How to make a claim on Vitality health insurance

To claim on Vitality health insurance you contact Vitality before the treatment, not after it: start from a GP referral, then ask Vitality to authorise the treatment, the hospital and the consultant through its online Care Hub or by phone. Still choosing a plan and want the claim side explained before you commit? An FCA-authorised broker can talk you through these steps for the Vitality cover being quoted, free, on a call you arrange through the form on this page.

Page numbers below refer to Vitality's Personal Healthcare Membership Guide, print code VHTCR0002 08/2024 (the August 2024 issue), as hosted on mytribeinsurance.co.uk and read there on 10 October 2026. Vitality may have issued a newer version, so the paperwork sent with your own quote is what counts.

How a Vitality claim starts: Care Hub, app or phone

The guide's opening page points members to a "Care Hub": "Access Care in the Health section in Member Zone or from 'Care & Claims' in the Vitality Member app" (page 3). From there you can make a claim, book a Vitality GP consultation and track existing claims. Page 32 gives a second way in: ring the number on your membership certificate.

Vitality describes the usual outcome like this: "More often than not we will be able to take your claim details online, or over the phone, and authorise and arrange your proposed treatment at the same time" (page 32). Authorisation is the step that matters. The same page is blunt about it: "We will not pay for treatment we have not authorised in advance."

GP referral first, then authorisation: the order Vitality sets

Page 32 lists what to do before any treatment. Be registered with a UK GP who holds your full medical records, which Vitality says helps avoid delay in authorising treatment. Get a referral from your own GP, or from a Vitality GP or another private GP. Then contact Vitality so it can authorise the treatment.

Two details on the referral are easy to miss. Unless a hospital list has been added to the plan, the referral "must be an open referral (i.e. not to a specific consultant or therapist)". And some routes need no GP at all: the guide says there is no need for a GP referral for talking therapy or physiotherapy, as long as you arrange them through Vitality's panels (with Out-patient Cover for physiotherapy), and it lets you refer yourself for talking therapy. The number of talking-therapy sessions is on your membership certificate.

The Vitality GP service is a quicker route into a referral for many people. The guide says that if you use it to obtain a referral, the GP may be able to approve the claim and arrange treatment (page 32), and that in some cases the Vitality GP will ask you to see your UK GP for a physical examination first. Video appointments are booked in the Vitality GP app, up to 48 hours ahead, Monday to Saturday (page 16). A missed appointment, or one cancelled less than four hours before, can cost £25 (page 17).

Consultant Select, hospital lists and which doctor you can see

Vitality will "only authorise treatment that takes place at a hospital eligible on your plan, under the care of a consultant or therapist recognised by us" (page 32). Choice is set by what the planholder bought, as page 24 explains. Under its Consultant Select approach Vitality assesses consultants and offers a choice of recognised consultants appropriate for your condition and where you live, and some are flagged as Premier Consultants in the authorisation. A planholder can add a hospital list, either Countrywide (most private hospitals and NHS private patient units outside central London, with fewer in central London) or London Care (all of them, central London included); the hospitals on each list can change during the plan year, though treatment already under way can be finished at the same hospital.

Using a hospital off your list is allowed but costly: "you will have to pay 40% of the costs of the treatment (excluding consultant’s fees) yourself" (page 25). The consultant and hospital must still be ones Vitality recognises, or nothing is paid. The excess, out-patient limit and hospital list all feed the premium too; what Vitality health insurance costs and the price of the Vitality health plans cover that side.

When do you pay the Vitality excess, and what does the out-patient limit do?

Your membership certificate shows whether the excess applies "per claim" or "per person per plan year". A per-claim excess is taken from the first invoice Vitality pays, and from the next if some remains, and it applies again if a claim runs on past a year. A per-plan-year excess is taken from the first invoice for treatment in the plan year, and only one is payable for each insured person that year, however many conditions they claim for (pages 25 and 46). You pay it to the hospital or person who treated you, and Vitality tells you how much and to whom. Report a bill smaller than the excess as well, so Vitality can work out how much excess is left.

The excess does not apply to Vitality GP consultations, though a face-to-face private GP visit carries a co-payment. Weight loss surgery and corrective surgery work on a 25% contribution instead.

The out-patient limit is the other number that shapes a claim. Where Out-patient Cover is on the plan, you are "covered up to the limit shown on your membership certificate for appointments with a consultant, following a referral from a GP", and also up to the certificate limit for diagnostic tests your consultant orders; MRI, CT and PET scans are covered in full (page 16). Tests a private GP orders at the same moment as a consultant referral are deducted from that limit (page 17). Where it is not clear that tests are related to cancer, their cost is first deducted from the limit and the deduction is reversed once cancer is confirmed (page 22). Medicines are a separate question, answered on claiming prescriptions on Vitality.

What can delay or reduce a Vitality claim

Several things in the guide slow a claim or shrink what is paid. A long-standing condition or a claim in your first year or two is where they bite hardest; if either would touch your claims on a new Vitality plan, raise it with the broker who phones when your request arrives through the form on this page.

• Treatment before authorisation. If you paid first without authorisation, Vitality "will only pay you the amount we would have paid the provider directly had we authorised the claim in advance", so you carry any gap.
• A claim form. "Sometimes, particularly if you claim in the first one or two years after joining us, we may need you to send us a fully completed claim form to help us assess your claim." It normally asks for at least five years of medical history, with sections for your GP, and Vitality "will be unable to assess the claim or pay for any treatment before we receive the claim form". The GP's fee for completing it is not paid by Vitality.
• Consent for records. Vitality asks your consent before it obtains reports or records, and without it the treatment may not be approved.
• Late invoices. Any invoice you receive for covered treatment should be sent to Vitality "within six months of your treatment to be eligible for payment, unless there is a good reason why you can’t do this". Where you paid and want reimbursing, you send an itemised receipted invoice, and six months applies there too.
• Underwriting. On a moratorium plan, "each claim is assessed on the information provided by you and, if necessary, a GP" when you claim (page 30), and conditions from the five years before cover began may be excluded. Full medical underwriting or moratorium on Vitality explains the two routes.
• Another policy. If another plan covers the same costs, Vitality asks for its details on your first claim so that it pays only its share (page 33).

Vitality can also ask for a medical report during treatment, in which case it pays the reasonable fee for it.

Does claiming change the Vitality premium?

It can. The guide says Vitality adds up what it paid in claims for you, places you in a claims band, and the lower the band, the lower the increase; claims under the Primary Care benefit, including Vitality GP consultations, are not counted (page 39). Your Vitality status then moves the renewal price as well. Why a Vitality renewal goes up covers that in full.

Quick answers before you phone Vitality

How soon can I claim on Vitality health insurance?

It depends on what the claim is for and how you were accepted. On a moratorium plan, the guide says anything that starts after your cover begins is eligible from day one. A problem from the five years beforehand stays excluded until you have gone two years in a row on the plan with no treatment, advice or medication for it, and some never qualify (page 30). With full medical underwriting, your exclusions are printed on the membership certificate.

How do I use Vitality health insurance for the first time?

Book a Vitality GP appointment through the app or arrange a referral from your own GP, then open the Care Hub or ring the number on your certificate and ask for the treatment to be authorised before you book anything.

Can I claim for treatment I have already paid for?

Yes, for eligible costs: send an itemised receipted invoice within six months of the treatment. Without prior authorisation, though, you get back only what Vitality would have paid the provider had it authorised the claim in advance.

Does the Vitality excess apply to every visit?

It depends on which type your membership certificate shows. A per-claim excess is paid each time you claim for a new condition, and again if treatment for that condition continues for more than 12 months; a per-plan-year excess is paid once for each insured person in the plan year (page 46). Vitality GP consultations sit outside the excess either way.

Weighing Vitality against another insurer partly on claim rules? The form here takes a phone number, and the broker who rings can explain how each insurer's claim rules work and quote on like-for-like excess and out-patient settings where it can arrange both.