Online Dental Claim

1. Checklist - Prior to Completing

Please also ensure that you also have the following available to complete your claim

  • Policy number
  • Dentist/Practitioner details
  • Personal bank details

If you have any problems with completing this form please contact us on 01204 555047. Lines are open Monday to Friday 9am to 5pm.


2. Make Your Claim
Policy Holder
Your Dentist/Practitioner
Treatment Claimed For

PLEASE NOTE: If the amount you are claiming is not shown in the drop downbox below please click on the following link to complete a paper based form CLICK HERE

For any claim submitted online Bolton and District Hospital Saturday Council reserve the right to request original receipts prior to processing, as part of it's rigorous anti-fraud measures.


For payment to be paid directly into your own bank account then please complete the details below:

Data Protection Act 1988

Information about health, medical history and any treatment that you have is sensitive personal information.

  • Usually we need your consent to process your personal information.
  • You have a right to receive details of the information we hold about you. We may make a small charge. We may ask for dental information via your dentist.
  • If on reading a dental record you believe it is inaccurate or misleading you can request that an amendment is attached to it.
  • You may request from us, in writing, a copy of any personal information contained in any independent report that we obtain.
  • You should contact your own dentist for any report they produce.
  • We send claims correspondence to the policyholder unless we are advised to do otherwise.
Prevention & Detection of Crime

Please note that your insurance policy with us is based on mutual trust. If we are suspicious that any claim may be fraudulent we have rigorous anti-fraud measures in place. These may include auditing the records of medical practitioners to prove that our customers are correctly billed for the services received effectively to prevent and detect crime. This may also involve auditing the policyholder's medical and health records before of after treatment. We may need to share information received with third parties such as the General Medical Council or the NHS Counter-Fraud Security Management Service as we deem appropriate. We may also be required by law to submit information to law enforcement agencies about our suspicions of fraudulent claims and other crime.

Policy Declaration

I confirm that

  • The treatment detailed on the invoice submitted has been paid in full
  • I have received a dental examination during the twelve months prior to the date of joining this scheme and that all remedial treatment was completed at that time
  • The treatment was not planned prior to the date of joining
  • The information provided is to the best of my knowledge true and correct