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How to make a health insurance claim

1. Log into Member Zone or the Member app 24/7
2. Go to your health plan and select Care Hub
3. Start a new care request or manage your approved care requests. 

 

Log in to Care Hub

How to access healthcare

When you need to make a claim against your health plan, you can use the following digital applications 24/7.

Member Zone
Log into Member Zone and select Health from the menu.

From here you can:
  • Request or manage care
  • Get coronavirus support, and
  • Understand or update your plan.
Member app
 Log into the Member app, scroll to your Health plan card on the home screen and choose ‘Access care’. This will take you straight to the Care Hub.

Vitality GP app
You can also use the Vitality GP app to access healthcare. Log in to refer yourself for physiotherapy or mental health support. You can also call the GP Advice Line and book a video appointment with a GP.

Before you access care, understand your cover

It’s a good idea to check your health cover before you access care, so you’ll know:
  • if we’ll cover the cost of your treatment
  • where you can get treatment
  • the level of cover we’ll pay for, and 
  • what excess payments may be payable by you.
You can access your health cover information from the Health menu in Member Zone. From there you can view a summary of your health plan cover under Health plan. Or read your cover in detail in your Plan terms.
Women looking at a phone together

Request or manage care

When you need some physical or mental healthcare, you can request help from: 
  • Private GPs – if you want to speak to a private GP, download and use the Vitality GP app. You can book and join a video consultation, as well as access your consultation notes
  • Physiotherapists – if you want physio for muscle, bone or joint problems, refer yourself via the Care Hub
  • Mental health therapists – if you’re struggling with your mental health, go to the Mental Health Panel. You’ll be able to access online mental health support or refer yourself for some talking therapy
  • Menopause practitioners – if you’re in need of some support and advice, find out how to connect with a Peppy menopause practitioner
  • Consultants – if you’ve seen a GP and have a treatment referral, use the Care Hub to arrange an appointment with a consultant.
If we approve your care request, you’ll then be able to manage your treatments, bills and payments in Care Hub too. 

Want to understand what happens next? Read the FAQs at the bottom of this page.

What you need to do when you see a consultant

When you go for your appointment, remember to give them your care reference number. They need this reference so they can bill us direct. You can find your care number in Care Hub. 

If you need hospital treatment, or you need extra treatment sessions, please let us know. It’s helpful if you can have the following details ready:
  • Date of the treatment
  • Procedure code – this is the CCSD code which your consultant can confirm for you
  • Expected length of stay/number of extra treatment sessions
  • Hospital and consultant’s name.

How to pay your treatment excess

If you have an excess to pay towards your treatment, we’ll send you an email to let you know. We’ll then pay all other treatment bills direct if they're covered by your health plan.

You can keep track of all your bills and payments for your approved care requests in Care Hub. If you make a payment that is more than your excess, please send us proof of payment and the invoice, and we’ll pay you back:
Want to understand more about bills and payments? Read the FAQs at the bottom of this page.

We're here if you need us

If you need to speak to one of our healthcare team, give us a call. You can find the contact details on our contact us page.

Health insurance claim FAQs

What can I expect to pay?

When we've approved your care request for treatment, you may have to pay an excess for your claim.

We will pay for your treatment if:
• we have approved your care in advance, and
• it’s with a consultant and hospital that's included in your plan.

If you decide to have treatment with a consultant and/or hospital that is not included in your plan, you will have to pay some or all the costs.

To check your health cover benefits, consultant list and excess, log into Member Zone and go to Health plan.

How long will it take to process my care request?

If you go via the Care Hub, you'll get a decision straight away in most instances. If more information is needed to make a decision, a call back will be booked. If your query is urgent and you need a quicker turnaround time, please contact us.

We will aim to make a decision on the call with you, but we may need further information from your GP.

Can I claim for emergency care?

Unfortunately we don't pay for emergency care. This includes treatment in an Accident & Emergency unit or other urgent care centres. Hospital admissions scheduled with less than 24 hours notice are also not covered.

If you need emergency help, please use the NHS 111 helpline, attend your local NHS A&E unit or dial 999.

Will I have to pay another excess if my treatment continues into a new plan year?

If your health plan includes an excess per plan year, you'll need to pay your excess again if you have further treatment after the next annual renewal date of your plan.

If your health plan includes an excess per claim, you'll need to pay your excess again if the treatment for the condition continues for more than 12 months.

Will my health insurance premium increase next year because I’ve made a claim?

If you made a claim on your private health insurance, your premium may increase at renewal. Your increase will relate to the amount we paid for your treatment.

As a Vitality member, you can reduce the increase to your renewal premium by staying healthy. Your renewal premium takes into account:
  • your Age
  • Base rate increase
  • the number of Claims you made, and
  • your Vitality status
The higher your status, the lower the increase to your premium. That's our ABC pricing.

Which hospitals can I visit?

If you want to check which hospitals are on your plan, you can use our Hospital Finder tool.

If you decide to get treatment in a hospital that's not on your plan, you will have to pay 40% of the treatment costs. Costs can be
significant, so we recommend that you choose a consultant and a hospital that is on your plan. Members can select and book a consultant in the Care Hub, using our Consultant Select tool finder. You'll be shown the consultants and hospitals available to you. 

If you select a consultant not included on your plan, you'll have to pay the costs.