What do I do if I need to make a claim ?
Gold and Silver Insurance, Hospitalisation Insurance
In order to obtain the reimbursement of your medical expenses within two years of the date of treatment, please send us your completed claim form (demande de remboursement) along with your original treatment forms (feuilles de soins) or invoices (factures) and the corresponding prescriptions (ordonnances). Please ensure that the nature of the illness and the date of diagnosis is indicated on the claim form
In order to obtain the reimbursement of the remainder of your medical expenses within two years of the date of treatment, please send us your completed claim form (demande de remboursement) along with the original paperwork from the French Social Security giving details of their reimbursement. Please ensure that the nature of the illness and the date of diagnosis is indicated on the claim form.
IMPORTANT : Please note that any reimbursements received from another health insurance scheme will be deducted from the amount payable under the Top-Up option.
Why do I have to give my consent ?
Since the GDPR (General Data Protection Regulation) came into force on the 25.05.2018, we need your explicit consent to enable us to process your sensitive data relating to your health in order to pay your claims.
Why do I need to complete the claims form ?
The Insurer needs certain information in order to assess whether the treatment you have received is covered by your Policy. It is therefore imperative that you indicate the nature of the illness and the date of first diagnosis on the claims form even if the treatment has been medically prescribed.
How do I complete the claims form ?
You should put the name and first name of the claimant in the first column, a description of the medical expenses incurred (for example consultation or medication) in the second column, and the type of illness and the date of first diagnosis in the third column (for example back ache dating from October 1999).
Click here to see an example of a completed claims form.
How are claims paid ?
Claims are paid by cheque or bank transfer in Euros and the majority are processed within one week of receipt. If you would like your claims to be paid by bank transfer, please attach a R.I.B. to your claim form (we shall then pay all your claims into this account unless you tell us otherwise).
What do I do if I need to be hospitalised ?
In the event of hospitalisation, you can request direct settlement of your hospitalisation expenses by filling in the reverse of your claim form (demande de prise en charge hospitalisation) and providing the medical information as specified. For non-emergency hospitalisations, we would be grateful if you could send your request to us at least 10 days before you are due to be admitted. In the event of an emergency, the hospital can contact us directly. Once your request has been reviewed, the acceptance will be sent directly to the hospital or clinic.
What types of treatment need prior authorisation ?
Orthodontics, orthoptics, speech therapy and physiotherapy.
I am going on holiday - am I covered abroad ?
Yes, cover is valid throughout the European Economic Area. Cover is also valid worldwide excluding Iran, Democratic Peoples’ Republic of Korea, Russia, Syrian Arab Republic and Ukraine for any stay not exceeding 3 months. Please note that your medical expenses will be reimbursed in Euro in accordance with the French Social Security’s Base de Remboursement, which will not provide sufficient cover for countries such as the United States for which you should purchase separate travel insurance.
If you need the equivalent of an E111 or EHIC, please contact us and we will send you an ‘attestation’.