How to Make a Health Insurance Claim

What is private health insurance

Private Health Insurance allows you to pay for private, non-emergency medical care should you wish to get fast-track access to consultancy and treatment. Some NHS procedures are subject to long waiting-times; private healthcare can help to bypass this. Sometimes, policies also allow you to choose the date, location and specialist for your treatment. Should treatment require an overnight stay at a hospital, most UK policies cover a well-equipped, private room.

When to use private health insurance

What you can claim for via your health insurance policy ultimately depends on your plan details and underwriting. Though, in most cases, UK PMI holders can claim for the following;

•    Appointments with health specialists
•    Seeing private doctors or consultants 

•    Certain treatments and surgery
•    Care and treatment at a private facility/hospital 

•    Diagnostic consultations and tests
•    Certain specialist drugs that aren’t available on the NHS

Not all health insurance policies cover emergency treatment, care for existing chronic or terminal conditions, cosmetic surgery that is not a medical necessity, nursing home care or alternative therapies. 

Your policy will not cover medications, weight-loss surgery or preventative tests. Typically, dental, vision and hearing are not included under a health insurance policy, unless additional coverage is taken out.  

Our step-by-step guide below shows you how to make a claim, should you need it. If you find your health insurance with us – we can provide you with advice, free mediation and annual policy checks. 

1. Going to your GP and getting a referral

Health Insurance claims must start with a referral by a GP for the claim to be deemed as valid. It is a good idea to contact a member of our claims team at this point to verify your policy covers your treatment or illness. We can then provide you with a claim form. 

You will need both your GP and specialist to complete and sign the form. Sometimes, your GP may charge a small amount for this service. The information provided will inform us of the cost of your treatment, so we can calculate how much of the total cost your policy covers and whether you will be required to pay any excess. We will also be able to determine whether your expenses will be met immediately, or whether you will be required to temporarily cover the costs until we can refund the money at a later date. 

2. Checking you are covered

Every health insurance plan is different – even ones provided by the same insurer; this is because different types will cover different specialists, treatments and services. Your plan may be a personal or family plan, a basic policy or one offering comprehensive cover. To find out more about what your particular plan covers, you can either log into your online account or speak to us to get a summary of your coverage.

3. How to let your provider know/arrange payment

A claim form is simply a document that provides us with some clear details about your ailment and what treatment was needed. The more information provided, the better we will understand what is required in order to process your claim. Our forms have clear instructions on how to fill out the paperwork and the nature of the information we would like you to provide. 

Note; If you run out of space when filling out the form, additional pages can be attached.

Some information we are likely to ask may include:
•    Identification – full name, address and date of birth
•    Insurance details – policy and group number
•    Information about your condition
•    Healthcare provider details – name of doctor and practice/doctor’s address
•    Expenses already paid by yourself that would be covered by your policy

How to make a medical claim
4. Scan or photocopy your claim form

Before sending us your claim in the post, it is a good idea to make a copy of the form. We recommend that the form is sent recorded delivery - this way, you will be able to track your document and know that it has arrived with us safely. 

5. Call a member of our friendly team

Once ready to send your claim you can call a member of our friendly team (0808 10 18 999) to check that you have covered everything needed to make it a successful and smooth transition. 

By ensuring your paperwork and documents are fully in order we can cut out any additional time needed to source missing pieces of information. Afterwards, simply send your documentation via post, and we will do the rest! 

Providing all is in order, we will settle your claim and pay the bill. Should we require any additional receipts or information, our specialist team will contact you. Similarly, we will contact you if you need to pay part of the bill (e.g. if you have an excess).

Our claims team aims to keep you informed at every step of the way and will help to provide you with any information you may require.

We're here to help

If you would like to find out more about how to submit a claim or have any other questions about health insurance, please visit our contact page.

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