TL;DR
As expert brokers in the UK private medical insurance market, having guided clients through over 900,000 policies of various kinds, WeCovr understands that the true value of your cover is only realised at the point of a claim. Navigating an International Private Medical Insurance (IPMI) claim can feel complex, especially when you're abroad and focused on your health. This guide is designed to demystify the process for individuals with an Expatriate Group policy.
Key takeaways
- Policy Excess (or Deductible): This is the fixed amount you must pay towards a claim or claims in each policy year. For example, if you have a £250 excess and your eligible treatment costs £2,000, you pay the first £250, and Expatriate Group pays the remaining £1,750.
- Co-insurance: This is a percentage of the claim cost that you share with the insurer after the excess has been paid. It's less common on individual IPMI but check your plan details.
- Benefit Limits: Your policy will have an overall annual limit, and potentially sub-limits for specific treatments like outpatient care, physiotherapy, or mental health.
- Area of Cover: Your policy will specify the geographical region where you are covered (e.g., "Europe" or "Worldwide excluding USA"). Seeking treatment outside your designated area will not be covered, except for emergency treatment on short trips, if included.
- Underwriting Terms: How your policy was set up dictates what is covered.
As expert brokers in the UK private medical insurance market, having guided clients through over 900,000 policies of various kinds, WeCovr understands that the true value of your cover is only realised at the point of a claim. Navigating an International Private Medical Insurance (IPMI) claim can feel complex, especially when you're abroad and focused on your health. This guide is designed to demystify the process for individuals with an Expatriate Group policy.
A step-by-step claims guide for individuals with Expatriate Group IPMI – documentation, authorisation, direct billing and common pitfalls
For expatriates, having robust health cover provides immense peace of mind. Expatriate Group is a specialist provider in this field, offering comprehensive plans for individuals and families living and working outside their home country.
However, a policy is only as good as its claims process. Understanding how to claim correctly is crucial to ensure your medical bills are paid promptly and without stress. This guide will walk you through every step, from understanding your benefits to submitting evidence and avoiding common mistakes.
Understanding Your Expatriate Group Policy Before You Claim
Before you even think about making a claim, the most critical action you can take is to read and understand your policy documents. These documents are your contract with the insurer and detail exactly what is, and is not, covered.
Pay close attention to these key terms:
- Policy Excess (or Deductible): This is the fixed amount you must pay towards a claim or claims in each policy year. For example, if you have a £250 excess and your eligible treatment costs £2,000, you pay the first £250, and Expatriate Group pays the remaining £1,750.
- Co-insurance: This is a percentage of the claim cost that you share with the insurer after the excess has been paid. It's less common on individual IPMI but check your plan details.
- Benefit Limits: Your policy will have an overall annual limit, and potentially sub-limits for specific treatments like outpatient care, physiotherapy, or mental health.
- Area of Cover: Your policy will specify the geographical region where you are covered (e.g., "Europe" or "Worldwide excluding USA"). Seeking treatment outside your designated area will not be covered, except for emergency treatment on short trips, if included.
- Underwriting Terms: How your policy was set up dictates what is covered.
- Moratorium Underwriting: Pre-existing conditions from the last 5 years are excluded until you go a continuous 2-year period after your policy starts without symptoms, treatment, or advice for them.
- Full Medical Underwriting (FMU): You declare your full medical history upfront, and the insurer lists specific conditions that will be permanently excluded.
The Golden Rule of Private Medical Insurance: UK PMI and global IPMI are designed to cover acute conditions that arise after your policy has started. A chronic condition, which is a long-term illness that requires ongoing management (like diabetes or asthma), is not typically covered. Pre-existing conditions are also excluded unless specifically agreed otherwise.
The Two Main Types of Claims: A Practical Overview
With Expatriate Group, as with most IPMI providers, your claims will fall into one of two categories. Knowing which path to take is the first step to a smooth process.
| Claim Type | Best For | Process | Key Benefit |
|---|---|---|---|
| Pre-authorisation & Direct Billing | Planned, high-cost treatment like surgery, inpatient stays, or advanced scans (MRI, CT). | You get approval before treatment. The insurer pays the hospital directly. | Avoids you having to pay large medical bills out-of-pocket. |
| Pay & Claim (Reimbursement) | Routine, lower-cost outpatient care like GP visits, specialist consultations, or prescriptions. | You pay the medical provider first and then submit your receipts to the insurer for a refund. | Fast and simple for everyday medical needs. No need for prior approval for small costs. |
Step-by-Step Guide: How to Submit an Expatriate Group Claim
Follow these steps carefully to ensure your claim is processed efficiently.
For Planned Treatment: Pre-authorisation & Direct Billing
This is the required process for any inpatient or day-patient treatment, surgery, or advanced diagnostic imaging.
Step 1: Get a Medical Referral
Your journey starts with a primary care doctor (a GP). You need a formal diagnosis and a referral to a specialist or for further investigation. The insurer needs to see that the treatment is medically necessary.
Step 2: Complete the Pre-authorisation Form
Before your planned treatment, you must get approval from Expatriate Group.
- Download the Form: Log in to your Expatriate Group Customer Portal and download the "Pre-authorisation Form".
- Complete the Form: The form has sections for you and for your treating doctor or specialist to complete. It will ask for:
- Your personal and policy details.
- The diagnosis (the medical condition).
- The proposed treatment plan and procedure codes, if known.
- The estimated cost of the treatment.
- The hospital or clinic details.
- Submit the Form: Upload the completed form via the Customer Portal or email it to the Expatriate Group claims team.
Insider Tip: Submit your pre-authorisation request at least 5-7 working days before your scheduled treatment. This gives the clinical team time to review the case and arrange payment, preventing last-minute stress.
Step 3: Receive the Guarantee of Payment (GOP)
The Expatriate Group medical team will review your request. They check that the condition and treatment are covered by your policy and that the costs are reasonable and customary for the location.
If approved, they will issue a Guarantee of Payment (GOP) directly to the hospital. This is their promise to cover the eligible costs. You will also receive a copy. The GOP is your green light – it confirms that the financial side is taken care of.
For Outpatient Care: The 'Pay & Claim' Reimbursement Process
For most day-to-day medical expenses, the process is simpler.
Step 1: Visit Your Doctor and Pay for Treatment
Attend your appointment or collect your prescription. Pay the provider directly and make sure you get two crucial documents:
- An itemised invoice showing the treatment you received and its cost.
- A receipt or proof of payment.
Step 2: Submit Your Claim for Reimbursement
This is easily done online.
- Log In: Access your Expatriate Group Customer Portal.
- Complete the Online Form: Navigate to the claims section and fill in the details of your treatment.
- Upload Your Documents: Scan or take clear photos of your invoice and receipt and upload them with your claim. You should also upload the original referral letter if it's the first time you're claiming for that condition.
Step 3: Receive Your Reimbursement
The claims team will assess your submission. Once approved, the funds (minus any applicable excess) will be paid directly into your nominated bank account. Expatriate Group can typically reimburse in several major currencies, which is a significant benefit for global citizens. Processing usually takes around 5-10 working days.
Essential Documentation: Your Claims Evidence Checklist
Submitting incomplete paperwork is the number one cause of claim delays. Use this checklist to ensure you have everything you need.
| Document | Why It's Needed | Pro Tip |
|---|---|---|
| Claim Form | The official request for payment, either online or the Pre-authorisation form. | Double-check that all fields are complete, especially your policy number and contact details. |
| Medical Report / Referral | Proves the treatment is medically necessary and provides the diagnosis. | Ensure the report is signed, dated, and clearly states the condition being treated. |
| Itemised Invoice | A detailed breakdown of the costs. A credit card slip is not enough. | The invoice must show the patient's name, treatment date, a description of each service, and its individual cost. |
| Proof of Payment (Receipt) | For 'Pay & Claim' only. Proves you have already paid the provider. | This can be a formal receipt from the clinic, a stamped invoice, or a bank statement showing the transaction. |
| Prescription Copy | Required for all medication claims. | The prescription must be issued by a licensed medical practitioner. |
Common Pitfalls and How to Avoid Them: An Adviser's Insight
As brokers, we see the same frustrating mistakes time and again. Here are the most common pitfalls and how you can steer clear of them.
-
Pitfall 1: Failing to get Pre-authorisation.
- The Risk: You proceed with surgery or an MRI scan without prior approval. Expatriate Group may have the right to decline the claim, leaving you liable for the entire bill.
- The Solution: When in doubt, ask. A quick call or email to the insurer to check if pre-authorisation is needed can save you thousands of pounds.
-
Pitfall 2: Claiming for Excluded Conditions.
- The Risk: Submitting a claim for a pre-existing condition on a moratorium policy, or for a general exclusion like cosmetic surgery. The claim will be denied.
- The Solution: Re-read your Certificate of Insurance and policy wording. Be clear on what your specific underwriting terms and general exclusions are.
-
Pitfall 3: Submitting Messy or Incomplete Paperwork.
- The Risk: The claims handler can't process your request. They have to contact you for more information, delaying your reimbursement by weeks.
- The Solution: Use the checklist above. Ensure all scans or photos of documents are clear and legible before you upload them.
-
Pitfall 4: Seeking Treatment Outside Your Area of Cover.
- The Risk: You have a "Europe" plan but decide to get planned treatment in Dubai. The claim will be rejected.
- The Solution: Check your area of cover before you book any treatment. If you are moving to a new region, speak to a broker like WeCovr about adjusting your cover.
-
Pitfall 5: Incurring Costs Above 'Reasonable & Customary' (R&C) Limits.
- The Risk: You choose a very expensive clinic where charges are well above the local average. The insurer may only pay a portion of the bill that they deem to be 'reasonable'.
- The Solution: Expatriate Group has a network of recognised providers. Using them helps ensure costs are aligned with expectations. Pre-authorisation also helps to lock in agreed costs before treatment begins.
How WeCovr Can Simplify Your IPMI Journey
Choosing and using an IPMI policy can be complex, but you don't have to do it alone. An expert broker acts as your advocate, providing clarity and support at every stage.
- Finding the Right Cover: The market is full of options. We compare Expatriate Group's plans against other leading providers like Bupa Global and AXA Global to ensure you get the right benefits at a competitive price.
- Application Support: We guide you through the underwriting process, helping you understand the implications of moratorium vs. full medical underwriting so there are no surprises at the claims stage.
- Claims Guidance: While we don't process claims on behalf of the insurer, our expert team can offer invaluable advice if you hit a stumbling block. As your broker, we can help you understand the insurer's decision and provide guidance on the next steps.
Furthermore, WeCovr clients get complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, and benefit from discounts on other insurance products like life or travel cover.
Frequently Asked Questions (FAQ) about Expatriate Group Claims
How long do I have to submit a claim to Expatriate Group?
What should I do if my Expatriate Group claim is rejected?
Can I claim for dental or optical treatment on my policy?
What is the difference between inpatient and outpatient treatment?
Understanding your IPMI policy and its claims process is the key to unlocking its full value. By being prepared, getting pre-authorisation when required, and keeping your paperwork in order, you can ensure a fast and stress-free experience with Expatriate Group.
Ready to review your international private medical insurance options or need help finding the right plan for your life abroad? Contact the friendly experts at WeCovr today for a free, no-obligation quote and impartial advice tailored to your needs.
