Claims FAQs

Log into the Member Zone and go to your health dashboard. Here you will find a summary of your cover and the information you need to make a claim. To see your full plan details, select ‘my documents’. This will show you the documents you have received from us, including those detailing your cover.

Normally, we settle all your charges directly with your healthcare provider. However, if you have an excess on your plan, you’ll need to pay this. We’ll let you know who the excess needs to be paid to.

Your excess is dependent on your excess type (per plan year or per claim) and is applied to the first bills we receive in your plan year or at the start or renewal of each claim.

Depending on your plan, your excess will start again either from your plan renewal date or a year after your claim was registered.

Your certificate will outline if you need to pay an excess. For more information about your excess, please read the details of your plan, which you can find in the documents on your Care Hub in Member Zone. Through your Care Hub you can also track the excess amounts you have paid.

If you’ve added one of the Hospital Select options to your plan and have a specific hospital in mind, please check if it’s included on your hospital list and let us know. You can find details of your hospital list here or find your nearest hospitals using our hospital finder.

If you haven’t added Hospital Select, Consultant Select will be automatically included on your VitalityHealth plan. When you contact us to claim and you have an open referral from your GP, we can help you select a consultant on your list.

If you choose to use a hospital that’s not available under your option, you’ll need to contribute 40% of all your hospital costs, excluding consultant charges. Please consider this carefully, as this could result in a considerable cost.

Read our guide on how to make a claim here. 

We try to make a decision for you as quickly as we can, but sometimes we may ask you and your GP to complete a form before we can assess your initial condition. If this is the case, we will let you know.

You’ll find this on the front page of your claims letter. Make sure you give your consultant your care number. If you’re having treatment via our consultant panel, they’ll arrange payment for your consultant.

You'll find your membership number on your plan documents and in 'My messages', from when you joined Vitality and at every renewal. 

If you have the Vitality Member app on your smartphone, you can log in, select the My Card button at the bottom of the screen and you’ll find your membership number, along with any dependant’s numbers, too.

In most cases, you’ll need a referral from a GP before making a claim. You can self-refer for some mental health treatments if they’re covered by your plan, so you don’t have to wait to see a GP first. If you have Out-patient Cover, you can also self-refer for physiotherapy through our network of over 2,000 physiotherapy clinics. 

There are some cases where we’ll take referrals that haven’t been made by a GP. For example, referrals following a Health Assessment or treatment in accident and emergency. For certain conditions, a referral may also be made by a dentist or optician.

If you submit a claim through the Care Hub, we aim to get back to you by the end of the next working day.  For physiotherapy requests in the Care Hub, we can put you in touch with our partner Ascenti the same day. 

If you call us, we try and make a decision straightaway but we may need to ask your GP for additional information, depending on your plan cover and condition.

Alternatively, if you have a video consultation with a Vitality GP and they can diagnose you on the call, the Vitality GP will arrange an onward referral and you won’t need to contact us. We may get in touch with you if we need any additional information.

Sometimes, we may need some more information or to ask your GP to complete a form. Once we’ve received this, we’ll usually let you know our decision within a maximum of two working days.

No, it needs to be completed by your usual GP who has access to your full medical history.

We only cover pre-planned and non-emergency care. If you need emergency treatment, please use the NHS 111 helpline, go to your local NHS accident and emergency department or dial 999 for immediate medical assistance. Please contact us within our opening hours before you accept any private medical care, so we can assess your claim to avoid any unexpected costs.

In most circumstances, this isn’t covered by our plans. For some business schemes, this is available if your company has chosen additional cover. We will need to speak to you when our office is open to advise you if any cover can be provided in this circumstance or if you’re eligible for a cash benefit. In the meantime, please do not delay any treatment and follow NHS advice.

Your plan covers care in the UK only. Please contact your travel insurance provider. 

If you’ve selected travel insurance as part of your VitalityHealth plan, this is indicated on your certificate and plan documentation, which you’ll find in My Messages in Member Zone.

To authorise a transfer, we need to talk to you to understand the circumstances of your admission. We may also need some information from your healthcare provider. Please contact us within our working hours, so we can let you know whether cover will be provided.

If you’re already in hospital, we’ll only cover eligible care that takes place after your consultant has confirmed – at your request – that: 

• Your vital signs are within normal limits and have been for at least for 48 hours
• You don’t require critical care.

Please take the care number we give you, which you’ll find on the front page of your acceptance letter.

You may find it useful to take a list of any questions you have and a pen and paper to make notes. 

You might also want to check with your GP or consultant to see if they suggest taking anything with you.  

If your consultant says you need hospital care as a day-patient or in-patient, or extra treatment sessions, you need to contact us or our Consultant Panel with the following details:

• The date of your treatment 
• The name of the consultant and hospital 
• The expected length of your stay – as either an out-patient, day-patient or in-patient
• For surgical procedures, we require a procedure code – known as a CCSD code – which your consultant or consultant’s secretary can provide.

If you need treatment, your consultant or consultant’s secretary, should give you a procedure code. This is called a CCSD (Clinical Coding and Schedule Development) code by medical professionals. The code will start with a letter of the alphabet followed by four numbers, for example A5720. We need this code as it tells us exactly what type of treatment you’ll be having and helps us to assess your eligibility.

If you submit online, we aim to get back to you by the end of the next working day. If you call us, we try to make a decision straightaway. 

Sometimes, we may need to ask your health provider or GP for more information. Once we’ve received this, we aim to contact you with our decision within five working days.

Please make sure you’ve settled any co-payments or excess amounts directly. Then send your bill to VitalityHealth Customer Services, Sheffield, S95 1DB, and we’ll settle any outstanding applicable amounts. Alternatively, you can email your bill to [email protected]. Please make sure you attach your care number and Vitality membership number.

In most cases, we’ll settle payment for your care directly with your healthcare provider, so you can focus on getting better. 

If you do make a payment yourself, please send the bill and proof of payment to VitalityHealth Customer Services, Sheffield, S95 1DB. We’ll then reimburse you less any co-payment or excess amounts that may apply to your plan. Alternatively, you can email your bill to [email protected]. Please make sure you attach your care number and Vitality membership number.

Just so you know, you need to send us this information within six months of paying your bill.

 In most cases, bills will be processed within seven to 10 working days and payment made shortly after. Please note that payments to providers can take up to 28 days, depending on their payment agreement with us.

 We’ll send a claims statement to your inbox on the Member Zone detailing all payments made on a monthly basis.

Your claims statement will show details of any bills that haven’t been settled in full. We might not be able to pay a bill in full for one of the following reasons:

• If an excess applies to your plan – this may be per claim or per plan year 
• If any monetary limits apply to your plan, for example if you have a limit on Out-patient Cover
• If treatment has taken place at a hospital that’s not included on your hospital list and a co-payment applies
• If treatment isn’t eligible under your plan terms and conditions.

Please take a look at your plan summary for further details.

If you’re having problems, try logging out and then logging in again to refresh your internet browser. If you’re still having problems, please contact us.

We always have your best intentions at heart, however we understand that sometimes things can go wrong. If you have reason to complain, we want to know so we can try and put things right and resolve your complaint quickly for you. You can find out how to make a complaint here.