Westfield Health Claim Form Instructions and Information

Submit the completed form along with the necessary documentation via email to enquiries@westfieldhealth.com, by fax to 0114 250 2001, or by mail to Westfield Health, PO Box 340, Sheffield, S98 1XB. Ensure that all required fields are filled out accurately and include any original receipts. Submit the form within 13 weeks of the payment date to ensure processing of your claims.

The form must be submitted within 13 weeks of the payment date to be valid for claims processing. For specific claims, like maternity/paternity/adoption, additional documentation is required and must be submitted within specified timeframes.

The purpose of this form is to facilitate the submission of claims for various health-related expenses covered under the Westfield Health insurance policy. The form includes sections for optical, dental, hospital benefits, and specific treatments such as physiotherapy and acupuncture. It ensures that all necessary information and documentation are provided for efficient processing of claims by Westfield Health. This form must be filled out carefully, using black ink and block capitals, to ensure legibility and accuracy. Policyholders, partners, and dependent children can use this form to submit claims for eligible expenses. It also addresses the submission of receipts, insurance coverage details, and declarations of consent from medical practitioners. Additionally, the form includes important notices regarding fraudulent claims and privacy processing. By submitting this form, claimants agree to provide true and complete information and authorize the sharing of relevant medical information for claims processing and fraud prevention purposes.

• 1. Westfield Account No.: The unique account number for the policyholder.
• 2. Date of Birth: The policyholder's date of birth in day, month, and year format.
• 3. Surname: The policyholder's last name.
• 4. First Name: The policyholder's first name.
• 5. Contact Tel No.: The policyholder's contact telephone number.
• 6. Email Address: The policyholder's email address for claim confirmation.
• 7. Account No.: The bank account number for the payment to be deposited.
• 8. Sort Code: The bank sort code for the payment to be deposited.
• 9. Dependent Details: Information about dependent child or partner if the claim is for them.
• 10. Receipt Details: Details about the receipts being submitted, including date of receipt and amount paid.
• 11. Treatment Details: Details about the treatment received, including practitioner's name and qualifications.
• 12. Declaration and Signature: The policyholder's declaration of truth and consent authorized by their signature.

If you fail to submit this form within the required timeframe, your claims may not be processed, and you may lose the benefits you are entitled to.

• Denied Claims: Failure to submit within 13 weeks may result in the denial of your claim.
• Loss of Benefits: Missing deadlines can lead to loss of entitled benefits under your policy.
• Legal Action for Fraudulent Claims: Submitting false information may result in legal action and cancellation of your policy.

• 1. Optical Claims: Submit claims for optical treatments and expenses.
• 2. Dental Claims: Submit claims for dental treatments and expenses.
• 3. Hospital Benefits: Claim for hospital stay benefits, including inpatient and day patient admissions.
• 4. Physiotherapy and Acupuncture: Submit claims for physiotherapy and acupuncture treatments.
• 5. NHS Prescription Charges: Claim for NHS prescription charges with required receipts.