Our plans aren't designed to replace all NHS services so sometimes cover won't be available on your plan. This is usually because:
We limit the amount we pay some specialists in order to keep premiums as low as possible. If you choose a non-approved specialist who charges more than our agreed limits you may have to pay a contribution towards the cost of your initial and ongoing treatment. These costs could be considerable so we recommend you speak to us before agreeing to any treatment and we can discuss your options.
Agreeing an excess when you take out your plan is a good way to reduce your premiums. When you call us to make a claim we’ll tell you whether there’s an excess on your plan. When we receive an invoice for your treatment we’ll reduce the amount we’ll pay by your excess. You’ll only have to pay your excess once in each membership year and not if you have more treatment throughout the year.
We’ll let you know how to pay your excess when we send you a statement following a consultation or treatment. Take a look at our short video.
Sally needs minor surgery on her knee. She gives us a call to chat through her options. We let her know that this kind of operation is covered by her plan, so we approve it. We also let Sally know that tests and consultations before the surgery will take her up to her out-patient benefit limit for the year. Sally knows that she may need some more treatment on her knee this year, so she starts putting some money aside every week - just in case.
Sally's surgery goes really well, and we cover the cost of it in full. We even settle the bill directly with the provider that performed the surgery. It means that Sally doesn't have to pay a penny upfront, so she's not out of pocket.
After her surgery, Sally's specialist suggests a course of physiotherapy to speed up her recovery. Sally knows that she's reached her out-patient benefit limit for the year, and we won't be able to cover her physiotherapy bills. Sally needs to decide whether to cover the cost herself, or to get her physiotherapy through the NHS. Even though she's saved up enough money to cover the treatment herself, Sally decides to go through the NHS. She uses the money she's saved for a relaxing holiday instead.