Navigating the maze of insurance claims can often feel overwhelming, especially when it comes to the well-being of our furry friends. The Homebase Pet Insurance Claim Form serves as a crucial first step in this process, inviting policyholders to provide comprehensive details to ensure their pet's health issues are promptly addressed and compensated according to their policy. With sections ranging from basic owner and pet information, detailed accounts of the pet’s condition, previous veterinary practices, to the policyholder’s preferred method of payment, the form is designed to collect all necessary information in a structured manner. It emphasizes the importance of including a pet's full medical history for new conditions and clearly outlines what is not covered, such as pre-existing conditions, certain types of treatments, and the specified excess. Furthermore, the form accommodates claims involving complementary treatments and requires a detailed veterinary declaration to avoid any discrepancies. By completing and returning this form to Homebase Pet Insurance, policyholders take a vital step towards managing their pet's health care needs efficiently, although they are reminded of their responsibility to cover any part of the claim not accepted by the insurer.
| Question | Answer |
|---|---|
| Form Name | Homebase Pet Insurance Claim Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | pets at home claim form pdf, vpi pet insurance claim form, fillable vpi claim, homebase pet insurance claim form |
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Claims Helpline: 0845 078 7575 |
Claim Form |
claims@homebasepetinsurance.co.uk |
To be completed and returned to: Homebase Pet Insurance, Freepost -
A About you (the Policyholder)
If your name or address has changed, please tick
Name, address and postcode
PLEASE NOTE that if any section of the form is not filled in, it may delay your claim – you MUST fill in sections A to E.
Please also read the following notes before submitting any claim and have your policy wording to hand for full details:
Your policy does NOT COVER in whole or as part
B About your pet
Your pet’s name (* multipet)
*If you have more than one pet insured with us, please ensure you enter the correct pet’s name and only one claim form per pet.
Contact details
Tel Number (mobile preferred)
Policy number |
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Policy Start Date |
/ |
/ |
of a claim:
•Any condition that started before the cover start date
•Any condition that started within the qualifying period of the cover start date
•The excess specified in your policy schedule
•Food
•Flea treatment
•Wormers
•Vaccinations
•Dental treatment unless caused by injury
If this is a claim for a new condition, please
Cat
Male
Breed
Date of birth |
/ |
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Has your pet been neutered/spayed?
What is the weight of your pet?
Dog
Female
/
Yes No
kgs
Level of Cover |
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Dog Silver |
Dog Gold |
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Dog Platinum |
Cat Care |
Cat Care Plus |
ensure the full medical history is attached to the claim form.
Note: If you are not sure about any of the above information, please ask your vet to complete this for you.
C About your pet’s condition
Condition 1
Name of condition as advised by your vet
Please tell us when you first noticed your pet was
unwell or injured, that led you to make an appointment Time & Date with your vet.
Did you contact our vetfone service?
Was your pet under your care at the time of the illness/injury/incident?
If no, please provide the name and address of any authorised third party looking after your pet at the time of the incident
Condition 2
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Time & Date |
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Yes |
No |
Date: |
/ |
/ |
Yes |
No |
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DYour previous veterinary practices (Please tell us all vet(s) where your pet was previously registered)
Vet name
Address
Postcode
Phone number
Date: from |
to |
Vet name
Address
Postcode
Phone number
Date: from |
to |
Please tell us your address at that time, if it was different to the address in Section A
Postcode
EYour signature (Policyholder – please complete one of the following boxes (a, b or c) to tell us who to pay)
I declare, to the best of my knowledge and belief, that all the information provided in this form is true and complete. I agree that Homebase Pet Insurance may seek any information it requires from any vet. I accept that the information provided may be released to other companies who provide a service to Homebase Pet Insurance in connection
with managing and handling claims
a Please pay my claim direct to me: |
b Please pay my claim direct to my vet: |
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Printed name: |
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Printed name: |
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Policyholder’s signature: |
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Policyholder’s signature: |
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Date: |
/ |
/ |
Date: |
/ |
/ |
Please note: if we decide we cannot pay some or all of your claim, it is your responsibility to pay your vet
cPlease pay my claim direct to the person named below:
Printed name:
Policyholder’s signature:
Date: |
/ |
/ |
FYour vet must fill in this section about each condition (We only accept claim forms from veterinary practices)
Please advise the date
this pet was registered/ / at your practice.
If this pet was referred to you, please advise the name and address of the registered vet
Was this pet referred to a complementary |
If Yes, please advise the condition |
treatment professional? |
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Yes |
No |
If Yes, please also complete Sections G & H |
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Did any condition being claimed result in the death or euthanasia of the pet?
Postcode |
Yes |
No |
Date of death |
/ |
/ |
If a house call was made, you must confirm in writing why it was absolutely essential |
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What are the main clinical signs?
What is the diagnosis? (This must be completed)
Please tell us the treatment dates for this claim Have you filled in a claim for this condition before?
If yes, treatment dates from the previous claim
Condition 1
From |
/ |
/ |
To |
/ |
/ |
Yes |
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No |
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Don’t know |
From |
/ |
/ |
To |
/ |
/ |
Condition 2
From |
/ |
/ |
To |
/ |
/ |
Yes |
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No |
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Don’t know |
From |
/ |
/ |
To |
/ |
/ |
IF THIS IS A NEW CLAIM, PLEASE COMPLETE THE FOLLOWING QUESTIONS AND FORWARD THE FULL MEDICAL HISTORY. Please tell us the date or the number of days before the first date of treatment, that the clinical signs were first noticed.
Days
Has this pet had this condition or clinical signs before, or any related condition or clinical signs before?
(If ‘Yes’ we will need the medical history to show the dates and full details)
Date / /
Yes No
Days |
Date |
/ |
/ |
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Yes |
No |
GComplementary treatment (N.B. If the claim involves complementary treatment this section of the claim form must be filled in by a vet and not the complementary treatment professional. Please ensure a copy of the referral letter and invoice(s) are attached.)
What complementary treatment did you refer this pet for?
What condition is the complementary treatment for?
What organisation does the complementary treatment professional belong to? (Please tick)
If you have not attached a copy of the referral letter or the letter does not contain the following information, please tell us:
How many sessions have you recommended?
Please tell us the cost of complementary treatment
Association of Chartered Physiotherapists in Animal Therapy |
McTimoney Chiropractic Association |
National Association of Veterinary Physiotherapists |
Canine Hydrotherapy Association |
International Association of Animal Therapists |
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Please explain how this treats the condition.
H The attending vet or a person authorised by the vet must fill in and sign this section
Please advise the cost of treatment incl. VAT |
Condition 1 |
Condition 2 |
I declare to the best of my knowledge and belief, that all information provided in this claim form is true and |
Practice Stamp |
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complete. |
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The fees I have charged are no more than the fees I would normally charge my clients. |
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Veterinary Surgeon’s Signature: |
Date: |
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Printed Name: |
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Email address of the Veterinary Practice: |
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Postcode: |
IMPORTANT: Please ensure that a dated and itemised breakdown of all treatment costs is attached to the claim form before you send it to us. This must state fees for consultation, prescription charge, hospitalisation,
Calls may be monitored and recorded for training purposes, to improve the quality of service and to prevent and detect fraud. Homebase Limited is an appointed representative of Home Retail Group Insurance Services (HIS). For Pet Insurance HIS acts as an introducer to Royal & Sun Alliance Insurance plc who arrange, administer and underwrite the policies. HIS and Royal & Sun Alliance Insurance plc are both authorised and regulated by the Financial Services Authority (FSA). Registered in England and Wales at St. Mark’s Court, Chart Way, Horsham, West Sussex, RH12 1XL.
453496