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How to make a claim

Care starts the minute you call us. Care isn't something that only happens in hospital. It starts the moment you make a claim. When you call us, you'll speak to someone who listens, who understands, and who'll do everything they can to help. That's because, on average, our team have seven years' experience looking after our members. They can guide you through your claim, step by step. So, you don't have to worry about your cover - instead, you can focus on getting better. We make it quick and easy to claim. Follow our four simple steps to making a claim.

First: Step 1

Firstly, visit your GP. If you're unwell, the first thing to do is to visit your GP. If they refer you for treatment, tell them you have cover with PruHealth and ask for the following:

  • Full details of your condition/injury, diagnosis and intended treatment.
  • Full name and address of the specialist or therapist and the hospital/clinic you've been referred to.

 

Need physio?

If you've been referred for physiotherapy, we have a network of approved physiotherapists we can recommend. Ask us for more information when you call, or if you fill in the details of your claim online, we can arrange for them to call you back to make an appointment.

 

Any claims that you do need to make, may result in your no-claims discounts being decreased in the next plan year. If you do feel unwell, please do not delay seeking treatment because of the impact it will have on your no-claims discount.

Then, Step 2

You can either claim online or give our team a call. Once you've got your details from your GP, call our claims team for your authorisation number. Remember to take this number with you when you visit the specialist, otherwise you might not be covered.

 

You may be able to claim online. Simply let us know the details from your GP and we'll get back to you usually within one working day. Go to the Member Zone and click on the 'Make a claim' tab.

 

Call the number on the back of your membership card.

 

When you call, select the option to 'get authorisation for treatment' so that you go through to our dedicated Claims Team. Make sure you have your membership number on hand when you call. Our Claims Team is available Monday-Friday 8am to 8pm and Saturday 8am to 1pm. Please note our offices will be closed on bank holidays.


Don't have your card on hand? Is your cover through your or your partner's employer?

  • Yes, Call us on 0800 028 5777
  • No, Call us on 0800 092 7333

You might be asked to give details of your condition over the phone, so you may want to make the call in private. You may also be asked to have your GP, specialist or therapist complete a medical report. This will help us to confirm that you are covered for your treatment.

Then, Step 3

Book your appointment. Once we've confirmed you're covered for your treatment you can book your appointment with the specialist. Once you have confirmed your appointment we will give you an authorisation number. We will also send you confirmation of your details by post or email, including your authorisation number and any limits that may apply on your cover.

 

Remember to take the authorisation number with you when you visit your specialist. You should also take a copy of your hospital list so your specialist can see which hospitals you are covered at for treatment.

 

For a full list of the hospitals you have access to, visit the 'My hospitals' tab when you log in to the Member Zone.

 

Need further treatment? Call us first

If you need further visits, ask for a procedure code and description of the treatment or investigation. Always speak to our Claims Team in advance to make sure you're fully covered for further treatment, or you may need to pay for the treatment yourself.

Finally, Step 4

We'll cover the bills

In most cases, medical bills will be sent directly to us, so we'll settle these for you. If you have an excess on your cover, you'll need to pay this to the hospital or treatment provider yourself.

 

If you do get a bill, forward it to us at PruHealth Customer Services, Stirling FK9 4UE. If you make a payment yourself, send us the bill with proof of payment and we'll pay you back. Please remember that we will only cover medical expenses - any personal expenses, such as newspapers, visitors' meals etc will need to be settled by you.

 

We'll add a claims statement to your Member Zone showing the amounts we've paid and whether there is any excess or co-payment you still need to pay.


Your hospitals

For a full list of the hospitals you have access to, visit the 'My hospitals' tab when you log in to the Member Zone.

Call us if you have any questions, or need any additional help.

Making a claim by phone

Covered as an employee?

Call us on 0800 028 5777

Covered as an individual?

Call us on 0800 092 7333

Forms for your GP

You can download any requested from here

Before you give these forms to your GP, therapist or specialist, make sure you have signed the declartation on the back which says that you agree to them providing your medical information to us. Read the full details in the form before you sign.