Do I need to pay an excess if I make a claim?

The excess is the amount you agree to pay towards a claim before your insurer contributes. Choosing to pay an excess can help make your premiums more affordable.

For example, if your policy has an excess of £250 and you make a claim for £1,000, you would pay the first £250 and your insurer would cover the remaining £750, subject to the terms of your policy.

Whether you need to pay an excess depends on your chosen policy. Many plans give you a choice of excess levels when you apply. Common excess amounts might include £100, £250, £500 or more. A higher excess typically means lower premiums, because you are taking on more of the upfront cost.

If you have chosen an excess, usually it applies per person, per policy year, not each and every time you claim or per symptom. However, there are providers that offer per claim. It is important to read your policy documents carefully so you understand how often you may need to pay it.

You will generally pay an excess when you make a claim for treatment covered under your policy. Examples include:

• Private hospital stays
• Consultant consultations
• Diagnostic tests and scans
• Day procedures

However, not all claims or types of cover attract an excess. Some policies may waive the excess for certain benefits, or have different excess levels for different parts of the cover. This is why it is important to check the details before you buy.

Selecting the right excess is a balance between what you can afford to pay and the level of premiums you are comfortable with.

If you choose a higher excess:

• Your premiums are likely to be lower
• You will pay more towards claims when they arise

If you choose a lower excess:

• Your premiums will normally be higher
• You pay less towards each claim

People who rarely expect to claim may prefer a higher excess because it reduces monthly or annual premiums. Those who want predictable costs at the time of treatment may prefer a lower excess. A Coversure Health adviser can help you weigh the pros and cons based on your circumstances.

If you need medical treatment and choose to use private healthcare, you’ll first need to contact your health insurance provider to obtain an authorisation number. This number confirms that your insurer has approved the treatment, and you should take it with you to all private consultations and appointments.

After receiving your private treatment, you’ll be given a medical bill, usually itemised so you can see exactly what has been charged. The bill should make it clear which costs are covered by your policy and which are not.

If the total cost of treatment is below your policy excess, you will need to pay the full amount directly. However, it’s important to keep your insurer updated. If you require further treatment for the same condition within the same policy year, once your costs exceed your excess, the insurer will begin paying eligible charges directly according to your policy terms.