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How do I claim for medical expenses that I have already paid for to my medical provider?
The procedure applicable to your policy will depend on the product available to you and will be described in detail in your Benefit Guide (which you will have received upon inception).
However, if you are under one of our standard International Healthcare Plans, we summarise below the general claiming procedure applicable to you:
If your Table of Benefits indicates that your treatment does not require pre-authorisation, then simply follow these steps:
01. Receive your treatment and pay the medical provider.
01. Get an invoice from your medical provider.
This should state your name, treatment date(s), the diagnosis/medical condition that you received treatment for, the date of onset of symptoms, the nature of the treatment and the fees charged.
02. Claim back your eligible costs via our MyHealth app.
Simply provide a few key details, take a photo of your invoice(s) and press ‘submit’.
As an alternative to MyHealth app, you can also claim your treatment costs by completing and submitting a Claim Form, downloadable here. You will need to complete section 5 and 6 of the Claim Form only if the information requested in those sections is not already provided on your medical invoice.
Please send the Claim Form and all supporting documentation, invoices and receipts to us by email, fax or post (details on the form).
Quick claim processing
We can process a claim and issue payment instructions to your bank within 48 hours, when all required information has been submitted. However, without the diagnosis, we cannot process your claim promptly, as we will need to request these details from you or your doctor. Please make sure you include the diagnosis on your claim!
We will email or write to you to let you know when the claim has been processed.
Watch our videos to find more information about getting treatment and claiming procedure!
What do I need to consider when claiming for maternity expenses?
The claiming procedure applicable to your policy will be described in your Benefit Guide.
However, if you are under one of our standard International Healthcare Plans, the above procedure for out-patient, dental and other expenses will apply to pre-natal care claims too, where pre-natal care is included in your cover.
For the delivery, however, submission of a Treatment Guarantee Form (available here) is required. Please complete and submit it 4-6 weeks before the estimated delivery date in order for our Medical Team to confirm cover and arrange for direct billing (where possible) with the medical provider of your choice.
In case of an emergency, don’t worry: just obtain your medical assistance and call us within 48 hours of the emergency, to inform us of the hospitalisation. Treatment Guarantee Form details can be taken over the phone when you (or your medical provider, or a family member – if you are unavailable to talk on the phone) call us.
Please note that we may decline your claim if Treatment Guarantee is not obtained: full details of our Treatment Guarantee process can be found in your Benefit Guide.
What do I need to consider when claiming for orthodontic treatments?
The claiming procedure applicable to your policy will be described in your Benefit Guide.
However, if you are under one of our standard International Healthcare Plans, the above procedure for out-patient, dental and other expenses will apply to orthodontic claims too, where orthodontic treatment is included in your cover.
Please note that the costs incurred will only be reimbursed after treatment has taken place.
This means that, if you are paying for your orthodontic treatment in instalments, you can submit your claims monthly or quarterly (depending on the payment frequency you have agreed with your medical provider).
- You will need to ensure that the invoice includes a description of the treatment received and the treatment dates for the period invoiced.
Orthodontic treatment is covered only in cases of medical necessity, and for this reason, at the point of claiming, we will ask you to submit supporting information to determine that your treatment is medically necessary and therefore eligible for cover.
The supporting information required (depending on your case) may include, but is not limited to, the following documents:
You will find the “Orthodontic treatment” definitions and any applicable exclusions in your Benefit Guide, if you wish to check the level of cover provided under your policy.
What do I need to consider when claiming for “In-patient cash benefit”?
If this benefit is included in your policy, a specified amount (indicated in your Table of Benefits) will be paid to you per each night you spend in hospital, up to a specified maximum number of nights per Insurance Year, where the hospital treatment you are receiving is free of charge and covered within the terms of your plan.
To claim for the “In-patient cash benefit”, please follow the procedure described in the question above regarding “How do I claim for medical expenses that I have already paid for to my medical provider?"
Note that you also need to attach your admission/discharge notice from the hospital when you send your claim to us (via MyHealth or Claim Form, as your prefer). The admission/discharge notice will need to show the number of nights spent in the hospital, the treatment received and a confirmation that the treatment received was free of charge.
What terms and conditions are applicable to the claiming process?
Please note that important terms and conditions are applicable to the medical claiming process. These terms and conditions may vary depending on the product available to you and on the type of insurance contract. We therefore advise to check your Benefit Guide to confirm the claiming terms and conditions applicable to your policy with us.
For convenience, we summarise below the terms and conditions that normally apply to standard policies in terms of medical claims:
01. All claims should be submitted (via our MyHealth app or Claim Form) no later than six months after the end of the Insurance Year. If cover is cancelled during the Insurance Year, claims should be submitted no later than six months after the date that your cover ended. Beyond this time we are not obliged to settle the claim.
|02. Submission of a separate claim (via our MyHealth app or Claim Form) is required for each person claiming and for each medical condition being claimed for. Please note that as well as our hard and soft copy claim forms, members can now avail of our MyHealth app for fast and easy claims submission.|
03. It is your responsibility to retain any original supporting documentation (e.g. medical receipts) where copies are submitted to us, as we reserve the right to request original supporting documentation/receipts up to 12 months after claims settlement, for auditing
|04. If the amount to be claimed is less than the deductible figure under your plan, keep collecting all out-patient receipts and Claim forms until you reach an amount in excess of your plan deductible, then forward to us all completed Claim Forms together with supporting receipts/invoices.|
05. Please specify on the Claim Form the currency in which you wish to be paid. Unfortunately, on rare occasions, we may not be able to make a payment in the currency you requested on the Claim Form, due to international banking regulations. In this instance we will review each case individually to identify a suitable alternative currency option. If we have to make a conversion from one currency to another, we will use the exchange rate that applies on the date on which the invoices were issued, or we will use the exchange rate that applies on the date that claims payment is made.
|06. Only costs incurred as a result of eligible treatment will be reimbursed within the limits of your policy, after taking into consideration any Treatment Guarantee requirements. Any deductibles or co-payments outlined in the Table of Benefits will be taken into account when calculating the amount to be reimbursed.|
07. If you are required to pay a deposit in advance of any medical treatment, the cost incurred will only be reimbursed after treatment has taken place.
|08. You and your dependants agree to assist us in obtaining all necessary information to process a claim. We have the right to access all medical records and to have direct discussions with the medical provider or the treating physician. We may, at our own expense, request a medical examination by our medical representative when we deem this to be necessary. All information will be treated in strict confidence. We reserve the right to withhold benefits if you or your dependants have not honoured these obligations.|
How quickly will I be reimbursed for eligible out-patient treatment?
Please note that the claiming process (including our Service Level Agreement) may vary depending on the product available to you and on the type of insurance contract. We therefore advise you to check your Benefit Guide to confirm the claiming process applicable to your policy.
For example, if you are covered under one of our standard International Healthcare Plans, (and as long as your claim is submitted with all relevant details, documentation, invoices and receipts within six months after the end of the Insurance Year) we will aim to process your claim within 48 hours.
Please note that without the diagnosis, we cannot process your claim promptly, as we will need to request these details from you or your doctor.To help us processing your claim in the quickest time possible, please ensure to include the diagnosis, an eligible copy of each invoice and any supporting documentation on your claim!
I was overpaid on a claim I submitted. What should I do now?
If you notice that you were overpaid for any claim submitted to us please contact our Helpline and provide the relevant claim number, amount overpaid and any important information.
A member of our team will instruct you on how to proceed and, in most cases, will provide you with bank account details to where the overpaid amount can be transferred.
My claim was declined or partially paid – why?
Before you submit a claim it is important to understand your level of cover and the terms and conditions applicable to your policy: for this, please check your Table of Benefits and your Benefit Guide.
Our Claims Team follow rigorous quality control measures to ensure your claim is processed correctly and efficiently. Nonetheless, there are a few reasons why a claim might be fully declined or partially reimbursed.
Some of the possible reasons why this may happen are detailed below. Please refer to the specific question/ answer below for more detail.
If you can not identify your claim with any of the reasons mentioned you might contact our Helpline for clarifications.
What does the “6 month period” refer to in relation to claim submission?
Unless otherwise stated in your Benefit Guide or in your Table of Benefits, all claims should be submitted no later than six months after the end of the Insurance Year. If cover is cancelled during the Insurance Year, claims should be submitted no later than six months after the date that your cover ended. Beyond this time we are not obliged to settle the claim.
My claim was declined or partially paid due to “Duplicate claim”. What does it mean?
If you submit an invoice that has already been processed and reimbursed under another claim submission, we will decline it as a duplicate.
My claim was declined or partially paid due to “Benefit limit exceeded”. What does it mean?
If the maximum benefit limit for the benefit you claimed for has been reached, the invoice(s) can not be reimbursed in full. Please refer to your Table of Benefits in conjunction with your Benefit Guide for full details of the benefit limits that apply to your policy.
My claim was declined or partially paid due to “Co-payment applied”. What does it mean?
If a co-payment your plan, it means that a percentage of the eligible costs incurred are to be paid by you. Normally co-payments apply per person, per Insurance Year, unless indicated otherwise in your Table of Benefits.
Some plans may include a maximum co-payment per insured person, per Insurance Year, and if so, the amount will be capped at the amount stated in your Table of Benefits. Co-payments may apply individually to the Core, Out-patient, Maternity, Dental or Repatriation Plans, or to a combination of these plans. The details of your co-payment are stated in your Table of Benefits.
In the following example, Mary requires several dental treatments throughout the year. Her dental treatment benefit has a 20% co-payment, which means that we will refund 80%. The total amount payable by us may be subject to a maximum plan benefit limit.
My claim was declined or partially paid due to “Deductible applied”. What does it mean?
If a deductible applies to your plan or to the benefit you are claiming for, it means that we will start paying your medical expenses once the fixed deductible amount has been reached. Where applied, deductibles are payable per person per Insurance Year, unless indicated otherwise in the Table of Benefits.
Deductibles may apply individually to the Core, Out-patient, Maternity, Dental or Repatriation Plans, or to a combination of these plans. When applied, the deductible will be listed in your Table of Benefits. You will find further information about deductibles in the “Cover overview” and “Claims” sections of your Benefit Guide.
In the following example, John needs to receive medical treatment throughout the year. His plan includes a €450 deductible.
My claim was declined or partially paid due to “Excluded under Terms and Conditions”. What does it mean?
Although we cover most illnesses, expenses incurred for certain treatments, medical conditions and procedures are not covered under the policy unless confirmed otherwise in the Table of Benefits or in any written policy endorsement.
Please refer to the “Exclusions” section of your Benefit Guide.
My claim was declined or partially paid due to “No further information received”. What does it mean?
In some cases, upon receipt and initial review of your claim, our Claims Team may request further information necessary to process the claim.
For example, if you are claiming for an orthodontic treatment, we will require submission of a treatment plan. If this information is missing from your claim, we will request it from you.
If the information is not received within two months of our initial request, we will be unable to evaluate and process your claim and therefore your file will be closed. We can of course re-open your claim, provided that this is done within the expire of the claim submission period.
When you submit the missing information requested in relation to your claim, our Claims Team will be happy to complete the processing of your claim according to the terms and conditions of your policy.
The missing information can be emailed to: email@example.com
My claim was declined or partially paid due to “Missing Pre-authorization (MPA)”. What does it mean?
Your Table of Benefits will indicate what (if any) treatments are subject to pre-authorisation through submission of a Treatment Guarantee/Pre-authorization Form. Usually these are in-patient and high cost treatments.
Use of the Treatment Guarantee/Pre-authorization Form helps us to assess your case and facilitate direct settlement of your bill with the hospital.
The terms related to the Treatment Guarantee/Pre-authorization process may vary slightly depending on the product available to you. For example, if you have one of our standard International Healthcare Insurance plans, the following applies to cases where the Treatment Guarantee/Pre-authorization is required but not obtained:
My claim was declined or partially paid due to “No benefit under your plan”. What does it mean?
Unfortunately, if the benefit you are claiming for is not included under your plan, we are not liable to reimburse your claim.
Please refer to your Table of Benefits and to your Benefit Guide to understand what is included in your cover.
My claim was declined or partially paid due to “Over-the-counter drugs”. What does it mean?
If the “Prescribed drugs” benefit is included in your Table of Benefit, cover is provided as stated there for over-the-counter medication that have been prescribed by your doctor. However, if the “Prescribed drugs” benefit is not listed in your Table of Benefits, over-the-counter medication will not be covered even if you have a prescription from your doctor.
Please check the definitions and exclusions included in your Benefit Guide to confirm this.
My claim was declined or partially paid due to “Waiting period applied”. What does it mean?
Your Table of Benefits indicates if any of your eligible benefits are subject to waiting periods. When a waiting period applies, you will be eligible for cover under that specific benefit when the waiting period has expired; e.g. if your benefit is subject to a six month waiting period, you will start being covered for it after six months have passed from your policy start date (or effective date if you are a dependant).
Please refer to your Table of Benefits and Benefit Guide for full details of the terms and conditions of your policy.
I have received reimbursement for my claim but bank charges have been applied to the payment. What should I do?
When we issue a claim payment, we instruct your bank to charge any applicable transaction fees to us: therefore, your bank should credit the full reimbursement amount to your account. Nevertheless, there may be multiple banks involved in the international transaction of your funds and each of them may charge a fee. These fees vary by bank, country and currency.
We have been advised by our bank, Citibank, that even though we instruct your bank that we pay the charges associated with the claim payment, this does not mean that your bank won’t charge you for crediting your account (as banks handle payments based on their own banking and country rules/policies). To investigate any charges applied to your claim payment, we advise you to first contact your bank.
Afterwards, should you require more clarification, we will be happy to help by setting up a case file to confirm if your payment was processed correctly: in this case, please email us your request and include a document from your bank that states the incurred charges. Also, please provide the claim number related to the payment.
I received a claim update letter saying that my claim was processed but I have not received the payment. What should I do?
Claim payments are issued by us the day after your claim is processed: however, please note that, depending on the bank transaction timelines, the payment can take up to 10 working days to appear in your bank account. If you have not received your payment within 10 working days, we would appreciate if you could re-confirm your bank account details to us.
You can check what account details we have used to pay your claim in your Statement of Accounts: this is made available to you on our MyHealth App (if your claim was submitted via the app) or was sent to you by email (if your claim was submitted via any other channel, e.g. email or post, etc.) If the account details in your Statement of Account are incorrect, please contact our Helpline to provide your correct bank details and related claim number so we can investigate your payment for you.
If you opted to receive your claim payment by cheque, please note that cheques might take up to 6 weeks to arrive at your address, depending on the geographic area of destination. If passed this time you still have not received your cheque please contact us, indicate the claim number that payment is related to and confirm your postal address – so we can check the status of your check in the post.
Alternatively, you can ask us to reissue the payment by bank transfer instead.
In that case, you will also need to provide your full bank details as stated below:
Our multilingual helpline staff are available 24 /7 to handle day to day policy enquiries and support you during emergencies.
Note that we will need your name and policy number to identify you in our system and be able to respond to queries on your cover, your claims, etc. – so please don’t forget to have your policy number with you when you call us or to state it in your email (together with your full name) if you prefer to write.
|Call us: +353 1 630 1301|