1. What is private health insurance and how does it work?
Private Medical Insurance (PMI) is designed to give you reassurance by offering access to eligible private health treatment; from seeing a specialist for diagnosis to receiving the appropriate care during a stay in hospital. These, plus flexible appointment times and a large choice of private hospitals, are just some of the benefits available to you through Private Medical Insurance, helping to keep you at work and enabling you to live life well. With the current challenges within the NHS, Private Medical Insurance works to complement the care available to you through the NHS.
2. Do I have an excess?
Your Certificate of Cover will tell you if you have an excess and how much it is. Excesses are applicable per person, per policy year.
Where there are multiple claims in one plan year, only one excess will be applied.
For full details regarding how the excess works, please see section 5 ‘Managing your membership’ of the membership handbook.
3. How do I make a claim?
You can contact PHC's claims helpline on 0800 068 7111 (or 01923 726 212 if calling from overseas).
To make a claim follow the steps below:
- Ask your GP for an open referral
We will accept referrals from the AXA Doctor at Hand service or a GP at your GP practice. If your GP says you need specialist treatment, tell them you want to go private and ask for an ‘open referral’. With an open referral your GP doesn’t name a particular specialist, but instead gives you the type of specialist you need to see, for example a cardiologist. This means we can help you find a suitable specialist and make a convenient appointment for you. Occasionally the NHS will be best placed to provide care locally (for example specialist paediatric (children’s) care at an NHS centre of excellence). When this is the case, we will talk to you about your NHS options as well.
- Contact us on 0800 068 7111 before you see the specialist
Contact us as soon as you’ve seen your GP. It’s important you contact us before you see the specialist or have any treatment so that we can tell you what you’re covered for. This will mean you don’t end up having an unexpected bill for treatment that you’re not covered for.
- We’ll check your cover and let you know what happens next
We may ask you to provide more information, for example from your GP or specialist. You, your GP, or your specialist must provide us with the information we ask for by the date that we ask for it or you may not be covered for your claim.
4. Where is your claims team based?
Our dedicated claims team is based in Croxley Park, Watford, Hertfordshire. We also have an out of hours/overflow service through our parent company, AXA Health, based in Tunbridge Wells, Kent.
5. Can I cover my family members?
Whether you can add family members, including babies, to your cover depends on the contract of insurance we have with your employer, as there may be restrictions on when you can add family members. Members who are joining the group plan may be required to complete an application form.
We are unable to add a new eligible member until we’ve received and accepted the application form or received formal instruction to add, and there are restrictions on the length of time cover will be back-dated dependent upon the underwriting terms that apply.
Who can members add?
Members can normally add:
- your partner. You must be either married, in a civil partnership, or living together permanently in a similar relationship
- Any of your children or your partner’s children
If you would like to add a new baby to your cover, you can normally do this from their date of birth, free of charge, so long as we are notified within 13 weeks of their birth.
Please note: Children cannot stay on a group member or eligible family members plan after the renewal date following their 25th birthday.
A lead member can cover up to 8 dependants.
6. Do I need a GP referral for all treatment?
You may not need a GP referral for certain conditions.
For musculoskeletal conditions, call PHC as soon as you develop a problem. We’ll check you’re covered and refer you to our muscles, bones and joints service who will arrange an initial clinical needs assessment with a physiotherapist. During the needs assessment the physiotherapist will listen to your concerns, take you through an initial assessment of the issues you're experiencing and then advise the most appropriate treatment for you.
In addition, you can get access to support and treatment for mental health conditions through our mental health assessments and support service, by speaking to a counsellor or psychologist who will assess your condition and recommend a treatment plan, without the need for a GP referral.
You also have access to our skin, prostate and breast cancer pathways.
For all other conditions, you will need a referral from our AXA Doctor at Hand services or a GP at your GP practice.
Please note: members under the age of 18 will need to see their GP for a referral for these conditions as these services are not available to them.
7. How do I register for AXA Doctor at Hand?
To register and activate your access to the AXA Doctor at Hand service, you’ll need:
- Your membership number or activation code, found in your membership communications.
- Photo ID – you can use a passport, driver’s licence, identity card or residence permit card.
- Camera access – you’ll need to be able to take a selfie on the phone or computer you’re using.
Access using the link below to get started.
https://member.doctorcareanywhere.com/SignUp/axa/
8. How do I access the Counselling & Support service?
Our Counselling and Support service is available 24 hours a day, 365 days a year, to help you and the family members aged 16 and over living in your household deal with life’s ups and downs. To speak to somebody, call AXA Health’s dedicated Counselling and Support service on 0800 316 1213. To access the online portal, please visit axabesupported.co.uk. To register for an online account, use access code: employee. You can then login using your own details.
9. Is dental treatment covered under my policy?
HealthCover4life plans do not include cover for treating emergency dental problems or any routine dental care. This includes any fees for dental specialists, such as orthodontists, periodontists, endodontists or prosthodontists.
We will cover the costs of oral surgery when you are referred for treatment by a dentist, such as:
- reinserting your own teeth after an injury; or
- removing impacted teeth, buried teeth and complicated buried roots; or
- removal of cysts of the jaw (sometimes called enucleation).
10. Does my policy cover me for treatment abroad?
We do not cover any costs for treatment you receive outside the UK or if you live outside the UK. If you move abroad, you won’t be able to keep your current membership and you will not be able to make any claims for treatment.
11. Can I add my newborn baby to my policy?
Newborn babies can be added to the policy from their date of birth (when added within 13 weeks) and are covered free of charge up to the first renewal. If your baby requires treatment in a Special Care Baby Unit or paediatric intensive care following birth, you may not be covered for the costs. Please contact us to confirm any cover available to you in this case.
12. Can I have a health check-up/assessment?
As part of your healthcare cover, you are entitled to 25% off a range of Nuffield Health or Circle Health Group Health Assessments (terms and conditions apply). For more information about the health assessments available to you including prices, please visit Health Assessments.
13. Can I have a hearing test?
Routine hearing tests are not covered by the policy. You will need to contact the claims team on 0800 068 7111 to discuss specific circumstances.
14. Do you cover investigations or treatment to do with learning and developmental disorders?
We do not cover any treatment, investigations, assessment or grading to do with learning and developmental disorders. This includes conditions such as dyslexia, dyspraxia, autism spectrum disorder and attention deficit hyperactive disorder (ADHD).
15. Can I have a psychiatric assessment?
As part of the Mental Health Assessments and Support service available to you through your healthcare cover, we can arrange an assessment with a counsellor or psychologist. Where appropriate, they may refer you to a psychiatrist for further assessment and treatment.
16. Do you cover emergency treatment?
Private hospitals are not set up to deal with life-threating illnesses or injuries and as such they do not have Accident & Emergency facilities. In an emergency, you should call an NHS ambulance or go to an NHS A&E department.
17. Do you have a mobile app?
Whilst we currently don’t have a mobile app, you do have access to this dedicated online platform. You can access all you need to know about your PHC cover, from membership literature, including your Membership Handbook and Directory of Hospitals. You will also discover the value-added health and wellbeing services available to you and how to access them.
