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Claims FAQs

If you’ve got a question about making a claim, our FAQs are here to help you find the answer.

If you can’t find what you’re looking for please contact us

My plan 

You can find a summary of your cover on your My plan page.

For full details of your cover and your certificate, which lists all your cover options, please see your plan terms and conditions in Notifications.

Normally, we settle all your charges directly with your healthcare provider. However, if you have an excess on your plan, you’ll need to pay this. We’ll let you know who the excess needs to be paid to.

Excesses are dependent on your excess type (per plan year or per claim year) and are applied to the first bills we receive in your plan year or at the start or renewal of each claim.

Depending on your plan, your excess will start again either from your plan renewal date or a year after your claim was registered.

Your certificate will outline if you need to pay an excess. For more information about your excess, please read your plan terms and conditions, which you can find in My documents.

If you’ve added one of the Hospital Select options to your plan and have a specific hospital in mind, please check if it’s included on your hospital list and let Vitality or Alliance Health Group know. You can find details of your hospital list here or find your nearest hospitals using our hospital finder.

If you choose to use a hospital that’s not on your hospital list, you’ll need to contribute 40% of all your hospital costs, excluding consultant charges. Please consider this carefully, as this could result in a considerable cost.

If you haven’t added Hospital Select, Consultant Select will be automatically included on your VitalityHealth plan. This means that our expert, independent medical partners, Alliance Health Group, will help you choose the most appropriate consultant and hospital for you to be treated at, based on your condition and where you live.

Making a claim

Before you get started, read our handy guide on How to make a claim.

Then, once you have the information you need to hand, there are three ways to make a claim:

1. Use our Vitality GP app

  • You can book a private video consultation with a Vitality GP instead of visiting your NHS GP. Some claims may not need a GP referral if referred within our physiotherapy or mental health networks
  • Vitality GPs work Mon-Fri 8am to 6.30pm and Sat 9am to 12.30pm
  • If they refer you for treatment, one of our partners will get in touch with you to arrange your appointment.

2. Use the secure Member Zone 

  • Make a claim 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

  • 0345 602 3523
  • Open Mon-Fri 8am to 7pm, Sat 9am to 1pm, excluding public holidays.

In some circumstances, we may ask you and your GP to complete a claim form before we can assess your initial claim. We’ve put together a guide so you can understand when we might need this extra information.

You’ll find this on the front page of your claims letter. Make sure you give your consultant your claim number. If you’re having treatment via our consultant panel, they’ll arrange payment for your consultant. 

You’ll find your membership number on your plan documents in Notifications on the Member Zone, from when you joined Vitality and at every renewal. 

If you have the Vitality Member app on your smartphone, you can log in, select the My Card button at the bottom of the screen and you’ll find your membership number, along with any dependant’s numbers, too.

In most cases, you’ll need a referral from a GP before making a claim. You can self-refer for some mental health treatments if they’re covered by your plan, so you don’t have to wait to see a GP first. If you have Out-patient Cover, you can also self-refer for physiotherapy through our network of over 2,000 physiotherapy clinics. 

However, there are some cases where we’ll accept referrals that haven’t been made by a GP. For example, referrals following a health screen or treatment in accident and emergency. For certain conditions, a referral may also be made by a dentist or optician.

 No, a claim form needs to be completed by your usual GP who has access to your full medical history. 

In an emergency

We only cover pre-planned and non-emergency treatment. If you need emergency treatment, please use the NHS 111 helpline, go to your local NHS accident and emergency department or dial 999 for immediate medical assistance. Please contact us within our opening hours before you accept any private medical care, so we can assess your claim to avoid any unexpected costs.

In most circumstances, this isn’t covered by our plans. For some business schemes, this is available if your company has chosen additional cover. We will need to speak to you when our office is open to advise you if any cover can be provided in this circumstance or if you’re eligible for a cash benefit. In the meantime, please do not delay any treatment and follow NHS advice.

Your plan covers treatment in the UK only. Please contact your travel insurance provider. 

If you’ve selected travel insurance as part of your VitalityHealth plan, this is indicated on your certificate and plan documentation, which you’ll find in Notifications in Member Zone. You can contact our assistance partner on 0044 345 278 5605.

To authorise a transfer, we need to talk to you to understand the circumstances of your admission. We may also need some information from your healthcare provider. Please contact us within our working hours, so we can let you know whether cover will be provided.

If you’re already in hospital, we’ll only cover eligible treatment that takes place after your consultant has confirmed – at your request – that: 

  • Your vital signs are within normal limits and have been for at least for 48 hours
  • You don’t require critical care.

What will I need to take when I go for an appointment?

Please take the claim authorisation number we give you, which you’ll find on the front page of your claim acceptance letter.

You may find it useful to take a list of any questions you have and a pen and paper to make notes. 

You might also want to check with your GP or consultant to see if they suggest taking anything with you.  

Further treatment

If your consultant says you need hospital treatment as a day-patient or in-patient, or extra treatment sessions, you need to contact us or Alliance Health Group with the following details:

  • The date of your treatment 
  • The name of the consultant and hospital 
  • The expected length of your stay – as either an out-patient, day-patient or in-patient
  • For surgical procedures, we require a procedure code – known as a CCSD code – which your consultant or consultant’s secretary can provide.

If you need treatment, your consultant or consultant’s secretary, should give you a procedure code. This is called a CCSD (Clinical Coding and Schedule Development) code by medical professionals. The code will start with a letter of the alphabet followed by four numbers, for example A5720. We need this code as it tells us exactly what type of treatment you’ll be having and helps us to assess your eligibility.

If you submit a continuation claim online, we aim to get back to you by the end of the next working day. If you call us, we try to make a decision straightaway. 

Sometimes, we may need to ask your health provider or GP for more information. Once we’ve received this, we aim to contact you with our decision within five working days.

Paying the bills

Please make sure you’ve settled any co-payments or excess amounts directly. Then send your invoice to VitalityHealth Customer Services, Sheffield, S95 1DB, and we’ll settle any outstanding applicable amounts. Alternatively, you can email your invoice to info@vitality.co.uk. Please make sure you attach your claim number and Vitality membership number.

In most cases, we’ll settle payment for your treatment directly with your healthcare provider, so you can focus on getting better. 

If you do make a payment yourself, please send the invoice and proof of payment to VitalityHealth Customer Services, Sheffield, S95 1DB. We’ll then reimburse you less any co-payment or excess amounts that may apply to your plan. Alternatively, you can email your invoice to info@vitality.co.uk. Please make sure you attach your claim number and Vitality membership number.

Just so you know, you need to send us this information within six months of paying your invoice.

 In most cases, invoices will be processed within seven to ten working days and payment made shortly after. Please note that payments to providers can take up to 28 days, depending on their payment agreement with us.

 We’ll send a claims statement to your inbox on the Member Zone detailing all payments made on a monthly basis.

Your claims statement will show details of any invoices that haven’t been settled in full. We might not be able to pay an invoice in full for one of the following reasons:

  • If an excess applies to your plan – this may be per claim or per plan year 
  • If any monetary limits apply to your plan, for example if you have a limit on Out-patient Cover
  • If treatment has taken place at a hospital that’s not included on your hospital list and a co-payment applies
  • If treatment isn’t eligible under your plan terms and conditions.

Please take a look at your plan summary for further details.

Reporting a problem

If you’re having problems, try logging out and then logging in again to refresh your internet browser. If you’re still having problems, please contact us.

We always have your best intentions at heart, however we understand that sometimes things can go wrong. If you have reason to complain, we want to know so we can try and put things right and resolve your complaint quickly for you. You can find out how to make a complaint here.