Health insurance excess and exclusions explained

How the excess works

Every private medical insurance policy asks you to choose an excess when you buy. The excess is deducted from what the insurer pays. Bupa's examples make the arithmetic plain. With a £200 excess and £500 of treatment, you pay £200 and Bupa pays £300. With a £100 excess and a £200 consultation, you pay £100. With a £500 excess and £200 of treatment, you pay all £200 and the insurer pays nothing, and Bupa says this usually does not count as a claim.

The levels on offer on 22 October 2026:

When the excess is taken matters as much as the amount. Vitality offers two bases. Per plan year, you pay the excess once per person per year, however many claims you make. Per claim, you pay it every time you claim, and a claim for the same condition after 12 months counts as new. Bupa's document applies the chosen excess to eligible treatment costs in any policy year. AXA Health takes the excess for each 12-month period in which you make at least one claim.

One trap catches people whose treatment runs past renewal. Bupa warns that a course of treatment spanning two policy years can mean paying the excess twice.

Excess and the premium

Bupa states the rule: the higher your excess, the lower the price will be. Vitality says the higher the excess, the lower it can set the premium. Neither publishes a table of savings. Vitality's one published example, £44 a month for a 35-year-old, assumes a £250 excess and a £500 out-patient limit.

The trade-off is simple to state. A zero excess costs more each month and leaves no bill at claim time. A £1,000 excess cuts the monthly cost and makes the first £1,000 of any year's treatment yours to pay. With a £1,000 excess, a £350 MRI scan or a £218 consultation would fall entirely on you.

Out-patient limits

Separate from the excess, most policies cap out-patient treatment, meaning consultations, tests and scans before any admission. Vitality offers full cover or a limit of £500, £750, £1,000, £1,250 or £1,500 a year, with MRI, CT and PET scans covered in full regardless of the limit and physiotherapy outside its network capped at £35 a session. A £500 limit would be used up by two private consultations and a handful of tests.

What is excluded

The ABI's guidance says insurers typically do not cover chronic conditions, defined as conditions that need long-term management, continue indefinitely or have no known cure, and that you will normally not be covered for illnesses you currently have or have already had.

Bupa's insurance product information document, read on 22 October 2026, lists what is not insured and what is restricted:

AXA Health's page lists chronic conditions, pre-existing conditions, routine pregnancy and childbirth, dental procedures, out-patient drugs, dressings and private prescriptions, and preventative treatment or tests when there are no symptoms.

Two of these lines settle the question of weight loss medicines. Weight loss is not insured at Bupa, and out-patient and take-home drugs are excluded at both Bupa and AXA Health. Vitality applies a 25% co-payment to weight loss and corrective surgery. Mounjaro, Wegovy, the Wegovy pill and Foundayo are unlikely to be covered by any of these policies, and the pharmacy prices are compared in the GLP-1 savings hub.

Emergencies are the other surprise. Private insurance does not replace A&E. An emergency admission goes to an NHS hospital, and the policy may pick up private treatment afterwards only once the condition is stable and eligible.

Moratorium vs full medical underwriting

The underwriting method decides how the insurer treats what you already have.

Full medical underwriting means you disclose your medical history on the application. The ABI says the insurer may contact your doctor with your consent, and any exclusions are stated from the start. Leaving something out carries a cost: the ABI warns the insurer may reduce a claim, refuse to pay and cancel the policy.

Moratorium underwriting means no medical history at application. Instead, AXA Health explains, the insurer excludes treatment for any condition you had in a set period before the policy, usually five years. The exclusion lifts after a trouble-free period, usually 12 or 24 months, in which you had no doctor's opinion, medication, special diet, treatment or clinic visits for that condition. AXA's own plan uses a three-year look-back and a two-year trouble-free test. The history is checked at claim time, which is when an undeclared condition surfaces.

Group policies through an employer often need no history at all, and the ABI notes basic schemes may cover only some treatments.

Your right to cancel

The FCA Handbook, ICOBS 7.1, gives a consumer 14 days to cancel a general insurance contract. The period runs from the day the contract is concluded or the day you receive the terms and conditions, whichever is later. Bupa goes further in its own document: 21 days from receiving the policy documents or the start date, with a full refund if you have not claimed.

The ABI adds a warning for mid-term switches. If you move provider before renewal you may face a fee, and a new moratorium clock starts with the new insurer.

Steps to check a policy before buying

1. Find the excess amount and whether it applies per year or per claim. Both appear on the membership certificate.
2. Read the insurance product information document. Every insurer publishes one. The not insured and restricted lists are the heart of it.
3. Check the out-patient limit and whether scans sit inside or outside it.
4. Decide between moratorium and full medical underwriting. If you have a condition from the last five years, ask how each method treats it.
5. Note the cancellation window, 14 days by law and 21 at Bupa, and put the renewal date in your diary.
6. Compare quotes on the same excess and limit. The comparison guide explains how.

Where the figures come from

Excess levels and examples are from Bupa's excess page and Vitality's excess and cover options pages. Exclusions are from Bupa's insurance product information document and AXA Health's explainer. Underwriting rules are from the ABI and AXA Health. The 14-day cancellation right is from the FCA Handbook, ICOBS 7.1. All read on 22 October 2026.