Simply Dental Plan

Your clients' questions answered

We've answered some common questions your client may have about the Simply Dental Plan for individuals with regards to:

  • Administering their policy
  • Your clients' benefits
  • Claims and claiming

If you do not currently have a policy with and your question isn't answered here, please contact us on 0800 294 7303


Administering your policy

Benefits

Claims and claiming


Administering your policy

What is the duration of my client's cover?

The cover under the plan is monthly and runs from month to month until it is cancelled or otherwise comes to an end.

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What happens if my client has more than one Simplyhealth plan?

If your client or anyone included on their policy also has a Simply Cash Plan covering dental, they can claim on either or both policies up to the maximum entitlement, as long as they have individual receipts to support the claims, and providing the total reimbursement does not exceed the value of the costs they have incurred.

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How can my client make a complaint?

We continually strive to provide the best possible service to our customers. A vital part of that is customer feedback, because we need to know how we can improve what we do.

You or your client can submit a feedback form, write to us at Simplyhealth Customer Services, Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ.

If you or your client are unhappy with the response you receive, then we will refer your complaint to the Simplyhealth Group Quality Assurance team for a final decision.  If you are not satisfied with our response, or we have not replied within 8 weeks, you have the right to refer your complaint to: Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London, E14 9SR. Or you can call them on 0845 080 1800.

You can also look at our complaints process.

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Benefits

When do the annual benefits start and end?

Your clients' annual benefits commence from the policy start date and begin again on the same day every year. Maintenance benefits are available as soon as your client takes out the policy. Treatment, Accident and Emergency benefits are available once the policy has been in place for three months. There is also a three-month qualifying period for mouth cancer cover. Any unused annual benefits will not be carried over to the next claiming year. Please refer your client to their Simply Dental Plan Policy Document for further details if they have arranged for you to send them, otherwise they are available when they register online.

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Are existing conditions covered?

Pre-existing conditions requiring treatment which was either known about by your client; planned or recommended by their dentist before they took out the policy; or which was revealed in the first check-up they had after taking out the policy (if they had not had a check-up for two years prior to taking out the policy), will not be covered. Your client will not be be able to claim for Mouth Cancer Cover where they have been diagnosed with any cancer or are having investigations or waiting for the outcome of tests before or during the three month qualifying period is not covered.

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Claims and claiming

What can my client claim for?

Subject to annual limits your client will receive up to 100% of their money back for check ups - which includes investigations and x-rays and up to 75% of their money back on scale and polish fees - as soon as the plan starts.

After three months they'll be able to claim back a proportion of their costs for dental treatment (including crowns, bridges, onlays and inlays, up to certain limits). They'll also be covered for dental accidents and emergencies.

Please note that pre-existing conditions or treatment identified in the qualifying period and cosmetic dentistry/procedures are not covered.  If your client has not had a check up for 2 years prior to taking out a policy, treatment identified in the first check up will not be covered.

From three months a one off payment of £5,000 is payable if they are diagnosed with primary mouth cancer. Secondary Mouth Cancer, or conditions where they have been diagnosed with any cancer or are having investigations or waiting for the outcome of tests before or during the three month qualifying period is not covered.

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What does my client need to make a claim?

To make a claim on their Simply Dental Plan, your client will need:

1. A claim form fully completed by them and their dentist. If they've lost the last one we sent but they have registered for an online account, they can log in and request one with a single click.

2. The original receipts and/or bills for the treatment they're claiming for. They must be on official headed paper, and show the full name of the patient. They must also show the name, address and qualifications of the person who treated them, details of the treatment and the amount paid for the treatment. We may need additional information to support some claims. 

3. For claims over £500 they must submit full clinical records provided by their dentist.

For further details of how to claim, refer your client to the Terms and Conditions in section 5 of their Simply Dental Plan policy document if they have arranged for you to send them, or check out the dental how to claim guide.

If you or your client have any queries, call our customer services team on 0370 908 3476* - we're always happy to help.

*Some mobile networks charge for calls to 0800 numbers. Our 0370 number is free if you have mobile inclusive minutes available. If not it's still no more expensive than calling numbers starting 01 or 02

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How are claims paid?

To make life easier for your client, Simplyhealth provides a service which pays claim money directly into their bank account via direct credit, sending them confirmation in the post.

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Need help?

If you would like more information please contact us on:

Health plans

0330 1025 337

Mon to Fri: 8am to 6pm

or email us.

Do you want to register as an Intermediary?

You can register as an intermediary by visiting our intermediary registration page.

Our preferred physiotherapy provider Nuffield Health, offers rapid access to physiotherapy

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mwWellbeingA convenient way for your clients and their colleagues to manage their health online and included with our corporate healthcare plans