Step by Step Guide to a Health Claim

How to make a claim

If you are in any doubt about whether or not you are covered, please contact Hibernian on 1850 717 717, prior to undergoing treatment. Hibernian can then confirm your level of cover which will assist you with your claim. Please provide your membership number when you contact Hibernian. Please forward all claims that you have settled to Hibernian within 3 months following the end of your policy year.

In patient and day case claims

Hibernian have a direct payment arrangement with a number of hospitals. This means they will settle the bill directly with the hospital if the claim is for eligible in-patient, day case or maternity treatment or for a scan performed in the listed approved treatment centres for scans. You may call Hibernian on 1850 717 717 to find out whether a specific hospital has a direct payment arrangement with them.

A hospital that has a direct payment arrangement will provide you with the claim form to sign at the end of your stay in hospital. The hospital will then submit the claim form to Hibernian for settlement. If the hospital does not have a direct payment arrangement with Hibernian you will need to complete the claim form and pay the bill. The hospital will supply you with a claim form or alternatively you can contact Hibernian to request one or you can download one from www.Hibernianhealth.ie. You will have to settle the claim directly with the hospital and get the treating hospital, doctor or consultant (as appropriate) to complete the form. Please ensure that you send the completed claim form and all receipts to Hibernian when you are discharged from hospital. In this manner Hibernian can swiftly assess the claim and reimburse you for all eligible treatment.

Out patient claims

If you are making a claim for out-patient benefits, you should settle directly with your health care provider. You must retain your receipts. At the end of your policy year you must call Hibernian to register your claim. After this call, you must send all receipts to Hibernian to ensure that they can reimburse you for all eligible treatment. Please check that all receipts state:

• the full name of the member receiving treatment
• the type of treatment received
• the date the treatment was received
• the signature and contact details of the treating consultant and the hospital or centre where you were attended

All receipts must be sent to Hibernian Health, PO Box 9686, Foxrock, Dublin 18 within 3 months after your renewal date. Please note a benefit cannot be claimed twice as both an out-patient benefit and a day-to-day benefit.

Day-to-day claims

If you are making a claim for day-to-day benefits you will need to settle directly with your doctor or health care provider. You must retain your receipts. At the end of your policy year you must call Hibernian to register your claim. After this call you must send all receipts to Hibernian to ensure that they can reimburse you for all eligible treatment. Please ensure that all receipts state:

• the full name of the member receiving treatment
• the type of practitioner that you attended
• the date the treatment was received
• the name, address and qualifications of the practitioner providing the care on the practitioner's headed paper

Claiming for accident and emergency cover abroad

Hibernian will only pay for services under this benefit where a member uses the international assistance number stated on the membership card in advance of receiving any treatment and follows the advice given. Hibernian shall make their best endeavours to pay your in-patient hospital or professional bills directly. However, in the event they cannot do so, please retain all original receipts and contact Hibernian on your return.

Claiming for overseas treatment; procedures that are available in Ireland

If Hibernian pre-authorises your overseas treatment they will send you an international claim form. This claim form must be fully completed and signed by both you and your treating consultant. You will need to settle the claim directly with the hospital but once Hibernian have received the completed claim form and all corresponding receipts, they can reimburse you swiftly for all eligible treatment.

Hibernian will pay for the cost of the procedure, associated hospital charges and the reasonable costs of unforeseen, additional and medically necessary procedures up to the level of benefit that they would have paid for the same procedure and related charges for you in Ireland in a hospital and accommodation type for which you are covered. Travelling costs are not covered.

Payment will only be made if a completed international claim form and a receipt or receipted invoices are received by Hibernian, including sufficient information for them to assess your claim. Payment will always be in line with the cover provided under the plan you are on at the time treatment was received, and as long as your premium payments are up to date and treatment has been pre-authorised.

Claiming for overseas treatment; surgical procedures not available in Ireland

When Hibernian pre-authorises your overseas treatment they will send you an international claim form. This claim form must be fully completed and signed by both you and your treating consultant. You will need to settle the claim directly with the hospital but once Hibernian have received the completed international claim form and all corresponding receipts they can reimburse you swiftly for all eligible treatment.

Hibernian will pay for the cost of the procedure, the associated hospital costs and the reasonable cost of unforeseen additional and medically necessary procedures as agreed during the pre-authorisation process. Travelling costs are not covered.

Important - for your information

• Waiting & Exclusion Periods
  
  Waiting Periods & Exclusion Periods for pre-existing conditions may apply to those persons:
  
  1. who have not had health insurance previously
  2. who are currently serving a waiting period with another health insurer
  3. whose cover has lapsed for more than 13 weeks (forced to serve them again)
  They apply to inpatient treatment and day case treatment only. All members will have immediate access to accident & emergency and out patient benefits. For more details on the waiting and exclusion periods that may apply to you, please contact Hibernian directly on 1850 717 717.

If you have any further queries, please contact Hibernian Health directly on 1850 717 717.