How to make a claim

Before making a claim

In order to make the process as smooth as possible please make sure you have:

• Checked your cover
  Log in to Member Zone and visit the ‘My messages’ section to find details of your benefit limits and any excess that may apply.
• A open referral from a GP
  You’ll also need an open referral with details of your symptoms or condition. You can get an open referral via the Vitality GP app or your NHS GP, meaning you can choose the quickest and easiest route for you.
  Alternatively, if you have selected a hospital list and want to see a specific consultant, you’ll need to provide details of a consultant or therapist who is registered with VitalityHealth. In many cases the GP or consultant will dictate which hospital they can see you at. However if you have a specific hospital in mind please check it’s included on your hospital list.
• Your Vitality membership number
  You can find this on your plan documents, on the Member Zone or on the Vitality Member app.

You have three ways to make a claim

1. Use our Vitality GP app

• You can book a private video consultation with a Vitality GP within 48 hours, including evenings and Saturdays, instead of visiting your NHS GP. The Vitality GP app is compatible with Apple iOS8 and above or Android 5.0 and above.
• If they refer you for treatment, one of our partners will be in touch to arrange your appointment.
• Often this means you won’t need to contact us again for authorisation – the Vitality GP will manage your claim.

2. Use the secure Member Zone

• Submit your claim online 24 hours a day, seven days a week.
• It only takes a few minutes and we’ll aim to get back to you by the end of the next working day

3. Call us

Personal Healthcare: 0345 602 3523
Business Healthcare: 0345 602 3437
Corporate Healthcare: 0345 279 8865
Open Mon-Fri 8am to 7pm, Sat 9am to 1pm, excluding public holidays.

How the claims process works

1. Get your claim approved

Once your claim is accepted we’ll get in touch with our medical expert partners Alliance Surgical - an independent doctor-owned organisation - to choose the best consultant for you, based entirely on your medical needs. You'll then get a call from Alliance Surgical to arrange all the details.

If you have a hospital list included on your plan and you had a referral to a named consultant we’ll let you know exactly what has been approved and send you a claim acceptance letter to take to your appointment.

Sometimes we may need more information from your GP or consultant in order to progress your claim, but we’ll let you know as soon as possible.

2. See the consultant

When you go for your appointment, give your consultant your claim acceptance letter. This will allow them to bill us directly.

If your consultant says you need hospital treatment as an in-patient or day-patient, or extra treatment sessions, you'll need to contact us again. It’s helpful if you have the following details:

• The date of the treatment
• The procedure code - this is called a CCSD code that your consultant can provide
• The expected length of stay/number of extra treatment sessions
• The hospital and consultant’s name

3. Leave the bill to us

Normally, we’ll settle direct with the healthcare provider. If you’ve got an excess on your plan, you’ll have to pay this yourself and we’ll let you know who it needs to be paid to. If you do make a payment above your excess, send us the proof of payment with the invoice to the address below and we’ll pay you back.

Post: VitalityHealth Customer Services, Sheffield, S95 1DB
Email: info@vitality.co.uk
Fax: 0800 015 8700

Making a claim may increase your premium in the next plan year.

VitalityLife 2015 claims statistics

Life cover	Serious Illness cover	Income Protection cover
98% paid	95% paid	96% paid

How to claim

If you need to make a claim, it’s important that you tell us as soon as possible. Most of our policies have a specific timeframe for submitting a claim, called the notification period. Please check the notification period for your policy, as we may not be able to accept your claim, if it’s outside the specified timeframe.

Check if your condition’s covered

If you need to make a claim, please check to see whether your condition is covered before you call us. We do cover over 170¹ Serious Illness conditions; however we don’t cover minor conditions, such as²: 

• Colds/ Flu
• Broken bones/ Sprains
• IBS

It’s a good idea to familiarise yourself with the serious illnesses that we cover, by either checking the Plan Provisions we send you at the start of your policy, or by using our handy online tool.

Call 0345 601 0072

Lines are open Monday to Thursday 8:30am to 6:00pm and Friday 8:30am to 5:00pm (excluding Bank Holidays)

Have the following details ready:

• Plan number (s)
• A copy of your Plan Provisions
• Name of the claimant
• Name and address of the claimant’s GP
• Type of cover being claimed against (e.g. Serious Illness Cover or Life Cover)
• Reason for the claim (e.g. cancer, heart attack, stroke)

You can also write to us or send us secure message via the Member Zone at member.vitality.co.uk and we’ll contact you to ask for more information.

What we require in the event of a claim

Depending on the plan, we may ask for:

• Proof of ID
• Proof of bank details –  e.g. a statement showing the account name and number, or a bank letter
• Proof of income
• Medical evidence
• Birth certificate
• Proof of death
• An original trust deed

Once you’ve submitted your claim, we’ll be in contact to notify you of any extra information that we may need and to keep you updated throughout the claims process.

Our service promise

We want our claims management service to be the best in the industry. We’re here to help when you need us most and we’ll support you at every step of the process. Read more.

Data Protection

We fully comply with the Data Protection Act 1998. Read how we protect your information

¹Number of conditions covered applies to comprehensive Serious Illness Cover. Numbers vary for Primary Cover. Your Plan Schedule will state whether you have Primary or Comprehensive Cover. Please note that conditions covered depend on when you took out your policy. You can find more information in either your Plan Provisions or by speaking to one of our dedicated VitalityLife team.

²Not an exhaustive list of minor illnesses – for example purposes only.

When do I need to submit a claim by?

Each benefit has a specific timeframe for submitting claims, called the notification period. If you don’t submit your claim within the notification period, we may not be able to accept the claim.

Benefit	Notification Period
Life Cover Mortgage Free Cover: Death Waiver of Premium on Death Mortgage Life Cover Family Income Cover: Death	No notification period
Serious Illness Cover (All)	We must get written notice within 6 months of the life-changing event
LifestyleCare Cover	We must get written notice within 6 months of the life-changing event
Disability Cover	Category A, B, D We must get written notice within 6 months of the life-changing event Category C We must get written notice within 3 months of the life-changing event
Mortgage Incapacity Cover	We must get written notice as soon as possible after date of incapacity
Income Protection Cover Your plan schedule shows the deferred period that applies to your plan. If we do not receive notice of your incapacity within the specified period, we may treat the deferred period as if it started on the date we actually receive notice. If we receive notice more than 90 days after the end of the deferred period, we may decline your claim.	Deferred period of 7 days We must get written notice immediately Deferred period of 1 month We must get written notice within 2 weeks of the date of incapacity Deferred period of 3 months We must get written notice within 1 month of the date of incapacity Deferred period of 6 or 12 months We must get written notice within 2 months of the date of incapacity
Waiver of Premium on Serious Illness	We must get written notice within 6 months of the life-changing event
Waiver of Premium on Incapacity Your plan schedule shows the deferred period that applies to your plan. If we do not receive notice of your incapacity within the specified period, we may treat the deferred period as if it started on the date we actually receive notice. If we receive notice more than 90 days after the end of the deferred period, we may decline your claim.	Deferred period of 7 days We must get written notice immediately Deferred period of 1 month We must get written notice within 2 weeks of the date of incapacity Deferred period of 3, 6 or 12 months We must get written notice within 2 months of the date of incapacity
Unemployment Cover	St Andrews must receive written notice no later than 120 days after unemployment starts
Carer Cover