Health Insurance Guides
Does health insurance cover outpatient treatment?
Key takeaways: Does health insurance cover outpatient treatment?
You can usually choose to include outpatient cover when you get a quote for health insurance.
If you include outpatient cover, you may have unlimited cover, or you may have a monetary limit (for example, £1,000 for consultations and tests) or a limit on the number of specialist consultations you have each year.
What's in this article
Jump to sections:
- Does health insurance cover outpatient treatment?
- How does an outpatient limit work?
- When your outpatient limit is an amount, like £1,000….
- What happens if I don’t have any outpatient limit left, but still need treatment?
- What counts as outpatient treatment?
- Are there any kinds of outpatient treatment or tests that health insurance doesn’t cover?
- How do limits work with my excess?
Does health insurance cover outpatient treatment?
Health insurance will cover outpatient appointments so long as you’ve chosen outpatient cover. Depending on the level you choose, you may have a limits on how many appointments you can have, or a cost limit.
Outpatient treatment is when you go to a hospital, consulting room or clinic for treatment and leave again straight afterwards – so you don’t stay in as a day patient or overnight. Outpatient cover varies between providers, but usually includes consultations with specialists, tests and scans, and appointments with physiotherapists, osteopaths and chiropractors.
How does an outpatient limit work?
With most health insurance, you can choose your level of cover for outpatient appointments. Usually outpatient limits are per person, and are yearly – so when you renew, your limit will reset.
It may be called an outpatient allowance, or an outpatient benefit.
There are three ways your outpatient cover may work:
There may also be a limit on GP-referred therapies (physiotherapy, osteopathy and chiropractor treatment).
If you buy a new AXA Health Plan, you can choose to have a specialist consultations limit of three consultations, or no limit. If you need physiotherapy, osteopathy or chiropractic treatment, there’s a limit of 10 sessions. (If further sessions are required, this would need a specialist referral.)
What could your outpatient limits be?
When your outpatient limit is an amount, like £1,000 per policy year
- Any treatment you have will come out of the outpatient limit.
Example case:
With an outpatient limit of £1,000, you could have:
- A specialist consultation to discuss symptoms
- Some blood tests
- A follow-up consultation to discuss results.
So long as this all adds up to less than £1,000, your plan should cover the costs.
When your outpatient cover has a limit on the number of specialist consultations per policy year
- Each specialist consultation you have will come out of the specialist consultations limit, even if they are with the same specialist every time.
- It doesn’t matter if the appointment is before surgery, or a follow-up afterwards.
- If you buy a new AXA Health Plan, you can choose three specialist consultations a year or unlimited.
Example case:
With a specialist consultations limit of 3 consultations, you could have:
- A first consultation to discuss your symptoms
- An MRI test and some blood tests (these don’t usually come out of your outpatient limit
- A second consultation to discuss the results
- An operation (if your membership covers this)
- A follow-up third consultation after the operation.
As you’ve had three consultations, your health insurance should cover the costs.
When you have no outpatient monetary limit
- You can have outpatient specialist consultations, tests or treatment you need, so long as your health insurance covers it – there won’t be a limit.
- The outpatient diagnosis and care option with AXA Health Plans doesn't have an overall monetary limit on treatment.
What happens if I don’t have any outpatient limit left, but still need treatment?
If you run out of outpatient limit and still need outpatient treatment, you’ll need to either pay for this yourself, or ask to be transferred to NHS care.
Like other insurers, we'll warn you that you're approaching your limit, so you can decide what to do.
What counts as outpatient treatment?
Outpatient treatment usually takes place in a hospital or consulting room. You aren’t admitted as an in-patient or day-patient, and don’t need to stay overnight.
Outpatient cover differs between insurers, but it will usually cover the cost of:
- Consultations with specialists (you may have a separate limit for these)
- X-rays, ultrasounds and blood tests
- MRI, CT and PET scans
- Physiotherapy and other therapy sessions.
Your insurance will not usually cover the cost of drugs you’re prescribed as an outpatient.
Are there any kinds of outpatient treatment or tests that health insurance doesn’t cover?
Outpatient cover won’t usually pay for:
- Emergency treatment that you have at A&E – the NHS is best set up for this.
- Treatment that your GP, optician or dentist would usually carry out – this is primary care, which health insurance doesn’t usually cover.
Many health insurance plans also won’t cover the following – but check your health insurance terms and conditions:
- Outpatient tests that your GP refers you for (rather than a specialist)
- Routine childbirth and pregnancy
- Prescriptions, drugs or dressings – even if they’re used as part of your outpatient care or if you’re given them to take home after treatment.
How do limits work with my excess?
If there's an excess on your plan, this is the amount you’ll pay towards your treatment each policy year.
An excess works differently depending on the health insurance you choose, but here’s an example of how it generally works:
- Rhea has an outpatient limit of £2,000 and an excess of £500.
- Rhea’s first treatment this year costs £1,200. She pays £500 of this, because she has to pay her excess.
- However, her provider will still need to take £1,200 off her outpatient limit, even though she paid her excess towards the treatment. This is because they take the treatment cost off the limit, regardless of who paid for the treatment.
Find out more about our AXA Health Plan or start a quote
Reviewed by Dr Corné Hurter
I was appointed Medical Director for Services and Delivery at AXA Health in January 2026. Before then, I spent 10 years working at HCA UK in roles such as Medical Director for Care Transformation and Director of Medical Services.
During my time at HCA UK, I was part of the first cohort of doctors to complete a Medical Management and Leadership Master’s degree.
I’m passionate about patient care and innovation that supports care delivery to patients in a manner which is sustainable and value-driven.
I’m excited to be using my experience to make a real difference to members and the service we provide.