How to claim from the Scheme

To claim payment from the Scheme for your medical costs, whether these are hospital, chronic or day-to-day, the same steps apply.

Important tips when claiming

Send your claims within four months, otherwise we’ll consider them expired and not pay them.

When sending claims, please make sure the following details are clear:

  • Your membership number
  • The service date
  • Your doctor’s details and practice number
  • The amounts charged
  • The relevant consultation, procedure or NAPPI code and diagnostic (ICD-10) codes
  • The name and birth date of the dependant for whom the service was 'done'
  • If you paid – is your receipt attached, or does the claim say “paid”?

Remember to always keep copies of your claims for your records.

Scan and email your claim to

For international claims, make sure the following details are clear:

  • Completed international claim form
  • Your membership number
  • Proof of payment
  • Claim marked as ‘travel’
  • Diagnosis.

You can track the status of your claims

To see the status of your claim, you need to first log in and go to the Claims Tracker or check your claim statement.

How to claim if you’re in a car accident

If you’ve had claims because of a motor vehicle accident, please call us on 0860 100 693 as there may be a third party claim against the Road Accident Fund.

How to claim if you’re injured at work

If you’re injured at work, the law says you must be compensated by the Compensation Commissioner for Occupational Injuries and Diseases (COID). To find out about it, call 0860 100 693. If a third party compensates you for your medical claims, you must let us know.