insurance, travel insurance, home insurance, health insurance

Important policy information
Health Solutions
Norwich Union Healthcare
Contents
Your requirements 1
Policy Summary - Keyfacts 2
- Guide to overseas cover 8
Policy Wording 9
Further Information 25
- Option to enhance your cover - summary 4
- Option to reduce your cover - summary 5
- What is not covered - summary 6
- Your questions answered 7
- What is covered - summary 3
1
Core Cover
Health Solutions is an individual Private Medical Insurance product which provides you with access to eligible in-patient or
day-patient treatment of acute conditions of brief duration at any hospital within the Key section of our Select Hospital List.
It also provides cover for eligible out-patient treatments including Specialist consultation fees, diagnostic tests,
physiotherapy, osteopathy and chiropractic on Specialist referral, as well as radiotherapy and chemotherapy.
In addition, extra benefits include home nursing, maternity cash benefit and access to our GP Helpline, Stress Counselling
Helpline and Personal Health Manager.
Health Solutions provides a flexible choice of options to enable you to select the cover you require.
Options
Other Treatments and Therapies
Extends the cover on your Policy to include services on GP referral such as treatment by a Physiotherapist, Osteopath,
Chiropractor and Acupuncturist and minor surgery by a GP.
Dental and Optical
Extends the cover on your Policy to include optical benefit of up to £200 with a £50 excess, accidental dental benefit of up
to £600 and routine dental benefit of up to £300 with a £50 excess. All of these benefits are per insured person per policy
year.
Extended Hospital List
Extends the hospitals covered by your Policy to also include those on the Extended Hospital List.
Trust Care Hospital List
Limits the hospitals covered by your Policy to only those within the Trust Care section of our Select Hospital List.
Signature Hospital List
Limits the hospitals covered by your Policy to only those on the Signature section of our Select Hospital List.
Reduced Out-Patient Cover and Selected Benefit Reduction
Limits the out-patient cover on your Policy to two consultations, diagnostic tests if directly leading to, or following within six
months of, related eligible in-patient or day-patient treatment and radiotherapy/chemotherapy. All these benefits are per
insured person per policy year. Additional benefits removed from the policy are; all pregnancy and childbirth including
abnormal conditions, investigations into the causes of infertility, all dental treatment, including oral surgical procedures,
unless otherwise stated on your Policy Schedule, Overseas cover and Specialist referred physiotherapy, osteopathy and
chiropractic treatment.
Member Excess
Addition of an excess. An excess of either £500 or £1,000 can be chosen per insured person per policy year. This will be
detailed on the Policy Schedule.
Six Week Option
Addition of the six week option. Benefits for in-patient or day-patient treatment and for NHS cash benefit will only be
available if treatment is not available at an NHS hospital within six weeks.
However, as is common with Private Medical Insurance products there are a number of exclusions. For example, Health
Solutions does not provide cover for long term or chronic conditions, normal pregnancy and routine medical examinations.
Please refer to the Policy Wording section towards the back of this document for full details of benefits and exclusions.
This is a summary of the features of this product. Please read the Policy Summary and Policy Wording sections of this
document to ensure that it satisfies your requirements. If it does not, please contact us.
Please note that in providing this information, Norwich Union Healthcare has not made a personal recommendation
or provided any advice on the suitability of this product for your circumstances. Please therefore read all of the
information provided carefully to ensure that this product meets your requirements. If you feel that this product does
not meet your requirements, please call our Telesales department on 0800 015 013 to discuss your needs further.
Your Requirements
2
Policy Summary
This Policy Summary has been designed to provide you with the key information about the
product, and it is important that you read this section. The Policy Summary does not contain
the full standard terms and conditions that apply to the product. These are contained in the
Policy Wording section toward the back of this document. Non-standard terms may apply.
What do you get from Health Solutions
when you’ve said yes?
More choice
Health Solutions is one of the most versatile individual healthcare products on the
market, offering you a real choice. Health Solutions not only offers a range of
comprehensive core benefits, but also the option to pick-and-choose the benefits
you need from one policy. It’s perfect because it enables you to adapt the product
to suit your needs and budget.
Rather than restrict you to a product that provides benefits you don’t want and
feel you may never need, Health Solutions offers you a wide range of options you
can select to create affordable healthcare that’s individual to you and your family.
No Claim Discount
We believe that people should be rewarded for staying healthy, which is why we
have introduced a No Claim Discount on the Health Solutions product.
The No Claim Discount applied to accepted applications in the first year will range
from 0-45%, depending on each person’s previous medical claims experience.
The No Claim Discount is reviewed annually and applies on a sliding scale.
After each consecutive year with no new claim paid, the percentage discount
applied to your premium moves up the scale by one level. Should you need to
make a claim, the No Claim Discount applied to your policy will fall by three
levels for the first new claim paid per policy year only. However, not all claims will
affect your No Claim Discount. No Claim Discount arrangements may change in
future years.
Please refer to the Policy Wording for
full details.
Cover for you and your
family
You, your spouse and your children
under 24 can all be covered by the
Health Solutions Policy, provided you
are all permanently resident in the UK.
Your children can be included even if
they are temporarily away from home.
Newborn babies qualify for up to three
months free cover, and can be added
to your Policy on full cover regardless
of their health if notified to us within
three months of birth.
Private Medical Insurance from
Norwich Union Healthcare
3
Policy Summary
What is covered - summary
You can purchase Core Cover separately which provides you with the benefits usually associated
with Private Medical Insurance. Cover may be reduced or added to by choosing from the selection
of Policy Options. It is important to note that this benefit table is only intended to provide you
with a summary of the benefits offered by Health Solutions. Please refer to the Policy Wording at
the back of this document for full details of the Policy benefits and exclusions.
Benefi ts Notes
In-patient or day-patient treatment of acute conditions of brief duration at a hospital in the Key section
of the Select Hospital List or in an NHS pay-bed.
Hospital charges ✔
Including accommodation, meals, nursing
care, drugs and dressings
Specialists’ fees ✔
Subject to Norwich Union Healthcareís fee
guidelines for Specialists
Diagnostic tests ✔
Such as pathology, X-rays, CT scans, MRI
scans and physiological tests such as ECGs
Radiotherapy/chemotherapy ✔
Additional Benefits
Nursing at home ✔
Immediately following eligible in-patient
or day-patient treatment; on Specialist
recommendation
Private ambulance ✔ Reasonable charges
Parent accommodation when staying with a child covered by
the Policy
✔
Child under nine undergoing eligible
treatment. One parent only
Hospice care £70 per day Donation to the Hospice; up to 10 days’
care maximum
Maternity Cash Benefit £100 per child
For each child born to an Insured Person
who is the mother, subject to a 10 month
qualifying period
NHS Cash Benefit £60 per night Up to 25 nights per person per policy year
Treatment for abnormal conditions of pregnancy and childbirth ✔ Subject to a 10 month qualifying period
Investigation into the causes of infertility ✔ Subject to a two year qualifying period
Oral surgical procedures ✔
Subject to Norwich Union Healthcare’s fee
guidelines for Specialists
Emergency overseas cover ✔
Emergency treatment when temporarily
abroad for a period of up to 90 days
Specialist referred physiotherapy, osteopathy
and chiropractic treatment
✔
GP Helpline ✔ Unlimited number of calls
Stress Counselling Helpline ✔ Unlimited number of calls
Personal Health Manager ✔ Unlimited use
Out-patient treatment of acute conditions of brief duration
Consultations with a Specialist ✔
Any procedures included are subject to
Norwich Union Healthcare’s fee guidelines
for Specialists
Diagnostic tests ✔
Such as pathology, X-rays, CT scans, MRI
scans and physiological tests such as ECGs
Radiotherapy/chemotherapy ✔
This is a summary of the policy benefits. Full details of standard cover and exclusions are set out in the Policy Wording section of this
document. Non-standard terms may apply. Applications are required.
Health Solutions Core Cover
4
Policy Summary
Benefit limits shown below apply per person per Policy year.
Other Treatments and Therapies
You may want to use complementary and alternative treatments with one
visit to your GP.
This option includes:
Dental and Optical
Although Core Cover includes cover for oral surgical procedures and opthalmic
procedures, you can also choose additional benefit towards routine dental
expenses, accidental injuries and optical expenses as well.
This option includes:
*A £50 excess applies separately to both Routine Dental Benefit and Optical
Benefit. The £50 excess is applicable per person per policy year.
Extended Hospital List
Health Solutions Key Hospital List provides access to a wide range of UK private
hospitals. You may wish to extend the list of hospitals you can use by choosing
the Extended Hospital List, which increases your access to hospitals.
This is a summary of the Policy benefits. Full details of standard cover and exclusions are given in the
relevant Policy Wording, at the back of document. Non-standard terms may apply. Applications are
required.
In addition to the Core Cover, you can choose from the following Options to enhance the
healthcare benefits available to you and your family.
Benefi ts Notes
GP referred physiotherapy, osteopathy, chiropractic and
acupuncture treatment
✔ Up to 10 sessions in combined total
Minor surgery by a GP ✔ Up to £70 per procedure; payable to the GP
Benefi ts Notes
Optical Benefi t* ✔ Up to £200
Accidental Dental Benefi t ✔ Up to £600
Routine Dental Benefi t* ✔ Up to £300
Benefit Options to enhance
your cover – summary
5
Policy Summary
This is a summary of the policy benefits. Full details of standard cover and exclusions are given in the
Policy Wording at the back of this document. Non-standard terms may apply. Applications are required.
Reduced Out-Patient Cover and Selected Benefit
Reduction
You can choose to reduce your out-patient cover. This option does include cover
for two Specialist consultations per person per policy year and out-patient
radiotherapy and chemotherapy treatment. It also includes out-patient diagnostic
tests leading to or following within six months of, related eligible in-patient or
day-patient treatment.
This cost-saving option is ideal if you are happy to use the NHS or pay the
relatively low cost for any additional consultations and out-patient treatment
that does not lead to further treatment as an in-patient or day-patient.
If this Option is selected the following exclusions will apply in addition to those
detailed on page 11 of this brochure.
Cover will not be available for:
■ All pregnancy and childbirth including abnormal conditions
■ All investigations into fertility
■ All dental treatment including oral surgical procedures unless otherwise
stated on your Policy Schedule
■ Overseas cover
■ Specialist referred physiotherapy, osteopathy and chiropractic treatment.
Reduced Hospital Lists
Health Solutions Key Hospital List provides access to a wide range of UK private
hospitals. You may choose to restrict the list of hospitals you can use and utilise
the Trust Care Hospital List, which uses excellent private patient units of NHS Trust
and Partnership hospitals. Or the Signature Hospital List, which has been designed
specifically for residents of Scotland and Northern Ireland. The Signature Hospital
List comprises seven private hospitals in Scotland and two in Northern Ireland.
Member Excess
Another way to reduce your premium
is to choose a claims excess to apply to
your policy. You can choose £500 or
£1,000. This means each person
covered by the policy has to pay that
fixed amount towards the cost of their
annual claims bill. This excess applies
once per person per policy year.
Six Week Option
Benefits for in-patient or day-patient
treatment and for NHS Cash Benefit
will only be available if treatment is
not available at an NHS hospital within
six weeks.
If you choose the Six Week Option,
you will still have the benefit of
prompt cover should a GP refer you
to a Specialist for diagnosis. And, if
subsequent eligible treatment as an
out-patient is required, that is covered
too. If there is an NHS delay of six
weeks or more for the eligible
operation or treatment required, there
is cover for prompt access to any of
the hospitals in the relevant section
of the Select Hospital List.
Options to reduce your cover
Perhaps you feel that while you and your family could benefit from the advantages of Health
Solutions, you would prefer a lower cost option.
The following Options may be chosen, in return for a premium reduction.
6
What is not covered
- summary
Health Solutions does not cover you for the following:
■ Pre-existing conditions (unless we
have expressly included treatment
relating to it)
■ Long term or chronic conditions
■ HIV/AIDS and related conditions
■ Normal conditions of pregnancy or
childbirth, although some
complications are covered
provided the mother has been on
the policy for at least 10 months
■ Infertility treatment (although
reasonable costs of investigations
into infertility may be covered
where both the husband and wife
have been on the policy for at
least two years).
■ Routine medical examinations and
any dental treatment other than as
provided for in the Dental and
Optical Option.
■ Surgical or medical appliances
■ Charges by a GP, medical
practitioner or Specialist for
completion of a claim form
■ Alcoholism, alcohol abuse, solvent
abuse, drug abuse and other
addictive conditions
■ Health hydros and similar
establishments
■ Treatment undertaken by a
Specialist without GP referral
■ Psychiatric or mental illness
■ Kidney dialysis
■ Cosmetic treatment
■ Out-patient drugs and
dressings
■ Professional sports injuries
■ Experimental treatment
■ Treatment required as a result
of war, terrorism, criminal
activity or contamination by
radioactivity of chemicals
■ Self inflicted injury.
Private Medical Insurance is designed to cover new and unexpected medical conditions. As is common with all Private
Medical Insurance products, you will not be covered on Health Solutions for medical conditions you have already had or
have at the time your cover starts.
Underwriting - Moratorium
An automatic exclusion applies to any disease, illness or injury (whether or not diagnosed), or of any related condition if,
■ you had symptoms of, medication or treatment for, or advice about such a disease, illness or injury within five years
before joining Health Solutions, and
■ there has not been a clear two-year period after joining during which you have been free of medication for, treatment for,
and advice about such a disease, illness or injury or related condition.
After this clear two-year period, your cover will be extended to include that disease, illness or injury, subject to Policy terms
and conditions. For a more detailed explanation, please read ‘Your Guide to Applying for Cover’.
This is a summary. Full details of standard cover and exclusions are set out in the Policy Wording section of this document.
Non standard terms may apply. Applications are required.
Policy Summary
7
Your questions answered
Making a claim
Once a GP has recommended that you
need treatment, all you need
to do is call your Claims Team on
0845 300 4542*.
*Calls may be monitored and/or recorded.
Can the Policy be
cancelled?
After your application is accepted
by us you will receive your Policy
documents and notice of your right to
cancel. You will have 14 days in which
you will be entitled to change your
mind and cancel your Policy.
What is the duration of
my Policy?
Your Private Medical Insurance Policy is
a one year contract.
The Financial Services
Compensation Scheme
(FSCS)
We are covered by the FSCS. You may
be entitled to compensation from the
scheme if we cannot meet our
obligations. This depends on the type
of business and the circumstances of
the claim.
Where you are entitled to claim,
insurance advising and arranging is
covered for 100% of the first £2,000
and 90% of the remainder of the
claim, without any upper limit.
Further information about
compensation scheme arrangements is
available from
Financial Services Compensation
Scheme
7th Floor, Lloyds Chambers
Portsoken Street
London
E1 8BN
Website: www.fscs.org.uk
If you have any cause for complaint
Our aim is to provide a first class standard of service to our members, and to do
everything we can to ensure that you are satisfied. However, should you ever feel
that we have fallen short of this standard and that you have cause to make a
complaint, please contact:
The Complaints Co-ordinator
Norwich Union Healthcare Limited
Chilworth House
Hampshire Corporate Park
Templars Way
Eastleigh
Hampshire
SO53 3RY.
In the unlikely event that the matter is not resolved, then your complaint can be
referred to the Quality Manager at the same address. It is very rare that matters
cannot be resolved amicably.
If you are still unhappy with the outcome, you may ask the Financial Ombudsman
Service to investigate by writing to:
The Financial Ombudsman Service
South Quay Plaza
183 Marsh Wall
London
E14 9SR.
Telephone: 0845 080 1800
Email: enquiries@financial-ombudsman.org.uk
Website: www.financial-ombudsman.org.uk
Please note that the Financial Ombudsman Service will be unable to consider your
complaint until you have given us the opportunity to resolve the matter directly
with you.
We have every reason to believe that you will be totally satisfied with your
Norwich Union Healthcare cover, and with our service. Nevertheless, we have
provided the above information to assist you should you ever feel that you have
cause to make a complaint.
Referring your complaint to any of the above will not affect your right to take
legal action.
Policy Summary
8
Overseas cover
The benefit is not available where Option C2
(Reduced Out-patient cover and Selected
Benefit Reduction) is selected.
This part of your cover is provided via a special agreement
with MEDEX Assistance Corporation.
MEDEX is a leading American company, which has
specialised in assistance services since 1977. They have a
fully computerised database, which includes over 40,000
preferred medical care providers. MEDEX will:
■ Assist you in locating the most appropriate medical care
■ Provide advice and assistance in English with translation
where necessary
■ Monitor your progress during the course of your
treatment and recovery
■ Maintain contact with your family and personal physician
■ Arrange for emergency evacuation if necessary
■ Send and relay emergency messages
■ Provide legal referrals.
Please ensure you give your Policy number and MEDEX
telephone number to a family member or companion who
is to contact MEDEX on your behalf should you become
involved in an emergency and are unable to contact
MEDEX directly.
Call the MEDEX Assistance Co-ordination Centre if:
■ You are hospitalised
■ You are involved in an accident requiring medical
treatment
■ You have difficulty locating medical care
■ You have a medical problem and require translation
services.
The telephone number for the MEDEX Co-ordination
Centre is:
United States, Baltimore, Maryland: +1-410-453-6330
Freephone access is available from within the UK,
Northern Ireland, Channel Islands and Isle of Man:
0800-252-074
The MEDEX Co-ordination Centre is open 24 hours a
day and you should call collect/reverse the charges if
necessary.
When you call MEDEX please give them your name;
Norwich Union Healthcare reference and a brief description
of your problem.
MEDEX will immediately take the appropriate action
necessary and continue to monitor your case until the
situation is resolved.
In an emergency – go immediately to the nearest physician
or hospital without delay, then contact the MEDEX
Co-ordination Centre.
Assistance co-ordinators are multilingual and are available
24 hours daily. The MEDEX Assistance Network extends
worldwide.
Remember: please ensure you quote the Norwich
Union Healthcare reference 657 to assist MEDEX
in answering your call.
*Calls may be monitored and/or recorded
Policy Summary
9
Policy Wording
Definitions
Accident or Emergency Admission
An admission:
a. by ambulance to a Hospital directly from or
immediately following an accident
b. to a Hospital ward directly from the A&E or Casualty
department for urgent or unplanned Treatment
c. to a Hospital ward on the same day as a referral for
Treatment is made either by a General Practitioner or
Specialist, when immediate Treatment or Diagnostic
Tests are a medical necessity.
Accidental Dental Injury
An unexpected injury arising from an accident which occurs
after your Date of Entry and causes damage or deformity
to the teeth or gums. This does not include accidents to or
disorders of the teeth or gums which have previously been
decayed, diseased, repaired, restored or treated (other than
scaling and polishing) before the accident, nor accidents
causing damage to dentures or implants.
Acute Condition
A disease, illness or injury that is likely to respond quickly to
Treatment which aims to return you to the state of health
you were in immediately before suffering the disease, illness
or injury, or which leads to your full recovery.
Advice
Any consultation or advice from a General Practitioner
or Specialist including the issue of any prescription or
repeat prescription.
Chronic Condition
A disease, illness or injury which has at least one of the
following characteristics:
■ It continues indefinitely and has no known cure
■ It comes back or is likely to come back
■ It is permanent
■ You need to be rehabilitated or specially trained to
cope with it
■ It needs long-term monitoring, consultations,
check-ups, examinations or tests.
Commencement Date
The date shown in the Policy Schedule on which cover
under this Policy commences.
Date of Entry
The date shown in the Policy Schedule on which you were
included under this Policy.
Day-patient Treatment
Treatment which, for medical reasons, means you have to
go into a Hospital or day-patient unit because you need a
period of clinically supervised recovery but do not have to
stay overnight.
Diagnostic Tests
Investigations, such as X-rays or blood tests, to find or to
help to find the cause of your symptoms.
Evacuation
The transport of an Insured Person from the country of
incident to the next nearest appropriate facility for the sole
purpose of receipt of In-patient or Day-patient Treatment.
General Practitioner
A general medical practitioner holding a Certificate of
General Practice Training and registered with the General
Medical Council in the United Kingdom.
GP Helpline Consultation
The provision by one of our retained General Practitioners
of such advice as it is reasonable and practical to give you
over the telephone when symptoms presented by you are
described during a telephone call to our GP Helpline (see
Benefit Terms).
Hospice
A Hospital or part of a Hospital recognised as a hospice by
us which is devoted to the care of patients with progressive
disease (where curative Treatment is no longer possible) on
an In-patient Treatment or domiciliary basis.
To avoid repetition, the following words or expressions, wherever used in this Policy,
have the specific meanings given below. To assist you in identifying the defined words
or expressions they are shown in bold print throughout the Policy.
10
Definitions
Hospital
i A private hospital in the United Kingdom which is
registered in accordance with United Kingdom
legislation and which has specialist facilities for carrying
out major surgical operations.
ii An NHS pay-bed.
iii Any hospital included on our list of Select Hospitals.
iv Any establishment which we regard as being an
appropriate facility for the provision of Treatment
and only if we have specifically agreed to such an
establishment prior to any Treatment being
carried out.
Where Option G is selected, the definition of a
Hospital is deleted and replaced with:
i) Any NHS pay-bed
ii) Any NHS facility included on our list of Trust
Care Hospitals current at the Relevant Date
iii) Any NHS establishment which we regard in our
sole discretion as being an appropriate facility
for the provision of Treatment and only if we
have specifically agreed to any Treatment being
carried out.
In-patient Treatment
Treatment which, for medical reasons, means you have
to stay in Hospital overnight or for longer.
Insured Person/you/your
A person named as an Insured Person in the Policy
Schedule.
Minor Surgery
A surgical procedure classified in accordance with the list
published by us.
Option(s)
Benefits available subject to the terms of the Policy which
add to or subtract from the Cover.
Out-patient Treatment
Treatment given at a Hospital, consulting room or
out-patient clinic where you do not go in for Day-patient
or In-patient Treatment.
Period of Cover
The period set out in the Policy Schedule during which
cover is in place and for which the premium has been paid.
Policy
Our contract of insurance with the Policyholder providing
the cover as detailed in this Policy document. The
Application, Policy Schedule and list of Select Hospitals
(current at the Relevant Date) form part of the contract
and must be read together with this Policy document (as
amended from time to time).
Policyholder
The person named as Policyholder in the Policy Schedule.
Policy Schedule
The schedule giving details of (amongst others) the
Policyholder and Insured Persons and endorsements
(if any).
Pre-existing Condition
Any disease, illness or injury for which:
■ you have received medication, Advice or Treatment;
or
■ you have experienced symptoms;
whether the condition has been diagnosed or not before
your Date of Entry.
Qualified Acupuncturist
A doctor registered with the General Medical Council
(GMC) who is also either a Medical Member or Accredited
Member of the British Medical Acupuncture Society and
who is recognised by us.
11
Qualified Chiropractor
A practitioner who is included as required by the
Chiropractors Act 1994 in the Register of Chiropractors
kept by the General Chiropractic Council and who is
recognised by us.
Qualified Nurse
A nurse who is on the register of the Nursing and
Midwifery Council (NMC) and holds a valid NMC personal
identification number.
Qualified Osteopath
A practitioner who is included as required by the Osteopaths
Act 1993 in the Register of Osteopaths kept by the General
Osteopathic Council and who is recognised by us.
Qualified Physiotherapist
A practitioner who is included, as required by the Health
Professions Order 2001, in the register of the Health
Professions Council as a Physiotherapist, and who is
recognised by us.
Related
Diseases, illnesses or injuries are related if, in our
reasonable medical opinion, one is a result of the other
or if each is a result of the same disease, illness or injury.
Relevant Date
The actual date of the Treatment.
Review Date
The annual anniversary of the Commencement Date.
Routine Dental Treatment
Dental treatment carried out by a dental practitioner in
a dental surgery including examinations, tooth cleaning,
white fillings (where appropriate), crowns, extractions
and surgery.
Select Hospital
A Hospital appearing in the relevant section of the Select
Hospital List chosen by the Policyholder for the Period of
Cover and issued by us and current at the Relevant Date.
Specialist
A registered medical practitioner recognised by us who:
a. has at any time held and is not precluded from holding
a substantive consultant appointment in the relevant
specialty in an NHS hospital, or
b. holds a Certificate of Higher Specialist Training in the
relevant specialty issued by the Higher Specialist
Training Committee of the relevant Royal College or
faculty, or
c. is included as required by the European Specialist
Medical Qualifications Order 1995 in the Specialist
Register kept by the General Medical Council in
respect of the relevant specialty.
Treatment
Surgical or medical services (including Diagnostic Tests)
that are needed to diagnose, relieve or cure a disease,
illness or injury.
We/our/us
Norwich Union Healthcare Limited on behalf of the
underwriter Norwich Union Insurance Limited.
12
Benefi ts Amount Payable Notes
A. In-patient or Day-patient Treatment at a Hospital in the Key section of the Select Hospital List or in
an NHS pay-bed. See Benefi t Term 3.
i. Hospital charges*
consisting of accommodation and meals; nursing
care, drugs and surgical dressings; operating theatre;
intensive and high dependency care; prostheses
inserted into the body during an operation;
physiotherapy
In full
ii. Specialistsí fees*
consisting of surgeons’, anaesthetists’ and
physicians’ fees
See Benefi t Term 2b Subject to Norwich Union Healthcare’s fee
guidelines for Specialists
iii. Diagnostic Tests*
such as pathology, X-rays, CT scans, MRI scans and
physiological tests such as ECGs
In full
iv. Radiotherapy/chemotherapy* In full
B. Additional Benefits
i. Nursing at home by a Qualifi ed Nurse In full
Immediately following eligible In-patient
or Day-patient Treatment. See Benefi t
Term 4
ii. Private ambulance In full Reasonable charges; see Benefit Term 5
iii. Parent accommodation when staying with a child
covered by the Policy
In full Child under nine undergoing eligible
Treatment; One parent only
iv. Hospice care £70 per day Donation to the Hospice; up to 10 days’
care maximum; see Benefi t Term 6
v. NHS cash benefit*† £60 per night
For each night spent as an NHS patient
undergoing eligible In-patient Treatment;
up to 25 nights per Insured Person per
one year Period of Cover, see Benefit
Term 7
vi. Maternity cash benefit† £100 for each child born
within a Period of Cover
See Benefit Term 8
vii. GP Helpline† Unlimited number of calls See Benefi t Term 9
viii. Stress Counselling Helpline† Unlimited number of calls See Benefi t Term 10
ix. Personal Health Manager† Unlimited use See Benefi t Term 11
Cover and Benefits
The purpose of this Policy is to cover you during a Period of Cover for the Treatment of
Acute Conditions of brief duration on a short term basis. Except as otherwise stated below, all
Treatment must be by Specialists following referral from your General Practitioner. We will
pay for eligible Treatment under the benefits below and as amended by any additional Options
chosen by you as shown on your Policy Schedule.
Benefits
Benefits available for Treatment under this Policy shall be limited to Hospital charges, professional fees and Hospice
donations for the following:
† Claims for these Benefits will not affect the No Claim Discount.
* See Benefit Term 20 for cover under these sections if you have chosen a Six Week Option.
The information on this page must be read in conjunction with the Definitions, Benefit Terms, Conditions and Exclusions and the other documents forming
the Policy.
13
Benefi ts Amount Payable Notes
C1. Out-patient Treatment This selection of Benefi ts can be substituted with those in
Section C2, in return for a premium reduction.
i. Consultations with a Specialist In full
Any procedures included are subject to
Norwich Union Healthcare’s fee guidelines
for Specialists; see Benefi t Term 2b
ii. Diagnostic Tests
such as pathology, X-rays, CT scans, MRI scans and
physiological tests such as ECGs
In full
iii. Radiotherapy/chemotherapy In full
Other Benefi ts
iv. Treatment for abnormal conditions of pregnancy
and childbirth
In full Subject to a 10 month qualifying period;
see Benefi t Term 12
v. Investigation into the causes of infertility In full See Benefi t Term 13
vi. Oral surgical procedures In full
Subject to Norwich Union Healthcare’s
fee guidelines for Specialists; see Benefi t
Term 2b
vii. Overseas cover In full
Emergency In-patient Treatment cover
when temporarily abroad for a period of
up to 90 days; see Benefi t Term 14
viii. Treatment of Acute Conditions by a Qualifi ed
Physiotherapist, Qualifi ed Chiropractor,
Qualifi ed Osteopath
In full On Specialist referral
C2. This may be selected instead of Benefi ts C1 in return for a premium reduction.
Reduced Out-patient cover for Acute Conditions and selected Benefi t Reduction
i. Two consultations with a Specialist In full Per Insured Person per one year Period
of Cover
ii. Diagnostic Tests
such as pathology, X-rays, CT scans, MRI scans and
physiological tests such as ECGs
In full
Only if directly leading to or following
within six months of Related eligible
In-patient or Day-patient Treatment
iii. Radiotherapy/chemotherapy In full
Benefi ts C1 iv, v, vi, vii and viii are removed from cover Benefi t Terms 12, 13 and 14 are deleted
and 15 is added
The information on this page must be read in conjunction with the Definitions, Benefit Terms, Conditions and Exclusions and the other documents
forming the Policy.
14
Benefi ts Amount Payable Notes
Options
D. Other Treatments and Therapies This Option may be added for an additional premium.
Claims for these Benefi ts will not affect your No Claim Discount
i. Treatment of Acute Conditions by a Qualifi ed
Physiotherapist, Qualifi ed Chiropractor,
Qualifi ed Osteopath, Qualifi ed Acupuncturist
on referral by a General Practitioner
Up to 10 sessions in
combined total
Per Insured Person, per condition, per
one year Period of Cover; See Benefi t
Term 16
ii. Minor surgery by a General Practitioner Up to £70 per procedure For procedures appearing on our Minor
Surgery list; payable to the GP
E. Dental and Optical Benefi ts This Option may be added for an additional premium.
Claims for these Benefi ts will not affect your No Claim Discount
i. Routine Dental Treatment
£300 benefi t limit
£50 excess
Per Insured Person per one year Period
of Cover. For details of how the excess
applies see Benefi t Term 17
ii. Treatment by a dentist in respect of an Accidental
Dental Injury
Up to £600 Per Insured Person per condition, per one
year Period of Cover.
iii. Optical benefi t
£200 benefi t limit
£50 excess
Per Insured Person per one year Period of
Cover; see Benefi t Term 18. For details of
how the excess applies see Benefi t Term 17
Hospital List Options The Key Hospital List may be substituted with one of the following:
F. Extended Hospital list
Benefi ts A, In-patient or Day-patient Treatment of
Acute Conditions can be received at any Hospital in
the Key, Extended or Signature sections of the Select
Hospital List or in an NHS pay-bed; see Benefi t Term 3
This Hospital List may be selected for an additional premium
G. Trust Care Hospital List
Benefi ts A, In-patient or Day-patient Treatment of
Acute Conditions can be received at any Hospital
in the Trust Care sections of the Select Hospital List
or in an NHS pay-bed; see Benefi t Terms 19
This Hospital List may be selected for a premium reduction.
H. Signature Hospitals only.
Benefi ts A, In-patient or Day-patient Treatment of
Acute Conditions can be received at any Hospital
in the Signature section of the Select Hospital List
or in an NHS pay-bed in Scotland or Northern Ireland;
see Benefi t Term 3
This list is only available to residents of Scotland or Northern
Ireland, for a premium reduction
Excess and Six Week Options Either or both of these Options may be selected for a premium reduction
I. Benefi t under this Policy is subject to an excess per
Insured Person per one year Period of Cover
i. £500
ii. £1,000
For details of how this is applied see
Condition 7a. This excess does not apply to
Option E if selected, and benefi t claimed
under Option E does not count towards this
excess. Claims which fall within the excess
will not affect your No Claim Discount.
J. Six Week Option
Benefi ts for In-patient or Day-patient Treatment will only
be available if Treatment is not available at an NHS Hospital
within six weeks; see Benefi t Term 20. If Treatment is available
at an NHS Hospital within six weeks, and no other claim has
been settled, your No Claim Discount will not be affected.
The information on this page must be read in conjunction with the Definitions, Benefit Terms, Conditions and Exclusions and the other documents
forming the Policy.
Cover and Benefits
15
Benefit Terms
1. The date for determining the benefits available for
Treatment shall be the Relevant Date.
2a. All costs for which benefit is claimed must:
i. be reasonable and be necessarily incurred; and
ii. unless otherwise specified in this Policy be wholly
and exclusively for the purpose of Treatment of
Acute Conditions of brief duration on a short term
basis. Benefit is only payable in respect of
Treatment that aims to return you to the state of
health you were in immediately before suffering
the disease, illness or injury or which leads to your
full recovery.
2b.We produce a list of fee guidelines for Specialists
based on factors such as the complexity and duration
of each procedure, which sets out the limits of what
we consider to be a reasonable payment for
Specialists’ fees. Any amount above the relevant
guideline figure will not usually be covered by this
Policy and will be your responsibility. A copy of our
fee guidelines for Specialists is available on request.
3. If any Treatment under Benefit A (In-patient or
Day-patient Treatment) is not undertaken at a Select
Hospital or NHS pay-bed, the amount payable will be
the lesser of the actual charge or the average cost of
equivalent Treatment across all Hospitals on the
Select Hospital List.
4. Benefit B(i) (Nursing at home) is only available for
nursing on Specialist recommendation which takes
place in your home. It is payable only when all the
charges are reasonable and necessary, and are
exclusively for exercising nursing skills of a nature of
which only Qualified Nurses are capable, and must
immediately follow Treatment which has been the
subject of a valid claim under this Policy.
5. Benefit B(ii) (Private ambulance) will only be available
where medically necessary for transportation of an
Insured Person to the nearest appropriate Hospital
for the purpose of eligible Treatment.
6. Benefit B(iv) (Hospice care) is payable only in relation to
care received as a patient of a Hospice recognised by
us, and must relate to a medical condition which has
been the subject of a prior valid claim under this Policy.
7. Benefit B(v) (NHS cash benefit) will not be available
where you have been admitted to the NHS hospital as
an Accident or Emergency Admission, or as a
fee-paying patient of any kind.
8. Benefit B(vi) (Maternity cash benefit) will only be
available if the birth takes place more than ten months
after the mother’s Date of Entry. This benefit is only
available to the mother.
9. Benefit B(vii) (GP Helpline). Each GP Helpline
Consultation is intended to deal with one call per
Insured Person to a General Practitioner on our
GP Helpline lasting up to 15 minutes per consultation
as required by the General Practitioner in respect of
one set of symptoms presented; but each such
consultation may at the discretion of the General
Practitioner involve a longer call or more than one call.
The GP Helpline service is designed to be available
24 hours per day but some reasonable delay may be
experienced. It is not an emergency service. Call charges
are the responsibility of the caller.
You may call on behalf of another Insured Person
subject to any patient confidentiality requirements of
the General Practitioner. In using the GP Helpline,
you (where applicable, on behalf of another Insured
Person) automatically authorise the use and disclosure
of any medical or other information, on a fully
confidential basis as between us, the General
Practitioners and any service providers we use in
making the service available, for the sole purpose of
policy and service administration.
We shall not be responsible for any failure in the
provision of the GP Helpline service to the extent that it
is due to circumstances beyond the reasonable control
of us or any of our service providers.
16
Benefit Terms
10. Benefit B(viii) (Stress Counselling Helpline). The Stress
Counselling Helpline aims to give such advice as it is
reasonable and practical to give to you over the
telephone.
The Stress Counselling Helpline is designed to be
available 24 hours per day but some reasonable delay
may be experienced. It is not an emergency service. Call
charges are the responsibility of the caller. You may call
on behalf of another Insured Person subject to any
patient confidentiality requirements of the service
provider. In using the Stress Counselling Helpline, you
(where applicable, on behalf of another Insured
Person) automatically authorise the use and disclosure
of any medical or other information, on a fully
confidential basis as between us and any service
providers we use in making the service available, for the
sole purpose of policy and service administration.
We shall not be responsible for any failure in the
provision of the Stress Counselling Helpline service to the
extent that it is due to circumstances beyond the
reasonable control of us or any of our service providers.
11. Benefit B(ix) (Personal Health Manager) entitles each
Insured Person to a code giving access to the Personal
Health Manager web service. Use of the web service is
subject solely to the terms and conditions contained on
the website itself. Once on the site users will be asked
to read and accept the terms and conditions of the
service and these will then apply, as amended from time
to time, throughout any use of Personal Health
Manager. Access to the GP Helpline service via Personal
Health Manager will be subject to the terms in Benefit
Term 9.
12. Benefit C1(iv) (Abnormal conditions of pregnancy and
childbirth) will only be available for Treatment directly
or indirectly arising from or required in connection with
abnormal conditions of pregnancy and childbirth arising
at least ten months after the Date of Entry.
13. Benefit C1(v) (Investigation into infertility) will only be
available for Treatment directly or indirectly arising
from or required in connection with the reasonable
costs of investigations into the causes of infertility
where both husband and wife;
i. have been continuously covered by us for at least
two years at the time of incurring such costs, and
ii. had been unaware of the existence of infertility at
the relevant Date of Entry.
14. Benefit C1(vii) (Overseas Cover) Benefit may only be
claimed for the medical services specified in this Policy
if they are provided:
a. in the United Kingdom, Channel Islands or Isle of Man;
b. overseas when temporarily overseas for a period of up
to 90 days during any annual Period of Cover and
incidental to the intended purpose of travel a medical
emergency arises requiring immediate admission to
Hospital for the sole purpose of receipt of Treatment
in respect of an Acute Condition of brief duration.
We shall decide whether or not there is any medical
necessity for Evacuation and will make all arrangements
concerning such Evacuation. In the event of a medical
Evacuation, you will be moved to the next nearest
appropriate facility for the Treatment you require which
may not be in the United Kingdom, Channel Islands or
Isle of Man. Benefits under this Policy will extend to
reasonable transport and accommodation costs incurred
by you during an Evacuation and in any event only
following specific authorisation of such Evacuation by
us. Benefits under this Policy will not extend to the costs
incurred on behalf of any person (whether or not another
Insured Person) accompanying you. For the purpose of
assessing benefit for Treatment received overseas, all
reference in this Policy to expressions which relate
specifically to the United Kingdom will be interpreted by
us as the appropriate local equivalent. Wherever possible
the emergency assistance company designated by us
from time to time should be contacted prior to any
In-patient or Day-patient Treatment costs being
incurred to advise you of the benefits available whilst
you are overseas. Details of the emergency assistance
company designated by us and contact telephone
numbers are listed in the Overseas Cover section of
this booklet.
Benefit Term 12 and Benefit Term 13 are deleted
where Option C2 has been selected.
17
15. When Option C2 is selected Benefit Term 14 is deleted
and replaced with: Benefit may only be claimed for the
medical services specified in this Policy if they are
provided in the United Kingdom, Channel Islands
or Isle of Man.
16. Option D(i) is available for a maximum of ten sessions
in combined total for all of these benefits. If the
medical condition requires more than ten sessions
during the same course of Treatment, for the same
one year Period of Cover then they must be requested
by and under the control of a Specialist.
However, if Option D and Option C2 are both chosen
benefit is not available for Specialist referral under
Option D(i).
17. Option E (Dental and Optical). The excess applies
separately to benefits (i and iii) under this Option, per
Insured Person per one year Period of Cover and is
deducted from the benefit available to you when total
eligible expenditure incurred by you during a one year
Period of Cover exceeds the amount of the excess.
For example, if a claim is made for £220 for eligible
Routine Dental Treatment, we will deduct the £50
excess from this sum and pay the balance of £170 to
you. This leaves a balance of £80 available to you in
this example for subsequent claims in the same Policy
year (£300-£220). The excess is only deducted once for
each Insured Person in each one year Period of
Cover.
18. Benefit Option E(iii) Optical Benefit is payable for
contact lenses or spectacles obtained as a result of a
change of prescription. The contact lenses or spectacles
must be obtained within three months of the eye test
which discovered the change in prescription. In order
to claim benefit under Option E (iii) the date of the
change in prescription and the relevant section of the
claim form must be completed and signed by the
dispensing Optician. This benefit excludes the cost of
optical solutions and sundries or optical care contract
schemes.
19. When Option G is selected Benefit C1 or C2
(Out-patient Treatment) will be available at a Hospital
other than at a Trust Hospital where facilities are not
reasonably available at a Trust Hospital. Please contact
our Customer Service Helpline. NHS Cash Benefit B(v)
is not available.
20. By opting for the Six Week Option, benefits for
In-patient or Day-patient Treatment or for NHS
cash benefit will only be available if that Treatment
is not available (except for reasons of country of
residence or of nationality) to you at an NHS hospital
within six weeks after the date on which the Specialist
recommends that Treatment (at or following a
consultation between the Specialist and you).
The NHS waiting period must be determined and
advised by the Specialist in charge of your
Treatment.
18
Exclusions from Cover
Benefits will not be available for:
1. Treatment
a. of any Pre-existing Condition or any Related
condition unless the Pre-existing Condition or any
Related condition was fully disclosed to us in writing
on our prescribed application form and we have not
expressly excluded Treatment relating to it;
(We may alter the above exclusion 1a, and if we do,
we will confirm this on the Policy Schedule).
b. of any condition that is not an Acute Condition of
brief duration, except that we will pay for Treatment
to the point of diagnosis of a Chronic Condition. Any
condition which is an Acute Condition of brief
duration but which also falls within the definition of
Chronic Condition will be deemed to be an Acute
Condition of brief duration;
c. attributable directly or indirectly to infection by Human
Immunodeficiency Virus (HIV) and/or any related illness
including but not limited to Acquired Immune
Deficiency Syndrome (AIDS);
d. for alcoholism, alcohol abuse, solvent abuse, drug
abuse or addictive conditions of any kind and
Treatment of any illness or injury arising directly or
indirectly from any such abuse or addiction;
e. received in health hydros, nature cure clinics or similar
establishments, or private beds registered as a nursing
home attached to such establishments;
f. by a Specialist without referral from your General
Practitioner except for Treatment of Acute
Conditions in an emergency but only if your General
Practitioner is kept fully informed of the Treatment
so he/she is able to support a claim for benefit;
g. of psychiatric, psycho-geriatric or mental illnesses or
conditions of any kind;
h. of myopia.
2. Supportive Treatment of renal failure including dialysis.
However we may at our discretion pay for the cost of
renal dialysis incurred:
a. immediately pre- and post-operatively during any
kidney transplant or attempted transplant;
b. in connection with acute secondary failure when the
dialysis is part of intensive care.
3. Cosmetic treatment, whether or not for psychological
purposes, and any consequence of such treatment.
4. Drugs and dressings other than:
a. those prescribed by a Specialist for use during the
course of In-patient or Day-patient Treatment; and
b. those prescribed by a Specialist for a surgical
procedure during the course of Out-patient
Treatment.
5. Hospital charges:
a. if for any reason the Hospital has effectively become
or could be treated as being your home or permanent
abode; or
b. where admission to the Hospital is arranged wholly or
partly for domestic reasons.
6. Treatment required as a consequence of an injury
sustained whilst training for, or participating in, sport
for which you receive payment or sponsorship (other
than travel costs).
7. Treatment directly or indirectly required as a result of:
a. war (declared or not), military, paramilitary or terrorist
activity (including the effects of radiological, biological
or chemical agents)
b. criminal activity and, or public disorder (including but
not limited to assault, use of offensive weapons, violent
disorder or riot)
c. use, misuse, escape or explosion of any gas or
hazardous substance (including explosives or
radiological, biological or chemical agents).
19
8. Treatment, including drug therapy, which we decide,
based on established medical practice in the United
Kingdom, is experimental or unproven.
9. Any treatment or surgical procedure carried out for
the purpose of removing undiseased body tissue, and
any consequence of such treatment.
10. Treatment directly or indirectly arising from or required
as a consequence of self-inflicted injury.
11. Spectacles; contact lenses; hearing aids; dentures;
other optical, dental, surgical or medical appliances
or equivalent appliances (other than a prosthesis inserted
into the body during the course of a surgical procedure).
12 a. Treatment by a General Practitioner.
b. Any Diagnostic Tests, which are specifically
requested by a General Practitioner.
c. Routine medical examinations including sight testing.
13. Any dental Treatment not involving an oral surgical
operation.
14. Treatment directly or indirectly arising from or required
in connection with pregnancy, childbirth or infertility
other than as specified in Benefit C1(iv) and C1(v).
Exclusions 11 to 14 may be amended subject to
any Options selected:
20
Exclusions from Cover
Options
Reduced Out-patient cover and
selected Benefit Reduction - Option C2
Unless Option E is also selected, Exclusion 13 is deleted and
replaced with:
Any dental Treatment whether or not involving an oral
surgical operation.
If Option E is also selected, Exclusion 13 is deleted and
replaced with:
Any dental Treatment whether or not involving an oral
surgical operation except as permitted under Option E(i)
and E(ii).
Exclusion 14 is deleted and replaced with:
Treatment directly or indirectly arising from or required in
connection with any of the following:
- pregnancy or childbirth whether complicated or not
- male and female birth control
- termination of pregnancy
- infertility including investigations into the causes of
infertility
- any form of assisted reproduction.
Out-patient Treatment (including all consultations) other
than as provided under Option C2.
Other Treatments and Therapies -
Option D
Exclusion 12a is deleted and replaced with:
Treatment by a General Practitioner (other than Minor
Surgery)
Dental and Optical Benefits - Option E
Exclusion 11 is deleted and replaced with:
Hearing aids; dentures; other optical, dental, surgical or
medical appliances or equivilent appliances (other than a
prosthesis inserted into the body during the course of a
surgical procedure).
Exclusion 12c is deleted and replaced with:
Routine medical examinations except as permitted
under Option E(iii).
Exclusion 13, if Option C2 is not also selected, is deleted
and replaced with;
Any dental Treatment not involving an oral surgical
operation except as permitted under Option E(i) and E(ii).
If Option C2 is also selected, Exclusion 13 is deleted and
replaced with:
Any dental Treatment whether or not involving an oral
surgical operation except as premitted under Option E(i)
and E(ii).
Hospital List Option G
In-patient, Day-patient and Out-patient Treatment
received other than at a Hospital in the Trust care section
of the Select Hospital List except as stated in Benefit
Term 19. Benefit Term 3 is deleted.
21
4. No Claim Discount
a) No Claim Discount and movements on the No Claim
Discount scale apply to the premium of the whole
Policy (rather than the premium per Insured Person).
Each claim in respect of one Insured Person which
affects the premium will thus affect the premium for all.
b) As from the Review Date No Claim Discount will
increase by one level on the scale shown if no claim has
been made on the Policy during the period of one year
leading to that Review Date (but at no time will No
Claim Discount exceed level 9).
c) For the first new claim paid under any of Benefits A,
B(i), B(ii), B(iii), B(iv), C1 or C2, at the next Review Date
No Claim Discount will reduce by three levels on the
scale shown (but it will not fall below zero). For the
purposes of No Claim Discount a new claim will be
incurred for each separate disease, illness or injury
whether or not involving a new claim form or other
claims process and a new claim will be incurred for each
separate course of treatment.
d) Total No Claim Discount (if any) will be at the percentage
shown at the relevant level on the scale (ie the percentages
are not added together). No Claim Discount is applied to
the net premium we otherwise set after deduction of
any other applicable discounts or reductions.
e) In line with reasonable underwriting principles, we may
change or remove all or any part of No Claim Discount
as from any future Review Date by giving at least one
year’s notice to the Policyholder. Any such change or
removal will be on a standard basis across Health
Solutions policies then in place with us.
f) A claim made late in a policy year may affect No Claim
Discount but may not show on the renewal papers.
If we delay increasing the premium due to any claim
this will not affect our right to make the increase.
Conditions
1. Compliance with Policy Terms
Our liability under this Policy will be conditional upon the
Policyholder and each Insured Person complying with its
terms and conditions.
2. Change of Risk
The Policyholder must inform us, as soon as reasonably
possible, of any changes relating to Insured Persons (such
as change of address, occupation or marital status) or of any
other material changes which affect information given in
connection with the application for cover under this Policy.
In line with reasonable underwriting principles we reserve
the right to alter the premiums or Policy terms or cancel
cover for an Insured Person following a change of risk.
3. Policy Duration and Premiums
a. This Policy shall be for one year and is continuable
subject to the terms in force at the time of each Review
Date where the product is still offered by us. On this
basis you agree that we may at our option renew the
Policy automatically on the terms in force at each
Review Date, that we may continue to collect your
premium at the rate in force and that we need not
obtain your request to do so for each renewal. We will
of course notify you of any changes to the premium or
Policy terms prior to each Review Date and you may
then notify us should you not wish to renew.
b. The Policyholder shall elect prior to or at the
Commencement Date or Review Date to pay
either an annual premium or monthly premium.
c. The premium rate shall be that prevailing generally at
the Commencement Date or if later the appropriate
Review Date.
d. The premium payable may be changed by us from time
to time in line with reasonable underwriting principles
taking account of actual and expected experience across
all Health Solutions policies. However this Policy
will not be subject to any alteration in premium rates
generally introduced until the next Review Date. In any
event if you move into a higher age band the premium
will increase at the next Review Date.
e. All premiums are payable in advance of any cover under
the Policy being provided. Each monthly premium relates
to one month’s cover. Each annual premium relates to one
year’s cover.
Level
Percentage off
level 0 premium
0 1 2 3 4 5 6 7 8 9
0% 10%20%30%35%40%45%50%55%60%
No Claim Discount scale
The level zero premium is the maximum premium to be paid if claims are incurred.
22
Conditions
5. Children
a. Where parents/guardians have covered their children
under this Policy cover for such children will not
continue beyond the next Review Date following
their 24th birthday.
b. A child born to an Insured Person during a Period
of Cover and whose birth has been notified to us
(in writing and including an application form or birth
certificate) within three months of birth will be accepted
for full cover from the date of birth regardless of health.
No premium will be payable for the child for three
months from the date of birth, or to the next Review
Date, whichever is the lesser period.
c. For so long as an Insured Person and his or her eldest
child under the age of 20 remain covered under the
Policy, the younger children of one such Insured
Person may be covered under the Policy at no
additional premium, subject to prior submission of
application forms. As each child of that Insured Person
successively reaches the age of 20, a premium will be
charged at our then prevailing rate for the next eldest
child under the age of 20. Children over the age of 19
but under the age of 24 may continue to be covered
under the Policy at our rates then prevailing.
6. Cancellation
a. This Policy will stand cancelled automatically upon
non-payment of the premium, although we may at
our discretion reinstate the cover if the premium is
paid within 45 days of its due date.
b. If any premium due from the Policyholder remains
unpaid we may in addition defer payment of all or any
claims until such time as the premiums outstanding are
paid in full.
c. Whilst we shall not cancel this Policy because of eligible
claims made by any Insured Person, we may at any
time (with retrospective effect where appropriate) cancel
this Policy or terminate an Insured Person’s cover or
subject his/her cover to different terms in line with
reasonable underwriting principles if he/she or the
Policyholder has at any time:
i. misled us by mis-statement or concealment;
ii. knowingly claimed benefits for any purpose other
than as are provided for under this Policy;
iii. agreed to any attempt by a third party to obtain
an unreasonable pecuniary advantage to our
detriment;
iv. otherwise failed to observe the terms and conditions
of this Policy or failed to act with utmost good faith.
If we do cancel this Policy or terminate cover for
reasons i to iv above we shall give the Policyholder
written notice sent by first class post or delivered by
hand to the Policyholder’s last known address, to take
affect as specified in the notice. If we do so we will not
be obliged to give a refund of premium.
7. Claims Procedure
a. If an excess applies to this Policy then payment of the
benefits under the Policy will only be available to you
to the extent that the total expenditure for Treatment
covered by this Policy incurred by you during any one
annual Period of Cover exceeds the amount of excess.
The excess is applied once per Insured Person for each
Period of Cover. This means that where the total
expenditure for Treatment continues from one Period
of Cover to another, the excess will apply again even if
a new claim is not submitted.
You will be liable for the amount of the excess and the
excess will be reapplied for each annual Period of
Cover. The excess should be settled by you directly with
the relevant provider (e.g Hospital or Specialist) and
not with us.
b. Before undertaking any Treatment (unless a medical
emergency) covered by this Policy, you must notify
us of its proposed nature and the name and address
of the Specialist and Hospital concerned. We advise
that where possible claims should be authorised in
advance of Treatment, but this will obviously not apply
to emergency admissions.
In order to confirm cover before claiming we must
receive all necessary medical information at least five
working days prior to any proposed Treatment. Usually
this will include a completed claim form but at our
discretion we may sometimes be able to take the
necessary information over the telephone; if this is the
case we will tell you at the time. You will then receive
written confirmation from us if your condition is covered.
c. We reserve the right to reject any claim which is not
submitted within a reasonable time period.
23
d. Many of the Hospitals on our Select Hospitals list operate
direct billing arrangements with us. This means that the
accounts for In-patient Treatment or Day-patient
Treatment covered under this Policy will be settled
direct with us. Direct billing may not be possible at other
Hospitals and in any event will not normally be possible
for accounts for Out-patient Treatment at any
Hospital whether a Select Hospital or otherwise.
In addition to the direct billing arrangements that we
have with some Hospitals we may also settle claims
directly with the providers of other services or with any
other person.
e. All documents or material (including but not limited
to accounts, certificates and X-rays) that we require
to support a claim, an application for cover or change in
cover shall be provided without expense to us (including
if requested by us a medical report from your General
Practitioner or Specialist).
f. Claims may only be made for Treatment actually given
during a Period of Cover and benefit will be available
only for expenditure incurred prior to the expiry or
termination of such a Period of Cover.
g. Where Treatment continues over an extended period of
time an updated claim form may be required at regular
intervals.
8. Claims – Our Rights
a. The Policyholder must without delay give us or procure
that the relevant Insured Person gives us without delay
written notification of any claim or right of action
against any party arising out of any circumstances which
gave rise to the claim under this Policy, and must
continue to keep us fully informed in writing and take
all steps we reasonably require in making a claim upon
that other party.
b. We shall be entitled to prosecute in any Insured Person’s
name for our own benefit any claim for indemnity or
damages or otherwise which relates to any benefits and
costs paid or payable under this Policy.
We shall have full discretion in the conduct of any such
proceedings and in the settlement of any such claim,
but we shall have no responsibility for any claim for
uninsured losses in respect of which the Policyholder
and each Insured Person should ensure that legal advice
is taken.
9. Other Insurance
If there is any other insurance covering any of the same
benefits, the Policyholder must disclose or procure that
the relevant Insured Person discloses the same to us and
we shall not be liable to pay or contribute more than our
rateable proportion.
10. Transfer
If the Policyholder dies, this Policy will automatically be
transferred to the oldest Insured Person over the age of
18 years who shall upon the date of death of the
Policyholder become the Policyholder for all the purposes
of this Policy, and be responsible for paying the premium.
11. Alterations
We may alter any of the terms of this Policy at any Review
Date. A copy of the current Policy terms will be sent to
the Policyholder at such time.
12. Fraudulent/ Unfounded Claims
If any claim under this Policy is in any respect fraudulent
or unfounded all benefit paid and/or payable in relation
to that claim shall be forfeited and (if appropriate)
recoverable.
13. Waiver
Waiver by us of any term or condition of this Policy will
not prevent us from relying on such term or condition
thereafter.
14. Settlement of Claims
All settlements will be made in sterling at the rate ruling
in London at the beginning of the month in which the
Relevant Date occurred.
15. Jurisdiction
This Policy is governed by and shall be construed in
accordance with the Laws of England and shall be subject to
the exclusive jurisdiction of the courts of England and Wales.
24
16. Enforcement
Only the Policyholder and us are parties to this Policy.
Other persons including Insured Persons will have no right
under the Contracts (Rights of Third Parties) Act 1999 to
enforce this Policy or any part of it. This will not affect any
third party right or remedy if available apart from that Act.
17. Consents
On behalf of each person covered, the Policyholder agrees
and consents on a continuing basis to the computer and
other processing and use of all personal and medical details
received by us from time to time. This includes processing
by the data controllers and relevant third parties (which
may include the Policyholder, medical and other service
providers and relevant intermediaries) for the purposes of
policy administration, service provision, reinsurance, claims
validation and fraud prevention. The Policyholder also
agrees to provide or procure the provision of such
confirmations of consent (if any) as we may require from
time to time. Processing may be in any part of the world.
Processing will be carried out in such a manner as to ensure
adequate standards of data protection within the meaning
of UK law apply. The data controllers are Norwich Union
Healthcare Limited, Norwich Union Insurance Limited
and Norwich Union Life & Pensions Limited.
Conditions
25
Further information
Language
All our communications with you in connection with this
Policy will be in English.
Can I cancel my Policy?
After your application is received and accepted by us, you
will receive Policy documents and notice of the right to
cancel. You will then have 14 days in which to change your
mind and cancel the Policy.
After your Policy has renewed you will have 14 days in
which to change your mind and cancel the policy, running
from the first day of your new policy year.
If you decide to cancel the Policy, any money you have
already paid during the 14 day ‘cooling off’ period will be
refunded, provided no claims have been made during this
period.
If you decide to cancel the Policy, you must notify our
Customer Service Department at: Norwich Union
Healthcare, Chilworth House, Hampshire Corporate Park,
Templars Way, Eastleigh, Hampshire SO53 3RY.
If you decide not to cancel the Policy your cover for eligible
treatment will continue until the renewal date and we will
continue to collect any applicable premium.
About Norwich Union Healthcare
The Financial Services Authority (FSA) is the independent
watchdog that regulates financial services. It requires us to
give you this information. Use this information to decide if
our services are right for you.
Norwich Union Healthcare Limited, Chilworth House,
Hampshire Corporate Park, Templars Way, Eastleigh,
Hampshire, SO53 3RY is authorised and regulated by the
Financial Services Authority. Our FSA registration number is
308139. Our permitted business is advising on, arranging
and administering general insurance and pure protection
contracts. You may check this on the FSA’s website
www.fsa.gov.uk/register or by contacting the FSA on 0845
606 1234.
Norwich Union Healthcare is a wholly owned subsidiary of
Aviva Plc, which includes within its group a number of
insurers.
Norwich Union Healthcare offers a range of products from
Norwich Union. You may have your own Insurance
Intermediary who will provide you with information about
their permitted business and the range of products they
offer.
You only need pay the premium; you do not otherwise
have to pay us for our services to you.
Norwich Union Healthcare Limited. Registered in England Number 2464270.
Private Medical Insurance is underwritten by Norwich Union Insurance Limited. Registered in England Number 99122. Registered Offices 8 Surrey Street, Norwich NR1
Authorised and regulated by the Financial Services Authority. Members of the Association of British Insurers. Members of the Financial Ombudsman Service.
Norwich Union Healthcare Limited Chilworth House Hampshire Corporate Park
Templars Way Eastleigh Hampshire SO53 3RY
www.norwichunion.com/healthcare
UNP906 02_07