
As FCA-authorised private medical insurance brokers in the UK, WeCovr has helped arrange cover for over 750,000 individuals and families. A question we hear daily is about 'excess'—that mysterious figure that dramatically changes your monthly premium. This guide demystifies the PMI excess, empowering you to choose wisely.
Choosing the right private medical insurance (PMI) is a balancing act. You want comprehensive cover for peace of mind, but you also need a monthly premium that fits your budget. The single most effective tool you have to control this cost is the excess.
In simple terms, an excess is the amount you agree to pay towards the cost of your treatment before your insurance provider pays the rest. It’s your contribution to a claim.
The rule is straightforward:
Insurers offer lower premiums to those who choose a higher excess because it means you are sharing more of the financial risk. It also discourages small, frequent claims which helps keep the insurer's administrative costs down.
Let's explore exactly how this works and what it means for your wallet.
Think of a private health insurance excess like the excess on your car or home insurance. It's a pre-agreed sum you pay out-of-pocket when you make a claim. Once you've paid this amount, your insurer steps in to cover the remaining eligible costs, up to the limits of your policy.
For example, if you have a policy with a £250 excess and you need a private procedure that costs £3,000:
If the treatment costs less than your excess—say, a consultation costing £200 with a £250 excess—you would pay the full £200 yourself. In this case, you wouldn't technically make a claim on your policy for payment, though you would still inform your insurer to get the treatment authorised.
Excess levels in the UK typically range from £0 up to £1,000 or more. Choosing where you sit on this scale is a crucial decision that directly shapes your private health cover.
It’s vital to understand how your chosen insurer applies the excess. There are two common methods:
Here’s a table to illustrate the difference:
| Feature | Excess Per Policy Year | Excess Per Claim/Condition |
|---|---|---|
| How it works | Pay the excess once per 12-month policy period. | Pay the excess for each new condition you claim for. |
| Example | You have a £500 excess. Your first claim is £4,000. You pay £500. Your second claim for a different issue is £2,000. The insurer pays the full £2,000. | You have a £500 excess. Your first claim is £4,000. You pay £500. Your second claim for a different issue is £2,000. You pay another £500. |
| Best for | Individuals who might have multiple, separate health issues in a year. Offers more predictable costs. | Often results in slightly lower premiums. Can be cost-effective for those who are unlikely to claim for multiple conditions in one year. |
An experienced PMI broker like WeCovr can help you understand which providers offer which type of excess, ensuring there are no surprises when you need to make a claim.
To see the powerful effect of excess on cost, let's look at some illustrative examples. The figures below are estimates for a healthy, 40-year-old non-smoker in a mid-range UK location seeking a comprehensive PMI policy.
Please note: These are for demonstration purposes only. Your actual quote will depend on your age, location, health, and chosen level of cover.
| Excess Level | Estimated Monthly Premium | Potential Annual Savings (vs. £0 Excess) | Your Contribution at Claim Time |
|---|---|---|---|
| £0 | £95 | £0 | £0 |
| £100 | £88 | £84 | £100 |
| £250 | £75 | £240 | £250 |
| £500 | £62 | £396 | £500 |
| £1,000 | £50 | £540 | £1,000 |
As the table clearly shows, increasing your excess from £0 to £1,000 could almost halve your monthly premium, saving you over £500 a year.
This cost reduction happens for two main reasons:
The key is to strike a balance. A £1,000 excess is only a good idea if you have £1,000 in savings readily available should you need to use your policy.
There is no "one-size-fits-all" answer. The right excess for you depends on a careful evaluation of your personal and financial situation.
Here are the key factors to consider:
Let's look at how different people might choose their excess:
Chloe, 29, a freelance graphic designer: Chloe is healthy and active. Her income can fluctuate, so keeping fixed monthly outgoings low is a priority. She has £2,000 in an emergency fund.
The Sharma Family (Ages 42, 40, 10, 8): The Sharmas want to ensure their children can be seen quickly if something happens. They have a stable joint income and some savings but don't want to face a huge bill unexpectedly.
Robert, 67, retired: Robert is in good health but is more aware of potential health issues as he gets older. He has a fixed pension income but also significant savings. His main priority is certainty and no large, unexpected costs.
It is essential to understand the limits of private medical insurance in the UK. PMI is not a replacement for the NHS; it is a supplementary service designed to work alongside it.
Standard UK PMI policies are designed to cover acute conditions that arise after you take out your policy.
An acute condition is a disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include cataracts, joint replacements, hernias, and most types of cancer.
The main exclusions on virtually all standard PMI policies are:
While the excess is a major lever, several other factors combine to determine your final premium:
| Factor | Impact on Premium | Why? |
|---|---|---|
| Age | High | The risk of illness and needing treatment increases significantly as you get older. |
| Location | Medium-High | Private hospital costs vary by region. Central London has the most expensive facilities, leading to higher premiums for residents. |
| Medical History & Lifestyle | Medium | Smokers pay more. Your Body Mass Index (BMI) and general health can also influence the cost. |
| Level of Cover | High | A basic policy covering only in-patient treatment will be cheaper than a comprehensive one that includes out-patient diagnostics, therapies, and mental health support. |
| Hospital List | Medium | Policies with a limited list of local hospitals are cheaper than those offering a nationwide network including premium London hospitals. |
| No-Claims Discount | Medium | Many insurers offer a discount for every year you don't make a claim, which can reduce your premium at renewal. |
Working with an independent broker like WeCovr is invaluable here. Our experts can compare policies from across the market, helping you tweak these different factors to build a plan that gives you the best possible cover for your specific budget.
While insurance is there for when things go wrong, the best strategy is to stay healthy in the first place. A proactive approach to your wellbeing not only improves your quality of life but can also help keep your insurance costs down over the long term by reducing claims.
To support our clients on their health journey, WeCovr provides complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, for all private medical insurance customers. It's a simple, effective tool to help you make healthier choices every day. Furthermore, clients who purchase PMI or Life Insurance through us can often access discounts on other types of cover, adding even more value.
Understanding your excess is the first step towards finding a private medical insurance policy that truly works for you. It’s about finding the sweet spot between an affordable monthly premium and a potential one-off cost you are comfortable with.
Ready to find the right balance for your budget and needs? Get a free, no-obligation quote from WeCovr today. Our expert, FCA-authorised advisers will compare the UK's leading insurers to find the perfect private health cover for you, at no cost for our advice.






