Pet Insurance Direct Claim Eligibility Form

Pet Insurance Direct Claim Eligibility Form

We are very proud to be able to offer many of our insured clients the option of not having to pay the full bill at the time of treatment, but claiming directly from their insurance company in most instances. Please complete the short form below to register for this service. Your insurance policy documents should have all the information you need to complete this form. If you have any queries, please contact insurance@stjamesvet.co.uk - we will aim to get back to you within 1 working day. Thanks!
Owner's Full Name*

First NameLast Name
Owner's Email Address*
example@example.com
Owner's Phone Number*
Please enter a valid phone number.Format: 00000-000000.
Owner's Address*

Street Address

Street Address Line 2
CityState / ProvincePost Code
Is the Owner the Policy Holder?*
Policy Holder's Full Name*

First NameLast Name
Policy Holder's Email Address*
example@example.com
Policy Holder's Phone Number*
Please enter a valid phone number.Format: 00000-000000.
Policy Holder's Address (if different to Owner's)

Street Address

Street Address Line 2
CityState / ProvincePost Code
Pet's Name*
Pet's Species*
Please enter your pet's age in years and months
Pet's Age (Years)*
Months
Who is your Insurance Company?*
Who is the insurer?
Please note, for your first claim for this condition you will need to complete a claim form once to enable us to process the claim. Any ongoing (continuation) claims can then be done online.
Certain treatment limits
Please be aware that certain treatments have a maximum limit or exclusion with this company, which may reduce the amount they pay in the event of a claim. A few examples are:

Hospitalisation costs

Out of hours fees

Certain "non-prescription" medication

Please read your T&Cs carefully and if in doubt contact your insurer for more information.

 

Most companies have a 14 day "cooling off" period if you are unhappy with their T&Cs
Please be aware that when making a claim, you will need to contact your insurer directly to initiate any claim before we will be able to process it. We will then be happy to complete the process on your behalf.
Policy Start Date*

DayMonthYear
Date
Direct claim could require internal pre-authorisation
Policies with this company might require pre-authorisation from our in-house insurance department in order to do a Direct Claim. We will contact you if we need to!
I understand that I will need to pay for any treatment at the time. St James Vets can still submit a form on my behalf, and any payment from the insurance company will be paid to me directly by them.*

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Policy Number*
Do you have a Lifetime or Annual (12 month) Policy?*
Lifetime or annual
Unfortunately, it is very likely that your policy will not cover:

ANY condition which there is ANY mention of in your pet's medical notes (including ANY related symptoms) prior to, or within 14 days of your policy start.

Please note, the 12 months of cover usually starts from the date the condition was first noticed, EVEN IF YOU DID NOT CLAIM FOR IT at that time.
Has your pet been insured with anyone else before this policy?*
Previous policy
Unfortunately, it is very likely that your new policy will not cover ANY conditions which there is ANY mention of in your pet's medical notes prior to your new policy start date. This is likely to be the case EVEN IF YOU HAVE NOT CLAIMED for the condition previously.
No previous policy
Please be aware that it is very unlikely that your policy will cover ANY conditions which there is ANY mention of in your pet's medical notes prior to your policy start date.
What is your policy limit PER CONDITION? (This MAY NOT be the same as the Policy Limit, please check carefully!)*
Limit per condition
Please be aware that many claims (for example eating toys, cruciate ligament disease, cancer) can result in bills of £7,000 or more. Your policy will not cover any amount greater than the maximum limit per condition for any one condition.
What is the amount per condition?*
What is your TOTAL policy limit per year? *
Annual maximum limit
Please be aware that many claims (for example eating toys, cruciate ligament disease, cancer, medical illnesses) can result in bills of £7,000 or more over a year. Your policy will not pay for any amount greater than your annual maximum limit.
What is the amount?
Are there any specific conditions listed on your policy with a different limit to the usual limit per condition? (for example, cruciate ligament disease)
What are the conditions and their specific limit? Please list
Limit per specified condition
Please be aware that many claims (for example eating toys, cruciate ligament disease, cancer, medical illnesses) can result in bills of £7,000 or more over a year. Your policy will not pay for any amount greater than the amount specified for any condition listed individually.
What is the excess per condition per year?
What is the excess?
Is there a co-payment as well as an excess? This can often apply if your pet is over a certain age.
What is the co-payment?
What is the co-payment?
Does your policy cover dental treatment?
Are there specific requirements for this? (for example, annual recorded dental assessment). Please list
Is there a specific limit on dental treatment?
How much is the specific limit on dental treatment?
See Claims Support Guide
Claims Support Guide
I have read the Claims Support Guide. I understand that having my pet insured is not a guarantee of payment, and that my insurance is an agreement between myself and my insurer, entirely independent of St James Vet Group. I will need to pay for any treatment my policy does not cover, including excesses, exclusions, co-payments and specific limits. I confirm that the details above are correct to the best of my knowledge, and I give my consent for any clinical history and treatment details to be disclosed to the insurers for the purpose of pursuing any claim. I also give my permission for payment of any claim to be made directly to the practice where appropriate.*

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Pet Insurance Direct Claim Eligibility Form

Please enter your pet's age in years and months