FAQs - Health Cash Plans

My GP wants to refer me to a Specialist – how do I claim?

All claims for Specialists Consultations, Diagnostic Tests, Therapy Treatments and Eye Care must first be pre-authorised by phoning the Claims Line who will make direct settlement of your approved bills.

I’ve had Repetitive Strain Injury for years- can I claim for physio?

ALL pre-existing conditions are covered. It does not matter how long you have had the condition for or what it is. Incidentally, if the physio does not help, there are five other therapies you can try.

My Doctor says I need a hysterectomy, and I am considering applying for your plan. Can I claim any cash when I go into hospital?

No. For the period of 2 years from the start date of the policy, we will not pay any hospital related benefits (hospital in-patient and day surgery benefits, recuperation or home help benefits), which arises from any medical or other condition of which you are aware of or which is being investigated, at the date of application.

Does the dental benefit cover check ups as well as treatments?

Yes. Up to the appropriate maximum can be claimed for dental or orthodontic treatment, every benefit year, towards the actual costs you have incurred for NHS or Private dental treatment. There is no minimum claim amount. You can claim for any treatment including check ups. There can be any number of claims up to the maximum benefit level. Claims cannot be made for purchases, for example toothpaste, brushes, denture adhesive, purchased from a dentist or other supplier.

Insurance premiums paid to a dental care contract scheme cannot be claimed back although if you are a member of such a scheme additional costs directly incurred, for example laboratory work, for which you might have to pay, can be claimed back.

I know I need extensive dental treatment and I have the lowest level of cover. Can I upgrade and use the extra benefits right away.

An existing member can upgrade to a higher benefit level and will be able to claim the enhanced benefits 3 months after the payment of the first contribution at the higher level. Transfers to a lower level of cover are not normally permitted especially after an upgrade and an additional level of claiming has taken place.

Can I get some glasses from my usual family optician?

No. To give the best value to all our customers we have negotiated a national voucher system with a top high street chain of opticians. It also means that you do not have any cash outlay.

Can my eye care benefit be used to pay for contact lenses?

Yes. Specsavers (who is the current voucher provider) will let you use the voucher for any purpose. You can have your eye test and then use it towards the products which you prefer.

Do I have to be referred by my GP for therapies?

No. Physiotherapy Treatment should be must be undertaken by a:
1. Chartered (M.C.S.P.) or State Registered (S.R.P.) Physiotherapist.
2. A member of the General Osteopathic Council (G.Os.C.)
3. A member of the General Chiropractic Council (G.C.C.)
This benefit is also paid when you need complementary medical treatment for a medical condition for which you have consulted your GP but you do not have to be actually referred to the complementary practitioner. If the claim relates to chiropody treatment, treatment must be undertaken by a State Registered Chiropodist (SRCh), a member of the British Chiropody and Podiatry Association, the Institute of Chiropody and Podiatry or the Society of Chiropodist and Podiatrist.

My hearing aid is not working properly – can I claim for repairs?

Yes. But not for batteries. Must be a registered Hearing Aid Dispenser.

My son needs arch supports in his shoes – is he covered?

Yes. His claims allowance will be 50% of your annual maximum or 100% if your spouse or partner is also a policy holder.

I have had treatment for cancer, how can a plan help me?

Private consultations and tests could be available. Surgical appliances; Examples of items covered within this benefit included medically prescribed … mastectomy bras and surgical wigs.

I have had major surgery and am unable to do housework. Can I claim home- help ?

Yes. You can claim if you have incurred a cost for charges made by a local authority or approved local authority supplier, after assessment by a local authority, for home help assistance.

I am having serious personal problems, can you help?

The 24 hour help line is available 365 days a year to help with the following : legal issues, relationships, tax, employment, benefits and welfare, bereavement and the legal issues following, medical, stress , debt, crisis counselling, and addiction.

My partner and I want to adopt a child, can you help?

A grant is paid for each child born to or adopted by a member or member’s partner. Adoption claims are not permitted in the case of adoptions where the adoptive parent is the partner or spouse of a natural parent.

I understand that my children are also covered, to what extent?

Children are regarded as dependent up to the age of 18 whilst in full time education. Dependent children are entitled to claim up to 50% of the adult benefit entitlements as listed in the benefit table up to the actual cost of treatment incurred. When both parents are members the joint entitlement will be 100%.

I have been in hospital for 18 days, how much can I claim?

If you are not claiming for a pre-existing condition in the first two years of membership you will get your daily hospital rate x 18 and a recuperation bonus ( the bonus only claimable once a year)

I’m not ill but can I claim for a medical check-up?

No. Your GP will only refer you to a Specialist if he suspects there is a medical problem which he cannot solve, and you can then claim for that, and tests if required. You can of course claim for the Health Screen which is an on-line or paper-based medical assessment.

My G.P. said I need blood tests - can I have them done privately and make a claim ?

No. You can only claim for a private blood and other tests if ordered by your Specialist as part of his investigations.

I have had a course of Physiotherapy which has not worked. Can I try Acupuncture now for the same condition?

Yes. You can try any listed therapy treatment up to your annual benefit maximum.

I forgot to send in the receipt from the Dentist for last month’s treatment. Can I send it in now?

Yes. As long as all claims are submitted within three months of treatment.