FAQs

Questions about your policy

How do I add my new baby to my policy?

If you are a Preferential, Accesible, Personal Health, Private Patients Scheme or a Vital policyholder, to include newborn children on your cover, all you need do is complete and return an Application Form for the child. Provided they are enrolled on an existing policy within three months of their birth, they will be accepted without evidence of health and no additional contributions will be payable until the next policy renewal date, following the date of birth. This does not apply to Hospital Cash Plus, Care for Corporates, Confidential and School Schemes policies.

Who can be covered on my policy?

You can include a spouse or partner under the age of 65 for Personal Health or 75 for Preferential and Accessible. You can also include unmarried dependant children under the age of 21, or 24 if they are in full-time education. As our company policies are bespoke, the age limits for partners can differ, so you will need to contact your Group Secretary to find out what age limit has been set. Special rates apply to membership covering one adult with dependant children. You can add new dependants to your membership at any time simply by completing an Application Form and returning it to us.

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Questions about medical conditions

What are acute conditions?

These are conditions from which you would expect to make a full recovery after appropriate treatment. In most cases they will be covered by your Simplyhealth plan, unless it is a pre-existing condition. If you have any questions about acute conditions call our Helpline on 0800 294 7302.

What are chronic conditions?

A chronic condition is a disease, illness or injury that has at least one of the following characteristics:

  • It continues indefinitely with no known cure.
  • It comes back or is likely to come back.
  • It is permanent.
  • You need to be rehabilitated or specially trained to cope with it.
  • It needs long-term monitoring, consultations, check-ups, examinations or tests.

If you have any question about chronic conditions call our Helpline on 0800 294 7302.

What if my chronic condition gets worse?

If you experience an acute flare-up of symptoms related to your chronic condition, we will cover the cost of treatment to return you to your state of health before that acute episode arose. Call our Helpline on 0800 294 7302 to establish exactly what is covered in your particular circumstances before incurring any treatment costs. Remember that you will not be covered for on-going treatment or investigations to maintain a chronic condition in a stable state.

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Questions about hospitals

What if a policyholder is treated in a hospital for which they are not covered?

If you select a scale covering the less expensive hospitals but receive treatment in a more expensive hospital (with a higher scale classification in the Hospital Directory) then they will not be eligible for any of the items listed under Benefit 1 in the table of benefits. Instead members will be paid 'Out of Scale' benefit (Benefit 3 for Preferential and Private Patients Scheme policyholders, Benefit 2 for Vital and Accessible policyholders), which will more than likely fall short of the expenses incurred. They will then be responsible for the balance. Please refer to the Benefits table. This does not apply for Care for Corporates, Confident and Hospital Cash Plus and Personal Health policies.

What hospitals can I go to?

We offer prompt treatment at clean modern hospitals all over the UK. Our aim is to make sure you are treated as close to home as possible, although the choice does depend on the product and your level of cover. Use the hospital finder to find the nearest hospital to you. If you have Personal Health or have selected Service+ you don't need to worry about choosing a hospital, as we will arrange it all for you.

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