How to make a claim and access treatment

Important information: Accessing treatment or making a claim is subject to your underwriting, so please check your membership documents for details of how your membership covers pre-existing conditions/symptoms. As well as your underwriting, there may be other reasons why your treatment may not be covered, here are some common reasons why. If you're unsure, talk to one of our live chat agents.

How to see a specialist or access treatment

Like most health insurers, we don’t pay for primary care – that’s care you’d usually get from your GP. That includes prescriptions or tests or treatments you’d usually have at your GP surgery.

You'll need a GP referral before you can use your AXA Health membership to see a specialist. You’ll also need to do this for any children under 18 on your plan.

You can use your own GP, or the AXA Health online GP service to get this. If you see your own GP, remember to tell them you have AXA Health membership and they'll be able to refer you if necessary. You’ll also need to check your membership handbook to make sure you have the appropriate benefits for out-patient specialist consultations and diagnostic tests.

There are two types of GP referral:

• It’s easier and quicker to ask for an ‘Open referral’ – this will mean we can help you find a specialist. Most of the time, we can also book your appointment too. If you have the guided option, you will need to ask for this type of referral. If you’re unsure if you have this option please check your membership documents.
• If the GP recommends a particular specialist, this is a ‘Named referral'. If the GP gives you a named referral, get in touch with us before arranging any ​visits, so we can check your membership covers that specialist. We don’t want you ​to have any unexpected expenses. You can find your claims phone number in your ​handbook.

Making sure your membership covers your treatment

In some cases we may need you to send your referral letter to check your membership can cover your treatment. The easiest way to do this is to log in to your online account, click on the 'Make a claim' button from your homepage or 'My claims'. Then select 'Authorise a treatment or appointment’. Or you can call us.

If you don't have an online account, setting one up will only take a few minutes, you'll just need your membership number, which you can find on your documents, or on a recent email from us.

If you have an open referral

We'll check that you are covered, and we'll find you a specialist. Just let us know the type of specialist you have been referred to, for example a cardiologist. We'll then book an appointment for you and provide you with an authorisation number to give to your specialist. If you start your claim from your online account you will receive your authorisation number in your online account inbox. If you call us, we will give you this over the phone.

If you have a named referral

We'll check your specialist is covered and provide you with an authorisation number to give to your specialist. If you start your claim from your online account you will receive your authorisation number in your online account inbox. If you call us, we will give you this over the phone.

Please note, if you’ve selected a guided option with your plan, you can check this in your membership documents, you’ll have the option of an open referral only.

Important information: If you have a Personal Choice plan please call us on 0345 600 4461 to start your claim.