Making a claim - NHS Plus Insurance

Claims procedure

This is a legal document and may not be altered in any way.

Medical Treatment

Visit your GP

If your GP is able to provide all the treatment that is necessary, no further action will be required as the services provided by a GP are not covered under the policy.

If a specialist referral is medically necessary you may:

(a) see the specialist under the NHS, or,
(b) arrange a private specialist consultation at your own expense.

Please note that in either event this policy does not cover you for out-patient or day-patient treatment. Please inform your GP as soon as possible, so that your details may be passed to the specialist and an appointment made.

If the specialist recommends that in-patient treatment is required, there are two courses of action available for which cover is provided under this policy.

NHS Treatment

If treatment is available under the NHS within 90 days of a specialist deciding that it is necessary we will pay a cash benefit for each night you spend in hospital as an in-patient. All treatment will be undertaken under the NHS, so no other costs will be involved.

Private Treatment

If treatment is not available under the NHS within 90 days of the specialist deciding that it is necessary, you may choose to have the treatment undertaken privately. We will arrange for the treatment to be undertaken in hospital approved by us, within a 30 mile radius of your home.

In either event, under the terms of your policy, it is essential that any treatment is pre-authorised by us.

Please therefore contact the Universal Provident claims helpline on 0844 8730 900 before you arrange any in-patient treatment. When you call the helpline you should have the following information available:

  • your policy number, 
  • the condition to be treated, 
  • the date you became aware of the condition, 
  • the name of your GP and the specialist you have been referred to, 
  • the treatment (or investigations) required.

Based on the information you have provided, we will confirm that :

  • the condition (as described) is covered by the policy, and
  • the specialist to be used is approved by us, and 
  • the condition and the treatment do not conflict with any of the policy terms.

Please note that any authorisation given at this stage is subject to confirmation upon receipt of a fully completed claim form.

If you are eligible for private treatment, we will make the necessary arrangements for the treatment to be undertaken at a hospital within a 30 mile radius of your home.

We will then send you a claim form, part of which will have been completed from the information provided. Please follow any instructions given to you when the claim form is issued and ensure that the form is completed by the correct person. If subsequent information contradicts the information upon which our pre-authorisation was based, your claim may be invalidated.

Income Benefit

Please contact our claims helpline within 30 days of the start of your disability. We will issue an appropriate claim form for completion. We will require medical certificates from your GP confirming your disability for the full period for which benefit is being claimed.