the premium; lowering it may need insurer agreement and can involve new underwriting on some policies, since you're asking them to take on more risk. Mid-year changes are at the insurer's discretion.
Does the excess apply to every member on a family or couples policy?
Typically yes — most insurers apply the excess per person per policy year, so a couple could each pay their own excess in the same year. A few plans use a shared policy-level excess instead. On family policies, factor the multiplied worst case into how high an excess you pick.