Small-to-Medium Enterprise Private Health Insurance Claims

Making a claim

Our in-house clinicians work closely with our claims teams to understand your employees' clinical needs. Together, they use a proven triage process that identifies routine pathways (treatment for things like hernias and cataracts) and separates them from the more complex conditions such as heart and mental health conditions, as well as cancer. And if it’s a more complex case, one of our specialist claims teams will provide dedicated case management.

Employees can rest assured, knowing that they’ll be talking to experienced staff who can empathise and understand what they're going through.

Expert Select, our core route to treatment

Our Expert Select hospital option is designed to help your employees find the most suitable specialist and hospital for their condition, giving them a range to choose from.

Backed by our clinical expertise and excellent customer service, when an employee speaks to us, we’ll offer them a choice of medical facilities who provide quality treatment at the time that they need to make a claim. All will be within 25 miles of the employee so local to them, offering access to a number of specialists. 

We base our recommendations on their diagnostic or treatment needs to make sure they get appropriate quality treatment options every time. This gives employees an informed choice based on their clinical need.

Making a claim with Expert Select

Step 1

Step 2

Step 3

Step 4

Additional support with Networks

Networks provide an even greater level of assurance - quality guiding for specific condition types such as cataracts or hip and knee conditions. We offer a network of treatment units who specialise in providing treatment for these specific conditions.

Networks are a way of clinically selecting providers who meet our high standards in delivering care for your employees and are updated frequently as we work to get the best possible service for our customers. Whilst not mandatory, by using one of our networks, we can offer greater assurance when it comes to clinical quality and treatment, and ensure that more treatment can be covered for the same cost.

More information on networks can be found at aviva.co.uk/health-network

Making a claim on our networks

To benefit from our networks, employees will need to obtain an open referral from their GP. This means that the GP specifies the required area of medicine (the speciality and sub-speciality), but not where you should go for treatment, or who you should see. 

Employees will then follow the claims process detailed below in the 'Making a claim for all other conditions and hospital lists'.

BacktoBetter - making a musculoskeletal claim

Making a claim through the BacktoBetter service couldn't be simpler.

If your employees ask you to explain how to claim through the BacktoBetter service, it's just three steps:

Step 1

Step 2

Step 3

Mental Health Pathway - making a claim

Your employees don't need to speak to their GP before making a claim.

Step 1

Step 2

Making a claim for all other conditions and hospital lists

Our documents are designed to help employees make a claim easily and the majority of cases can be approved over the phone. 

If employees have a Hospital List option, they should always telephone our customer service helpline as detailed below, prior to receiving any treatment. We can then confirm that the hospital they've selected is recognised by us to provide the type of treatment they require and for the condition that requires treatment.

There is a 4 step claims process.

Step 1

Step 2

Step 3

Step 4

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 eligible under the policy, we'll explain to them why it's not covered.

How our BacktoBetter service works

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Awards

Defaqto 2020 Group PMI

Contact us

Want to talk about Solutions?

Call our Sales Support team for a quote:

0800 158 5182

Monday to Friday 9:00 to 17:00

Calls to and from Aviva may be monitored and/or recorded.

Contact our claims team:

0800 158 3344

Monday to Friday 8:00 to 18:30

Saturday 8:00 to 13:00

Calls to and from Aviva may be monitored and/or recorded.