Co-payment, coinsurance, excess, deductible: who pays what

Excess and deductible are one mechanism with two passports: the first amount of a claim — or of a policy year — that you pay before cover begins. British policies say excess; American ones say deductible; international policies use both, sometimes in the same document. Our deductible guide covers how that lever trades against premium.

A co-payment is a fixed sum per event: a set amount each time you see a doctor or collect a prescription, regardless of the bill. Coinsurance is a proportion: you pay a stated percentage of each eligible cost and the insurer pays the rest. The two are often confused because both are "cost-sharing", but they behave differently as bills grow — a co-payment stays flat while coinsurance scales with the invoice, which is why a coinsurance percentage on a surgical benefit matters far more than the same percentage on consultations.

On the plans we arrange there is no menu of excess options in the brochure; the excess and coinsurance amounts that apply to you are stated on your Certificate of Insurance. The mechanics in the policy wording are worth reading once: where a coinsurance plan has been bought, you pay the applicable proportion of each claim; every benefit limit is reduced by the coinsurance amount; and where a specific rate is printed under a particular benefit — 25 per cent on major dental at the Comprehensive level, for instance — the higher rate prevails when more than one could apply.

The deductible on these plans is defined narrowly: the amount deducted from reimbursement for treatment outside the direct-settlement network — so pre-authorised hospital treatment settled directly is handled differently from a receipt you reclaim. And the general exclusions close the loop with one line: any excess, deductible or coinsurance, per benefit, per condition, per year, is yours to pay. The compare page shows which benefit lines carry a stated rate at each level.

Compare the plan levels side by side

Cost-sharing is one of the few policy features a visa officer actively looks for. Some countries' rules ask for cover without co-payments, or with cover equivalent to the public system; the wording differs by consulate and by route, and our country hubs quote each authority's language rather than paraphrase it — the Spain hub in particular carries the cited consulate wording on co-payments and what it means for the certificate.

The practical order is: read the hub for your country first, so you know whether the rule mentions cost-sharing at all; then read your Certificate of Insurance, because that is the document where the numbers that describe your policy sit. A plan summary tells you what the level covers; the certificate tells you what you will pay when it does.