Making a claim

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:

• A completed claim form
  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.
• Notification of Payment Details
  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.
• Prescription Drugs
  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
• Psychiatric treatment (if you have this benefit)
• Treatment for alcohol and drug addiction (if you have this benefit)

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.

It should be noted that foreign currency costs are converted into the contractual currency at the rate applicable on the day on which we receive the documents.  Where reimbursement is made in a currency other than the contractual currency, the amount reimbursable will be converted into the payment currency at the rate applicable on the day on which payment is made.

Middle East Plans

If you have purchased a Middle East plan, you will be eligible to take advantage of a local claims handling through our partner, MedNet UAE.

The current Network Provider listing can be accessed by clicking the relevant link:

• Inpatient Network
• Outpatient Network (you can also make use of outpatient facilities at any facility included in the inpatient network too)
• Dental Network
• Pharmacy Network

Indonesian Plans

If you have purchased an Indonesia plan, you will be able to take advantage of local claims handling through our partner, Global Assistance & Healthcare.

Contact Details