"Hello, how can we help you?"

Our friendly Customer Service team has prepared answers to the questions we get asked the most about our Health Plan benefits.

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Got a question about one of your benefits? Wondering if something’s covered?

Simply choose the benefit you have a question about below and see if we have a quick answer to your query.

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- Customer Service team

Your plan may not cover all the benefits listed below. Always check your table of cover, under My Documents, to see what you’re covered for.

Chiropody

What can I use my chiropody / podiatry benefit for?

Chiropody and podiatry are often seen as the same thing. Podiatry is the internationally recognised name for a foot specialist. 

A chiropodist or podiatrist can assess, diagnose, and provide treatment for conditions related to the foot, ankle and lower limb. 

You can use your chiropody benefit for things like:

  • Problematic toenails (inclusive of ingrown toenails, damaged and fungal nails)

  • Callus and corns 

  • Skin fissuring, such as cracked heels 

  • Athletes foot and other dermatological complaints 

  • Verrucae 

  • Blisters and shearing stress or tissue damage

  • Flat feet

  • High arches

  • Joint and muscular pain

  • Heel pain

  • Shin pain

  • Bunions

  • Other sport-related injuries

  • Consumables prescribed and bought from the chiropodist/podiatrist at the time of treatment

Make sure your treatment is provided by a chiropodist or podiatrist who is registered with the Health and Care Professions Council (HCPC). You can check the register here www.hcpc-uk.org/check-the-register

What qualification must my chiropodist or podiatrist have so I can claim back my treatment?

If you want to claim for your chiropody or podiatry treatment, make sure your treatment is provided by a chiropodist or podiatrist who is registered with the Health and Care Professions Council (HCPC). You can check the register here: www.hcpc-uk.org/check-the-register

The HCPC is the governing body for chiropody and podiatry and, by law, anyone using these titles has to be listed on the register. As a company, this enables us to be satisfied that our members receive safe and good quality treatment. A foot health professional may choose to not complete extra qualifications or register with the HCPC. Our terms are in no way an assumption about the quality of treatment provided by a practitioner not registered on the HCPC, however, we feel they help us act in the best interests of all of our members.

When you submit your claim, always make sure the name of your chiropodist or podiatrist clearly shows on the receipt so we can check their qualification and pay your claim as fast as possible.

Can I claim for treatment provided by a qualified foot health professional?

No, our health plans only provide cover for treatment provided by a chiropodist or podiatrist who is registered with the Health and Care Professions Council (HCPC). You can check the register here: www.hcpc-uk.org/check-the-register

You can’t claim for treatment with a foot health professional or foot health practitioner even if they are registered with The Professional Register for Foot Health Care. A foot health professional may choose to not complete extra qualifications or register with the HCPC. Our terms are in no way an assumption about the quality of treatment provided by a practitioner not registered on the HCPC, however, we feel they help us act in the best interests of all of our members.

Optical

What can I use my optical benefit for?

Looking after the health of your eyes and the quality of your eyesight including sight tests, prescription glasses and contact lenses.

You can claim back towards the costs when you see, or buy items from a qualified optical professional or buy optical items online that are covered by your plan.

You can use your optical benefit for things like:

  • Sight-test fees, scans or photos for an eye test

  • Fitting fees

  • Adding new prescription lenses into existing frames

  • Glasses frames

  • Prescription contact lenses, including contact lens plans paid by monthly instalment

  • Repairs to glasses

  • Consumables supplied as part of your prescription

Can I claim for laser eye surgery?

No, laser eye surgery is excluded under the terms of our health plans. If you’re admitted to hospital as a day case patient or inpatient, you may be able to claim for this under the hospital benefit, if your plan includes this benefit.

If you have this treatment as an outpatient, you won't be able to claim for this because outpatient treatment is not covered under our health plans.

Can I claim for cataract surgery?

No, cataract surgery is excluded under the terms of our health plans. If you’re admitted to hospital as a day case patient or inpatient, you may be able to claim for this under the hospital benefit, if your plan includes this benefit.

If you have this treatment as an outpatient, you won't be able to claim for this because outpatient treatment is not covered under our health plans.

I have a contact lens payment plan with my optician. How can I claim back the monthly payments?

If you have a monthly payment set up for your prescription contact lenses, we will need to see the monthly statement from the opticians, confirming your monthly payments for your contacts.

You need to wait until the payment has been collected because you can’t claim for advance payments. You can either claim back your monthly payments month by month or wait until you have made several payments and submit a claim for a block of direct debit instalments.

If you choose to claim a block of payments just add the earliest collection date in the treatment date field and upload your monthly statement with the payments you wish to claim back highlighted.

Can I claim for frames that I’ve bought online or from a high street retailer?

We don’t cover ready readers from any high street retailers. However, if you purchase frames from the high street or an online retailer, as long as you get these fitted with a prescription lens, you can claim for both the frames and the lens.

Can I claim for my sunglasses?

Yes, as long as they are prescription sunglasses. These must be prescribed lenses and accompanying frames.

Can I claim for prescription swimming goggles?

Yes, you can claim back costs towards prescribed lenses and accompanying frames for swimming goggles and safety glasses.

Dental

What can I use my dental benefit for?

This benefit helps you look after your oral health by helping towards the costs when you see a qualified dental professional in a dental surgery.

You can use your dental benefit for things like:

  • dental check-ups

  • treatment provided by a dentist, periodontist or orthodontist

  • endodontic treatment

  • hygienists’ fees

  • local anaesthetic fees and intravenous sedation

  • dental brace or gum shield provided by a dentist or orthodontist

  • dental crowns, bridges and fillings

  • dentures

  • laboratory fees and dental technician fees

  • referred by a dentist or orthodontist

  • dental x-rays

  • denture repairs or replacements by a dental technician

Can I claim for orthodontic treatment?

Treatment that isn’t clinically necessary is excluded under the dental benefit. This means cosmetic procedures like veneers and Invisalign (or similar) are not covered.

Can I claim for a tooth extraction in hospital?

Dental treatments provided at a hospital as a day patient or inpatient are not covered. This benefit is designed for you to claim back towards the costs of treatment received in a dental surgery.

I have a monthly payment plan with my dental practice. Can I claim back the cost of these payments?

No, your Simplyhealth plan does not cover regular payment plans including dental practice plans and Denplan.

This means you can’t use your Simplyhealth plan to claim money back towards treatment or services provided under the terms of your practice plan or any other form of insurance you pay for by monthly/regular payments.

If you receive and pay for any treatment that isn’t covered under your dental practice payment plan, check the terms of your plan to see if it’s covered under your dental benefit.

Can I provide a treatment plan as supporting evidence for my dental claim?

We don’t accept invoices or treatment plans. A treatment plan is an estimate for the treatment recommended by your dentist. You can only claim back the costs once you’ve received the treatment and paid for it. When you submit your claim you must provide a receipt that shows what treatment you’ve received and how much you’ve paid for it. Lots of dentists call this a Statement of Account and they should be happy to provide you with a copy of this.

Can I claim for a toothbrush if I buy it from my dental practice?

No, you can only use this benefit to claim back costs towards your treatment. Our plans exclude dental consumables like toothbrushes, dental floss or mouthwash.

Diagnostic consultation scans

What can I use my diagnostic consultations benefit for?

This benefit helps towards the cost of consultant's fees that you pay as a private patient for a diagnostic consultation to find or help find the cause of your symptoms. The consultant or GP you see must be registered on the General Medical Council's register.

Diagnostic means the initial consultation you have with the consultant to diagnose or help find the cause of new symptoms. If you’ve already received a diagnosis and you know about your condition, any appointments to monitor or manage the condition are excluded.

What can I use my diagnostic scans benefit for?

You can use your diagnostic scans benefit for things like:

  • diagnostic blood tests performed or referred by a GP connected to a GP appointment blood tests or visual field tests directly connected to a diagnostic consultation

  • allergy tests performed by a GP or consultant (not tests or advice about nutrition or food intolerance)

  • the fees for tests and scans that you pay for when you have been referred by a consultant or GP who is registered on the General Medical Council's register (e.g. x-rays, scans, endoscopy, test on body tissue samples, ECGs)

What qualifications must my consultant have?

You can claim back towards the costs of a video consultation if the consultant or doctor you meet with is registered on the General Medical Council's register.

What paperwork do I need to submit with my consultation claim?

Make sure your receipt or supporting paperwork clearly states you’ve received and paid for an initial or diagnostic consultation.

Make sure the name of the consultant is included. We’ll need to check their qualifications to process your claim as fast as possible.

The receipt or supporting paperwork must not be an invoice, we need confirmation that you’ve attended the appointment and the fees have been paid in full.

Can I claim for an ADHD assessment?

ADHD assessments are not generally provided by a consultant or doctor registered on the General Medical Council's register. However, if your assessment is with a doctor registered on the GMC and this appointment is an initial consultation to assess ADHD symptoms with a view to diagnosing ADHD, this would be covered. To check the registration status of a consultant please take a look at the General Medical Council's register.

Can I claim for a consultation about fertility treatment?

Fertility treatment, assisted conception and pregnancy care are not covered under our health plans.

Can my GP refer me for a scan?

If your GP is not registered on the General Medical Council's register any tests or scans they refer you for would not be covered. Check if they’re registered here www.gmc-uk.

Can I claim for a video consultation?

You can claim back towards the costs of a video consultation if the consultant or doctor you meet with is registered on the General Medical Council's register.

Am I covered for a MRI scan?

If your plan includes a diagnostic consultations or diagnostic scans benefit, you will be able to claim back money towards any scans, including an MRI scan, that your consultant refers you for under this benefit, up to your maximum entitlement.

Please note: MRI scans are excluded under the x-rays and scans benefit. If you want to claim money back towards the cost of an MRI scan, your plan MUST include one of these benefits:

  • Diagnostic consultations

  • Diagnostic scans

Am I covered for a PET scan?

If your plan includes a diagnostic consultations or diagnostic scans benefit, you will be able to claim back money towards any scans, including a PET scan, that your consultant refers you for under this benefit, up to your maximum entitlement.

Please note: PET scans are excluded under the x-rays and scans benefit. If you want to claim money back towards the cost of a PET scan, your plan MUST include one of these benefits:

  • Diagnostic consultations

  • Diagnostic scans

Am I covered for a CT scan?

If your plan includes a diagnostic consultations or diagnostic scans benefit, you will be able to claim towards any scans, including an CT scan, that your consultant refers you for under this benefit, up to your maximum entitlement

Please note: CT scans are excluded under the x-rays and scans benefit. If you want to claim money back towards the cost of an CT scan, your plan MUST include one of these benefits:

  • Diagnostic consultations

  • Diagnostic scans

Hospital

What can I use my hospital benefit for?

You can claim back a cash amount when you’re admitted to hospital and occupy a bed either as a Day Admission or an inpatient overnight stay.

You can claim back on outpatient cancer treatment appointments that are carried out at a hospital.

Are home admissions or home visits covered?

This benefit is intended to help with the costs of being admitted to hospital. You can’t claim under the hospital benefit if a doctor, nurse, or health professional visits you at home for a checkup or to provide medical treatment.

How do I claim for more than one day admission?

To claim for multiple appointments, you need to submit a claim for each date. If all your appointments are confirmed in one document, you need to upload a copy of this to support each claim. Don’t worry about uploading the same document for more than one claim.

How do I claim for chemotherapy, radiotherapy and other cancer treatment?

If you receive treatment for cancer as an outpatient at a hospital, you're covered for this under the day admission benefit. We need you to provide a copy of your appointment card or a letter confirming the dates of your appointment(s).

To claim for multiple appointments, you need to submit a claim for each date. If all your appointments are confirmed in one document, you need to upload a copy of this to support each claim. Don’t worry about uploading the same document for more than one claim.

You can claim for appointments where you receive treatment. Routine check-ins with your GP where treatment isn’t administered and blood test appointments are excluded.

What paperwork do I need to submit with my hospital claim?

To assess your claim under the hospital benefit we need confirmation of the date you were admitted and discharged from hospital. Most customers provide a copy of the discharge summary they're given by the hospital when they leave. Your GP can provide you with a copy of this if needed. If you don’t have a copy of this document you can provide written confirmation of your admission from the hospital.

We no longer accept a stamped or signed claim form so you don’t need to take a form with you to the hospital.

I was admitted to hospital and discharged the next day, how much can I claim?

If you’re admitted to hospital and then stay overnight, we will pay for one night’s hospital admission (not one day and one night).

I spent all day in the hospital for an outpatient appointment, can I claim this back?

Outpatient appointments aren’t covered under the hospital benefit unless the appointment is for cancer treatment. If you were admitted to a bed for treatment you can claim as an inpatient. You just need to provide a copy of your discharge summary when you submit your claim.

Dental accident

What can I use my dental accident benefit for?

Restorative treatment to return your oral health to its pre-accident state, if you receive medical or dental attention within 30 days of the accident.

The standard NHS rate for one prescription (whether the prescription is an NHS or private prescription). The prescription must be written by a dentist or doctor.

Dental treatment that you need as a result of participating in a sport or activity that carries a higher than average likelihood of dental injury, only where you were wearing the appropriate face or mouth protection.

How does my 3 month qualifying period work?

The 3 month qualifying period means that you can only claim for a dental accident that occurs on or after 3 months from the start date of your plan.

If you increase your level of cover you will need to serve a further 3 month qualifying period. This means if you make a claim for a dental accident that happens within 3 months of the date you upgrade your level of cover, you will only be able to claim back the annual entitlement you had before on the lower level.

Can I use my dental accident benefit if I’ve broken a tooth or denture while eating or drinking?

If the cause of your dental accident is due to eating or drinking you won’t be eligible to claim this back under the dental accident benefit. We exclude dental treatment that you need as a result of an injury caused by food or drink.

You can use your dental benefit to claim back towards the cost of this treatment.

What information do I need to provide when I make a claim under the dental accident benefit?

When you submit your claim online or through the SimplyPlan app, you'll be prompted to fill in an online dental accident form that will ask you to confirm the details of your accident. We also need you to provide a declaration from your dentist to confirm that your treatment was required as a direct result of an accident.

If you don't have this, we may ask for a copy of your dental records to help us verify that your claim is eligible under the terms of this benefit.

Health assessment

What can I use my health assessment benefit for?

This benefit helps towards the costs of a detailed assessment which you have to help assess your general health.

As a minimum, the health assessment must include all of the following:

  • Body composition measurement including height, weight (BMI) and body fat percentage

  • Blood pressure measurement

  • Cholesterol or diabetes check

All the above tests must be carried out at the same time, within one appointment, by a registered professional at a registered establishment.

You can’t claim for individual diagnostic tests or checks.


Important information

Health assessments must be carried out:

  • by a doctor registered on GMC or

  • by a nurse registered with the Nursing and Midwifery Council (NMC) or

  • by a pharmacist registered with the General Pharmaceutical Council (GPhC) or

  • by a physiologist with the Registration Council for Clinical Physiologists (RCCP)

  • by a qualified doctor, nurse or pharmacist registered with an equivalent governing body if the treatment is received outside of the UK.

And must be carried out at one of the following places:

  • An establishment registered with the General Pharmaceutical Council (GPhC)

  • Care Quality Commission (CQC).

These could include, for example, a hospital, GP practice, pharmacy or health screening unit.

Where can I book a health assessment?

Health assessments must be carried out at an establishment registered with the General Pharmaceutical Council (GPhC) or Care Quality Commission (CQC).


These could include, for example, a hospital, GP practice, pharmacy or health screening unit.

Can I claim for a home health assessment kit?

We don’t cover home or self-administered health assessments, or health assessments done online.

Health assessments must be carried out:

  • by a doctor registered on GMC or

  • by a nurse registered with the Nursing and Midwifery Council (NMC) or

  • by a pharmacist registered with the General Pharmaceutical Council (GPhC) or

  • by a physiologist with the Registration Council for Clinical Physiologists (RCCP).

And must be carried out at one of the following places:

  • An establishment registered with the General Pharmaceutical Council (GPhC)

  • Care Quality Commission (CQC).

These could include, for example, a hospital, GP practice, pharmacy or health screening unit.

I’m having a blood test, can I claim for this under my health assessment benefit?

This benefit doesn’t cover individual tests, and you can only claim under this benefit if your blood test has been part of a more comprehensive health assessment that must include all of the following and where all the tests were administered in one sitting.

  • Body composition measurement including height, weight (BMI) and body fat percentage

  • Blood pressure measurement

  • Cholesterol or diabetes check

If your blood test is to help diagnose a condition or help you find out the cause of your symptoms, you may have cover for diagnostic consultations. Please see your terms and conditions to check if your claim is eligible under another benefit.

Am I covered for a health assessment with BlueCrest?

If the health assessment you receive from BlueCrest meets the terms of your plan, you can claim back towards the cost of this treatment.

To be eligible, your health assessment MUST be carried out by a registered doctor, nurse, or pharmacist at a registered establishment. As a minimum, the health assessment must include all of the following:

  • Body composition measurement including height, weight (BMI) and body fat percentage

  • Blood pressure measurement

  • Cholesterol or diabetes check

I’m starting a new job and need to complete a work health assessment, am I covered under the health assessment benefit?

Different employers request various types of health checks to establish if an employee or potential employee can safely carry out a specific job or task. If you have an assessment that meets the terms of your plan, you can claim back towards the cost of this treatment.

To be eligible, your health assessment MUST be carried out by a registered doctor, nurse, or pharmacist at a registered establishment. As a minimum, the health assessment must include all of the following:

  • Body composition measurement including height, weight (BMI) and body fat percentage

  • Blood pressure measurement

  • Cholesterol or diabetes check

Prescriptions

What can I use my prescription benefit for?

You can claim money back towards the costs for NHS and private prescriptions issued by a GP or dentist, as well as pre-paid prescription certificates.

Important:

Medication that is not prescribed is not covered

Over-the-counter medication is not covered

What information do I need to submit for my prescription claim?

We just need to see that your prescription has been paid for and who the prescription was for.

All you need to do is include a receipt and a photo of the prescription label on the box or bag of your medication.

Are NHS prescription prepayment certificates covered under the prescription benefit?

Yes, you can use this benefit to claim back money towards the cost of your prescription prepayment certificate. We will need a copy of the certificate to assess your claim.

New child payment

How does the new child benefit work?

If you, or your partner have a baby, adopt or become legal guardians you can claim back a cash amount.

We don’t cover the legal guardianship or adoption of your partner’s child.

What paperwork do I need to provide to make a claim under the new child payment benefit?

You don’t need to send us any original documents, copies are fine. We need one of the following documents:

  • Birth certificate

  • MATB1 form

  • Adoption papers

  • Proof of legal guardianship

The document needs to confirm the name of the policyholder or adult dependant who is making the claim.

I have more than one plan with Simplyhealth, can I make a new child payment claim under both of them?

We only make one claim per child no matter how many policies you or your partner are covered on. It's up to you to choose which plan to use.

How can I claim for twins under the new child benefit?

If you give birth to twins you can submit a claim for each of them and receive two payments. You need make two separate claims and provide the supporting documents for each child.

Chiropractic

What can I use the chiropractic benefit for?

You can use the chiropractic benefit to claim back towards the cost of chiropractic treatment. Chiropractors can treat patients for a variety of conditions, such as:

  • Back pain

  • Neck pain

  • Headaches

  • Joint pain e.g. shoulder/elbow/knee

  • Migraines

  • Sports injuries

  • Pain from osteoarthritis

What qualification does my chiropractor need to have?

Your treatment must be supplied by a chiropractor who is registered with the General Chiropractic Council (GCC).

Can I claim for sports massage under my chiropractic benefit?

Sports massage can be covered as long as the professional you receive the massage from is registered on the GCC. When you submit your claim make sure the name of the professional is included on the receipt or paperwork so that we can check their qualification and get your claim paid as fast as possible.

Physiotherapy

What can I use the physiotherapy benefit for?

You can use the physiotherapy benefit to claim back towards the cost of physiotherapy treatment. Physiotherapists can treat patients for a variety of conditions, such as:

  • Musculoskeletal conditions (bones, joints, soft tissue) such as spinal and joint pain, sports injuries, and degenerative and inflammatory conditions such as arthritis

  • Neurological conditions (brain and nervous system) such as stroke, Parkinson’s disease, multiple sclerosis (MS) and head injuries that result in movement and balance problems

  • Medical rehabilitation following surgery or medical procedures

  • Elderly rehabilitation, assisting to maintain independence and mobility

  • Respiratory conditions (lungs and breathing) such as chronic obstructive pulmonary disease (COPD), cystic fibrosis and asthma

  • Pre and postnatal conditions

  • Paediatric conditions such as physical developmental delays or disabilities.

What qualification does my physiotherapist need to have?

Your treatment must be supplied by a qualified physiotherapist, who is registered with the Health and Care Professions Council (HCPC). The HCPC ensures that each physiotherapist adheres to a professional code of conduct and performs continual professional development (CPD).


You can check if your physiotherapist is registered on the HCPC website:

www.hcpc-uk.org/check-the-register

Can I claim for sports massage under my physiotherapy benefit?

Sports massage can be covered as long as the professional you receive the massage from is a qualified physiotherapist who is registered with the Health and Care Professions Council (HCPC).

When you submit your claim make sure the name of the professional is included on the receipt or paperwork so that we can check their qualification and get your claim paid as fast as possible.

Osteopathy

What can I use the osteopathy benefit for?

You can use the osteopathy benefit to claim back towards the cost of osteopathy treatment.

Osteopaths can treat patients for a variety of conditions, such as:

  • Arthritis

  • Lower limb joint pain such as foot, ankle, knee and hip

  • Back and neck pain, including referred pain such as sciatica

  • Upper limb joint pain, such as hand, wrist, elbow and shoulder

  • Headaches

  • Soft tissue conditions such as tennis and golfer’s elbow

  • Postural problems due to pregnancy.

What qualification does my osteopath need to have?

Your treatment must be supplied by a qualified osteopath. In order to use this title, they must be registered with the General Osteopathic Council (GOsC) and renew this registration annually.

The GOsC ensures that its members have current professional indemnity insurance, remain in good health and character and meet mandatory continuing professional development (CPD) requirements.

You can check if your osteopath is registered on the GOsC website: www.osteopathy.org.uk/register-search

Acupuncture

What can I use the acupuncture benefit for?

You can use the acupuncture benefit to claim back towards the cost of acupuncture treatment.

Acupuncture can be used as a treatment option for:

  • Chronic pain

  • Chronic tension-type headaches

  • Migraines

  • Prostatitis symptoms

Acupuncture is also commonly used for symptoms such as:

  • Joint and muscle pain

  • Jaw pain

  • Pain caused by cancer

  • Side effects of chemotherapy e.g. sickness

Before booking an appointment, it's always worth discussing treatment options with your GP to ensure no underlying issues need reviewing.

What qualification does my acupuncturist need to have?

There is no statutory regulation of acupuncturists in England. However, they may be required to register with their local authority. Acupuncturists can be recognised medical practitioners such as nurses, doctors, physiotherapists or members of a recognised national acupuncture organisation.

The NHS recommend that you check to see if the acupuncturist is a regulated healthcare professional, such as those stated above.

The British Acupuncture Council holds an Accredited Register of Practitioners, which has been approved by the Professional Standards Authority (PSA).

Your account

Check your table of cover


We can't list all of our benefits on this page, so please check your table of cover for more details. Depending on the level of plan you have, you may or may not have the benefits that are talked about above.

To check if you can claim for a treatment or service, take a look at your Table of cover in your online account, or under the 'My documents' section in the Simplyplan app.


Check your allowance


If you need to check your benefits and remaining allowance, you can do this under the 'Policy' section in the SimplyPlan app or on the 'My policies' page in your online account.


Register for an account


If you don't have an online account, you can register on our website or through the SimplyPlan app. Once signed up, you'll be able to access your account using both the app and the website.

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Managing your plan

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Claiming

Covering how to make a claim, claim status, claim payment, etc.

Can't find your answer?

Our Help and Support hub is always evolving and we know we may have missed a few questions. If you can't find what you need, please reach out and get in touch with our team.