How we deal with your claim
In most cases we pay eligible claims direct to the provider of your treatment - such as your hospital or consultant. Otherwise we will pay the main member. We will write to tell the main member how we have dealt with any claim.
We pay claims under the rules and benefits of the scheme that applied to you on the date you received your treatment.
We only pay costs for treatment that you receive while you are a member of the scheme.
We only pay eligible costs and expenses actually incurred by you for treatment you receive.
We do not have to pay a claim if you break any terms and conditions of your membership.
We reserve the right to change the procedure for making a claim. If so, we will write and tell you about any changes.
You must provide us with information to help us assess your claim if we make a reasonable request for you to do so. For eg, we may ask you for one or more of the following - medical reports and other information about the treatment for which you are claiming.
Ex-gratia payments
If we agree to pay for the costs of treatment to which you are not entitled under the terms of your cover, ie an 'ex-gratia payment', this payment will still count towards the maximum amount we will pay under your cover. Making these payments does not oblige us to make them in the future.