How Do I Make a Claim On My PMI Policy?
Photo: Jasleen Kaur: /CC

How Do I Make a Claim On My PMI Policy?

If you have taken out a Private Medical Insurance (PMI) policy, most will hope to never have to use it. In this way PMI is like all insurance. But we all know that accidents do happen, and illnesses do occur. So if the worst does happen, and you start to have some symptoms, how do you make a PMI claim?

Well, the process has 4 stages:

1) GP - Go to your GP as usual. Apart from emergencies, all medical treatment will start with your GP. Note - GP’s are not normally part of cover on PMI policies (Some leading insurers now offer a more convenient GP-by-Skype option. If you have one of these appointments, you may be able to skip step 2 entirely.

During your appointment, your GP will assess you. If they feel that a further consultation is needed with a specialist, you will be given a referral. This may be “open” (referral to a specialist in a particular field) or “closed” (referred to a specific consultant by name/hospital).  At this point tell your GP that you have PMI.

2) Call Insurer – After the GP appointment, call your insurer to check the cover of your policy and any possible limitations. The claims department will assess the claim by asking you questions about your symptoms. Much of the claim process will be conducted over the phone, but it may be in some circumstances that the insurer will need to obtain further info from your GP.

When you call the insurer, have these details to hand:
  • Your policy number, found on your policy documents
  • Details of the symptoms, and when they first started
  • What your GP has told you
  • Referral information

We understand that you may not be feeing 100% at this time, but the insurers will take you through the whole process and make it easy for you.

3) Hospital / Consultant appointment – Your insurer will usually schedule an appointment at a convenient time and date to suit you. Give your authorisation code to the hospital/Consultant you are seeing and they will invoice the insurance company direct after the appointment has taken place.
If your consultant refers you for further tests or scans then contact the claims department of your insurer.

4) Scans, Tests and Treatment – You may be referred for additional scans, tests or, alternatively, you may require an operation but you should always ensure you gain authorisation from your insurer before proceeding. Should you require hospital admission, a policy will cover your stay entirely.

If you need to stay in hospital longer than you anticipated, don’t worry – you can concentrate on getting well. The staff at the hospital will liaise with the insurer on your behalf. As long as the doctor’s deem the stay medically necessary, then you should be covered.


The key is to keep in touch with your insurer as much as possible, and to give them all the info they need. If you have any questions, please don’t hesitate to give us or your insurer a call; we will endeavour to answer any questions you may have on this matter.

I hope this blog post makes the claim process simpler; it can seem quite complex at first glance, but just breaking it down into manageable steps makes the whole thing easier and more pleasant.