Claiming
Making a claim
How do I make a claim through the SimplyPlan app?
Making a claim through our SimplyPlan app is the quickest and easiest way to get your money back in your account. And it's a very similar process to making a claim online through the website.
If you've not registered online yet, please head to this page to get started. If you have registered, you're ready to make a claim:
- Download the SimplyPlan app from your device's app store.
- Open SimplyPlan on your device and sign in using your details.
- Select Make a claim in the list of options available on the home screen.
- Read the declaration and, if happy, tap Agree and continue.
- You’ll be shown what you’ll need to make a claim. Once you have everything, tap continue.
- Now it’s time to upload your receipt or supporting documents. If you have a physical copy, you can choose the Take A Photo option, ensuring you capture the whole page without any blur. If you already have an image of the receipt on your phone, choose Upload Image.
If you have a digital copy of your receipt e.g. a PDF sent via email, select the Upload File option and find it on your device. Once you select it, the file will be uploaded, and you’ll be taken to the next step.
- The next step is where you add your treatment details. Select the:
- Treatment date
- Which policy the claim is being made on
- Who the claimant is
- The treatment type
- The treatment price
- And in some cases, your practitioner.
- Once you’ve filled in all the details correctly, you can click Submit Claim, and you’re done.
- Your claim will be processed, this can take up to 5 working days. You can always view your claims history and see the progress of any recently submitted claims by clicking on Claims at the bottom of your screen.
How do I make a claim through my online account?
If you've already registered, you can make a claim in minutes. If you're not yet registered, take a look at this page to get started.
To make a claim online, you'll need to sign in to your online account. You can get there by clicking 'My Account' at the top of this page.
- Sign in to your account (If you're already signed in, you can skip this step) and be on your online account homepage.
- Find 'Make a Claim' in either the dashboard or in the menu and click on it
- Read the declaration and, if happy, click 'Agree and continue'.
- The next step is to make sure you have what you’ll need to make a claim. Read what’s required and if you’re ready, click continue.
- Now you'll upload your receipt. Click the 'Upload files' button and find your the digital copy of your receipt on your computer or device; click the file, and press open. It will upload the file for you and then show a preview. If the correct file has been uploaded, click continue.
- You’re now on the 'Review details' page, where you can fill in the treatment details. You’ll need to add the treatment date, the policy, the claimant, and the treatment type. Once you select the treatment type, the field for the price will appear, and if relevant, the field for the practitioner.
- Once you’ve filled in all the details correctly, you can submit your claim, and you’re done. And that’s how you make a claim online.
- Your claim will be processed. This can take up to 5 working days. You can always view your claims history and see the progress of any recently submitted claims by clicking on My Claims on your dashboard. You will also get an email to confirm your claim has been received.
What's the best way to add a picture of my receipt or supporting documents to my claim?
The easiest way to do this is to take a photo when prompted when you click 'make a claim' on SimplyPlan. If you prefer, or have a digital version of the receipt, you can upload that instead, again when prompted in the claims journey.
There are two things to keep in mind when uploading your receipt online: file type and file size. We accept .pdf, .jpg, .gif and .png files. Just so you know, changing the name of the file does not change its type, so you'll need to use an image editor to save it instead. When it comes to file size, the maximum size for all files is 10 megabytes, and you can upload at most 6 images.
Please note: In order to upload pictures on the app, you need to allow the app access to your smartphone camera. This normally occurs as a pop-up when you first download and open the app.
When can I make a claim?
You can claim for most benefits as soon as your plan starts, but please check your Terms & Conditions if you're unsure. Any qualifying periods can be found on your Table of Cover.
For those with a Simplyhealth Dental Plan:
If you have a Dental plan, some benefits have a three-month qualifying period or exclude pre-existing conditions, and these are explained below:
Dental treatment
You can’t claim for treatment received in the three-month qualifying period.
You’re not able to claim for treatment you need within this qualifying period - which you or a dental clinician identified that you needed before you joined your plan. In addition, you cannot claim for part of a course of treatment that began before you joined the policy or during your qualifying period that is not fully completed or paid for.
Dental accident
You can’t claim for treatment that you need as a direct result of an accident that occurred before or within the 3-month qualifying period.
Dental emergency
You can’t claim for any dental appointments or dental treatment required after an emergency visit that you attended within the three-month qualifying period.
An emergency appointment for treatment you knew about/that had been identified before or within the three-month qualifying period will not be covered.
How can I submit a claim for someone else named on my plan?
As the policyholder, you can submit a claim for anyone named on your plan.
It's the same process as making a claim for yourself, just changing one field during the process. If you aren't sure how to make a claim online, we've got a digital guide explaining all the steps. When you reach the 'Review details' page, simply choose the correct claimant's name in the 'Claimant' field.
Claim status
Where can I check the status of a claim?
You can check the status of a claim through both your online account and the SimplyPlan app.
Online Account
To view your claims, sign in to your online account and click 'My Claims' from the homepage. This shows you a list of the claims you've made and their status.
SimplyPlan app
If you're using SimplyPlan, open the app and tap the 'Claims' tab at the bottom of the home page.
You'll get a list of all your claims, and you can find a more detailed breakdown by clicking on the individual claim. This includes the treatment date, payment date, the amount claimed and claim status.
What does claim status mean?
All of your claims will be assigned a status based on where they are in the journey. This means you can keep track of what's happening with your claim. Our statuses are explained here:
Claim Submitted: We've received your claim and it's with our team for processing. Claim payments typically reach your account within 10 days after your claim has been submitted.
Awaiting Assessment: We're waiting to assess your original claim or supporting documents.
Additional Information: We just need to get some information to finish processing your claim. Click ‘My Claims’ in your online account or tap ‘Claims’ in the SimplyPlan app. Click into the claim to see what information we need to support your claim. Click the “Upload Information” button to upload the required information.
Approved: Good news, your claim payment is on its way. Please note that, depending on your bank, it can take up to 3 working days for the payment to arrive in your account.
Declined: Unfortunately, we weren't able to accept your claim. If you're checking your claim on your online account, you'll find the reason we've declined your claim explained underneath the claim details. If you're using the SimplyPlan app, select the claim you're checking from the Claims tab at the bottom of your home page. Click into the claim and use the arrow to see any further information about why your claim has been declined.
How will you keep me updated about my claim?
We'll try to contact you by email first because it's faster and helps us use less paper.
If we have an email address on your account, we'll use this to let you know when your claim is ready to view in your online account or on the SimplyPlan app.
If we cannot contact you by email, we’ll write to you, but this can take a bit longer.
If you want to make sure we have the right email address for you, or you want to add your email to your account, you can do this through the 'personal details' section in your online account.
Why has my claim been declined?
When we assess your claim, we’ll check for the following things:
- If the treatment or services you’ve claimed for are covered under the terms and conditions of your plan.
- The date of your claim to make sure your policy was active at the time of treatment and you had entitlement available in the policy year it falls under.
If you're checking your claim through your online account, you'll find why we've declined your claim under 'My Claims'. You'll see a list of your claims, find the one that has been declined and the reasons will be included in the details.
If using the SimplyPlan app, click the Claims tab at the bottom of your home page. Tap the claim that's been rejected to open the claim details
Can I view old claims?
You can check your claim history through your online account or on the SimplyPlan app.
Online Account
To view your claims, sign in to your online account and click 'My Claims'. From here, you can use the filters available to find claims you've made.
SimplyPlan app
If you're using the SimplyPlan app, open the app and tap the 'Claims' tab at the bottom of the home page. You can scroll through all your old claims and use the filters if necessary.
Claim payment
When will my claim be paid?
We process all claims in date order from when we receive them, and our priority is to pay your claim as quickly as possible.
Typically an online claim takes around 2 to 3 days to process from the date we receive it. If approved, payment should then be in your bank account within 3 to 5 working days. However, when we receive higher volumes of claims than usual, it might take a bit longer.
We'll always email you when your claim has been updated, and you can check the status of your claim within your online account and the SimplyPlan app.
If we can't email you, we'll send you a letter.
How will my claim be paid?
We pay claims directly back into your bank account.
If you haven’t added your bank details to your plan, it’s easy to do so and only takes a couple of minutes; why wait any longer than you need to for your money to come back to you? This link will take you to the Bank and Payment details section within your online account.
Click the 'Change to Direct Credit' button under 'Claim Payment' and fill in the fields.
Why is my claim payment less than I was expecting?
There could be a couple of reasons for this:
- No entitlement left: When we assess your claim, we’ll check the date of it to make sure you have entitlement available in the policy year it falls under. If you’ve already used all or some of your annual entitlement for the benefit you're claiming for, we will either decline the claim or send you a payment for the entitlement you have remaining.
- Percentage payback: We also check the percentage payback for the benefit you're claiming under. It’s possible you’re entitled to 75% or 50% of the amount you’ve claimed, which could explain why you’ve received less than you expected.
Check the payback for each benefit through your online account or the SimplyPlan app. You can sign in to your online account and click My Policies from the dashboard or follow this link to take you directly where you need to be.
If you're using SimplyPlan, click 'Policy' within the app.
Scroll down to 'Entitlements' and click ‘see more’ to find the payback information for the benefit you’ve selected.
For those with a Simplyhealth Dental Plan:
If you’re claiming under your Dental Treatment benefit on a Dental plan, there is a maximum we will pay for crowns, bridges, inlays and onlays. This can be found in your Table of Cover within your online account.
