Claiming

Our fast online claims process means you can easily make a claim using either the SimplyPlan app or your online account in a few simple steps!

Before you get started, make sure you have either physical copy of your receipt to hand, or a saved photo or digital image that you can upload.

Your receipt must include:

• Patient’s full name

• Practitioner’s name and contact details

• Treatment details, date and amount paid

Remember: Credit/Debit card receipts alone will not be accepted.

Okay, you're good to go! Just follow these steps:

1. Sign in to your SimplyPlan app or online account

2. Click 'Make a claim'

3. Add your receipt

How to add your receipt

If you’re using the SimplyPlan app and you have a physical copy of your receipt, 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 device, choose ‘Upload image’. Alternatively, if you have a digital copy of your receipt (e.g. a PDF sent via email), select the ‘Upload file’ option.

If you’re making a claim through your online account, select the file you’d like to upload, and you’ll be taken to the next step.

4. Let our system scan your receipt

Review the image to make sure you're happy with it and select 'Scan my receipt'. Our scanner will pull through as much information as it can to save you some time.

5. Check your claim details are correct

Always check the information that's pulled through is correct. Make sure you change any details that are wrong and enter the correct information.

6. Select ‘Submit claim’

That's it - you’re all done!

We’ll send you an email to confirm we’ve received your claim. You can track its progress in the ‘Claims’ section of your SimplyPlan app or online account, where the status will show as ‘In progress.’ We’ll also email you when your claim is ready to review. Claims usually take up to 2 working days to process, but we’ll work to get it done as quickly as possible!

The easiest way to do this is to take a photo when prompted when you click 'Make a claim' on the SimplyPlan app. 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.

You can claim for most benefits as soon as your plan starts and once you’ve received the treatment or service. However, some benefits may have a qualifying period or exclusions for pre-existing conditions.

What’s a qualifying period?

This is the minimum amount of time you need to wait before you can make a claim for certain benefits. This means any treatment you receive before your plan starts, or during the qualifying period won’t be covered under that benefit.

What’s a pre-existing condition?

A pre-existing condition refers to any treatment, diagnosis, or medical/dental issue that was already discussed, documented, or diagnosed before your plan started, or during any qualifying period.

Please note that if you haven’t visited a dentist in the two years before your plan’s start date, some of our dental plans may not cover treatments identified during your first dental appointment after your plan begins.

To see if any of these rules apply to your benefits, please check your Terms and Conditions. If you’re using the SimplyPlan app, you’ll need to tap ‘My Documents’ and then 'Terms and Conditions’.

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.

No, our health plans are designed for you to submit each claim once, under one plan. This means you must choose which plan you want to submit your claim under and submit your claim online. When we process the claim, we'll consider how much entitlement you have available and the percentage payback set for the benefit you're claiming against.

Once approved, we'll send you a payment for the maximum amount available under the benefit you've used, on the plan you've selected to submit your claim under. If you don't receive the full amount back, you can't submit the same claim under an additional Simplyhealth plan to claim up to the total value of your claim.

We recommend you regularly review your overall cover with Simplyhealth and make sure the combination of plans you have in place, continue to meet your needs.

If you’re unsure whether having more than one plan with Simplyhealth continues to offer you value for money or meet your needs, we’d like to talk to you about how we can help you review your cover options. This could mean combining your cover into one plan, changing your level of cover or cancelling additional plans you no longer use. To help you review your options, here’s a link to a few of our most popular plans that might suit you better going forward.

If you’d like to discuss your cover with us, please contact our Customer Options team who will be happy to help. Call 0330 102 5335 between the hours of 9am and 6pm Monday to Friday.   

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.

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.

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.

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

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.

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.

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.

There could be a couple of reasons for this:

1. You may have used up your annual entitlement
   Each benefit has a set allowance for the policy year. When we assess your claim, we check if you have any remaining entitlement for that benefit. If you’ve already used some or all of it, we’ll either send you a payment for the remaining entitlement or decline the claim if nothing is left.

   
   

2. Your plan may cover only part of the cost
   Some benefits don’t pay back the full amount you claim. For example, your plan might cover up to 75% or 50% of the cost. This means you’ll receive a percentage of what you claimed, not the full amount.

   
   

3. There may be limits on certain treatments
   If you have a dental plan, there may be set limits on how much you can claim back for specific treatments. These limits vary depending on your plan.

You can find full details of your entitlement, payback percentages, and treatment limits in your ‘Table of Cover’. Just head to the 'My Documents' section in your SimplyPlan app or online account.