Simply Personal Health - Claiming guide

The claiming process differs depending on which hospital network your client has chosen.

National and Metropolitan how to claim

The National and Metropolitan hospital lists give your client the greatest amount of control of where they go and who they see.

Step 1

If they feel unwell, your client should go to their GP so they can understand the symptoms. If their GP wants them to visit a consultant, your client should tell them that they have Simply Personal Health private medical insurance and they will write a letter of referral for them to see a specialist or therapist.

Step 2

They should then call our claims helpline on 0800 328 1202. Our helpful staff will discuss the claim with your client and authorise consultation, diagnostic tests or treatment (based on the cover choices that have been made).

We can give guidance on exactly what the policy will pay for, check whether the specialists' proposed fees are within our fee schedule limits and that the hospital they plan to use is within your client's scale of cover. We can also highlight any costs that we will not pay, helping make an informed decision about treatment.

If we need more medical information to assess the claim, we will ask for your client's consent to approach the relevant doctor for this.

Step 3

We will ask your client to pay their excess over the phone if they haven't paid the full excess in that claiming year. This means that we can settle bills with providers like hospitals and specialists more quickly, and they will not need to pay the provider at a later date, although there is a choice to pay the excess directly to the provider if your client wants to.

Step 4

We will pay invoices directly and promptly to the treatment providers (for example the hospital or specialist) so there is no worry about settling any bills.

 

Connections how to claim

The Connections hospital list is the lowest cost option of the three and offers a different solution to finding a hospital than the National and Metropolitan lists.

With Connections, once your client has been referred to a specialist by their GP, they need to call our claims team and they will put your client in touch with one of the hospitals on the Connections list.

Step 1

If they feel unwell, your client should go to their GP so they can understand the symptoms. If their GP wants them to visit a consultant, your client should tell them that they have Simply Personal Health private medical insurance and they will write a letter of referral for them to see a specialist or therapist.

Step 2

They should then call our claims helpline on 0800 328 1202. Our helpful staff will discuss the claim with your client and decide whether or not the policy will pay for the consultation, diagnostic tests or treatment (based on the cover choices that they have made). If the claim is authorised we will put your client in contact with a hospital from our network in order to arrange tests or treatment that the policy covers.

If we need more medical information to assess the claim, we will ask for your client's consent to approach the relevant doctor for this.

Step 3

We will ask your client to pay their excess over the phone if they haven't paid the full excess in that claiming year. This means that we can settle bills with providers like hospitals and specialists more quickly, and they will not need to pay the provider at a later date, although there is a choice to pay the excess directly to the provider if your client wants to.

Step 4

We will pay invoices directly and promptly to the treatment providers (for example the hospital or specialist) so there is no worry about settling any bills.

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.

Hospital locator

Find a hospital for treatment if you are a PMI customerGot a health insurance plan? Need treatment?

Find a hospital

Employees leaving a company scheme?

From 1st August Simplyhealth no longer provides continuation quotations for customers leaving company schemes.  Please call AXA PPP healthcare, who now provide special continuation terms for these customers.

0800 33 33 11

Mon to Fri: 8am to 8pm
Sat: 9am to 1pm
Or email them

Do you have a question?
Then visit our page for Simply Personal Health where we answer some of the most Frequently Asked Questions we receive.