Claiming

Our fast online claims service means you can make a claim on our SimplyPlan app or online account in a few simple steps! Before you get started, make sure you have a receipt you can take a photo of, a saved photo or a digital image of your receipt that you can upload.

Your receipt must include:

• Patient’s full name

• Practitioner’s name and contact details

• Treatment details, date and amount paid

Important information: credit or debit card receipts alone will not be accepted.

Okay, you're good to go! Just follow these steps:

1. Sign in to your SimplyPlan app or online account

2. Click 'Make a claim'

3. Add your receipt

The easiest way to do this is on the SimplyPlan app because you can just 'take a photo' or, if you already have an image of the receipt in your photo gallery, choose 'Upload photo' and select the photo you want. Make sure you always capture the whole page without any blur.

If you’re making a claim through your online account, or you have a digital copy of your receipt, like. a PDF sent via email, select the 'Upload File' option and find it on your device. Once you select it, the file will be uploaded, and you’ll be taken to the next step.

4. Let our system scan your receipt

Review the image to make sure you're happy with it and press 'scan my receipt'. Our scanner will pull through as much information as it can to save you a bit of time.

5. Check your claim details are correct

Always check the information that's pulled through is correct. Make sure you change any details that are wrong and enter the correct information.

6. Click 'Submit claim'

That's it, you’re done!

We'll email you to confirm we've got your claim, and it will show as 'In progress' in your SimplyPlan app or online account, under the 'Claims' section. This is where you can check the progress of your claim and see when the status of your claim is updated. We'll also email you when your claim is ready to review. It usually takes up to 2 working days for your claim to be processed, but we'll get it done as fast as we can.

The easiest way to do this is to take a photo when prompted when you click 'Make a claim' on the SimplyPlan app. If you prefer, or have a digital version of the receipt, you can upload that instead, again when prompted in the claims journey.

There are two things to keep in mind when uploading your receipt online: file type and file size. We accept .pdf, .jpg, .gif and .png files. Just so you know, changing the name of the file does not change its type, so you'll need to use an image editor to save it instead. When it comes to file size, the maximum size for all files is 10 megabytes, and you can upload at most 6 images.

Please note: In order to upload pictures on the app, you need to allow the app access to your smartphone camera. This normally occurs as a pop-up when you first download and open the app.

You can claim for most benefits as soon as your plan starts and after you have received the treatment or service, however there are a few benefits that have a qualifying period or exclude pre-existing conditions.

A qualifying period means we won't cover you for treatment received under that benefit if it happens before the start date of your plan, or at any time throughout the duration of your qualifying period.

A pre-existing condition is treatment that's been diagnosed, discussed or documented in your medical/dental records before your start date or during any applicable qualifying period.

Please note that some of our dental plans may not cover any treatment identified at your first dental appointment from the start date of your plan if you haven’t been to the dentist in the last two years before your plan started.

You can check if there are any of these exclusions for the benefits included with your plan in your SimplyPlan app or online account. Go to 'My Documents' from the homepage and tap 'Terms and Conditions'.

As the policyholder, you can submit a claim for anyone named on your plan.

It's the same process as making a claim for yourself, just changing one field during the process. If you aren't sure how to make a claim online, we've got a digital guide explaining all the steps. When you reach the 'Review details' page, simply choose the correct claimant's name in the 'Claimant' field.

No, our health plans are designed for you to submit each claim once, under one plan. This means you must choose which plan you want to submit your claim under and submit your claim online. When we process the claim, we'll consider how much entitlement you have available and the percentage payback set for the benefit you're claiming against.

Once approved, we'll send you a payment for the maximum amount available under the benefit you've used, on the plan you've selected to submit your claim under. If you don't receive the full amount back, you can't submit the same claim under an additional Simplyhealth plan to claim up to the total value of your claim.

We recommend you regularly review your overall cover with Simplyhealth and make sure the combination of plans you have in place, continue to meet your needs.

If you’re unsure whether having more than one plan with Simplyhealth continues to offer you value for money or meet your needs, we’d like to talk to you about how we can help you review your cover options. This could mean combining your cover into one plan, changing your level of cover or cancelling additional plans you no longer use. To help you review your options, here’s a link to a few of our most popular plans that might suit you better going forward.

If you’d like to discuss your cover with us, please contact our Customer Options team who will be happy to help. Call 0330 102 5335 between the hours of 9am and 6pm Monday to Friday.   

You can check the status of a claim through both your online account and the SimplyPlan app.

Online Account

To view your claims, sign in to your online account and click 'My Claims' from the homepage. This shows you a list of the claims you've made and their status.

SimplyPlan app

If you're using SimplyPlan, open the app and tap the 'Claims' tab at the bottom of the home page.

You'll get a list of all your claims, and you can find a more detailed breakdown by clicking on the individual claim. This includes the treatment date, payment date, the amount claimed and claim status.

All of your claims will be assigned a status based on where they are in the journey. This means you can keep track of what's happening with your claim. Our statuses are explained here:

Claim Submitted: We've received your claim and it's with our team for processing. Claim payments typically reach your account within 10 days after your claim has been submitted.

Awaiting Assessment: We're waiting to assess your original claim or supporting documents.

Additional Information: We just need to get some information to finish processing your claim. Click ‘My Claims’ in your online account or tap ‘Claims’ in the SimplyPlan app. Click into the claim to see what information we need to support your claim. Click the “Upload Information” button to upload the required information.

Approved: Good news, your claim payment is on its way. Please note that, depending on your bank, it can take up to 3 working days for the payment to arrive in your account.

Declined: Unfortunately, we weren't able to accept your claim. If you're checking your claim on your online account, you'll find the reason we've declined your claim explained underneath the claim details. If you're using the SimplyPlan app, select the claim you're checking from the Claims tab at the bottom of your home page. Click into the claim and use the arrow to see any further information about why your claim has been declined.

We'll try to contact you by email first because it's faster and helps us use less paper.

If we have an email address on your account, we'll use this to let you know when your claim is ready to view in your online account or on the SimplyPlan app.

If we cannot contact you by email, we’ll write to you, but this can take a bit longer.

If you want to make sure we have the right email address for you, or you want to add your email to your account, you can do this through the 'personal details' section in your online account.

When we assess your claim, we’ll check for the following things:

• If the treatment or services you’ve claimed for are covered under the terms and conditions of your plan.

• The date of your claim to make sure your policy was active at the time of treatment and you had entitlement available in the policy year it falls under.

If you're checking your claim through your online account, you'll find why we've declined your claim under 'My Claims'. You'll see a list of your claims, find the one that has been declined and the reasons will be included in the details.

If using the SimplyPlan app, click the Claims tab at the bottom of your home page. Tap the claim that's been rejected to open the claim details

You can check your claim history through your online account or on the SimplyPlan app.

Online Account

To view your claims, sign in to your online account and click 'My Claims'. From here, you can use the filters available to find claims you've made.

SimplyPlan app

If you're using the SimplyPlan app, open the app and tap the 'Claims' tab at the bottom of the home page. You can scroll through all your old claims and use the filters if necessary.

We process all claims in date order from when we receive them, and our priority is to pay your claim as quickly as possible.

Typically an online claim takes around 2 to 3 days to process from the date we receive it. If approved, payment should then be in your bank account within 3 to 5 working days. However, when we receive higher volumes of claims than usual, it might take a bit longer.

We'll always email you when your claim has been updated, and you can check the status of your claim within your online account and the SimplyPlan app.

If we can't email you, we'll send you a letter.

We pay claims directly back into your bank account.

If you haven’t added your bank details to your plan, it’s easy to do so and only takes a couple of minutes; why wait any longer than you need to for your money to come back to you? This link will take you to the Bank and Payment details section within your online account.

Click the 'Change to Direct Credit' button under 'Claim Payment' and fill in the fields.

There could be a couple of reasons for this:

• No entitlement left: When we assess your claim, we’ll check the date of it to make sure you have entitlement available in the policy year it falls under. If you’ve already used all or some of your annual entitlement for the benefit you're claiming for, we will either decline the claim or send you a payment for the entitlement you have remaining

  
  

• Percentage payback: We also check the percentage payback for the benefit you're claiming under. It’s possible you’re entitled up to 75% or 50% of the amount you’ve claimed, which could explain why you’ve received less than you expected. Check your ‘Table of Cover’ under 'My Documents'

  
  

• Treatment limits: If you have a Dental plan with Simplyhealth, there is a maximum amount you can claim back towards certain treatments under some of your dental benefits. You can see details of any treatment limits in your ‘Table of Cover’, under 'My Documents' in your SimplyPlan app or online account