How to claim
No matter the time of day or night, of what time of the year, Expacare is always there. Having to make a claim can be stressful but is even more so when a person’s health and wellbeing is involved. At Expacare, we understand how this can feel and work hard to put you at ease every step of the way. The below information will guide you through the process.
- Reimbursement Claims >
If you have paid for treatment and wish to make a claim under your policy, it is essential that the correct process is followed. In order to ensure the smooth processing of your claim, we must receive:
This can be downloaded here and must be fully completed. Please ensure that you have signed it AND that the treating doctor/dentist has fully completed and signed it. Original invoices / receipts If original invoices and receipts are not provided, your claim will be declined.
Please ensure that it is clearly indicated on the claim form how you wish to receive payment (see below) and who should receive the payment. If there is any doubt about who to pay, we will always reimburse the policyholder.
If the claim is in respect of prescription drugs, a copy of the prescription should be provided. Alternatively the doctor must specify the drugs prescribed on the claim form and a receipt for the prescription can be provided.
Hospital Cash Benefit
If the claim is in respect of Hospital Cash Benefit, a certificate confirming the inpatient treatment, the diagnosis, the date of admission and the date of discharge will be required. Claims must be submitted within 6 months of the start of your treatment. Claims submitted later than 6 months following the start of treatment will not be paid.
- Pre-authorisation >
Pre-authorisation must be obtained to receive benefit for the following services:
- Emergency Medical Evacuation
- Hospital treatment as an in-patient
- All maternity care
- Hospice care
- Psychiatric treatment
- Rehabilitation for alcohol and drug addiction
- Cancer treatment
- Repatriation of mortal remains or local burial costs
- Over seven sessions of
- Rehabilitation as an alternative to acute care
You should inform us at least 5 days before admission. In an emergency you (or someone acting for you) should notify us within 24 hours of hospital admission. We will decline part of your claim if we have not pre-authorised these benefits. If you require in-patient treatment, we may be able to settle the costs directly with the hospital. This would normally involve our providing a ‘guarantee of payment’ to the hospital which the hospital accepts. This may not always be possible.
- Payment Options >
Expacare prefer to make all payments by bank transfer as this is the most secure payment method as well as being more cost effective. In order to effect a bank transfer it is essential that you provide us with the full information:
- Name of account holder
- Account number
- Sort Code (for UK banks only)
- Swift Code (for ALL banks)
- IBAN Number (for European banks)
- Bank Name
- Branch Name
- Bank Address
Failure to provide the full information may result in the payment of your claim being delayed. Cheque payments can be made upon request but we must be in receipt of the full name and address of the payee. We will normally reimburse invoices in the same currency. However, we can reimburse invoices in currencies other than the invoice currency. The preferred currency for payment should be specified on the claim form.
- Middle East Plans >
If you have purchased a Middle East plan, you will be eligible to take advantage of a local claims handling service through our partner, MedNet UAE. Please note this is a network for cashless services and that the use of facilities that appear on these networks are still subject to our reasonable and customary costs rules set out in the Membership Guide and in the Your Guide To Making a Claim document. The current Network Provider listing can be accessed by clicking the relevant link:
You can also make use of outpatient facilities at any facility included in the inpatient network.Source: www.expacare.com