Navigating the intricacies of pet insurance claims can be a daunting experience for pet owners, making the clarity and completeness of claim forms vitally important. The Saga Pet Insurance claim form is a structured document designed to facilitate the submission of insurance claims related to veterinary treatments that are not covered for a range of specified conditions and treatments, including pre-existing conditions, illnesses occurring before or shortly after the policy start date, preventative treatments, and more. This form necessitates detailed input from both the policyholder and the veterinary surgeon, encompassing the pet's medical history, the specific incident leading to the claim, and a breakdown of the treatment costs incurred. It emphasizes the necessity for transparency and accuracy in the reporting of information, not only to expedite the processing of claims but also to uphold the integrity of the claims process itself. That said, the documentation includes a comprehensive declaration section, underscoring the serious consequences of fraudulent claims. Administered by Ultimate Pet Partners Ltd, the process outlined in the Saga Pet Insurance claim form underscores the importance of meticulous adherence to policy terms and conditions, the collaborative role of veterinary practitioners, and the nuanced approach required in the administration of pet insurance claims.
| Question | Answer |
|---|---|
| Form Name | Saga Pet Insurance Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | cst hm1092 download, saga pet insurance claim form, Ltd, SignedDate |
Saga Pet Insurance claim form
Please return completed form to: Saga Pet Insurance claims,
5th floor, The Connect Centre, Kingston Crescent, North End, Portsmouth PO2 8DE.
Fax: 0843 309 4513
Important
Saga Pet Insurance does not cover the following veterinary treatment:
a)Any
b)Any illness or condition, arising prior to, or within 14 days of, the policy start date
c)Preventative, elective treatments and routine examinations
d)
e)Dental treatment, other than required as a result of injury.
Please check Policy Terms and Conditions for full details of what is and isn’t covered.
Section 1 – This section and section 3 to be completed by the policyholder
Title
Surname
Address
Home tel number
Forename
Postcode
Policy number
Start date
Pet name
Age of pet
Purchase price of pet £
Cover level
Policy dates
Breed
Sex of pet
First date of relevant illness/injury/condition
Please provide a brief description of illness/injury/condition:
Is your pet currently covered by another insurance policy? Yes
No
If ‘Yes’, please give name of insurer
Policy number
Has your pet been microchipped?
Yes |
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No |
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If ‘Yes’, please provide microchip number |
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Expiry date
Please complete section 3 after section 2 has been completed by your veterinary surgeon.
Section 2 – to be completed by the veterinary surgeon
Age of pet
How long have you been treating the animal?
If this is a referral, please state name and address of practice that referred case:
Practice name
Address
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Postcode |
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Tel number |
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Date |
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Diagnosis
Treatment
Cost (inc VAT) £
Has the animal received treatment for any of the above, or any related conditions before? Yes |
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No |
If ‘Yes’, please give details:
Is this a continuation claim? Yes |
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No |
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Has the pet died as a result of the illness/injury/condition stated above? Yes
Declaration by veterinary surgeon:
No
Veterinary practice stamp and VAT number
I certify to the best of my knowledge that all relevant information in Section 2 of this form is correct and, in my opinion, the condition treated was not present on the policy start date. I also confirm that, in my opinion, the fees charged are the normal amount relating to this matter.
Signed |
Date |
Print name
A full clinical history and itemised receipt or account must be enclosed.
Section 3 – to be completed by the policyholder
Should we make payment direct to the veterinary surgeon? Yes
No
If ‘No’, payment will be made to the policyholder. Please complete your bank details below.
If you would like your claim payment to be settled straight into your bank account by BACS (Bankers Automated Clearing Services) please provide the details here.
Account holder name
Sort code
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Account number
If bank details are not provided, payment will be made by cheque.
If we pay your claim by BACS a confirmation
Declaration
i.I declare that all details provided herein represent a true and accurate statement of details pertaining to my claim and I have not omitted any details pertinent to the circumstances of this claim.
ii.I understand and agree that information relevant to my claim(s) may be obtained from, and shared with, my vet in order for my claim(s) to be administered.
iii.I declare that where a claim involves a potential refund from other insurers or a third party, I hereby authorise them to remit any refund to my insurer.
iv.I understand that, in the event this claim is found to be fraudulent, in whole or in part, this will invalidate the policy and may render me liable to prosecution.
Signed |
Date |
Print name
Saga Pet Insurance claims are administered by Ultimate Pet Partners Ltd (Registered no. 6740793. FCA No 493636), 5th Floor, The Connect Centre, Kingston Crescent,
Portsmouth PO2 8DE. Tel: 0845 604 2308, fax: 0843 309 4513, who are an appointed representative of Ultimate Insurance Solutions Ltd (FCA No. 311368)
who are authorised and regulated by the Financial Conduct Authority.