Claims FAQs

This page has FAQs about claims. We hope it gives you the answers you're looking for, but if you can't find what you need here then please call us on:

We’ve listed the most frequently asked questions about claims in one place. We hope you find the answers you’re looking for.

Am I covered?

If you're unsure about whether or not you can make a claim, please call us. We're happy to help.

Do I call you first, or get treated first?

You should always call us before organising treatments or appointments. We may not be in a position to provide cover towards your costs if you make arrangements without getting approval first. If you're not sure about how to claim, please call us – we're happy to help you.

What are exclusions?

An exclusion is a treatment or condition that a policy doesn't cover. There are standard exclusions which apply to the policy. You can find a list of these in the policy wording, which your Group Administrator holds.

Depending on your type of underwriting, that is to say Full Medical Underwriting, Continiued Medical Exclusions or Moratorium, we may apply exclusions that are personal to you rather than to everyone on the policy. Check your policy schedule and Group Member Booklet or call us for more information.

Do I need to fill in a claim form?

We can assess most claims over the phone, which means that you can concentrate on getting better. Sometimes we need more information from your GP, or details about your specialist's recommendation, but in most cases there's very little paperwork to complete.

Where can I get treatment?

If we have a network for your condition or suspected condition, we’ll tell you where you can have your treatment. If you have the extended hospital list, you don’t have to use our networks.

To see which hospital list is included on your company’s policy, take a look at your member documentation.

What is a network?

We’re developing a number of networks of facilities, specialists or other practitioners that we recognise to provide the treatment required for a specific condition or suspected condition.

By creating networks, Aviva has more control over the treatment pathway. This means we can drive better commercial deals, which helps us maintain affordable prices. What’s more, by controlling the treatment pathway we can give you greater assurance when it comes to clinical quality and treatment, which ensures we can cover more treatment before reaching any benefit limit.

Our networks are updated frequently as we work to get the best possible service for you. We regularly add or evolve networks, and sometimes – in the event that a facility or specialist is no longer suitable for a network – we may remove them. Please contact our claims team on the number below.

How does my policy excess work?

If you have a policy excess, then it will be shown on your member documentation. You'll pay this amount once a year if you need treatment. We will pay for treatment covered by the policy, minus the amount of your policy excess. We'll write to you, and ask you to pay your excess amount directly to the hospital or specialist. For example, if your excess is £100 and your specialist's fees are £1,000, then we'll pay £900 of the bill. You would pay £100 to the specialist directly. Please note that the excess applies to each person each policy year. This means that if a claim or course of treatment continues from one policy year to the next, the excess will apply again.

Is there a maximum amount I can claim each year?

No. With your company's private health insurance policy there's no limit to the number of times you can make eligible claims in any policy year. There's also no ceiling to the value of your claims for eligible private treatment at a hospital on your chosen hospital list, but there are limits to specific benefits.

Still can’t find what you’re looking for?

Give our claims team a call on 0800 158 3333.

Our lines are open Monday to Friday 8am – 8pm and Saturday 8am – 1pm.
Calls to and from Aviva may be monitored and/or recorded.

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