How to claim on international health insurance

Almost every international health policy pays in one of two ways, and which one applies depends on the type of treatment rather than on the size of the bill.

• Direct settlement. The provider invoices the insurer and you never handle the money. On the plans we arrange, this is how planned inpatient and outpatient surgical treatment works, and pre-authorisation is mandatory before it happens.
• Reimbursement. You pay, then reclaim. On these plans that covers outpatient consultations, which need no pre-authorisation at all.

Emergencies sit slightly outside both. You or someone acting for you notifies the insurer as soon as possible after admission, and invoices are settled directly where the treatment is covered. Nobody expects a pre-authorisation call from an ambulance.

One detail worth reading in your own wording: a deductible, where you have one, is defined as the amount taken off a reimbursement for treatment outside the direct settlement network. Staying inside the network and outside it are not financially identical.

Regency publishes the health claim as four steps, and they run in this order.

• Get your treatment. For inpatient care, tell the claims team first, either yourself or through someone acting for you, and the insurer contacts the hospital. For outpatient care, attend the facility you choose.
• Gather your documents. Medical reports, admission notes, receipts, invoices and any letters.
• Complete the claim form. Sign it. For inpatient claims the attending doctor completes their section, and where your documents do not show the medical diagnosis, the doctor completes that part of the form instead.
• Email it in. Completed form plus the medical documents, to the claims address on your member card.

The practical version: take a claim form to the appointment so the clinician can fill in their part while you are in the room. Chasing a signature weeks later, in a second language, is the part that goes wrong.

A claim is assessed on paper, so the paperwork is the claim. Keep the originals of everything you scan, because the insurer may ask for them.

Two requirements catch people out on these policies. Everything has to be submitted in English, and the cost of translating or otherwise producing that information is the member's, not the insurer's. Separately, the cost of completing claim forms and providing adjudication documents is itself an excluded expense, so a doctor who charges to fill in a form is a cost you carry.

Claims are assessed by an appointed independent adjudication company rather than by the sales side of the business, and the wording is blunt that any indication of eligibility given before that assessment is subject to the final assessment. Treat a helpful phone call as guidance, not as an approval.

The hard deadline on these policies is two months: a claim must be submitted no later than two months after the event. That is the single date to put in your calendar the day treatment happens.

Settlement runs either through the direct settlement network or as a reimbursement, which can be paid in a wide range of currencies, and Regency publishes a 24-hour settlement service and a claims payout figure of 99% of claims paid. Those are the underwriter's own published figures, quoted as theirs; we have no independent audit of them and will not present them as ours.

If you pay by instalments, read this one before you claim. On a periodic-payment policy, making a claim makes all remaining premiums for the 12-month term fall due as a debt, which can be offset against what the insurer pays you. Annual billing avoids that mechanic entirely, and it is also the cheaper way to pay.

Most declines are procedural rather than medical.

• No pre-authorisation. The insurer reserves the right to decline any inpatient or outpatient surgical claim that was not pre-authorised, emergencies aside.
• Late submission. Past two months from the event, the claim is out of time.
• Pre-existing conditions. These are excluded, including conditions you did not know you had. The visa-file version of that question is answered in our guide to visa health insurance with a pre-existing condition, which quotes the clause in full.
• Treatment in the United States. Not covered on these plans, anywhere in the policy.
• A benefit that is not on your schedule. If it is not listed for your plan, it is excluded, however it is described in the general wording.
• The annual limit is spent. There is no cap on the number of claims, but there is an annual limit on the total, and exhausting the aggregate benefit ends the policy.
• Undisclosed other cover. Other insurance has to be disclosed, and it is expected to be exhausted first.

Ten minutes now saves the bad week later. Save the claims email and phone number from your member card into your phone, and give them to whoever would be making the call if you could not. Download a claim form and keep a copy on your phone, so a clinician can complete it during the appointment. Read your own schedule once so you know which treatments need pre-authorisation and what your annual limit is.

If you are still choosing cover, the plan tier decides more about your claims experience than the price does, because it decides which benefits are on your schedule at all. See the exact price for your age, or request a quote and ask the specific claims question about the treatment you expect to need.