Total Care

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 policy section under which you are claiming.

PRIVATE MEDICAL INSURANCE

Visit your GP
If your GP is able to provide all the treatment that is necessary, no further action will be required as the services provided by a GP are not covered under the policy.If your GP refers you for further treatment, advise the GP that you have private medical insurance so that details can be passed to the specialist and an appointment made.

Phone the Universal Provident helpline before you have further treatment.
Under the terms of your policy all treatment must be pre-authorised by us. It is therefore essential that you call the helpline on 0870 513 3432, before having further treatment. When you phone, you must have the following information available:

•  your policy number,
•  the condition to be treated,
•  the date when you first became aware of the condition,
•  what treatment is planned at this stage,
•  the name of the specialist, physiotherapist or complementary medicine practitioner you have arranged to visit, and
•  the hospital to be used (if known or if applicable).

Based on the information you provide, we will confirm that:

•  the condition (as described) is covered by the policy,
•  the hospital to be used is approved by us and is within your chosen hospital scale,
•  the specialist to be used is approved by us,
•  the condition and treatment do not conflict with any of the policy terms, and
•  you may proceed to the next stage of treatment.

Please note that any authorisation given at this stage is subject to confirmation upon receipt of a fully completed claim form. We will then send you a claim form, part of which will have been completed from the information provided. If subsequent information contradicts the information upon which our pre-authorisation has been based, your claim may be invalidated.

When you receive the claim form
If treatment is to be provided by a specialist, ask your GP to complete the claim form and return it to us. We will then provide a claim form for the specialist to complete and return to us.

If treatment is to be provided by a physiotherapist or complementary medicine practitioner, ask your GP to complete Section C and return it to us. We will then send a separate claim form to the physiotherapist or complementary medicine practitioner to complete and return to us.

If treatment is in a NHS hospital (without charge) and you only intend to claims the NHS Cash Benefit, ask your GP to complete Section C and return the form to us. We will then send a separate form to the senior registrar to complete and return to us.

You must phone the helpline after the initial consultation/treatment so that any further treatment can be authorised.

At this stage we will confirm the eligibility of any treatment planned.

Any additional accounts should be sent to us as soon as you receive them. A further claim form will not be required unless:

•  you are referred to a new/different specialist, or
•  you have further in-patient treatment, or
•  there is a gap of more than six months between treatments.

Payment
Wherever possible we will pay all bills direct to the provider of the treatment or services. You must advise the provider of your insurance details before you have the treatment so that they can send their bills to us. You must also check whether direct settlement is available for out-patient treatment. If you have paid for any treatment yourself, we will reimburse you. If your policy is subject to an excess, we will deduct the excess from the appropriate bills and advise you to whom the excess should be paid.

DENTAL CARE

Visit your dentist
If your dental practitioner advises that you require treatment, telephone our helpline to request a claim form. You should also inform your dental practitioner of your insurance details.

Please note that certain treatment (implants, treatment for tooth wear and any treatment where the estimated cost is more than £500) covered by this policy must be pre-authorised by us before you have the treatment. If you need to have such treatment please have the following information available when you telephone us:

•  your policy number,
•  the condition being treated,
•  the date you first became aware of the condition,
•  the treatment planned and the estimated cost, and
•  the name of the dental practitioner who will undertake the treatment

Based on the information you provide we will confirm:

• that the condition and treatment are covered by the policy,  
• that the dental practitioner is approved by us,
• and  the eligibility of the proposed treatment.
We will then send you a claim form, part of which will be completed from the information you have provided.

When you receive the claim form
Ensure that the information already on the form is correct and complete any remaining information within the “Member’s Section”.

Ask the dental practitioner who undertakes the treatment to complete the “Dentist’s Section” of the claim form.

Once the form is complete
Return the claim form to us together with any accounts you may have received for the treatment provided, so that we can reimburse you for the eligible costs you have incurred. Please let us know if you would like us to pay the accounts directly to the dental practitioner.

Any additional accounts should be sent to us as soon as you receive them.

1. once the last treatment is regarded as complete, or
2. after a period of six months has elapsed since the last treatment,

we will regard this as a new claim and will require a new claim form to be completed and the treatment to be pre-authorised, if appropriate.

LIVING CARE

Phone the Universal Provident helpline.
If you need to claim under this policy you must first of all call our helpline on 0870 513 3432. When you phone us, please have the following information available:

•  your policy number
•  details relating to your disablement
•  the disability commencement date.

We will then be able to discuss the claim with you and issue a claim form.

When you receive the claim form
Please complete the claim form in full and return it to us with any additional documentation requested. We will then request a medical report from your medical attendant to enable us properly to assess your claim.

Once we have received the medical attendant’s report and any additional information we may require, we will inform you of the validity of your claim and, if appropriate, arrange for benefit payments to commence at the end of the deferred period.