Making a claim - PremierCare Insurance

CLAIMS PROCEDURE

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

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 your GP refers you for further treatment, advise the GP that you have private medical insurance so that details can be passed to the specialist and an appointment made.

Phone the Universal Provident helpline before you have further treatment. Under the terms of your policy all treatment must be pre-authorised by us.

It is therefore essential that you call the helpline on 0844 8730 900, before having further treatment. When you phone, you must have the following information available:

  • your policy number,
  • the condition to be treated,
  • the date when you first became aware of the condition,
  • what treatment is planned at this stage,
  • the name of the specialist, physiotherapist or complementary medicine practitioner you have arranged to visit, and
  • the hospital to be used (if known or if applicable).

Based on the information you provide, we will confirm that:

  • the condition (as described) is covered by the policy,
  • the hospital to be used is approved by us and is within your chosen hospital scale,
  • the specialist to be used is approved by us,
  • the condition and treatment do not conflict with any of the policy terms, and
  • you may proceed to the next stage of treatment.

Please note that any authorisation given at this stage is subject to confirmation upon receipt of a fully completed claim form. We will then send you a claim form, part of which will have been completed from the information provided. If subsequent information contradicts the information upon which our pre-authorisation has been based, your claim may be invalidated.

When you receive the claim form

If treatment is to be provided by a specialist, ask your GP to complete the claim form and return it to us. We will then provide a claim form for the specialist to complete and return to us.

If treatment is to be provided by a physiotherapist or complementary medicine practitioner, ask your GP to complete Section C and return it to us. We will then send a separate claim form to the physiotherapist or complimentary medicine practitioner to complete and return to us. If treatment is in a NHS hospital (without charge) and you only intend to claim the NHS Cash Benefit, ask your GP to complete Section C and return the form to us. We will then send a separate form to the senior registrar to complete and return to us.

You must phone the helpline after the initial consultation/treatment so that any further tests or treatment can be authorised.

Once the claim form is complete

Return the claim form to us together with any accounts you may have received for treatment already provided. At this stage we will confirm the eligibility of any treatment planned. Any additional accounts should be sent to us as soon as you receive them. A further claim form will not be required unless:

  • you are referred to a new/different specialist, or
  • you have further treatment as an in-patient, or
  • there is a gap of more than six months between treatments.

Payment

Wherever possible we will pay all bills direct to the provider of the treatment or services. You must advise the provider of your insurance details before you have the treatment so that they can send their bills to us. You must also check whether direct settlement is available for out-patient treatment. If you have paid for any treatment yourself, we will reimburse you. If your policy is subject to an excess, we will deduct the excess from the appropriate bills and advise you to whom the excess should be paid.