How to make a claim

Our Claims Helpline is here to help you whenever you need to make a claim. We will always try to make the process as simple as possible and our team will guide you from start to finish, answering any questions or concerns you may have about your claim or treatment in a caring way, quickly and efficiently.

If you are feeling unwell or if you are suffering from any injury, you must first consult your General Practitioner (GP).

Consulting your GP

If your GP suggests you need treatment from a Specialist or a practitioner, tell your GP that you have private medical insurance and that private treatment would be preferred.

Calling our Claims Helpline - 0870 444 8291

You must then call our Claims Helpline for advice on whether your condition and treatment are covered, even if in the end the treatment is not needed.

We will check that you have enough cover, based on the information you give us when you call, and will issue a personalised claim form to your home address.

Issuing a claim form does not guarantee that your claim will be accepted. When we get the completed claim form, it may give us extra or different information to that previously given. If this happens, we will contact you straight away to let you know. Any claim must be eligible and in line with our Schedule of Procedures where it applies.

If you would like written assurance that we will cover a particular treatment, before you start paying for extra or expensive items, we will be happy to provide this once we have received your completed claim form.

Completing your claim form

When you receive your claim form, check it carefully to ensure that all the pre-completed details are correct and then ask your GP to complete their section of the claim form where indicated.

Claim forms in respect of treatment for an accidental dental injury will need to be completed by your dentist and be supported by all relevant dental x-rays.

Attending your first appointment

When you attend your first appointment with the Specialist or practitioner, take the claim form with you and ask them to complete the appropriate section.

Following your first appointment, send us your completed claim form together with the original invoice from the Specialist or practitioner. Often the Specialist, practitioner or hospital will do this for you.

Returning your claim form and invoices

You must send us your completed claim form and invoices as soon as you can, but no later than 6 months after the treatment date otherwise we may not pay your claim. If you are claiming either the NHS or the maternity cash benefit, you must send us your claim within 3 months of the event.

Specialist visits

If you are visiting a Specialist, we suggest you also take your policy documents with you as these contain all the information that the Specialist will need to know about your cover.

The Specialist will discuss with you the best way of treating your condition - this may include the possibility of an operation in hospital. When you have more information about the treatment the Specialist is recommending, you must contact the Claims Helpline again so we can check that the treatment is covered by your policy. This is especially important if an operation is likely as the associated costs may be significant.

Hospital treatment

If you go to a hospital for treatment, they will ask you for your insurance details, including your policy number and the name and address of your insurance company. Please give these details to the hospital as they will use this information to send their invoices straight to us and we can then settle them directly with the hospital.

We prefer to settle all invoices directly with the providers, but if you pay any invoices yourself, you must send us the original invoices, clearly receipted, along with a written request for reimbursement which will always be in the form of a cheque payable to you.

You will be responsible for payment of any excess or co-insurance contribution directly to the Specialist or hospital as advised by us.