What´s not covered in my NHS Top-Up health cash plan?
As with all insurance policies, there are certain things that are not covered. NHS Top-Up specifically excludes the following list which is a summary only.
For a full list please see A Guide to Your Policy. A copy is available upon request.
- Chronic conditions (which are long-term illnesses that lead to long-term monitoring or management).
- Childbirth, fertility or neonatal treatment (except new baby benefit).
- Psychiatric conditions (except 24/7 helpline).
- HIV/AIDS.
- Winter and/or extreme and professional sports injuries.
- If you have chosen the mycancerdrugs extra, you will not be eligible for cover if:
- You have had, or at the time of application have, cancer or symptoms of cancer or you are on a medically supervised health screening or review programme because you are considered to be at higher risk of developing cancer.
- Either your parents, brothers or sisters have developed or died of cancer under the age of 60.
Which benefits require GP/Specialist referral?
Referral required:
- GP has to refer for specialist consultation benefit.
- GP (or specialist) has to refer for therapy benefit if more than 4 sessions claimed within a benefit year.
- Specialist has to refer for MRI, CT and ultrasound scans (if scans and screens extra chosen).
Health Screening, does NHS Top-Up cover mammogram & smear tests?
Health Screens must be carried out by medically qualified staff in a hospital or clinic and include well-man, well-woman, mammograms, bone density screening and heart disease screening. It does NOT include smear tests unless this is performed as part of a full body health screen or well-woman.
Are diagnostic tests covered within the GP benefit?
Diagnostic tests are covered within the specialist consultations & second opinion benefit. Tests performed by the GP in GP surgery that are subject to fees (e.g. private GP) can be claimed for under the GP Services benefit.
What is the cancellation period?
The cooling off period, when you first take out the plan is 14 days.
What are the qualifying periods?
The new baby benefit has a 10 month qualifying period. For mycancerdrugs extra there is a 90 day deferment period for this extra. Under the dental injury extra you must visit an A&E department or a dentist (and call WPA) within 72 hours of the injury.
What is the maximum joining age for NHS Top-Up (cash plan)?
There is no maximum joining age. Upon joining you may continue to renew your plan thereafter with the exception of ´mycancerdrugs´ extra which is only available up to your 66th birthday.
How do I make a claim on the NHS Top-Up plan?
Once you have had treatment you should pay in full. Visit www.wpa.org.uk/claim to download a pre-populated NHS Top-Up claim form. Complete this claim form and return by post attaching the original receipt within 6 months of your treatment. Reimbursement of eligible cash plan claims will be made by direct credit to your bank account.
Can I claim for prescription sunglasses?
Yes.
How can I claim for contact lenses?
Visit your contact lens provider and ask for proof of payment/statement to satisfy an insurance company.
When do NHS parking claims need to be processed, can I send car park tickets at any time?
- Download a claim form from wpa.org.uk/claim.
- You have to request a receipt when validating your car parking ticket on exiting the car park. WPA will check that the dates match your treatment dates and that it is a valid NHS car park, not any other car park.
- For NHS car parking fees relating to in-, or day-patient treatment you must submit your car parking claims at the same time as the hospital cash benefit claim.
How does the Personal Accident benefit work?
We will pay either 50% or 100% of the amount shown in the benefit table if a personal accident / bodily injury resulted in one of the following:
- Permanent total disablement (other than stated below) - 100%;
- Total and irrecoverable loss of sight of both eyes - 100%;
- Total and irrecoverable loss of sight in one eye - 50%;
- Loss of or total loss of the use of two limbs - 100%;
- Loss of or total loss of the use of one limb - 50%;
- Total and irrevocable loss of sight of one eye and loss of one limb - 100%.