Private health insurance

Making a claim

If your employees need to make a claim, then we’ll do everything we can to make things go smoothly. We understand that they may not be feeling 100% when they call. Most claims can be approved over the phone, with no need for paperwork at all. It’s a four step process, but we’ll explain what needs to happen at every stage of the claim:

• When a specialist’s opinion and diagnosis is needed, the GP must make a referral to a specialist working at or from a hospital on your company’s chosen list.
• As soon as a referral has been made, your employee should call us.
• We’ll do our best to assess the claim and authorise it over the phone, if possible. If we need more information, then we’ll send out a claim form. We’ll also help your employee complete it.
• As soon as the treatment has finished, we’ll settle the employee’s claim directly with the hospital.

Over 90% of claims are approved over the phone

If we need more information, we’ll do our best to make sure that paperwork doesn’t hold things up. If we can’t approve your employee’s claim because it’s not covered by your policy, we’ll explain the details to you – although we won’t divulge any confidential medical details.

We’re here to help you

We have claims teams that have received specialist training. For example, our oncology claims department is trained to deal with the circumstances surrounding a claim for cancer treatment. We have a specialist Women's Health Unit that deals with claims unique to women: a female member of staff would be your employee’s personal contact, from start to finish. And our psychiatric team understands that dealing with an insurance claim may be difficult at this time.

Back-Up claims, if your policy has GP-referred services

If you have our Back-Up service included as one of the benefits on your policy, there’s no need for your employees to see a GP if they’re suffering from back or neck pain. We can often provide early intervention for these common problems – helping your employees recover as soon as possible, and reducing the amount of time they need to spend off work.

• If you have Back-Up, your employees should call us as soon as they have back or neck pain
• We’ll let them know if the condition can be referred to our Back-Up service
• Your employees will then get a call-back, to schedule a telephone assessment with our back experts
• If appropriate, the assessor will make a referral to a local physiotherapist. The physiotherapist will make contact directly within 24 hours and arrange treatment within two working days.

Don't worry; our advisers will always let your employees know if any of the treatment is not covered under your policy and a dedicated case manager will stay in touch to check on progress…

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