Small-to-Medium Enterprise Private Health Insurance Claims

If your employee is unwell, they'll need to see a GP where they may be referred for further assessment. They'll need to ask their GP for an open referral, specifying the type of specialist they need to see without naming one.

When they have their open referral, they'll need to call us to set up their claim. We'll give them a choice of local medical facilities and consultants who meet our quality requirements.

0800 158 3344

Monday to Friday, 8.00am to 6.30pm

Saturday: 9.00am to 1.00pm 

Calls to and from Aviva may be monitored and/or recorded.

We can immediately transfer the employee to the booking team at their chosen facility.

We'll settle all eligible bills in full with the approved provider so the member doesn't have to worry about any unexpected fees.

The employee should call our customer service helpline and describe their symptoms - remember they don't need to see their GP before calling us.

0800 158 3344

Monday to Friday: 8.00am to 6.30pm
Saturday: 9.00am to 1.00pm

Calls to and from Aviva may be monitored and/or recorded.

Providing it's a valid claim, our advisers will arrange for a case manager from our independent clinical provider to contact them at a convenient time, to assess their symptoms.

The clinical case manager will determine whether a referral for treatment is necessary. If treatment is not necessary, the employee will be taught how to self-manage their condition.

If treatment is recommended they will be referred promptly to one of the clinical provider's approved physiotherapists, or they'll be referred to a specialist for diagnostic tests and/or treatment.

The employee should call our customer service helpline where one of our advisers will transfer them through to our independent clinical provider for an assessment or we can arrange a suitable call back time.

Following the telephone assessment, the therapist will agree on the most appropriate help for the employee from a range of treatment options ranging from self-directed online support through to remote talking therapies, face-to-face treatment or further assessment by a psychiatrist, if clinically necessary.

If an employee is unwell they'll need to see a GP, where they may be referred for further assessment or treatment. This could be an open referral or a named referral. If they would like to use our networks, they will need to obtain an open referral enabling us to suggest treatment facilities and specialists for their condition.

It’s really important that employees get in touch with us before attending any further appointments so we can make sure their claim is covered under the terms and conditions of the policy before they incur any costs.

When an employee has been given a referral by their GP, they need to call us to set up their claim. They should call the claims team on: 

0800 158 3344

Monday to Friday: 8.00am to 6.30pm
Saturday: 9.00am to 1.00pm

Calls to and from Aviva may be monitored and/or recorded.

If we have a network in place for the treatment recommended, we will offer suggestions where they can have their treatment. To benefit from our networks, they'll need to obtain an open referral.

If we don't have a network for the employee’s condition or suspected condition or the employee would rather be treated at a treatment facility on their chosen hospital list:

• If the employee has been given a named referral, we’ll check to make sure the specialist is recognised by us, or
  
• If it’s an open referral, we’ll use our specialist finder database to select an appropriate specialist and/or hospital.

After the employee attends an appointment, their specialist may recommend hospital treatment – this is when they need to ask for a procedure code (CCSD code).

Once they’ve called us with these details, we'll confirm whether their treatment can be covered. If it can, we'll provide further information about where they can have their treatment, which may be through one of our networks, at a hospital on their hospital list or at other facilities recognised by us.

Most eligible bills can be settled directly with the hospital. Specialists usually send their bills straight to us, but if you or the employee receives the paperwork, it will need to be forwarded to us at:

Bill Payment Team
Aviva Health UK 
Chilworth House 
Templars Way
Eastleigh
SO53 3RY

We’ll do everything we can to make sure your employees get the support they need if they're injured or ill. That includes being empathetic with their situation when they call to make a claim. Our teams are trained to understand that people may not be feeling well – and do their best to make it a stress-free process.