Frequently Asked Questions

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

All claims for Specialists Consultations, Diagnostic Tests and Therapy Treatments must first be pre-authorised by phoning the Claims Line who will make direct settlement of your approved bills, removing the need to lay out the cash yourself and claim it back.

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

Yes because ALL pre-existing conditions are covered. It does not matter how long you have had the condition or what it is. Incidentally, if the physio does not help, there are many 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, the hospital-related benefits are only for new medical conditions that occur after joining. For the period of 2 years from the start date of the policy, you cannot claim any hospital related benefits (hospital in-patient and day surgery benefits, recuperation or home help benefits), which arise from any medical or related condition of which you are aware or which is being investigated at the date of application. After 2 years you can apply to the Underwriters to review the exclusion. At their sole discretion this may be removed or continued.

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

Yes. Up to the appropriate maximum can be claimed every benefit year for dental or orthodontic check ups and treatment whether NHS or Private. There is no minimum claim amount and 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?

Yes. You can go to any optician of your choice for eye tests, glasses or contact lenses. And we cover laser eye treatment as well!

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

Yes. Your sight test will be the date used for your first claim for contact lenses if you are a wearer of disposables.

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

No. However, Therapies 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, unlike many other plans. You must visit a registered Hearing Aid Dispenser for the hearing aid purchase or repair. You cannot claim for batteries.

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

Yes, under the Surgical Appliances benefit provided he is registered on your plan and is under 18 and in full time education. He is entitled to claim up to 50% of the adult benefit entitlement up to the actual cost incurred. If your partner is also a member, your son's entitlement will be 100%.

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

Amongst all the benefits provided, Private consultations and tests would be available, Therapy treatments could relieve symptoms, Surgical appliances could be claimed; examples of items covered within this benefit include medically-prescribed mastectomy bras and surgical wigs.

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

Yes, as long as you were hospitalised for a new medical condition after starting your plan. You can claim for home help assistance if you have incurred a cost for charges made by a local authority or approved local authority supplier, after assessment by a local authority.

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, medical, debt, identity theft fraud, stress, 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?

Up to 5 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 partners are members the entitlement will be 100%. Children are regarded as dependent up to the age of 18 whilst in full time education.

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

If you are not claiming for a pre-existing condition you will get your daily hospital rate x 18 and the 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 needing investigation .You can claim for that, and tests such as x-rays, scans and blood tests if required.

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 the date on the receipt.