Making a claim on your Global Health insurance plan

If you need to make a claim on your Global Health insurance plan you will find our staff helpful, sympathetic and efficient. We are here to ensure that the business of getting your medical bills paid is as simple and stress free as possible.

Use these frequently asked questions below to answer your queries, or contact us using the details at the base of this page.

 

 

What do I need to do in the event of an emergency?

You must contact us before you are admitted to hospital so that we can pre-authorise your claim. As soon as you know that you need hospital treatment, contact our Claim Help-line either in the UK or Malaysia, or in an emergency, contact the 24 hour Emergency Medical Assistance Help-line.

Please contact William Russell using the following details:

24/7 Emergency Medical Assistance Help-line
If you are located outside Indonesia contact Cega on + 44 1243 621155 or email william.russell@cegagroup.com

If you are located in Indonesia contact Global Healthcare on 021 725 2866

Claims Help-lines
During UK working hours contact + 44 1276 486460 claims@william-russell.com  

During Malaysian working hours contact + 6 03 2171 2071 claimskl@william-russell.com  

Upon receipt of your call we, or the Assistance Service, will, when appropriate, authorise the proposed treatment and issue any necessary guarantee to the hospital and make arrangements to settle your hospital bill direct.

The Assistance Service retains the right to decide whether your medical condition is life-threatening, whether the treatment available locally is adequate, where you are evacuated to, and the means and method of the evacuation.

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I have to go to hospital, but it’s not an emergency, what do I need to do?

Please contact us as soon as possible using the details below. It is a condition of the Global Health insurance plan that we will only pay for in-patient or day-patient hospital treatment costs that have been authorised in advance by us.

By in advance we mean before you have been admitted to hospital. If you do not obtain pre-authorisation for in-patient or day-patient treatment we reserve the right to decline your claim or to pay only 80% of the eligible in-patient or day-patient treatment cost.

If it was not reasonably possible for you to contact us in advance, provided you contact us within 72 hours of your admission, no treatment penalty will be applied.

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Will you pay the hospital direct?

Yes, we will settle all in-patient claims directly with the hospital concerned.

As soon as you know you need to be admitted to hospital you must contact us for pre-authorisation, otherwise we may not pay your claim.

Upon receipt of your call we, or the Assistance Service, will, when appropriate, authorise the proposed treatment and issue any necessary guarantee to the hospital and make arrangements to settle your hospital bill direct.

If it is a medical emergency that occurs outside UK and Malaysia working hours, you must contact the Assistance Service on + 44 1243 621155.

Full instructions about this procedure are stated on your Global Health Membership Card.

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How do I make a claim and what do I need to submit?

When you make a claim you must complete a Global Health insurance claim form in full and return it to us by post, with the original invoices for all the treatment you have received. The medical doctor in charge of your treatment (or the dentist if it’s a claim for dental treatment) must complete and sign Section C of the claim form.

Please download the appropriate claim form below:

 

Important points to remember when submitting your claim:

- Your claim form must be fully and accurately completed and signed. We will not settle your claim if Section C has not been fully completed and signed by your medical doctor (or dentist).

- We will not settle your claim unless we have the original invoices for the treatment you have received.

- We will not pay claims which are received by us more than six months after the date of treatment, unless it was not reasonably possible for you to submit the claim within six months.

-   You must provide any information or proof we may reasonably require to support your claim. For example we may ask you for a medical report. If we do, you will have to provide the medical report at your own expense.

-   You must, if requested to do so by us, provide your consent for us to obtain medical reports and medical records from any medical doctor or medical practitioner who has ever treated you or any hospital or clinic that you have ever been treated in. If you do not provide your consent we will not pay your claim.

-   We do not pay doctor’s fees for completing your claim form.

-   If after you have sent us your claim form you incur more invoices relating to the same illness or injury, send these to us quoting your certificate number and advising us that they relate to an on-going claim.

-   If your treatment continues for more than six months we reserve the right to ask you to submit a new claim form or an up-to-date medical report at your own expense.

-   When we are assessing the amount of benefit to which you are entitled, the amount we pay will not exceed the cover provided by the plan you have bought as stated on your certificate of insurance.

-   We have the right to appoint and pay for an independent medical doctor or medical practitioner to medically examine you and advise us on the medical issues relating to any claim. If you do not agree to have an independent examination we will not pay your claim.

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What if my doctor charges me a fee for completing the claim form?

We do not reimburse doctor's fees for completing your claim form. This must be funded at your own expense.

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Where do I send my claim form?

Please send your fully completed and signed claim form to either our UK Claims Department or, if you live in Asia Pacific, our Malaysia Claims Department.

William Russell Ltd
Claims Department, William Russell House, The Square, Lightwater, Surrey, GU18 5SS, UK.

William Russell (Asia Pacific) Limited
Claims Department, Suite 7-3, 7th Floor, Wisma UOA II, 21 Jalan Pinang, 50450 Kuala Lumpur, Malaysia.

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What can I claim for under the routine dental treatment benefit?

After you have been insured under the Elite Gold or Elite Platinum plan for 6 months you are covered for routine dental treatment, subject to the excess stated in your certificate of insurance.

Routine dental treatment means:

– Screening (once per year), i.e. the assessment of diseased, missing and filled teeth, including X-rays where necessary,

– Preventive scaling, polishing, and sealing (once per year),

– Fillings (with standard amalgan filling - we do not pay for fillings with gold or ceramique fillings) and extractions, and

– Root-canal treatment but not fitting of a crown following routine dental treatment.

If you need to make a claim for routine dental treatment, please complete a dental claim form

 

What can I claim for under the complex dental treatment benefit?

After you have been insured under the Elite Platinum plan for a continuous period of 12 months you are covered for crowns, in lays and bridges, subject to the excess shown in your certificate of insurance.

If you need to make a claim for complex dental treatment, please complete a dental claim form

 

How do I claim for routine maternity care?

If you need to make a claim for routine maternity care, please complete a routine maternity claim form. Once you have been given an expected delivery date and have chosen the hospital at which you would like to give birth, please contact us to provide us with these details. We will contact your chosen hospital to request a cost estimate for the delivery and an expected length of stay.

During UK working hours Tel: + 44 1276 486460  claims@wiliam-russell.com

During Malaysia working hours Tel: + 6 03 2171 2071  claimskl@william-russell.com

Routine maternity care means pre-natal, childbirth and post-natal treatments and examinations and elective caesarean sections, subject to the benefit limits stated in the table of benefits.

If you have been insured by the Elite Platinum plan for a continuous period of not less than one year, we will pay the cost of routine maternity care.

If you have been insured by the Elite Gold plan for a continuous period of not less than one year, we will pay 80% of the cost of routine maternity care.

For example, if you have Elite Gold cover (which has 80% co-insurance and a limit of $6,400 for routine maternity) and you have a $100 excess, we will calculate payment on the following basis:

– If your covered routine maternity care costs total $8,500
- $8,500 (medical costs) x 80% (co-insurance) = $6,800 - $100 (excess) = $6,700.
- Amount left exceeds $6,400 (limit)
- Payment = $6,400

– If your covered routine maternity costs are $7,500
- $7,500 (medical costs) x 80% (co-insurance) = $6,000 - $100 (excess) = $5,900
- Amount left is less than $6,400 (limit)
- Payment = $5,900

We will also pay the hospital accommodation charges and treatment charges of a child born to a mother who has been insured by the Elite Platinum plan or the Elite Gold plan for at least 12 months.

Cover will be restricted to the first 28 days of life. After that an application form must be completed and submitted to us in respect of the newborn child. During the first 28 days of life we will pay for any necessary treatment required relating to birth defects and congenital abnormalities.

In the event of a multiple birth, the limit stated on the table of benefits is the maximum amount that can be claimed regardless of the number of children born.

 

How do I claim for psychiatric treatment?

Before you embark on a course of psychiatric treatment you must contact us prior to treatment on:

During UK working hours Tel: + 44 1276 486460 claims@wiliam-russell.com
 
During Malaysia working hours Tel: + 6 03 2171 2071 claimskl@william-russell.com  

If it is outside working hours, contact the Assistance Service on + 44 1243 621155.

We will not pay for psychiatric treatment that has not been authorised by us in advance.

 

How do I claim for the well-being benefit?

You may make a claim for the well-being benefit once you have been insured by the Elite Silver, Elite Gold or Elite Platinum plan for a continuous period of 12 months.

The well-being benefit may be claimed once during any annual period of cover towards the cost of an annual medical examination carried out in accordance with our well-being medical examination report form, and the following additional tests: an annual cervical smear test and mammogram for women, and an annual prostate cancer test for men.

To make a claim, you must first contact us for a copy of our well-being medical examination report form . We can mail this to you, or send it by fax or by email.

When you have received the form you must take it along to your doctor together with a urine sample. The doctor who examines you must complete the medical examination report form and return it to us. We will only make reimbursement in respect of those examinations listed on our well-being medical examination report form and the additional tests stated above.

Upon receipt of the medical examination report form, the original receipts for the medical examination and any additional tests performed, we will make reimbursement to you in the normal way. The benefit we pay is limited to a maximum annual amount of £150, $240 or €225 under the Elite Silver plan and £250, $400 or €375 under the Elite Gold plan and £300, $480 or €450 under the Elite Platinum plan.

The well-being benefit is not available to children insured as dependants under your plan.

For persons whose date of entry is prior to 1st January 2007, making a claim for the well-being benefit will not invalidate your entitlement to the no claim incentive.

 

What do I need to submit when I make a claim for compassionate home travel?

 If you need to submit a claim for compassionate home travel, you will need to submit your claim with the following documents:

- A certified true copy of your relative’s death certificate,

- Your travel documents which must bear the costs of the tickets,

- If your deceased relative had suffered from a long-term or chronic illness, we will require a statement from their doctor confirming the date on which the terminal diagnosis was made.

 

How long will it take to settle my claim?

We aim to assess and agree settlement of your claim within 5 working days.

Upon receipt of your Global Health insurance claim form we will send you an acknowledgement by email, fax or by letter. Provided we have a fully completed claim form with all the information we require, and the original bills for the treatment you have received, we will settle your claim without any unnecessary delay.

Our preferred method of settlement is by bank transfer direct to your bank account, or, if we are paying the hospital direct, direct to the hospital’s bank account. Alternatively we can issue a foreign currency draft, (provided our bankers are able to issue a draft in the currency you require), or a sterling, US dollar or euro cheque.

If you have an excess or co-insurance and you ask us to settle the hospital’s or doctor’s bills directly, we will deduct the excess or co-insurance amount, and you will be responsible for paying the excess or co-insurance amount to the hospital or doctor yourself.

What exchange rate will you use to settle my claim?

We will settle your claim in the currency of your plan unless we are specifically requested to

do otherwise. If we have to make a conversion from one currency to another we will use the exchange rate on the date on which your treatment starts. We will use www.oanda.com to calculate exchange rates.

We are not responsible for any loss you may incur due to fluctuations in exchange rates, or for any bank charges you may suffer when you cash a foreign currency draft, a cheque or when you receive a bank transfer from us.

 

I have been involved in an accident and required medical treatment, what will you need to settle my claim?

If you are making a claim for injuries incurred as the result of an accident you must submit to us all relevant documentation including the police report, the ambulance report and any other report or documentation that would have been completed at the time, before we will settle your claim.

 

What if I am covered by another insurance plan?

 If you have any other insurance cover for the cost of the treatment or benefit you have claimed from us, you must tell us in writing as soon as possible or tell us on your claim form.

If you do have other insurance cover, we will only pay our share of the cost of the treatment.

 

How do I make a claim on the Global Travel Plan?

When you wish to make a travel claim you must complete a travel claim form in full and return it to us within 30 days of the date of loss.

We may also request additional supporting documentation, as described in the relevant sections of the Travel Plan Rules. If you wish to contact us prior to submitting your claim, we will be happy to confirm the details of all supporting documentation that will be required in order to assess your claim.

 

I can’t find the answer to my question, who should I contact?

If you have any further questions then please do not hesitate to contact our claims team by using the details below:

During UK working hours
Tel: + 44 1276 486460
Fax: + 44 1276 486466
claims@william-russell.com

During Malaysia working hours
Tel: + 6 03 2171 2071
Fax: + 6 03 2171 2072
claimskl@william-russell.com