Group NHS Plus

To enable us to help you to ensure that your claim runs smoothly, you must follow these simple steps that you will find invaluable in the unfortunate event that you may need to make a claim under your policy. Please note that the procedure varies according to the benefit that you are claiming.

MEDICAL TREATMENT

If a specialist referral is medically necessary you may:

1. see the specialist under the NHS, or,
2. arrange a private specialist consultation at your own expense.

Please note that in either event this policy does not cover you for out-patient or day-patient treatment. Please inform your GP as soon as possible, so that your details may be passed to the specialist and an appointment made.

If the specialist recommends that in-patient treatment is required, there are two courses of action available for which cover is provided under this policy.

NHS Treatment
If treatment is available under the NHS within six months of the specialist deciding that it is necessary we will pay the cost of an amenity room in a NHS hospital. All treatment will be undertaken on the NHS, so no other costs will be involved.

Private Treatment
If treatment is not available under the NHS within six months of the specialist deciding that it is necessary, you may choose to have the treatment undertaken privately. We will arrange for the treatment to be undertaken in hospital approved by us, within a 30 mile radius of your home.

In either event, under the terms of your policy, it is essential that any treatment is pre-authorised by us.

Please therefore contact the Universal Provident claims helpline on 08705 133432 before you arrange any in-patient treatment. When you call the helpline you should have the following information available:

•  your policy number,
•  the condition to be treated
•  the date you became aware of the condition,
•  the name of your GP and the specialist you have been referred to,
•  the treatment (or investigations) required.

Based on the information you have provided, we will confirm that

•  the condition (as described) is covered by the policy, and
•  the specialist to be used is approved by us, and
•  the condition and the treatment do not conflict with any of the policy terms.

Please note that any authorisation given at this stage is subject to confirmation upon receipt of a fully completed claim form.

If you are eligible for private treatment, we will make the necessary arrangements for the treatment to be undertaken at a hospital within a 30 mile radius of your home.

We will then send you a claim form, part of which will have been completed from the information provided. Please follow any instructions given to you when the claim form is issued and ensure that the form is completed by the correct person. If subsequent information contradicts the information upon which our pre-authorisation was based, your claim may be invalidated.

PRESCRIPTION CHARGES
Contact our helpline on 08705 133 432. We will require the original receipts for any prescription charges for which you are claiming.

EMERGENCY DENTAL TREATMENT
Contact our claims helpline on 08705 133 432 with the following information to hand:

•  your policy number,
•  the dental treatment being undertaken, and
•  the cause of the condition being treated.

Once we have confirmed that the treatment is eligible under the policy, we will issue a claim form for completion. You should return it to us with the appropriate original receipts for the treatment.

HOLIDAY RECUPERATION BENEFIT
Please contact our claims helpline (number as above). We will require, if not already received, confirmation of your condition and hospital stay, from the attending doctor. Please be aware that there is no automatic entitlement to this benefit and we must therefore receive your written request to claim the benefit.

MATERNITY BENEFIT
You will need to submit proof of birth, in the form of a birth certificate. Please be aware that there is no automatic entitlement to this benefit and we must therefore receive your written request to claim the benefit.

INCOME BENEFIT
Please contact our claims helpline within 30 days of the start of your disability. We will issue an appropriate claim form for completion. We will require medical certificates from your GP confirming your disability for the full period for which benefit is being claimed.

DISABLEMENT BENEFIT AND TERMINAL ILLNESS BENEFIT
Please contact our helpline as soon as you are aware of a condition that could result in a claim under this benefit. We will issue the appropriate claim form for completion and will also require a medical certificate/report from your GP and/or specialist confirming the condition. If further medical evidence is required we will inform you at the appropriate time.