FAQs for all plans


Find answers to some of the questions that are frequently asked by our customers with individual or family cover.
We've split them into the following categories.

Administering your policy Claiming and troubleshooting Self service portal Benefits and entitlements SimplyConsult app

Administering your policy

When does my cover start?

You’re covered from your policy start date, for treatments had on or after that date. This is subject to any relevant qualifying periods which can be found in your policy handbook.

 

Is there a "cooling off" period?

You have a 14 day ‘cooling off’ period from receipt of your policy documents.

We’ll refund the premium for the cooling off period. However, we will deduct the costs of any claims paid during that time. If the cost of your claims is greater than the premium, then you won’t be entitled to a refund.

What is the duration of my cover?

Your cover starts from the date that we include you on the policy. It then carries on until your renewal date. It will carry on from one renewal date to the next, until either you, your employer, or Simplyhealth cancel it.

Is this private medical insurance?

No, our health cash plan offers money back towards everyday healthcare costs, like optical and dental bills, up to annual limits. We let you choose your own treatment providers – as long as they're a registered practitioner

Can I change my level of cover?

You can increase or decrease your level of cover once during your renewal year. If you do decide to change your level of cover, you will be unable to change it again until your next renewal date.
 

Please be sure to check your policy documents. Some plans do not have renewal dates. In which case, if you do change your level of cover, you then need to stay on the same level for at least 12 months. If you’re unsure, feel free to contact us.
 

Your health cover should remain useful, and right for your needs. We recommend you review your plan on a regular basis. Please let us know any significant changes to your requirements.

Can I add members of my family to my plan?

You can add your partner, providing they are:

  • permanently living with you
  • aged 79 or under.

They will have their own entitlements to claim.

Our policies can cover up to four children under the age of 18. The benefit entitlement and upper age limits of the children may vary, so please be sure to check your policy terms and conditions.

You should also check your policy documents if you are wanting to cover your parents or siblings. Our plans differ in who can be covered, and how many people can be on the plan. If you’re unsure, feel free to contact us.

What happens if I have more than one Simplyhealth plan?

You may decide to take out a cash and dental plan, for example. Or have an additional plan provided by your employer. In any case, you’re welcome to claim on either policy, up to your maximum entitlements. You will not be able to claim under both policies for the same treatment. 

Does cover continue when I reach 79?

Yes. You keep your policy for as long as you need. However, you cannot increase your level of cover after your 80th birthday. But you’re welcome to decrease, if you so wish.

Can I use my spouse or child's entitlement, if they don’t use it?

No, they're specific to each person named on the policy. If you've used up yours, don't worry, everyone’s entitlements reset annually, on your renewal date.

Can people on my plan be on different levels?

No, everyone who's on the plan will be on the same level as the policyholder. 

When do my benefits reset?

Your entitlements begin on your policy start date, then reset again on your renewal date. Your summary of cover will confirm the dates for your policy year, or you can find them on your online account.
 

If you have a plan through your employer, your benefits will reset on the group renewal date. This date can be found in your summary of cover.

What happens if my personal details change?

If you have a change of address, email, bank account or anything, you can update these on your online account. If not, you can call in, send us an email, or start a Livechat. All of these contact details can be found here

I have a cash plan through my employer. What do I need to do if I'm leaving my workplace?

You can apply for a personal cash plan through Simplyhealth, to ensure you always have cover. Call our Customer Options team on 0370 908 3304 to discuss the available choices.

Who do I need to call?

To discuss an existing cash plan, call: 0370 908 3481
 

For queries regarding your dental plan: 0370 908 3476
 

If you’d like to discuss cancelling your cover with us: 0370 908 3304
 

Or to speak to our Telesales team about setting up new cover: 0330 102 5356

How do I make a complaint?

Our goal is to provide the highest levels of service and care at all times. We are customer driven, and always keen to improve. We may not always get it right, and if this happens we want to hear from you. You’re welcome to raise any concern, complaint or recommendation you have. To get in touch with our Customer Services team, you can:

  • call 0370 908 3481
  • send an email to [email protected]
  • start a Livechat on our website
  • write to:
     

Simplyhealth Customer Relations
Hambleden House
Waterloo Court
Andover
Hampshire
SP10 1LQ

We can send full details of our complaints procedure upon request.

How do I change my email address online?

This is under ‘Security settings' on your online account, it also doubles up as your username.

 

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Claiming and troubleshooting

When can I claim?

You can start claiming straight away, for treatment had on or after your start date. This is subject to any relevant qualifying periods, or exclusions which can be found in your policy handbook.

How do I make a claim?
  1. Attend your healthcare or dental appointment and pay as usual, ask for a receipt
  2. Upload your receipt and submit your claim online
  3. Sit back and wait for the payment to appear in your account. Payment is usually made within 3-5 working days


What does the claim receipt need to include?

To make a claim on your cash plan you will need a full itemised receipt which shows:

  • the name of the patient
  • the details of the practitioner or establishment
  • the service or treatment that they have provided
  • the date of the service or treatment
  • the amount paid for that service or treatment
     

To make a claim on your dental plan you will need to request from your dentist a statement of accounts which clearly shows:

  • the name of the patient
  • the details of the practitioner or establishment
  • the service or treatment that they have provided
  • the date of the service or treatment
  • the amount paid, itemised to show the cost of each individual treatment
     

There may be instances where you may be asked to provide more information, such as your dental records.

Why do I have to pay a hospital fee for completing my claim form?

Some hospitals may charge you for the completion of claim forms. We don’t cover the cost of this charge. Instead, we accept claims submitted with a hospital discharge letter. You should be provided with one, but can ask the ward staff if necessary.

My claims are paid by cheque. Can they be paid straight into my bank account?

Absolutely, we can pay claims straight into your bank account. It can even be the same account you use to pay your direct debit.
 

To add your banking details log in to your online account. Under your selected health plan, complete the bank and payment details form. We'll do the rest.

When I click ‘Make a claim’ I am presented with another log in page?

Try closing down your browser and starting again.

File size is too large?

You can try cropping the image down to size. Or change it to black and white. 

I can’t claim or find my claims history?

Double check you've selected the right policy number you wish to view.

Why is the claim I just made on SimplyPlan not visible on my online account or vice versa?

Submitted claims will appear on your online account (and the SimplyPlan app) once they are processed, which can take up to 3 working days.

 

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Your benefits and entitlements

What can I claim for?

Our plans let you claim money back towards everyday healthcare costs, such as a dental check-up. What you can claim for, and the amounts you can claim, will depend on your plan type and level of cover.
 

You can see your personal entitlements in your online account. You can also access your policy documents, and visit the 'My entitlements' page for a quick overview of your cover.

What are the limits on my plan?

To see your personal entitlements, login to your online account, and visit the 'My entitlements' page.

Can I pick and choose benefits to suit my needs?

It’s a set plan, so you’re covered for the benefits listed. You're unable to add or remove anything.
 

Your cover should remain useful, and right for your needs. We recommend you review your plan on a regular basis and if needed let us know any significant changes to your requirements.

Can I carry over my unused benefits into next year?

No, your benefits are set per claiming year.

Can I submit claims to use different year entitlements?

You’re welcome to submit claims whenever you can. However, we pay claims by the date of treatment, not the date we receive them.

 

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Self service portal

Am I registered for online self service already?

We don’t set up self-service accounts automatically. But doing so is quick and easy. Visit our Home page, click on the login button and select register. You’ll need your policy number, a few personal details and an active email address.
 

However, if you are a returning customer, it’s possible that your previous login will still work.
 

If you get stuck at all, please contact our customer services team.

How do I unlock my account?

Your account will become locked if a login is input incorrectly three times. First, reset your password. Close your browser and then try again. If that doesn't work, try clearing your cookies. (See our privacy and cookies pages for assistance.) You can speak to our customer services department if you need any help.

 

Where do I find my entitlements, claims history and policy information?

Your policies are listed in the top left menu. Click one, to see all info relevant to that policy.

Why do the benefits listed on the website differ to those shown in my account?

Our website displays the current Simplyhealth plans. These may differ from policies sold in the past. The correct details for your policy can be found on your online account. 
 

If you'd like to discuss switching your plan, you're welcome to call our Customer Options team on 0370 908 3304.

How do I login?

You need to have registered for an online account. This is simple to do on the webiste. Just visit https://login.simplyhealth.co.uk/register.


Once registered you can login here. This can also be done by clicking the login button at the top right of the page. You’ll need your username and password to access your account. 

Can I download a claim form?

We don’t currently have the facility to download claim forms. You can claim online, without having to post anything. Just take a photo or scan of your receipt, and submit it through the ‘make a claim’ process. 

Benefits and entitlements


Can I claim for Personal Accident benefit online?

No, if you would like to make a claim under this benefit please contact our Customer Services team on 0370 908 3481.

Why do the benefits described elsewhere on the website differ to those shown under my account?

Each plan has different benefits, so it is possible that the plans described elsewhere do not match yours. To see what benefits your plan entitles you to you should look at your Benefit entitlements page and consult your Terms and conditions. Any benefits detailed elsewhere on the site may have different conditions to yours.

Why do the benefits listed on the website differ to those shown in my self-service area?

The benefits listed on the website are for the current version of Simply Cash Plan, Simply Cash Plan 70+, Simply Dental Plan and Simply Personal Health and these may differ from policies that we have sold previously either as Simplyhealth or one of our legacy brands (HSA, BCWA, LHF or Healthsure). 

The correct benefits, entitlements and exclusions for your policy can be found in your self-service area either under Benefits or within the Terms and Conditions document.

Payments

 

What can I do if my claim has been rejected?

Within your claims history you can expand the record for that particular claim and see the reason it was rejected.

Why do some of my claims have details about the rejection and others don't?

For all claims sent to us by paper we simply record whether the claim has been approved or rejected.  For claims you have submitted online we provide you with all of the details of your claim payment or rejection reason via your Online self service area and this information is held in your claims history page.

Why is my claim payment less than I was expecting?

If your payment is less than you were expecting please check that the following do not apply to your claim:

  • Percentage repayments - some percentage payments vary between plans and different levels.  Please check your Benefits for the percentage paybacks your plan entitles you to
  • Benefit entitlement exceeded - you may have made a claim that exceeds the remaining amount you can claim within that claiming year

If you none of these apply or you are still unsure please contact us.

Making a claim online

Why can I not claim for everything under my plan?

Depending on your plan there may be a small number of benefits that you are unable to claim for online due to the information required to settle that claim. If you can not see the benefit you wish to claim against under the Treatment type dropdown on the claims page, you need to request a claim form and complete it as you normally would.

Why can I not claim for Private Medical Insurance?

Our Simply Personal Health and other PMI products work differently from our cash plans and we like to talk to you to ensure that you are covered for the treatment you require, so these types of plans are not currently available for online claiming.

What if I can't upload an image?

If you are encountering problems uploading an image please ensure that the image is in one of the following formats:

  • .pdf
  • .jpg
  • .jpeg
  • .gif
  • .png

If you are using Internet Explorer 9 or older you will only be able to upload .pdf files (which must be less than 10mb).

We are aware of an issue that could prevent a PDF document from being uploaded when a PDF reader is not installed on your computer. Our website might not be able to determine the correct file format therefore using a different browser or device to submit the claim may help to resolve this issue.

If you need any help with completing your claim, please contact us at [email protected]

What if I need to upload more than one image?

As part of the online claim submission you can make up to eight separate claims, each of which can have two images, within a single 24 hour period.  However, due to processing speed of some mobile handsets we have restricted to this a single image for each claim.  If you are not provided an option to upload a 2nd image, please try submitting your claim on another device such as laptop or desktop computer.

How do I claim a New child payment for multiple births?

The easiest way to claim a new child payment for multiple births is to submit a claim for each child separately. You will need to provide a birth or adoption certificate as part of the claims submission.  

Why can't I process claims for one of my family members?

The claim information you have entered will be checked against our records according to the treatment date that you have submitted.  If your dependent has recently been added to the policy or their cover upgraded, it is possible that they were not covered at the time you are claiming for.  If you believe our records to be incorrect please contact us to discuss.

What if I want to split a claim across several plans?

As long we have a notification from you to advise how you would like your claims paid across several plans you will not need to complete multiple claims forms. Your claim will get looked at by a claims handler to ensure we pay your claim as per your request. If you haven’t yet let us know how you’d like your claims paid across your plans, you can make a note on the receipt or documentation you will be required to upload when submitting your claim.

Why can't I validate my email address?

1. Log in to your Self Service account.
2. Press the 'confirm and continue' button in the validation box
3. Log out of your Self Service account.
4. Go to your email inbox and click on the validate link in your email
5. This will open up your browser and ask you to log back into your Self Service account.
6. Your email validation is now complete.

Can I download/print a claim form?

For the majority of customers who have a cash plan product we have created a claim form that can be completed online, then printed and sent to us for processing. This eliminates the need to have an electronic image (e.g. a photo or scan) of your receipt.

We are currently rolling out the ability to generate & download claim forms on a product by product basis to ensure the best possible experience for our customers. If your product does not currently have the ability to complete a claim form online for you to print, you can still request a blank claim form & submit it by post in the usual way.

Why can't I see all my plans?

The majority of our customer who have multiple plans will be able to view them under a single online account with a single username. If you have more than one policy with us it may not be linked. To check please contact our customer services department using the telephone number on your Policy page.

What do I need to make a hospital or New Child Payment claim?

If you're submitting a hospital claim, you can send us the original discharge letter provided to you by the hospital. Alternatively, please complete the 'patients details' section on the back of the claim form and ask a hospital representative to complete the 'Admission details' section.
the appropriate section of the claim form needs to be completed, stamped and endorsed by the relevant hospital authorities.

If you're making a new child payment claim, we need to see a copy of the birth certificate.

For further details of how to claim, refer to the Terms and Conditions in section 5 of your Simply Cash Plan policy document and/or check out our how to claim guide.
If you have any queries, call our Customer Services team on 0800 980 7890.

SimplyConsult app

Who are Square Health?

Squarehealth has been clinically chosen by Simplyhealth to provide this GP and Physio triage app, SimplyConsult. Together, we work to deliver a trusted service to our customers.

Square Health gives you access to over 5,000 medical specialists across the UK. Our Video GP service allows you to speak face-to-face to a doctor at a convenient time and from the comfort of your own home.

Square Health is the culmination of over 20 years of experience within the healthcare sector. Our founders are practising doctors who have a wealth of experience and expertise in the delivery of medical services.

Who should I contact if I have a query with the SimplyConsult app?

For any queries relating to your Simplyhealth plan or the app, please visit www.simplyhealth.co.uk/existing-customers/contact-us for details.

If you’re having a problem accessing the app to book a GP or Physio appointment, please call this number 0330 102 5443.

Can I access my Simplyhealth account through the app?

You can access your Simplyhealth account by clicking on the Claims icons on the home screen

Can I add my children to my Simplyhealth Plan through this app? 

No, please visit www.simplyhealth.co.uk/existing-customers/contact-us  to contact us to add your children to your plan.

Can you issue a sick note?

Yes, your Square Health doctor will go through all the usual information, including likely return dates and any special instructions for your employer. Your sick note/ fit to work note will be ready to email or post to you immediately following your appointment.

What should I do if I need an emergency appointment?

Square Health should not be used in an emergency or life-threatening situation. If you require urgent medical assistance you should call 999 immediately.

Do I need to do anything before my appointment?

Please make sure you are available at the time of your appointment and that the app is open on your phone.

Where will my medical records kept? 

Following your consultation, your health history will be updated within the app and stored securely by Square Health.

Will I speak to a different doctor or specialist each time?

You will be able to choose which doctor you speak to when you book your appointment. You may be able to choose a GP you’ve seen before as long as they are available at the time of booking your appointment.

What happens if under exemption arrangements I don’t pay for prescriptions?

Your current exemptions will not apply. If you require a prescription following your medical consultation you will be required to pay for the prescription medicine. Your Square Health doctor will go through this with you during your consultation.

Will I incur any additional costs for using this service?

If you use Prescription Services, upon collection you will need to pay for the prescription medicine. No NHS exceptions are valid with this service. You may be able to claim for these prescriptions under your plan – please refer to your plan terms and conditions for more information.

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