Your guide to benenden health services

Transcription

1 Your guide to benenden health services 3rd edition June 2013

2 Contents 2/3 Before you get in touch 4/5 Eligibility for services What s not covered 6 Information services 7-9 Consultation services 10 Physiotherapy service 11 Counselling and psychology 12/13 Treatment services 14 Chronic medical conditions 15 Tuberculosis treatment 16 Financial help for cancer and Tuberculosis 17 Travelling expenses 18/19 Standards of service Complaints procedures Glossary Useful phone numbers Care and comfort for every moment of your time with us As a mutual organisation we re totally committed to treating every member within our community fairly. To help us do that, this guide outlines who s eligible to request our help, the range of services we offer and those services we can t help with. It s our aim to provide a range of discretionary services that will help our members and to deliver them with care, compassion and understanding. We always think about being both efficient and cost-effective, after all it s our responsibility to do what s right for our community of members. We review our services annually ensuring they can be delivered for an affordable contribution. Services may vary depending on the funds available, but we ll always endeavour to give the best value possible. What does discretionary mean? With the exception of treatment for Tuberculosis, all our services are discretionary. This means we ll carefully consider every aspect of your request and the relevant funds available, then we ll use our discretion to decide whether we can help or suggest an alternative option. As a responsible benenden health member who shares our values and ethos, we trust you to use your judgement to decide if your problem can be resolved in an appropriate way through the NHS or other means without unnecessary worry. If you do need additional support, it s vital you discuss your case with us so we can authorise help. Please don t arrange any services until you receive our authorisation in writing because we will be unable to reimburse these costs. Members, nominees, you and we This guide is for members and nominees. To avoid repetition, we usually say members or you. Both mean members and nominees. References to we mean benenden health. It s easy to get in touch To make everything as smooth and easy as possible for you when you contact us: have your membership number ready to help us find your records make sure you have seen and discussed your concerns with your GP so we know that we are helping appropriately tell us about the NHS waiting times for the services you re requesting support for and how that affects your life to help us apply discretion be aware that we must speak with the person that the request for help relates to unless they are under 18 years of age or are a legal dependent we will ask a series of necessary questions to validate a person s identity we may record your call for training and quality purposes. 3

3 Eligibility for our services Please read this carefully You can request help from our information services as soon as you join. After six months, you can request all other treatment and consultation services. Before you arrange any service you wish us to support, you must receive written authorisation from us first. We do not fund services that have not been authorised by us in writing. If a nominee becomes a member, the time spent as a nominee on someone else s membership counts towards the six month qualifying period, providing their contributions have been kept up to date. You can only request services if you are named on a current membership record. You must keep your contributions and personal details up to date. If your contributions are not up to date, you are not entitled to request services until you have paid any amount owing. In some cases, we expect you to pay the cost of certain services we authorise and reclaim the cost from us. This will normally be paid within 7 days directly into your bank account. If this would create financial hardship for you, please discuss it with us first and, in exceptional circumstances, we may be able to pay the costs directly to the hospital or consultant. If you are not resident in the UK, you are entitled to request Information Services only. If you return to live in the UK, you must register with a GP and test the NHS before requesting any other services. 4 Misuse and abuse If you fail to attend a medical appointment authorised or arranged by us, you will not be entitled to ask for further services for the same healthcare issue. We are unable to defer appointments. We work to complement the NHS and make our services available as promptly as we can. If you verbally or physically abuse or threaten one of our employees, representatives or providers, you may be refused further services. If you are discharged from hospital or another medical establishment for breach of regulations or against medical advice, you will not be entitled to further services for that healthcare issue and you may be expelled from benenden health. If you misapply the funds of benenden health or wilfully supply false information when requesting a service, you may be required to repay sums due to benenden health. You may also be expelled from benenden health. Costs we cannot generally help you with As every service we provide is funded entirely by our members contributions, there are some costs and services that we cannot help you with in any circumstances. We ve listed some of these below. When there are additional exclusions relating to a specific service, we will let you know about these in our letter of authorisation. We re unable to reimburse you for services: arranged before we have given our written authorisation carried out after six months from our authorisation that cost more than the financial limit we agreed with you Other costs we cannot help you with: additional support for the same medical condition within two years of us first providing support ongoing monitoring, follow-up consultations or treatment for the same medical condition, as we would expect you to obtain ongoing help through the NHS services carried out by a practitioner who does not hold one of our required qualifications. The required qualifications are listed on the relevant service page procedures not recognised by the National Institute of Clinical Excellence private patient facilities in an NHS hospital whilst you are receiving NHS care any services provided outside the UK any services if you are not a UK resident other than information services described on pages 6 and 7 Personal expenses when in hospital. 5

4 Information and helplines available as soon as you join If you need help in the first six months of becoming a benenden health member, you can use a range of information and helplines to help you on your route to recovery. You can call upon these services whenever you or your family need them. They re just a phone call away. We d like to let you know that when you call any of these helplines, essential information, such as your membership number and name, will be shared between benenden health and the organisation providing the service, but we will treat this information with respect and keep it confidential. 24/7 GP Advice Line Our 24-hour GP Advice Line gives you the round-the-clock reassurance of knowing you can speak to a qualified, UK-based GP day or night, from anywhere in the world. You can talk to the GP about a wide range of things such as an ache or pain that won t go away, sensitive or confidential concerns that you have, to get a clearer explanation of diagnosis or treatment you ve been given, or the side-effects of medication. Please note: As the GP is not your own GP, they cannot make referrals or write a prescription for you, but they can suggest a diagnosis and recommend the best course of action. How to use this service To use the service call * from the UK or * from abroad This is a call-back service so you can specify a convenient 15 minute time slot and a doctor will call you back. 24/7 Stress Counselling Helpline If you re feeling anxious our qualified counsellors can offer information about local UK services that can help with a range of topics including relationship problems, money worries, employment anxiety and bereavement. 6 How to use this service To use the service call * from the UK or * from abroad Someone will be there day or night to offer advice and put your mind at rest. If you need ongoing therapy, you can arrange this through the NHS or a private therapist, but we can only consider funding this once you have been a member of benenden health for six months or more. See page 11 of this guide for more information on our counselling service and how to request it. Independent Care Advice Service It can be a very difficult decision when you or a family member requires long-term care, short term convalesence, residential or respite care. So our Independent Care Advice Service assesses your circumstances and gives you the information you need to make an informed decision from basic advice to detailed reports on UK care providers, respite care and much more. How to use this service You can use this service for yourself or on behalf of a family member Call * to arrange to speak to one of our sympathetic experts (Lines are open 8am - 8pm, Monday - Friday (excluding bank holidays) and Saturday, 8am - 4pm). benhealth magazine At benenden health we know it s important to look after our members, even when you re fit and healthy. So our quarterly benhealth magazine is packed with news stories, healthy living advice, delicious recipes and much more. How to access benhealth magazine Members can choose to receive the magazine by post or . Log in to the members area at secure.benenden.co.uk to see every issue. You can read online and/or download as a pdf. Member Services have a limited number of benhealth back issues available for members. Please contact Member Services if you have missed the most recent issue; we will check your member record to ensure your mailing options and address details are correct then arrange for a replacement to be sent subject to availability. We cannot arrange for copies to be sent to nominees or for members to receive additional copies for friends and family this helps us to keep our costs down. Diagnostic consultations and tests When you re ill, waiting for a diagnosis can be very distressing. So if your consultations and tests are delayed and you become anxious, we may be able to help you get a prompt diagnosis. You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing before arranging any appointments if you want us to help with funding. Please visit your GP first and if they feel you need to see a consultant or have tests, ask them about the help available through the NHS and the waiting time involved. As every service is funded by our members contributions we ask you to use the NHS where possible but, if you feel the waiting time for a diagnosis is unreasonable and causing you anxiety or distress, then please contact our Member Services team on * (see page 3 for the information you need to give them). As a guide we ask members to stay with the NHS if their wait is four weeks or less. We strongly recommend that you stay on the NHS waiting list. We re unable to help you with We have listed the general exclusions on page 5 and there are some additional exclusions specifically for this service, which include: any form of treatment, where a bed is needed on a hospital ward, even if just for a short period pre- and post-operative consultations cosmetic consultations medical aids, appliances or prescription costs complementary therapy consultations consultations that are not for diagnostic purposes pain management speech therapy second opinion consultations where the condition was diagnosed at benenden hospital or at one of our other approved hospitals. Please be aware that the above list of exclusions is not exhaustive and we ask that you always contact our Member Services team before arranging any healthcare services to find out whether benenden health can help you. 7

5 You may be given two options If we can help, you may be given two options to obtain a diagnosis. Option 1 benenden hospital Option 2 Local diagnostic service Option 1 benenden hospital If you live within a two-hour journey time of benenden hospital in Kent you will be expected to have your consultation or tests there. Wherever you live in the UK, you can request to be seen at benenden hospital, and relatives who live a long way from the hospital can find affordable overnight accommodation at Peek Lodge in the hospital grounds. You need to send us a referral letter from your GP before we can say if we can help you. You will be asked to send to us a letter from your GP called a referral. If we can help you, we will authorise the service and liaise with benenden hospital. The hospital will contact you to arrange a prompt appointment. If you need treatment after your diagnosis we may be able to continue your treatment at benenden hospital. After diagnosis or treatment you will then be referred back to your GP for on-going management and monitoring of your condition. You do not need to worry about the cost of diagnosis or treatment as we will pay benenden hospital directly. Option 2 Local diagnostic service If this option is authorised, we will help you receive prompt diagnosis from a local consultant who is recommended by your GP and we will fund diagnostic consultations or tests up to 1,500. These may be: outpatient consultations with a specialist consultant recommended by your GP outpatient tests or investigations recommended by your GP or consultant a selection of minor treatments that can be delivered at the time of your consultation appointment. This is detailed in our letter of authorisation. The consultant must have one of the following qualifications: FRCP, MRCP, FRCS, MRCS, FRCOG, MRCOG, FRCPOphth, MRCPOphth, FRCPsych, MRCPsych, FDS RCS, MFDS RCS, F.Ch.S, M.Ch.S or FCPods. They must also hold a current NHS post. For podiatry and chiropody, they must be registered with the Health and Care Professions Council (HCPC) UK-wide health regulator. You may be asked to send to us a letter from your GP called a referral. If we can help, we will authorise the service and you can arrange an appointment with the consultant recommended by your GP. Following a diagnosis, you will be referred back to your GP for any treatment, ongoing management and monitoring of your condition. You should discuss your treatment needs with your GP, test NHS availability and, if necessary, ask us to support your treatment by calling our Member Services team on *. We ask you to pay for your diagnostic care at your appointment and then simply send the invoice to us within three months of its date and we will quickly reimburse your costs up to the agreed limit. We can only reimburse invoices that are less than three months old so please don t wait to send all your invoices together. If it would create financial hardship for you to pay the costs, please discuss it with us first; in exceptional circumstances we may be able to pay the invoices directly for you. Second opinion consultations If you have already seen a consultant through the NHS and would like a second opinion from a different consultant we will need a letter from your GP called a referral, which supports your request for a second opinion before you can fully consider your request. We will always consider using the consultation services at benenden hospital in the first instance. We will guide you through seeking a second opinion and if appropriate the payment process. We are unable to help with If we have helped you to achieve you re original diagnosis we will ask you to use NHS services to obtain your second opinion. My bad back suddenly got much worse. I needed a scan which involved a wait for an appointment then a referral for an MRI scan, but I could not stand upright. benenden health came to my rescue and I was able to see an orthopaedic surgeon and have an MRI scan. Cathy Pielou 8 9

6 Physiotherapy This service allows you to be assessed by a qualified Physiotherapist who will determine if you will benefit from face-to-face physiotherapy or from a course of selfmanaged at-home exercises. You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing before arranging any appointments. Face-to-face treatment If the Physiotherapist recommends face-to-face treatment we will arrange for you to attend one of over 600 accredited physiotherapy clinics around the UK. Self-management treatment If the Physiotherapist feels that you would benefit from self-managed treatment, you will be provided with a course of exercises to work through at home which will be tailored to treating your condition. You can call a qualified Physiotherapist for support and advice at any time. Please visit your GP first and if they feel you need physiotherapy, ask them about the help available through the NHS and the waiting time involved. As every service is funded by our members contributions we ask you to use the NHS where possible but, if you feel the waiting time for an appointment is unreasonable and causing you anxiety or distress, then please contact our member services team on * (see page 3 for the information you need to give them). As a guide, we ask members to stay with the NHS if their wait is four weeks or less. You should stay on the NHS waiting list as this service is designed to be used as an interim solution, until your NHS appointment becomes available. Once we have confirmed we can help, we will authorise the service in writing and arrange for one of our Physiotherapists to call you at a mutually convenient time. You do not need to worry about the cost of your treatment sessions as we will pay the Physiotherapist directly. We re unable to help you with We have listed the general exclusions on page 5 and there are some additional exclusions specifically for this service, which include: physiotherapy treatments in a centre that is not within the accredited benenden health network treatment by chiropractors, osteopaths, muscular-skeletal practitioners, complementary or sports therapists tests pain management treatment including injections treatment for a recurring or ongoing condition. Please be aware that the above list of exclusions is not exhaustive and we ask that you always contact our Member Services team before arranging any healthcare services to find out whether benenden health can help you. Counselling and psychology If you are suffering with work or personal problems, our counselling and psychology services can offer the positive support and personalised service you need to get back on track. This service allows you to have up to 300 of counselling or psychology treatment which has been recommended by a GP or consultant. You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing before arranging any appointments. Please visit your GP first and if they feel you need counselling or psychological treatment, ask them about the help available through the NHS and the waiting time involved. As every service is funded by our members contributions we ask you to use the NHS where possible but, if you feel the waiting time for an appointment is unreasonable and causing you anxiety or distress, then please contact our Member Services team on * (see page 3 for the information you need to give them). We strongly recommend you stay on the NHS waiting list in case on-going therapy is required. If we can help you, we will authorise the support in writing and you can arrange an appointment with a counsellor or psychologist. Counsellors must be accredited either with the British Association for Counselling and Psychotherapy (BACP) or the British Association for Behavioural and Cognitive Psychotherapy (BABCP). Alternatively, they should be registered with the United Kingdom Council for Psychotherapy (UKCP). Psychologists must be registered with the Health and Care Professions Council (HCPC) and hold a CPsychol qualification. We ask you to pay for your appointment and then simply send the invoice to us within three months of its date and we will quickly reimburse your costs up to the agreed limit of 300. We can only reimburse invoices that are less than three months old so please don t wait to send all your invoices together. If it would create financial hardship for you to pay the costs, please discuss it with us first; in exceptional circumstances we may be able to pay the invoices directly for you. We re unable to help you with We have listed the general exclusions on page 5 and there are some additional exclusions specifically for this service, which include: prescription charges self-referred counselling or psychology. Please be aware that the above list of exclusions is not exhaustive and we ask that you always contact our Member Services team before arranging any healthcare services to find out whether benenden health can help you

7 Treatment service If you re waiting for treatment or surgery, we may be able to help you avoid a distressingly long wait by funding your prompt admission at benenden hospital in Kent or at one of our approved hospitals. You can find your nearest approved hospital on the Your choice of hospitals page at You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing in advance. benenden hospital and other benenden health approved hospitals can offer treatment for a wide range of conditions including day case orthopaedics, hernias, varicose veins and cataracts. If you live within a two-hour journey of benenden hospital, you will be expected to have your treatment there. Wherever you live in the UK, you can request to be treated at benenden hospital, and relatives who live far away can find affordable accommodation at Peek Lodge in the hospital grounds. If you live more than 2 hours away from benenden hospital, we will normally ask you to go to the nearest benenden health approved hospital to your home, but you can request to be treated at another benenden health approved hospital if it is more convenient. Please note, only benenden health can authorise treatment and say where and when it will be provided. Please visit your GP first and if they feel you need treatment, ask them about the help available through the NHS and the waiting time involved. As every service is funded by our members contributions we ask you to use the NHS where possible but, if you feel the waiting time for treatment is unreasonable and causing you anxiety or distress, then please contact our Member Services team on * (see page 3 for information you need to give them). As a guide we ask members to stay with the NHS if their wait is four weeks or less. We first need to see how we can help you so we will need a letter from your GP called a referral. This letter should include the results of any appointments or tests you have had. We will also ask for a copy of the consultant s report. At this point we may need to refer you to benenden hospital or your nearest benenden approved hospital for further tests, or ask our consultant to see you to confirm your treatment needs. During this time we strongly recommend that you stay on the NHS waiting list until we have confirmed your treatment date. We aim to provide treatment within 8 weeks from our authorisation. benenden hospital or the benenden health approved hospital will contact you to arrange an admission date. After your treatment, we fund one post-operative consultation and you will be discharged back to your GP for ongoing monitoring and management of your symptoms and condition. You do not need to worry about the cost of your treatment sessions as we will pay the hospital directly. Deferring treatment We always do our best to offer you prompt treatment to relieve your anxiety or distress, for this reason we cannot defer treatment to suit your personal circumstances. We re unable to help you with We have listed the general exclusions on page 5 and there are some additional exclusions specifically for this service, which include: treatment outside benenden hospital or one of our approved hospitals heart/arterial surgery head/neurological surgery eye treatments except cataracts inpatient or complex orthopaedic surgery such as joint replacements, spinal, neck or back surgery complex ear surgery cosmetic surgery emergency treatment fertility treatment i.e. IVF complementary therapies breast surgery pain management dental treatment or oral surgery inpatient mental health treatment surgery for transplants surgery for obesity cancer care. Please be aware that the above list of exclusions is not exhaustive and we ask that you always contact our Member Services team before arranging any treatment to find out whether benenden health can help you

8 Chronic medical conditions As chronic conditions are generally managed better through an established relationship with a GP or NHS consultant, we don t usually fund ongoing appointments or treatment for them. However, we can help to fund inpatient treatment for up to two weeks if there has been significant deterioration or change in your condition and in-patient or similar treatment is not readily available on the NHS. You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing before arranging any appointments. Defining a chronic medical condition At benenden health we define chronic as a condition that usually has at least one of the following characteristics: it needs ongoing or long-term monitoring it needs ongoing or long-term control for relief of symptoms it requires rehabilitation or for you to be specially trained to cope with it it continues indefinitely it has no known cure it comes back or is likely to come back Examples of chronic medical condition are diabetes, asthma, chronic obstructive pulmonary disease (COPD) or multiple sclerosis. Please visit your GP first and if they feel you need treatment, ask them about the help available through the NHS and the waiting time involved. As every service is funded by our members contributions we ask you to use the NHS where possible but, if you feel the waiting time for an appointment is unreasonable and causing you anxiety or distress, then please contact our member services team on * (see page 3 for the information you need to give them). We will ask you to send us a letter from your GP or a consultant s report outlining the clinical background to your condition, your current treatment plan and the NHS waiting time. We will then consult our medical advisers and, in more specialist cases, our colleagues at benenden hospital to decide how we can best help you. We will write to you with our decision and details of the next steps within five working days. We strongly recommend you stay on the NHS waiting list. We will liaise with your GP to agree the most appropriate type and location of in-patient treatment for you. This treatment may last for up to two weeks and is usually arranged at a hospital near to your home. You do not need to worry about the cost of your treatment sessions as we will pay the hospital directly. Tuberculosis (TB) treatment As benenden health was founded over a century ago to treat Tuberculosis, we are pleased to offer TB treatment on a non-discretionary basis, rather than on a discretionary basis. You can request this service anytime after you have been a member for six months and are still a UK resident. Please note: you must get our authorisation in writing before arranging any appointments. Please visit your GP first and if they diagnose you with TB, ask them about the help available through the NHS and the waiting time involved. As every service is funded by our members contributions we ask you to use the NHS where possible but, if you feel the waiting time for an appointment is unreasonable and causing you anxiety or distress, then please contact our member services team on * (see page 3 for the information you need to give them). We will liaise with your GP to agree the best treatment for you. If this is in-patient treatment it may last for up to two weeks and is usually arranged at a hospital near to your home. We recommend that you use the NHS to give you the clinical care and ongoing support you need. We may also be able to offer you financial help with the added expenses of living with TB. Please turn to page 16 for details. You do not need to worry about the cost of your treatment sessions as we will pay the hospital directly

9 Financial help for cancer and Tuberculosis If you find yourself living with an active cancer or TB, it can be stressful enough without the worry of added costs relating to your illness such as hiring home help, travelling to and from hospital, extra heating, equipment hire and more. We may be able to ease this burden by providing extra financial help to add to the help given by the NHS, Social Services and other organisations. You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing before you incur any costs. Please find out about the help that is available to you through the NHS, Social Services, and other organisations such as Macmillan Cancer Support, then call our Member Services team on *. One of our team will guide you through the support that may be available and any useful contacts. You may be asked to send us a report from your GP or consultant outlining the clinical background to your condition so we can decide if and how we can help. This will depend on several factors including the help available from the NHS, Social Services and other organisations, your clinical condition and your personal circumstances. We will write to you to confirm the type and level of financial help we can provide including the length of time we can offer our support for. We may ask you for a letter from your GP or consultant which details your condition and your treatment plan. This clinical information is used to help us validate the support we are offering and to appropriately adjust the discretionary financial support that we can offer. This type of information may be requested at any time. In line with our organisational values and ethos we ask you to let us know if your 16 situation changes or if you no longer need our support. This helps us to support other members of the benenden health community at their time of greatest need. We re unable to help you with We have listed the general exclusions on page 5 and there are some additional exclusions specifically for this service, which include: daily living costs not related to your condition costs outside the authorised period of help long-term ongoing support cancer surgery or treatment prescriptions complementary therapies modifications to your home loss of income support when your condition is in remission or when your care is moved into a monitoring phase. Please be aware that the above list of exclusions is not exhaustive and we ask that you always contact our Member Services team before incurring costs to find out whether benenden health can help you. Travel expenses As the services we offer are totally funded by the contributions of our members, we must ensure that we concentrate our funding on caring for the health of our members. For this reason we ask members to pay for their own travel to healthcare appointments supported or provided by us. However, if you cannot afford to pay your travel expenses and doing so would cause you financial hardship, you can ask us for help. You can request this service anytime after you have been a benenden health member for six months and are still a UK resident. Please note: you must get our authorisation in writing before incurring any costs. If you would like us to consider giving you financial help for travel expenses please call our member services team on *. We will send you written authorisation along with guidance about how to claim your travel expenses and a claim form. We use a reimbursement system, so you will need to pay for your travel as usual and then send your claim form, receipts and travel details back to us, within three months of your appointment. We ask members to cover the first 20 of their travel costs. Please note: We do not reimburse travel expenses which are more than three months old. We re unable to help you with We have listed the general exclusions on page 5 and there are some additional exclusions specifically for this service, which include: the cost of travel before we have given our written authorisation costs over three months old costs for travel to NHS or private appointments which are not supported or arranged by us costs of first class travel costs for companions unless the patient is under 18 years old or there is a clinical need for a companion. 17

10 Our standards of service As a mutual organisation everything we do at benenden health is completely focused on giving our members the very best care and excellent service every time you contact us. We aim to: answer your call within 55 seconds repay your authorised healthcare costs within seven working days of receiving an original invoice respond to routine correspondence within three working days, either by letter or acknowledge complex queries and complaints within two working days and provide a full response within 20 working days. If we are unable to do this we will update you on our progress at this time treat you and other members fairly give our names in all correspondence and on the phone be welcoming, courteous, respectful and responsive advise you clearly about the services that we can or cannot assist you with and to confirm these details verbally and in writing each time you contact us keep you informed and communicate with you clearly provide good quality information suited to your individual needs. To help us achieve these standards, we ask you to: be courteous and respectful to our staff have your membership number ready when you contact us help us by providing any information we need give us feedback on our performance through our website When things go wrong We recognise that from time to time things may go wrong, so we value the opportunity to put things right and to use what we have learned to improve our service for the future. This philosophy is at the heart of our complaints policy which we ve described below. We do our best to offer a caring and effective service, but if there is a problem with any aspect of our service please contact us as we welcome your comments and complaints. Our staff will be courteous, efficient and helpful and we will deal with your concerns quickly and professionally. If we have made a mistake we will apologise and do everything we can to put things right. Third party complaints If your complaint is about a third party organisation to whom you have been signposted by benenden health, we will acknowledge your complaint and provide you with relevant contact details before forwarding your complaint to the relevant organisation to respond to you directly. We will ask for the response to be sent to you within 20 working days from receipt by the third party and ask for a copy of the response for our database records. Clinical complaints If your complaint is about a benenden health contracted provider, and of a clinical nature, we will ask for your written consent to disclose your relevant personal details before your complaint is forwarded to the provider to respond to you directly. We will ask for the response to be sent to you within 20 working days of the provider receiving the complaint and we will ask for a copy of the response to be sent to us. Financial Ombudsman Service We will do our best to resolve your complaint at the first opportunity. However, if we have investigated your complaint through the benenden health internal complaints policy and you are unhappy with our response, or if we fail to provide you with a full written response to your complaint within eight weeks of us receiving it, you may be able to refer your complaint to the Financial Ombudsman Service. You can contact them at the address following and they will be able to advise you whether it is appropriate for them to review your complaint. Their contact details are: The Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London E14 9SR or you can call complaint.info@financial-ombudsman.org.uk

11 Glossary 20 Authorised (service) Authorised (representative) Availability (services) Availability (NHS) benenden health approved hospital Chronic condition Complementary treatment Consultant Consultant s report Consultation service Diagnosis benenden health will send written confirmation of approval for a service to you but we will not reimburse the cost of any service that has not been authorised in writing by benenden health. A person authorised by you in writing to represent you when dealing with benenden health. We cannot deal with anyone other than a member or nominee if we have not received an instruction naming an authorised representative from that member or nominee, unless it is for a nominee under 16. Access to benenden health services may vary according to the resources available and other relevant factors. Services are provided on a discretionary or non-discretionary basis (see below), depending on the current rules and guidelines. We use this to describe whether medical consultations, tests, or treatment can be easily obtained through the NHS or not. We often use availability in connection with the NHS waiting time. A hospital that we have selected for its range of services, quality and value, and to which we send members to for consultations, tests and or treatment, which are arranged and funded by us. A disease that is long-lasting or recurrent. This includes: Dietitian, speech therapy, homeopathy, pain clinics, acupuncture (unless carried out by a Physiotherapist). This is not a comprehensive list. A doctor who holds the title of consultant and has one of the following recognised qualifications: FRCP, MRCP, FRCS, MRCS, FRCOG, MRCOG, FRCPOphth, MRCPOphth, FRCPsych, MRCPsych, FDS RCS, MFDS RSC, F.Ch.S, M.Ch.S or FCPods. benenden health will only refer or approve a referral to a consultant who holds a current NHS post, or who is paid by, or contracted by, benenden health to provide services to members. A document produced by the diagnosing consultant to confirm the patient s state of health, the clinical diagnosis and any recommendations for treatment and NHS wait. The provision of diagnostic consultations through benenden health s consultants at benenden hospital or contracted hospital. Alternatively, through a private NHS registered consultant recommended by your GP. Also, any necessary follow-up consultations that are authorised by benenden health, and tests and investigations needed as part of the diagnostic consultation as described in our letter of authorisation. Finding out what is wrong with you. Discretionary Eligibility Executive Director Expulsion GP referral letter Local diagnostic service Limitations, exclusions and restrictions Medical report Member Nominee Non-discretionary Accredited physiotherapy clinic Provider Contracted/ approved hospital Reimbursement benenden health is not a medical insurer and cannot provide guaranteed services, this is why members do not pay insurance premium tax on their contributions. We use our discretion to administer our services depending on your needs and available benenden health resources. The term we use to describe whether someone has met all the rules which apply to qualification for benenden health services. For most services, you must have served a six-month qualifying period. Contributions must be paid up to date. You must be able to provide your membership number and/or other personal identifying details if asked by a member of staff. A Director responsible for a named area of benenden health. benenden health can expel a member who misapplies our funds or breaches benenden health s rules. See benenden health rules 5.1, 5.2, 5.3 and A letter from the patient s General Practitioner that outlines the clinical symptoms and requests the patient to be seen by a specialist. Authorisation of up to 1,500 for you to have private diagnostic consultations and tests locally, as recommended by your GP. The range of services which members and nominees may request is currently limited to those described in this guide and other benenden health literature. They are in line with Rule 9 of the Rules of the Society and approved by the Committee of Management. A detailed report produced by a consultant or a General Practitioner that provides specific clinical information about the patient s current and ongoing state of health, with details of any medication or treatment provided and any recommendations for future medical care. A member or nominee of benenden health. A person who is named on the membership of a member and is nominated by the member to receive our services. If an eligible member with Tuberculosis living in the UK asks for our help, we will authorise guaranteed treatment for Tuberculosis provided benenden health has the resources to meet the costs of treatment. A physiotherapy provider that we have included in our approved network list of recognised providers based on location, clinical compliance and value, and to which we send members to for physiotherapy treatments, which are arranged and funded by us A person or organisation in the UK, such as a named hospital, approved by benenden health to provide a service to a member. A hospital approved and contracted by benenden health to provide services for our members. The agreed amount benenden health will pay back to you for authorised medical and related expenses on production of a valid invoice. You must provide original, valid invoices within three months. 21

12 Retrospective Services Treatment service We You benenden health cannot provide funding after the event for any service which has not been authorised in writing by us in advance. This includes information, consultation, medical, surgical and financial services, provided by benenden health within the current guidelines, on a discretionary or non-discretionary basis. A selected range of surgical procedures, which can only be funded if undertaken at benenden hospital or one of our benenden health approved hospital. benenden health. A member or nominee of benenden health. for only 7.80 per person, per month Useful numbers Consultation, treatment, physiotherapy, * counselling and psychology services Lines are open 8am 8pm, Monday to Friday (except Bank Holidays) and Saturday opening 8am 4pm. 24/7 GP Advice Line and * Stress Counselling Helpline Grow our community benenden health protects the health of over 900,000 people, so let us help take good care of your family and friends too. 1. Add family and friends to your membership As a member, you have the freedom to add as many family and friends to your membership as you want, for the same affordable flat rate. 2. Recommend benenden health to your family and friends If you ve already added loved ones to your membership have you ever thought about recommending benenden health to others? For more information call or visit us online; * quoting GUIDE 22 *Calls to 0800 numbers are free from BT landlines, calls from mobile phones may incur charges. Please note that your call may be recorded for quality and training purposes and for our mutual security. Membership is available to anyone over the age of 16 who is normally resident in the UK. Members can add family and friends to their membership regardless of their age. Some services have a six month qualifying period. benenden health is a trading name of The Benenden Healthcare Society Limited which is an incorporated friendly society, registered under the Friendly Societies Act 1992, registered number 480F. The Society s contractual business (the provision of tuberculosis benefit) is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. The remainder of the Society s business is undertaken on a discretionary basis. The Society is subject to Prudential Regulation Authority requirements for prudential management. Registered Office: The Benenden Healthcare Society Limited, Holgate Park Drive, York, YO26 4GG. AD/GUIDE/SP6185/05.13/V1

13 benendeninsurance protect what is precious benenden insurance has been created to develop and offer a range of services complementing and supporting your benenden health membership. Our aim is to offer a range of products to support the health and wellbeing needs of members. The returns help to support the benenden health mutual fund and provide the membership with even more medical help. In 2013 we plan to extend our existing product range of cash plans and over 50s life insurance to include travel, home and motor insurance. Keep visiting our website to get updates on what new products are available and to register to receive further information as these products are launched. benenden insurance is the trading name of the Friendly Healthcare Organisation Limited, Company No registered in England, which is a wholly owned subsidiary of The Benenden Healthcare Society Limited. Registered Office: Holgate Park Drive, York, YO26 4GG. LFT/GTSS/SP6185/06.13/V1