If the amount you are claiming is lower than your policy excess (and co-payment, if you have chosen this as part of your policy), we can still process your claim, but we will not be able to make a payment.
However, the cost of the first treatment and/or submitted claim, less any applicable deductions (such as inner limits), will count towards your excess for the same condition within the same policy year. This means that if you make a continuation/subsequent claim for the same condition later in the policy year, the initial claim amount will count towards any remaining excess you need to pay.
In the following examples, the initial lower claim amounts help reduce your excess for subsequent claims, but do not result in a settlement after the first claim. Therefore, it may potentially be beneficial in these scenarios to only submit claims after the second claim, once the settlement amount exceeds the excess.
EXAMPLE 1 – POLICY EXCESS: £275, SELECTED CO-PAYMENT: 0%
First Claim:
- £280 – Claim Value
- Less £40 – Applicable Deductions*
- £240 – Settlement Amount (before excess)
- Less £275 – Policy Excess
- £0 – Final Settlement (since £240 is less than the £275 policy excess)
- £240 is credited towards your excess for a continuation/subsequent claim for the same condition within the same policy year.
Second Claim (Continuation claim for same condition, in same policy year):
- £150 – Claim Value
- Less £20 – Applicable Deductions*
- £130 – Settlement Amount (before excess)
- Less £35 – Remaining Excess (after first claim – £275 minus £240)
- £95 – Final Settlement
EXAMPLE 2 – POLICY EXCESS: £125, SELECTED CO-PAYMENT: 20%
First Claim:
- £110 – Claim Value
- Less £10 – Applicable Deductions*
- £100 – Settlement Amount (before excess)
- Less £125 – Policy Excess
- £0 – Final Settlement (since £100 is less than the £125 policy excess)
- £100 is credited towards your excess for a continuation/subsequent claim for the same condition within the same policy year.
Second Claim (Continuation claim for same condition, in same policy year):
- £350 – Claim Value
- Less £45 – Applicable Deductions*
- £305 – Settlement Amount (before excess & co-payment)
- Less £35 – Remaining Excess (after first claim – £125 minus £100)
- £280 – Settlement Amount (before co-payment)
- Less £56 – Co-Payment (20%)
- £224 – Final Settlement
(*Deductions could include anything not covered under your policy terms and conditions, amounts exceeding inner limits as specified in your policy schedule, amounts exceeding 100% markup on medications.)