
As an FCA-authorised broker that has helped arrange over 800,000 policies, WeCovr understands that navigating the world of private medical insurance in the UK can feel complex. This expert guide demystifies one of the most critical factors in your policy's cost: the excess.
When you buy private health insurance, the 'excess' is one of the most powerful tools you have to control your monthly or annual premium. But what exactly is it, and how does your choice truly impact your wallet?
In simple terms, an excess (also known as a deductible) is the amount of money you agree to pay towards the cost of your treatment before your insurance provider pays the rest. It's a way of sharing the cost of a claim.
The relationship between your excess and your premium is an inverse one:
Think of it like car insurance. If you agree to pay the first £500 of any claim, your insurer sees you as a lower risk, and they reward you with a cheaper policy. The same principle applies to private medical insurance (PMI). By choosing a higher excess, you are telling the insurer you will handle the smaller claims yourself, reducing their potential payout and, in turn, your premium.
Most UK health insurance policies apply the excess on a per-policy-year basis. This is a crucial detail. It means you only pay the excess once per year, regardless of how many separate claims you make. Once you've paid your chosen excess amount, all subsequent eligible claims for the rest of that policy year are typically covered in full by your insurer (up to your policy limits).
Let's look at an illustrative example for a 40-year-old non-smoker in Manchester seeking mid-range cover. These figures are for demonstration purposes only, as your actual quote will depend on numerous personal factors.
| Excess Chosen | Illustrative Monthly Premium | Illustrative Annual Premium | Potential Annual Saving (vs. £100 Excess) |
|---|---|---|---|
| £100 | £75 | £900 | £0 |
| £250 | £68 | £816 | £84 |
| £500 | £60 | £720 | £180 |
| £1,000 | £50 | £600 | £300 |
As the table shows, increasing your excess from £100 to £1,000 could potentially save you £300 a year on premiums. This trade-off is central to tailoring a policy to your budget.
While the excess is a major lever, it's just one piece of the puzzle. The final cost of your private health cover is determined by a combination of personal and policy-related factors.
Age is the single most significant factor. As we get older, the statistical likelihood of needing medical treatment increases. Insurers price their policies based on this risk, so premiums for a 55-year-old will be considerably higher than for a 25-year-old. Premiums often see noticeable increases at milestone birthdays (e.g., 30, 40, 50, 60).
Where you live in the UK—your postcode—directly affects your premium. This is due to the varying costs of private medical care across the country.
Insurers use "hospital lists" to manage this. A policy with a nationwide list including top London hospitals will cost more than one with a more restricted, local list.
This is about how comprehensive your policy is. Insurers typically offer tiered plans:
An expert PMI broker, like WeCovr, can help you compare these different levels across multiple providers to find the perfect balance between cover and cost.
Choosing an excess isn't just about finding the lowest premium; it's about finding the right balance for your financial situation. You need to be comfortable paying that amount if you need to make a claim.
Let's explore the common excess levels in more detail.
| Excess Level | Typical Candidate | Pros | Cons |
|---|---|---|---|
| £0–£100 | Someone who wants maximum peace of mind and minimal out-of-pocket costs when claiming. | Predictable costs; you pay very little or nothing when you need treatment. | The highest monthly premiums. |
| £250 | The most popular choice. A good balance between manageable premiums and a reasonable excess. | Offers a noticeable premium saving compared to a £0 or £100 excess. | You still need to find £250 if you make a claim. |
| £500 | Someone who is generally healthy and wants to significantly reduce their monthly costs. | Substantial premium savings, making comprehensive cover more affordable. | £500 can be a significant upfront cost for many people. |
| £1,000+ | Someone with a healthy emergency fund who sees PMI as a safeguard against major costs. | The lowest possible premiums, offering maximum long-term savings. | You must have £1,000 readily available to pay towards your treatment. |
Scenario 1: Amira, £250 Excess Amira, a 35-year-old graphic designer, has a policy with a £250 annual excess. In May, she develops severe shoulder pain and is referred by her GP to a specialist.
Amira pays the first £250 of the consultation fee herself. Her insurer covers the remaining £750 for the MRI scan. Her annual excess is now met. In October of the same year, she needs an unrelated procedure costing £3,000. Because her annual excess has already been paid, her insurer covers the full £3,000.
Scenario 2: Ben, £1,000 Excess Ben, a 50-year-old project manager, opted for a £1,000 excess to keep his premiums low. He requires a hernia repair operation.
Ben pays the first £1,000 directly to the hospital or specialist. His insurer then pays the remaining £3,500. While his out-of-pocket cost is higher than Amira's, his monthly premium has been significantly lower throughout the year, which might have saved him hundreds of pounds already.
It is absolutely vital to understand the fundamental purpose of private medical insurance in the UK.
PMI is designed to cover acute conditions that arise after you take out your policy.
Furthermore, pre-existing conditions are excluded. A pre-existing condition is anything you have had symptoms, advice, or treatment for in the years leading up to your policy start date (typically 5 years). Under moratorium underwriting, if you remain symptom-free for two continuous years after your policy begins, that condition may become eligible for cover.
| What's Typically Covered? | What's Typically Excluded? |
|---|---|
| In-patient and Day-patient Treatment (hospital stays) | Chronic Conditions (e.g., diabetes, asthma) |
| Surgery (as an in-patient or day-patient) | Pre-existing Conditions (for at least the first 2 years) |
| Specialist Consultations (with out-patient cover) | Accident & Emergency (A&E) Visits |
| Diagnostic Tests (e.g., MRI, CT, PET scans) | Routine Pregnancy and Childbirth |
| Cancer Treatment (often extensive, including chemo/radiotherapy) | Cosmetic Surgery (unless for reconstructive purposes) |
| Mental Health Support (with mid-range/comprehensive cover) | Organ Transplants |
| Physiotherapy & Other Therapies (as an add-on or on comprehensive plans) | Self-inflicted Injuries |
Beyond choosing a higher excess, there are several other effective strategies to make your private health cover more affordable.
Modern private health insurance is evolving. It's no longer just about treatment when you're ill; it's about helping you stay healthy in the first place. Many leading insurers now include valuable wellness benefits and rewards programmes designed to encourage a healthier lifestyle.
These can include:
At WeCovr, we enhance this value proposition even further. When you arrange your private medical insurance through us, you also get:
Understanding how excess choices and other factors influence your premium empowers you to build a private health insurance policy that truly works for you. You don't have to navigate the market alone.
At WeCovr, our team of friendly, independent experts is here to provide clear, jargon-free advice. We'll compare leading insurers to find you the right cover at the right price, ensuring you have peace of mind without breaking the bank.
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