How to make a claim

How to make a claim

Making a health insurance claim - PruHealth with Vitality

CLAIM ONLINE 24 HOURS A DAY, 7 DAYS A WEEK

You can submit a claim online 24 hours a day, 7 days a week. It's secure, will only take a few minutes and we'll aim to get back to you by midday on the next working day.

Your claim will be assessed by one of our claims assessors who have on average, six years' experience looking after our members. They'll guide you through the next steps so you don't have to worry about your cover - instead, you can focus on getting better.

Step 1 Get a referral from your GP

If you're unwell, the first thing to do is to visit your GP. If they refer you for treatment, tell them you have cover with PruHealth and ask for the following:

  • Full details of the condition, symptoms and diagnosis, if known, and intended treatment
  • Full name and address of the specialist or other healthcare provider and the hospital or clinic that the claimant has been referred to

Any claims that you do need to make, may result in your no-claims discount being decreased in the next plan year. If you do feel unwell, please do not delay seeking treatment because of the impact it will have on your no-claims discount.

Step 2 Get your claim approved

Once you’ve got a referral you’ll need to register your claim and check you’re covered. You can make a claim online 24 hours a day, 7 days a week. It’s secure, will only take a few minutes and we’ll aim to get back to you by midday on the next working day.

To help assess your claim we’ll ask you a short set of questions. We’ll need the following information, so make sure you have these details to hand:

  • Full details of the condition, symptoms and diagnosis, if known, and intended treatment
  • Full name and address of the specialist or other healthcare provider and the hospital or clinic that the claimant has been referred to

If you can provide this information, we should be able to give you a decision quickly. You can also register your claim by calling us on the number on your membership card or your certificate of insurance. Once your claim’s approved we’ll send you an authorisation letter. You should take this letter to your appointment to show you’re covered.

Sometimes we might need more information from your GP or specialist in writing. When we do we’ll need your consent. To make this process as quick as possible we’ll ask you to speak directly to your GP or specialist to make sure they get back to us. In some cases we’ll also need you to complete a claim form to register your claim. Once you’ve sent in your form we’ll make a decision as soon as possible and confirm in writing whether you are covered.

Step 3 Book your appointment

As soon as we've approved your claim you can book your appointment with the specialist or other healthcare provider. They'll need your claim authorisation number so that they can bill us directly for your treatment. You'll find this on the front page of your authorisation letter, so remember to take this to your first appointment so show you're covered.

You'll need to contact us again if your specialist or other healthcare provider says you need hospital treatment as an in-patient or day-patient or if you need further treatment sessions for which you are yet to receive our approval.

Step 4 Leave us to pay the bill

In most cases we’ll settle your bills direct with the healthcare provider. This means you can focus on getting better. If you have an excess on your plan you’ll have to pay this directly to your provider and we’ll let you know exactly when you need to pay this.

If you do make a payment yourself send us the proof of payment to the address below and we’ll pay you back.

Post: PruHealth Customer Services, Stirling, FK9 4UE,
Email: authorisations@pruhealth.co.uk
Fax: 0800 015 8700

Your hospitals

For a full list of the hospitals you have access to, visit the 'My hospitals' page when you log in to the Member Zone.

Guide to Cover

Health insurance from PruHealth with Vitality

Take a look at the Guide to Personal Healthcare for full details on all the elements of our cover

Guide to Personal Healthcare