How to make a claim on your plan

Please download a claim form and complete Section A.
If the total amount of your claim is going to exceed US$500 (or the equivalent in another currency), please ask your doctor to complete Section B of this form.
Submit the completed form, along with the fully itemised invoices and receipts for all treatment you have received and medications you have been prescribed, to claims@william-russell.com.
We will acknowledge your claim, and we will get back to you within 5 working days with either a request for more information or confirmation that we have settled your claim in accordance with the instructions you provide on the claim form.

Important notes

• In some cases, we may require your doctor to complete Section B, even if your claim is for less than US$500.
• We can only reimburse your claim when we have received copies of the fully itemised invoices and receipts, which give us a complete breakdown of all treatment you have received and any medication you have been prescribed.
• We also reserve the right to request original documentation relating to your medical treatment, so please retain all original invoices and receipts for a period of 12 months.

We aim to assess your claim within 5 working days.

This means that, within 5 working days, we aim to have determined if we have enough information to process your claim and to proceed to settlement, or if we need to ask you for further information.

If we do need to ask you for further information, or if we need to contact your doctor, we will let you know and we will keep you fully informed about our progress.

If you have the Gold plan

You are covered for basic dental treatment within the benefit limit specified in your plan agreement after you have been insured for a continuous period of 10 months.

Basic dental treatment means:

• screening (e.g., checks, X-rays, assessments)
• scaling and polishing
• sealing
• fillings (both composite and amalgam)
• simple extractions
• root canal treatment

If have the Gold plan and you have paid the additional premium for the Dental Plus benefit, you are entitled to claim for 80% of the following up to the benefit limit specified in your plan agreement:

• denture repair
• full/partial dentures
• dental bridges
• crowns, inlays, and onlays
• dental implants

If you have the Silver plan

If you have the Silver plan, and you have paid the additional premium for the Dental Basic benefit, you are entitled to claim 80% of the cost of the following treatments, up to the benefit limit specified in your plan agreement after you have been insured for a continuous period of 6 months:

• screening (e.g., checks, X-rays, assessments)
• scaling and polishing
• sealing
• fillings (both composite and amalgam)
• simple extractions
• root canal treatment

If you have the Silver plan, and you have paid the additional premium for the Dental Plus benefit, you are entitled to claim for 80% of the following up to the benefit limit specified in your plan agreement:

• denture repair
• full/partial dentures
• dental bridges
• crowns, inlays, and onlays
• dental implants

If you have the SilverLite plan

If you have the SilverLite plan, and you have paid the additional premium for the Dental Basic benefit, you are entitled to claim 80% of the cost of the following treatments, up to the benefit limit specified in your plan agreement after you have been insured for a continuous period of 6 months:

• screening (e.g., checks, X-rays, assessments)
• scaling and polishing
• sealing
• fillings (both composite and amalgam)
• simple extractions
• root canal treatment

You have the freedom to choose where you have your medical treatment within your area of cover. Contact us for confirmation that your chosen medical provider is within our network.

Check out the link below to see some of the medical providers we work with.

If you have a Silver or Gold plan we offer benefits for vaccinations, and preventive health and well-being for adults, after you have been insured by your plan for a continuous period of 6 months.

These benefits can be used towards routine or preventive health checks or vaccinations, including an annual eye examination.

There is also a Well Child benefit for children insured as dependents under the Silver and Gold plans, after they have been insured for a continuous period of 12 months.

If you are claiming for health checks, vaccinations or optical tests, simply scan and email us your itemised invoices and receipts, and a summary of what you are claiming for, and how you wish to be reimbursed.

If you have a Silver or Gold plan, you may claim the cost of an eye examination under the Preventive Health Check benefit.

We do not cover visual aids such as glasses or contact lenses and we do not pay for corrective treatment.

If you have a Silver or Gold plan, you have cover for physiotherapy sessions with a registered physiotherapist provided you have a medical doctor’s referral letter. After the 6th session, if you need further sessions, you must contact us for pre-authorisation and we will require a further medical referral letter.

When you submit your claim, please also include the medical referral letter from your doctor.

If you have a Bronze plan, you have cover for physiotherapy sessions with a registered physiotherapist up to the benefit limit stated in your plan agreement, following a hospital admission, provided you have a medical doctor’s referral letter. Please note that the physiotherapy sessions must be related to the in-patient treatment you have received, and each session must fall within the 90-day period following your discharge from hospital.

If you have a SilverLite plan, you have cover for physiotherapy sessions with a registered physiotherapist up to the benefit limit stated in your plan agreement.

When you submit your claim, please also include the medical referral letter from your doctor.

Our health plans provide cover for treatment with an acupuncturist, homeopath, chiropractor or osteopath, or chiropodist or podiatrist.

You have to have been referred by a medical doctor for complimentary treatment, and we will require the doctor’s referral letter before we can assess your claim.

There are limits to the number of sessions you may claim for in any one year and these limits are stated in your plan agreement.

If you have a Bronze plan, you can only claim for any of these treatments if you receive them during the 90 day period following discharge from hospital, and the treatment must be related to the in-patient treatment you have received.

Our health plans provide cover for consultations with a psychiatrist.

All psychiatric treatment must be authorised by us in advance, and there is no cover for any psychiatric treatment you receive within the first 12 months of your cover.

After 12 months, you may claim for consultations with a psychiatrist, provided you have been referred to the psychiatrist by your medical doctor.
If your claim is eligible and the psychiatrist feels it would be beneficial for you to see a psychologist, we will pay for the consultations with the psychologist up to the number of sessions specified in the Table of Benefits applicable to your plan.

When you submit your claim we will require your medical doctor’s referral letter and your psychiatrist’s referral letter.
Please note that the Bronze, Silver and Gold plans each provide cover for up to a maximum of ten out-patient psychiatric consultations per period of cover. Each consultation with a psychologist would be included in this maximum.

If you have a Bronze plan, you are only eligible to claim for post hospital psychiatric consultations that occur within 90 days of your discharge from a psychiatric unit.

There is also a lifetime limit to the amount you can claim for psychiatric treatment. Please refer to your plan agreement to view the limits for your plan.

You do not have to pre-authorise your advanced diagnostic tests with us in advance, but we will require a referral letter from your doctor, (or from your specialist if it is a PET scan), before we can assess your claim.

If you would like us to confirm cover prior to undergoing the scan or you would like us to try to place a guarantee of payment directly with the medical facility, we will need at least 48 hours notice prior to the scan to enable us to obtain the information we need to assess whether the scan is covered.

Please contact us as soon as you know you need to have a scan. You can find our contact details here

We recommend that you submit your claims into us within six months of the date of treatment, however if your claim is older than this please still do submit into us for us to review.

Unfortunately, we do not cover fees for the completion of claim forms, or any other administration or registration fees charged by doctors or hospitals.

The first place to check if a condition or treatment would be covered by your plan is by turning to the Table of Benefits for your plan type, in your plan agreement.

Please also refer to the Costs We Don’t Cover section in your plan agreement.

Alternatively please contact our claims department on +44 (0) 1276 486460 or email claims@william-russell.com.

You can download a copy of our claim form from the Document Library section on our website. Alternatively please contact us at claims@william-russell.com and we will be happy to email you a copy.

The excess shown on your certificate of insurance is the amount you will have to pay towards the cost of your treatment.

If your plan has an excess and the benefit you are claiming for has co-insurance and/or limits, we will apply the co-insurance first, then the excess, then the limit.

If you have chosen a plan which has an excess per claim, this is the amount you will have to pay each time you make a new claim for treatment covered by your plan. New claims are those that are for a condition which is not related to an existing claim.

If your claim is for the treatment of a chronic condition, AIDS/HIV, or for out-patient follow-up consultations and/or tests for cancer and the treatment continues into a new period of cover, we will treat it as a new claim. In these circumstances we will reapply the excess at your plan renewal date and each subsequent plan renewal until the claim is finished.

If your claim is in respect of the well-being benefits, your excess will be applied once per period of cover.

If your excess is per annum it will be applied once per period of cover. For example, if your excess is US$250 per annum, we will not pay for the first US$250 of eligible expenses you incur during your period of cover. We will apply one excess per period of cover irrespective of the number of claims you make. You must submit all eligible claims to us – even claims within your annual excess, as we will only be able to reimburse you when the value of the eligible expenses you incur exceeds the amount of your annual excess. When you renew the plan, the annual excess will apply again in respect of your new period of cover.

Please send us the fully itemised invoices and receipts for which you are claiming reimbursement to claims@william-russell.com, together with your bank account details. A claim form is not ordinarily required.