Corporate INSIDE. Healthcare Cash Plan HOW JOIN. Corporate Scheme Membership Plan 2014 APPLICATION FORM AND

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1 Corporate Corporate Scheme Membership Plan Healthcare Cash Plan HOW TO JOIN AND APPLICATION FORM INSIDE

2 96% of our members rate their overall experience of making a claim with Health Shield as good 100% CASHBACK ON ALL BENEFITS Thanks Happy I joined Second to none Very good Don t change Excellent Are you one of them? Corporate Scheme Membership Plan 2014

3 Everyone deserves the benefit of good health Why join Health Shield? Health cash plans are a great way to ensure your everyday healthcare costs are covered Your employer has introduced special corporate scheme rates from as little as 1.35 a week Peace of mind that you and your family are protected for everyday healthcare Look after your health, you don t have to be ill to claim The Health Shield difference 100% cashback on all benefits - up to chosen annual limits and subject to annual review Dependent children are covered FREE up to the age of 21 in full-time education Quick cash we aim to process claims within 48 hours which means your cheque or credit in your bank will usually be with you in 5 working days Members Area you can register for the Members Area where you can check benefit allowances, amend your personal details, and download claim forms online Paperless receive your membership documentation by rather than post. Quicker, easier to store and find, and better for the environment Direct credit - It s quicker, more convenient and your money should be in your bank account within 3 working days of us processing your claim How to join It s easy. Simply choose your level of cover, complete the form at the back of this booklet and return it to us. No need for a stamp, we use freepost telephone claims processed HRS 48 WITHIN PAID DIRECTLY INTO YOUR BANK ACCOUNT 2

4 corporate HeaLTHcare MeMberSHip plan TabLe of contributions and annual benefits 2014 LeveL of cover access LeveL LeveL 1 LeveL 2 LeveL 3 LeveL 4 prestige LeveL WeekLy payments for you (Includes benefits for dependent children) child cashback WeekLy payments for you and your partner cover LeveL (Includes benefits for dependent children) all contributions and benefits are SUbjecT To an annual review everyday dental 100% optical 100% chiropody 100% prescriptions per item HoSpiTaL HoSpiTaL benefits - HoSpiTaL inpatient (per NigHT) - HoSpiTaL day SUrgery (per day) Up To a MaxiMUM of 25 NigHTS/dayS per year parental HoSpiTaL STay Up To a MaxiMUM of 25 NigHTS per year SpeciaLiST consultation, ecg, x-ray, pathology fees and Mri ScaNS 100% HeaLTH & WeLLbeiNg HeaLTH & WeLLbeiNg 100% HeaLTH ScreeNiNg 100% fitness benefit access To SpeciaL rates plus 100 online HeaLTH risk assessments instant access To a range of HeaLTH risk assessments peace of MiNd dental accident 100% physiotherapy, chiropractic, osteopathy, acupuncture and HoMoeopaTHy 100% MaTerNiTy - antenatal appointment and adoption a SiNgLe payment personal accident protection a SiNgLe payment HoMe assistance cover Up To 14 Ho UrS HoMe care assistance after a pre-planned HoSpiTaL STay of 2 NigHTS or More HeaLTH, LegaL & counselling 24-HoUr HeLpLiNe 24/7 counselling & LifeSTyLe, HeaLTH & MedicaL and LegaL information 24/7 gp TeLepHoNe consultations Speak To a gp at a TiMe THaT SUiTS you benefits for prestige LeveL MeMberS family planning 500 critical illness cover extra benefits exclusive To prestige LeveL MeMberS 2000 contribution protection SickNeSS and accident protection for SickNeSS & accident WorLdWide cover for MaNy benefits please See SeparaTe TabLe for direct debit MoNTHLy contributions The above benefits are the maximum levels which apply for The type of benefit, benefit levels and contribution rates may change in future. (please see your membership plan for more details). 3 4

5 policy summary The Health Shield corporate Scheme membership plan ( the plan ) The plan is a healthcare cash plan provided by Health Shield Friendly Society Limited ( Health Shield ). This policy summary highlights some of the key aspects of Health Shield membership. For full details please refer to the terms and conditions. key features and benefits The plan pays for a range of everyday healthcare and wellbeing related benefits. You can choose from a range of benefit levels, and provide cover for your partner and dependent children where applicable. Claim limits are refreshed at the beginning of each benefit year. Your benefit year runs from 1 January to 31 December. Members must be at least 16 years of age to join in their own right. Dependent children can be covered by your membership up to their 21st birthday. We will write to you separately if we need more details of any pre-existing medical conditions you tell us you have. Until we receive this information we will be unable to accept claims for benefits which may potentially be excluded as a result of your health. When we have received this information from you we will tell you if your cover is affected. You can apply to change your level of cover at any time, but we will not pay out more than the applicable annual benefit limit for each claim. Claims already paid to you within the benefit year will be taken into account when determining the maximum amount available to claim at your new level. Cover will start from the date you make your first contribution, but you should check the qualifying periods section of the terms and conditions to see how they may affect your ability to claim certain benefits. If you are intending to make a claim under the Home Assistance Cover benefit, you should contact Aria Assistance as detailed in the terms and conditions before you are due to be admitted to hospital. If you pay your contributions by direct debit rather than by payroll deduction, your membership will be converted to Health Shield s Connect Plus plan when you reach the age of 65. prestige level only Certain benefits are not available for dependent children. Critical illness and family planning cover are payable only once during the lifetime of the person entitled to benefit. Sickness and accident protection cover is payable only up to the age of 65 (or your retirement age, if earlier). An exclusion period of 30 days applies to all sickness and accident claims. can i change my mind? You can cancel your Health Shield membership at any time by letting us know in writing or by telephone. If you tell us that you do not wish to proceed with the plan, within 30 days of the commencement date, we will return all contributions you have made but you must also return any claims we have paid to you. If you wish to cancel after 30 days have passed, we will not return any contributions. 5 existing members This plan completely replaces the terms and conditions of any existing plan you have. If you join this plan having already been a member of a different Health Shield plan, any pre-existing medical conditions you have may not be waived (even if they were covered before). Your previous plan s benefit year may be different to this plan. Claims paid under your previous plan may be taken into account if they were paid in the current benefit year of the new plan. Please take particular notice of any differences in qualifying periods between the two plans. If you are unsure as to how they may or may not be applied, please contact our Head Office. If you are changing to this plan from a similar scheme provided by a different cash plan provider, you should be aware that we may not offer cover for some preexisting medical conditions provided by your previous arrangement. There may have been benefits available under your previous plan that are not available under this plan. Members of this plan aged 65 or over who retire or leave a company that offers the Health Shield Corporate Scheme can continue their Health Shield membership by converting to our Connect Plus plan. If you convert from this plan to the Connect Plus plan, you will not have to serve any qualifying periods, and any medical conditions you have will continue to be either covered or excluded as they are in this plan. How do i make a claim? Complete the claim form included with your welcome pack and send it to us with any supporting documents (receipts, etc.) as required. You should send your claims directly to our Head Office address, not via your adviser, therapist or anyone else. If you are claiming for an excess payment in connection to private medical insurance, your claim procedure will be different. Please call us if you are unsure of how to proceed. Claim forms are available to download from our website, or you can call us on to request one. For Home Assistance Cover only, you should contact Aria Assistance prior to your hospital admittance. Please see the terms and conditions for full details. Who regulates us? Health Shield Friendly Society Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Our Financial Services Register number is You can check this on the Financial Services Register by visiting or by calling For Home Assistance Cover only, Health Shield is acting as a sub-agent of Aria Assistance, a trading style of Aria Insurance Services Limited who are authorised and regulated by the Financial Conduct Authority. Home Assistance Cover is underwritten by Aria Insurance Limited who are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. financial Services compensation Scheme We are members of the Financial Services Compensation Scheme (FSCS). If we are unable to meet our obligations you may be entitled to compensation from the FSCS.

6 policy summary data protection Statement We will keep your information confidential. Where it is appropriate however, we may share your information with fraud prevention agencies or other organisations with the sole intention of detecting and preventing financial crime. We may also share your information if we have a duty to do so (such as to regulatory or law-enforcement bodies), but only if the person requesting your information has, in our opinion, a legitimate interest in the disclosure. We may exchange limited information with your employer, their authorised intermediary, or a business partner if this is necessary to perform the day-to-day administration of your membership. We will only share your information with others on the understanding that they will keep the information confidential and in accordance with the Data Protection Act. We will not use your data, or that of your partner or dependents if applicable, for any purpose other than that for which it was gathered. We will only retain data for as long as it is required to administer your membership and fulfil any legal or regulatory obligations. rules of the Society Your Health Shield membership is subject to the Rules of the Society. The terms and conditions in your plan booklet describe the benefits and contributions available to you but the Rules are separate to these because they govern how your membership fits into the Society as a whole. A copy of the Rules is available on request, or you can download an electronic version from our website. ending your membership Our board of management may end your membership if they think: you have broken our rules; your continued membership may have a negative effect on the interest of the members generally; you have failed to act with utmost good faith which includes: repeatedly making claims which threaten our financial wellbeing; deliberately providing misleading or false information (or not providing information which we have specifically asked for); behaving in a threatening or abusive way towards any member of our staff; and making a claim that is fraudulent or that we believe to be deliberately false, misleading or exaggerated. We are committed to preventing financial crime and we will report all instances of fraud or attempted fraud to the police. other important information Health Shield Friendly Society Limited is registered in the United Kingdom and its products are only available within the UK. Health Shield has chosen English Law as the law applicable to the contract. The language used in all documents and communications, whether verbal or written, will be English. All regular membership contributions are inclusive of insurance premium tax. Although claim limits are refreshed each year, your membership has no fixed term and will typically continue from one benefit year to the next unless you request otherwise. Your Health Shield membership is subject to an annual review of benefits and contributions. Even if the benefits and contributions do not change from one year to the next, the wording and meaning of the terms and conditions, and other supporting documents, may be updated. We will point out any such changes to you before they are put in place but you should ensure that you understand how they may affect your ability to claim certain benefits. Your membership contributions may be paid either via a deduction taken from your pay or by direct debit. If your employer provides the payroll deduction facility however, you must use it rather than any other payment method. If you apply to increase or decrease your level of cover, the change can sometimes take a number of weeks to implement. You should always ensure that the change you have applied for has been made before committing yourself to treatments which may be affected by your changed membership level. Please also bear in mind any qualifying periods which may apply to increased levels of cover. We have the right to turn down any application to join the scheme, or to change the level of cover, if we think that this would have a negative effect on our members. Health Shield s Solvency and Financial Condition Report (SFCR) can be obtained from our website, when it becomes available. The SFCR is the public report that authorised firms are required to publish annually under Solvency II. Treating customers fairly We have 10 Conduct of Business Principles to ensure that our members are treated fairly. We will: 1. put you first in everything we do 2. strive to identify your needs 3. devise products that meet these needs 4. not provide staff with incentives that may risk your being sold an unsuitable product 5. be open and clear in all our dealings with you and will not hide behind small print 6. be courteous, responsive and consistent 7. listen to what you have to say 8. keep you informed of any product changes 9. deal with any complaint promptly and impartially 10. treat you as we would want to be treated ourselves How can i make a complaint? If you are unhappy with any aspect of the service provided by Health Shield, please contact our Head Office. Our contact details can be found on the back page of the membership plan booklet. We have our own internal complaints and appeals processes but if you cannot settle your complaint with us, you may be entitled to refer it to the Financial Ombudsman Service. you should review your level of cover regularly to ensure that it continues to meet your needs 6

7 7 direct debit MoNTHLy contributions corporate HeaLTHcare MeMberSHip plan access LeveL of cover LeveL Terms and conditions for the Health Shield corporate Scheme membership plan GENERAL TERMS AND CONDITIONS Who can join? If you want to join the Health Shield Corporate Scheme membership plan ( the plan ) or increase your level of cover, you must be between 16 and 64 (that is, not yet 65) when you apply and be employed by a company that offers the Health Shield Corporate Scheme. The terms of your new plan, including the benefit and contribution levels, completely replace those of any previous Health Shield membership. If you apply to join the plan, or if you are an existing member applying to increase your level of cover, you will not be entitled to receive benefit for any pre-existing condition. We will tell you about any conditions that are not covered. Exclusions for pre-existing conditions may apply to the following benefits only. Home assistance cover Hospital inpatient Hospital day surgery Parental hospital stay Physiotherapy, chiropractic, osteopathy, acupuncture and homoeopathy Specialist consultation, ECG, X-ray, pathology fees and MRI scans Critical illness cover Sickness and accident protection cover To make claims for a partner, you must be contributing to the plan at the rate that covers you and your partner. You must have filled in the appropriate forms so we can officially register your partner and dependent children. You, and your partner and dependent children (if this applies), may only be covered or included in one membership plan. We have the right to turn down any application to join the scheme or increase your level of cover, if we think that this would have a negative effect on our members. If you retire or leave a company that offers the Health Shield Corporate Scheme and you are not yet 65, you can convert to the Health Shield Connect Scheme. If you are 65 or over, you can convert to the Health Shield Connect Plus Scheme. When you reach the age of 65, if you are paying by direct debit, you must convert to the Health Shield Connect Plus Scheme. Your membership For 2014, we will refund 100% of each valid claim up to your yearly benefit limit. This is also our aim for future years, although this will depend on our financial performance in the future. As a result, we will review all benefits and contributions each year and we may make changes to them. If this leads to a reduction in the benefits we pay you in the future, we will tell you, but the percentage of each claim we refund is guaranteed to be 70% of the rates published for the relevant year. We will also apply this percentage reduction to the maximum amount shown in the benefit table. During the lifetime of this contract, it is important you understand that if our overall claims experience, position in the marketplace or surplus are worse than expected, we may increase your contribution rates, or reduce, change or remove any benefit. However, if our overall claims experience, position in the marketplace or surplus are better than expected, we may be able to improve your terms. TabLe of additional contributions prestige LeveL 1 LeveL 2 LeveL 3 LeveL 4 LeveL MoNTHLy payments for you MoNTHLy payments for you and your partner As a member, you agree to us processing personal and sensitive information about you. You, the member, must also sign all claim forms to declare that the details you have provided on the forms are true, and to allow us to get independent confirmation of the details from the healthcare provider the claim relates to. If we believe that any documents you send us are not genuine, we may keep them. Our board of management may end your membership if they think: you have broken our rules; your continued membership may have a negative effect on the interest of the members generally; you have failed to act with utmost good faith which includes: repeatedly making claims which threaten our financial wellbeing; deliberately providing misleading or false information (or not providing information which we have specifically asked for); behaving in a threatening or abusive way towards any member of our staff; or making a claim that is fraudulent or that we believe to be deliberately false, misleading or exaggerated. We are committed to preventing financial crime and we will report to the police all instances of fraud or attempted fraud. We will write to you to tell you about any changes to the terms and conditions of your membership plan. You should read the membership plan with the rule book. You can get a copy of the rule book from our Chief Executive or from the members area of our website at To make sure that we can provide high levels of customer service, we may monitor or record phone calls. Contributions You will be entitled to receive the maximum benefit if your contributions are up to date and you do not have a pre-existing condition that we cannot cover. If you make a claim and your contributions are not paid up to date for any reason, we will not be able to process your claim. We will put a hold on your claims until your contributions cover the dates that you are claiming for. If you decide to end your membership, all benefits will stop after the date you have paid up to. Qualifying period If you apply to join the plan, or if you are an existing member applying to increase your level of cover, you will become eligible to make claims: 40 weeks after your first or increased contribution for maternity-antenatal appointment and adoption benefit and all benefits connected with maternity; and 13 weeks after your first or increased contribution for all other claims. From the date you make your first contribution, you will be covered for the following benefits only. Overnight admissions to hospital as a result of an accident Personal accident protection A 24-hour helpline A 24/7 GP telephone consultation service An online health-risk assessment tool Fitness benefit (this does not include the 100 benefit for Prestige-level members)

8 Terms and conditions for the Health Shield corporate Scheme membership plan Exclusions We cannot pay benefit for any claims directly related to the following. GP fees for private treatment Drugs, medicines and vaccinations (including medicines relating to homoeopathic treatment and travel-related vaccines, for example anti-malarial tablets) Vasectomies, sterilisation, IVF, fertility treatment and examinations (not including the family planning benefit for Prestige-level members) Pregnancy terminations, contraceptives, sex-change operations or cosmetic surgery Medical examinations, consultations or reports for employment, emigration, legal or insurance reasons Treatment provided to you by a member of your family or a work colleague Postage and packing costs Internet, telephone and group consultations Treatment charges covered by private medical insurance other than any excess. (Excess fees are covered under the Specialist Consultation allowance.) We cannot pay benefit for claims you make as a result of the following. A pandemic disease Radioactive contamination Attempted suicide You deliberately injuring yourself War, hostilities, invasion or civil war, and full-time active military service Nuclear, chemical or biological terrorism Drug, alcohol or solvent abuse, or taking drugs (unless you have been told to by a registered medical practitioner) Please also see what is not covered under each section of cover If you live in the Republic of Ireland, we do not cover the first 5 a year for claims based on receipts. We can only pay claims for these benefits once a year. Benefit period The maximum benefits are shown in the table on pages 3 and 4. As a member, you will not receive more than the maximum benefit amount under any of the benefit rules for yourself, your partner (if they are covered) or dependent children in each case for any one calendar year. We treat claims in a calendar year according to the dates you (or your partner or dependent child) were admitted to hospital or received treatment, whichever applies. If you have been covered before as a dependent child or registered partner under someone else s Health Shield membership, we will take account of any claims you have made during your new plan s calendar year. When you change your level of cover, we will take account of previous claims you have made when we work out your maximum entitlement for the calendar year. How to claim We will deal with claims on the day we receive them, but we cannot accept photocopied, faxed or scanned receipts and claim forms. We also cannot accept credit- or debit-card receipts. You should include the following details on the original receipts. The date you received treatment (we cannot pay for anything you have paid for in advance and not yet received) The full name and title (Mr, Mrs, Ms or Miss) of the person who has received the treatment The official stamp and qualifications of the dentist, optician, chiropodist, physiotherapist, consultant and so on The type of treatment received We cannot accept receipts which have been altered. The receipts must only apply to the amount paid for the person who received treatment. We need separate receipts for each person covered. We will only pay claims to you direct, not to the healthcare practitioner who provides the receipts. We will not pay for any part of your receipt which you paid for by using gift cards or vouchers, including vouchers from third-party discount sites, or loyalty and reward points. We will not accept applications for benefit that are more than 12 months old at the time we receive them. Worldwide cover Some benefits apply during business visits and holidays abroad that last up to 28 days. The terms and conditions (including what is and what is not covered) will apply to the claims you send in, and you must send the details translated into English, if necessary. We will convert the amount of your claim into pounds sterling using the currency exchange sell rate, supplied by our bank, on the date we process your claim. Before we can pay your claim, we may ask for a copy of your travel documents. What benefits are covered Dental Optical Hospital inpatient Hospital day surgery Parental hospital stay Physiotherapy, chiropractic, osteopathy, acupuncture and homoeopathy (the qualification or accreditation of the practitioner may be an international equivalent) Personal accident protection What benefits are not covered Dental accident Maternity-antenatal appointment and adoption Specialist consultation, ECG, X-ray, pathology fees and MRI scans Chiropody Health and wellbeing Health screening Prescriptions Fitness ( 100 Prestige-level only) Family planning (Prestige-level only) Critical illness (Prestige-level only) Also see the Exclusions section on this page. This cover does not replace travel insurance. DEFINITIONS Accepted qualifications a list of approved professional organisations and accepted qualifications that we recognise. We review this list every year. The practitioner s qualifications, registration or membership must be relevant to the treatment that they are providing. Accident a sudden, unexpected and identifiable event causing injury or illness. Care and support assessment a telephone-based assessment carried out by our medically-qualified staff to cover the following areas you may need help with. Personal hygiene and grooming Dressing and undressing Feeding yourself Moving around (getting into and out of bed or a wheelchair, getting onto or off the toilet and so on) Bowel and bladder management Walking with or without an assistance device for example, walker, cane, or crutches or using a wheelchair. Care Quality Commission makes sure hospitals, care homes, dental and GP surgeries, and all other care services in England provide people with safe, effective, compassionate and high-quality care. They will encourage them to make improvements if this is necessary. Claims experience the number and cost of claims we paid for any one calendar year (that is, January to December). Dependent children your or your partner s children or legally adopted children who are under the age of 21, in full-time education and living at home. Excess the first part of any eligible treatment costs, that would otherwise be paid by a private medical insurer, which you have chosen to pay yourself. Full health screen a full medical check-up that may involve giving details of your and your family s medical history and having a physical examination, tests, laboratory tests, scans or X-rays, and may be followed by counselling, education, referral to hospital or further treatments, or further tests. Home where you permanently live. For Home Assistance claims, your home must be in the United Kingdom and cannot be a nursing, rest, retirement or convalescent home or similar establishment. 8

9 Terms and conditions for the Health Shield corporate Scheme membership plan 9 Hospice an institution that provides palliative care for the terminally ill. Hospital an institute which has permanent facilities for caring for patients, has facilities for diagnosing and treating injured or sick people and provides nursing services supervised by registered general nurses. If you are admitted to a hospital it should be following a referral by a GP, consultant or through the accident and emergency (A&E) department. Membership plan ( the plan ) the Health Shield Corporate membership plan, and the long-term insurance cash benefit plan described in these terms and conditions. The plan is registered in a single name only (that is, your name), although cover may also be provided for your partner and dependent children, if this applies. Palliative care an approach that improves the quality of life of patients and their families facing the problems associated with lifethreatening illness. Pandemic an infectious disease that is widespread throughout an entire country, continent, or the whole world. Partner your husband, wife or any other person who lives with you as if you are married, no matter whether they are male or female. Practice-plan premiums payments made to a scheme provided by your dentist. Pre-existing condition any disease, illness or injury that you have received medication, advice or treatment for, and experienced symptoms of, no matter whether the condition has been diagnosed before the start of your cover. Registered treatment centre a centre that is registered with the Department of Health and appears on the National Administrative Code Service Register. Surplus any money left over after meeting claims and expenses during the financial year. We, our, us Health Shield Friendly Society Limited, Electra Way, Crewe Business Park, Crewe, Cheshire, CW1 6HS. You you, as well as any partner and dependent children who are covered, if this applies, in this membership plan. BENEFIT TERMS EVERYDAY Dental We will pay benefit for dental treatment, at the appropriate rate and up to the appropriate maximum in any one calendar year. When you send the claim form, you must also send us an original receipt showing your name, dates of treatment and the dentist s official stamp. Anaesthetic fees Check-up charges A dental brace or gum shield provided by the dentist Premiums and joining fees for the practice s dental plan (for example, Denplan) Dental crowns, bridges and white fillings Dental veneers Dentures, or repairs to dentures at dental laboratories Hygienist fees Orthodontic and periodontic treatment Tooth-whitening treatment provided by the dentist X-rays Cancellation charges made by the dentist (for example, for missed appointments) Dental consumables (for example, toothbrushes, mouthwash, dental floss and so on) Dental insurance premiums Dental prescription charges (we cover these charges under the prescriptions benefit) Dental treatment charges resulting from a dental accident (we cover these charges under the dental accident benefit) Optical We will pay benefit for optical treatment, at the appropriate rate and up to the appropriate maximum in any one calendar year. When you send us the claim form, you must also send us an original receipt showing your name, the date of treatment or payment and the optician s official stamp. Contact lenses (permanent or disposable) Contact lens check-ups Contact lens solutions (including if you buy these separately) Eye laser surgery to correct long- and short-sightedness paid according to date of treatment and not when payments are made Eyesight tests Lenses you buy separately to fit to existing frames Lenses supplied under an optical insurance plan Prescribed glasses Prescribed magnifying glasses Repairs to prescribed glasses Sunglasses, safety glasses and swimming goggles (as long as they have prescribed lenses) Insurance premiums Non-prescribed glasses and contact lenses (for example, ready-made glasses and coloured lenses) Optical consumables (for example, glasses cases) Frames you buy separately Chiropody We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, for chiropody treatment from a practitioner who is a member of an approved professional organisation. There is a list of accepted accreditations and qualifications on our website at You can also ask us to send you a list by ringing or ing We review this list every year. The practitioner s qualifications, registration or membership must be relevant to the treatment that they are providing. When you send us the claim form, you must also send us an original receipt showing your name, dates of treatment and the chiropodist s official stamp. Assessments (for example, gait analysis, which is an analysis of how you walk) Chiropody treatment Podiatry treatment Consumables (for example, arch supports, orthotics or insoles) even when prescribed and supplied by the chiropodist or podiatrist at the time of the treatment Surgical footwear (for example, corrective shoes prescribed and supplied as a part of the treatment) X-rays Chiropody prescription charges (we cover these charges under the prescriptions benefit) Prescriptions (for each item) We will pay benefit to you and your partner (if they are covered), at the appropriate rate and up to the appropriate maximum number of individual prescription items in any one calendar year, for NHS prescription charges (or the NHS cash equivalent). When you send us your claim form, you must also send us an original, dated and fully-itemised receipt, which you can get from your chemist. NHS prescription charges or the NHS cash equivalent for private prescription charges An NHS prepayment certificate up to the appropriate maximum of individual prescription items Dental prescription charges Charges above the current rate set out in the NHS prescription pricing structure We do not pay prescription benefit for dependent children.

10 Terms and conditions for the Health Shield corporate Scheme membership plan HOSPITAL Hospital benefits We combine hospital inpatient and hospital day-surgery benefit payments. The maximum period for receiving combined daily or nightly rates of benefit is 25 nights in any one calendar year for each person who is entitled to benefit. Hospital inpatient We will pay benefit at the appropriate nightly rate for the period a person entitled to benefit is admitted (after being referred by a GP or consultant or being admitted by A&E) for inpatient treatment in a recognised hospital or hospice. You must fill in your claim form yourself confirming the medical reason for the hospital treatment. The claim form must be checked and stamped with the hospital or hospice stamp, and signed by a member of their staff. Or you can send us your inpatient letter which would have been given to you when you were discharged. Before we can pay your claim, we may ask for more information about the treatment provided by the hospital. If there is a dispute, our Board of Management will decide whether you needed to be admitted and whether a medical facility keeps to the policy definition of a hospital. Any period of overnight stay in a hospice, an NHS hospital, a private hospital or a registered treatment centre, from one to 25 nights, for a medical condition to be treated or investigated Being admitted to the ward, from the accident and emergency department, before midnight Fees for filling in claim forms or certificates, as long as you provide an official hospital receipt with your claim Attending accident and emergency Clinics, medical centres or nursing homes Hospital accommodation for an elderly person who is not able to live independently Maternity-related admissions for dependent children The first 10 consecutive overnight stays as a maternity inpatient, during which time the woman gives birth A child s first 10 consecutive overnight stays as an inpatient after being born Outpatient treatment Permanent stays in hospital Pre-existing conditions Any voluntary admissions to medical spas and spa hospitals for non-essential treatments Hospital day surgery We will pay benefit at the appropriate day rate for the period a person entitled to benefit is admitted (after being referred by a GP or consultant or being admitted by A&E) for hospital day-surgery treatment in a recognised hospital without an overnight stay. You must fill in your claim form yourself confirming the medical reason for the hospital treatment. The claim form must be checked and stamped with the hospital stamp, and signed by a member of their staff. Or you can send us your inpatient letter which would have been given to you when you were discharged. Before we can pay your claim, we may ask for more information about the treatment provided by the hospital. If there is a dispute, our Board of Management will decide whether you needed to be admitted and whether a medical facility keeps to the policy definition of a hospital. Any day-surgery admission in an NHS hospital, private hospital or registered treatment centre, from one to 25 days, to have a medical condition investigated under anaesthetic or sedation using theatre facilities, or to have a medical condition treated under anaesthetic or sedation using theatre facilities Operations which are cancelled after you have been admitted to hospital Colonoscopy, laparoscopy, colposcopy and sigmoidoscopy procedures, as long as an anaesthetic or sedation was needed and the procedure was carried out in theatre Fees for filling in claim forms or certificates, as long as you provide an official hospital receipt with your claim Outpatient treatment for chemotherapy Outpatient treatment for kidney dialysis Outpatient treatment for oncology Outpatient treatment for radiotherapy Attending accident and emergency Attending clinics, medical centres or nursing homes Admissions immediately before or following an overnight stay (one day either side) for which we will pay a claim under the hospital inpatient benefit Elderly care Hospice day care Maternity admissions Outpatient appointments or treatments that are not covered above Pre-admission appointments (appointments before you are admitted to hospital) Psychiatric treatment Pre-existing conditions Any voluntary admissions to medical spas and spa hospitals for non-essential treatments Parental hospital stay We will pay benefit at the appropriate nightly rate for one parent to stay overnight with a registered child who has been admitted for inpatient treatment in a recognised hospital or hospice. You must fill in your claim form yourself confirming the medical reason for your registered child being admitted. The claim form must be checked and stamped with the hospital or hospice stamp, and signed by a member of their staff. Or you can send us your registered child s inpatient letter which would have been given to you when they were discharged. Any period of overnight stay in a hospice, an NHS hospital, a private hospital or a registered treatment centre, from one to 25 nights, where one parent stays with their registered child and is entitled to hospital benefits Your registered child being admitted to the ward, from the accident and emergency department, before midnight A parent who stays with their registered child An adoptive parent staying with their registered child Fees for filling in claim forms or certificates, as long as you provide an official hospital receipt with your claim Attending accident and emergency Clinics, medical centres or nursing homes More than one parent staying with their child A child s first 10 consecutive overnight stays as an inpatient after being born Outpatient treatment Permanent stays in hospital Pre-existing conditions Specialist consultation, ECG, X-ray, pathology fees and MRI scans We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, when a person entitled to benefit has a specialist consultation or treatment from a medically qualified person who specialises in a field of medicine. The specialist does not have to hold a consultant position in a hospital, but must be a member, fellow or licentiate (licence holder) of one of the Royal Colleges (or their international equivalent) or be included on the register of specialists maintained by the General Medical Council. This benefit also refunds costs you would have to pay for an ECG, X-ray, pathology fees and MRI scans charged to you at the appropriate department of a hospital or as part of a consultation. You must send us an original receipt showing your name, dates of the consultation or treatment, the physician s or surgeon s qualifications and their official stamp. On the claim form, you must fill in the reason for the consultation, treatment or tests. Hearing aids and audiology tests provided by a registered hearing-aid supplier Hearing-aid repairs Investigative procedures (for example, colonoscopy, laparoscopy, colposcopy and sigmoidoscopy) Medical tests, including ECG, EEC and lung-function tests Pathology and biopsy fees Physicians or surgeons operation fees 10

11 Terms and conditions for the Health Shield corporate Scheme membership plan Speech therapy, dyslexia and dyspraxia treatment provided by a registered medical practitioner X-ray, including mammograms, CT scans, ultrasounds, MRI scans and screenings carried out at a hospital or as part of a consultation If a claim has been settled by a provider of private medical insurance, we can only pay benefit (up to the appropriate maximum) for any remaining excess if you send us your statement from the provider of private medical insurance. Anaesthetists fees Counselling fees (we cover these fees under the health and wellbeing benefit) Private antenatal scans Private hospital charges (for example, theatre and room fees) Pre-existing conditions ECG, X-ray, pathology fees and MRI scans charged to you other than when part of a hospital stay or a consultation HEALTH AND WELLBEING Health and wellbeing We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, when a person receives treatment related to their health and wellbeing, or treatment to relieve pain or prevent an illness or pain, from a practitioner who is a member of an approved professional organisation. There is a list of accepted accreditations and qualifications on our website at You can also ask us to send you a list by ringing or ing We review this list every year. The practitioner s qualifications, registration or membership must be relevant to the treatment that they are providing. We will only pay claims for the treatments listed below. The practitioner must have the appropriate qualifications as shown on the separate accepted qualifications list referred to above. When you send us the claim form, you must also send us an original receipt showing your name, dates of treatment and the practitioner s qualifications and official stamp. The claim form must include the reasons for the treatment, and the type of treatment provided. Acupressure Allergy testing, including food intolerance and nutrition tests Aromatherapy massages Bowen and Alexander techniques Chair massage Cognitive behavioural therapy Colonic hydrotherapy Counselling fees (for example psychiatric, psychological and bereavement) Hopi ear candles Hypnotherapy Indian head massage Kinesiology Naturopathy Nutritional therapy Reflexology Reiki Shiatsu Sports and remedial massages Beauty treatments (including facials) Herbs, herbal remedies, supplements or vitamins, even if they have been supplied as part of your treatment Vega testing Laboratory testing not referred for by a doctor Hair analysis Home testing kits Any treatment, provided by a practitioner recognised by us, which is not listed above Appliances (for example, lumbar rolls and back supports), even if they have been supplied as part of your treatment Stop-smoking patches, gum and so on Weight-management programmes (for example, Weight Watchers, Slimming World or LighterLife) Relationship counselling Internet, telephone and group consultations 11 Health screening We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, for a health screen carried out by medically qualified staff at a hospital or health-screening clinic to prevent an illness. When you send us the claim form, you must also send us an original receipt showing your name, the date of the health screen and the health-screening provider s official stamp. A Well Man or Well Woman screen A full health screen Home testing kits Tests not included within the full health screen (for example, X-rays and blood tests) Any health-screening checks, medical examinations, consultations or reports for employment, emigration, legal or insurance reasons Any other screening check or test not carried out as part of one of those listed above Worksite health screens arranged through your employer Health screens carried out in mobile facilities Fitness benefit Health Shield membership will give you and your family access to special rates for a network of health clubs and hotels via Incorpore s Corporate Fitness Network. You can join a health club at the lowest corporate rate available and enjoy special discounts and take advantage of preferred rates on leisure, relaxation and pamper breaks at hotels around the world. To search for your nearest health club which is taking part, you will need to visit or phone Incorpore s Customer Support Line on (quoting reference HEA). Also, if you are a Prestige-level member, we will contribute up to 100 towards the cost of your yearly gym membership, swimming sessions, exercise classes or personal trainer. You must provide an original receipt showing your name, the dates of payments and the gym or trainer s official stamp. There is a list of the qualifications any personal trainer must have on our website You can also ask us to send you a list by ringing or ing We review this list every year. The trainer s qualifications, registration or membership must be relevant. Online health-risk assessment This service is provided on behalf of Health Shield by Capita and provides instant access to a range of health-risk assessments. You will need to visit and quote access code Once logged in, please choose the Fitness2live section. You will then be asked to register and accept their separate terms and conditions before starting your assessment using your employer s code, which is the access code quoted above. PEACE OF MIND Dental accident We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, for dental treatment you need as a result of an accidental injury to your teeth. The injury must have been caused by a direct blow to the head. When you send us the claim form, you must also send us an original receipt showing your name, dates of treatment and the dentist s official stamp. Your dentist must also confirm on the receipts that the treatment has been caused by a direct blow to the head which has resulted in accidental injury to your teeth. You must also provide full details of the accident. Your dentist must fill in and sign the claim form confirming the date of the accident and that the treatment received is as a result of that accident. We treat dental accident claims in a calendar year according to the date the accident happened. We will only pay one maximum for all treatment that lasts from one calendar year to another.

12 Terms and conditions for the Health Shield corporate Scheme membership plan Dental treatment directly related to an accident (for example, a sports injury or a fall), including the following. Anaesthetic fees Dental crowns, bridges and white fillings Dental veneers Replacement dentures or repairs Cancellation charges made by the dentist (for example, for missed appointments) Damage to dentures when not being worn Dental consumables (for example, toothbrushes, mouthwash, dental floss and so on) Dental prescription charges (we cover these charges under the prescriptions benefit) Dental insurance, premiums and joining fees for your practice s dental plan Any treatment you receive 12 months after the date of the accident Dental treatment you receive for an accident which happened before you joined the plan Injuries caused by eating and drinking Physiotherapy, chiropractic, osteopathy, acupuncture and homoeopathy We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, when a person entitled to benefit receives treatment, from a practitioner who is a member of an approved professional organisation, to relieve pain or prevent an illness. This benefit also covers charges for x-rays and scans carried out at clinics on the recommendation of the practitioner as part of the treatment. There is a list of accepted accreditations and qualifications on our website at You can also ask us to send you a list by ringing or ing We review this list every year. The practitioner s qualifications, registration or membership must be relevant to the treatment that they are providing. When you send us the claim form, you must also send us an original receipt showing your name, dates of treatment, the type of treatment and the practitioner s official stamp. We will only pay claims for the treatments listed below. The practitioner must have the appropriate qualifications as shown on the separate accepted qualifications list referred to above. The claim form must include the reasons for the treatment, and the type of treatment provided. Acupuncture Chiropractic Homoeopathy Osteopathy (including craniosacral therapy) Physiotherapy X-ray, when necessary as part of the treatment Any treatment, provided by a practitioner who is recognised by us, which is not listed above Appliances (for example, lumbar rolls and back supports) even if prescribed and supplied by your practitioner as part of the treatment Pre-existing conditions Herbs, herbal remedies, supplements or vitamins, even if they have been supplied as part of your treatment Prescription charges (we cover these charges under the prescriptions benefit) Maternity antenatal appointments and adoption We will make a single payment for each pregnancy, up to the appropriate maximum in any one calendar year, for an NHS or private antenatal scan carried out by a doctor or midwife. For any scan which has taken place within 26 weeks of you becoming pregnant, we will only pay benefit if you have been covered by the scheme for at least 40 weeks. You must fill in the claim form yourself. The hospital or surgery must then check it and stamp it with its official stamp. An NHS or private antenatal scan carried out by a doctor or midwife which takes place within 26 weeks of you becoming pregnant Fees for filling in claim forms or certificates, as long as you provide an official receipt with your claim If it is a registered partner having the scan We will only make a single payment for a pregnancy that lasts from one calendar year to another. Attending accident and emergency Antenatal appointments for dependent children A partner who is not registered with us, unless you have confirmed that they live with you We will also make a single payment, up to the appropriate maximum in any one calendar year, if you adopt a child aged five or younger (as long as you have been covered by the scheme for at least 40 weeks). You must send us a copy of the adoption order with your claim form. Personal accident protection Please call the claims department on or for a separate personal accident claim form. Under the following conditions, we will only consider the amount of benefit we will pay under this section if a bodily injury results in death or permanent total disability (permanent disability that prevents you from doing any job which is not limited to your occupation at the time of the accident) within one year of the accident. We will pay the sum insured in line with the level of contribution you have paid. Protection will end on your 70th birthday. You must write to us within six months of an accident to let us know about it. We will not pay more than your benefit maximum per person as a result of any one accident. Bodily injury means an injury caused only by an accident and not by any sickness, disease or gradual cause. Bodily injury does not cover post-traumatic stress disorder. We will decide, based on medical advice, if we will pay benefit. Personal accident protection does not cover death or permanent total disability caused by the following. Radioactive contamination Taking part in professional sports or flying as a pilot or crew member (that is, aircraft, gliders, hang-gliders, microlights, parachuting, paragliding, ballooning) Suicide or deliberate injury War, hostilities, invasion or civil war, and full-time active military service Nuclear, chemical or biological terrorism Drug, alcohol or solvent abuse, or taking drugs (unless you are told to by a registered medical practitioner) Home Assistance Cover Cover is provided and arranged on our behalf by Aria Assistance and underwritten by Aria Insurance Limited. This benefit provides you and your partner (if covered) with help at home immediately after a period of at least two nights hospital inpatient treatment. Treatment can be in a hospice, NHS hospital, private hospital or registered treatment centre. Your hospital inpatient stay must be for planned treatment only. Before you are due to be admitted to hospital, you will need to call (This call is not free.) During this call, you will be asked to quote your scheme number which is 70840, and then a care and support assessment will be carried out. If you are eligible for assistance, we will arrange for our appointed care provider to contact you to carry out a full assessment of your needs in your home (in line with the Care Quality Commission s requirements). The care provider will also monitor your needs to make sure that the assistance provided continues to meet your needs. We will then arrange and pay for up to 14 hours necessary personal care or domestic assistance in your home for up to one week. If you make more than one claim for this benefit in a plan year, cover is limited to six weeks in total for the period of insurance. You may be able to receive the following benefits and services. Personal care, including help with: bathing, showering and cleaning teeth; support with getting up and going to bed; 12

13 Terms and conditions for the Health Shield corporate Scheme membership plan help in using the bathroom and toilet; dressing, undressing and caring for clothes; preparing, and cleaning up after, meals and drinks; hair care and shaving; foot care; and recognising and discussing health needs. Domestic assistance, including help with: cleaning; general tidying and light household duties; changing bed linen; ironing and laundry; and dog walking and feeding your household pets. Wellbeing call To discuss the services and benefits that you are eligible to receive under this policy and to answer any questions about your cover that you may have We will not pay for any services that: are not arranged by us; follow a period of hospital inpatient treatment of less than two nights; are not covered under the hospital inpatient benefit of this plan; follow an emergency hospital admission; are received outside of the United Kingdom or away from your home; include medical treatment of any kind; include transportation services of any kind; or are related to a pregnancy. HEALTH, LEGAL AND COUNSELLING 24-hour helpline You and your family can use our professional telephone service, 24 hours a day, seven days a week. This service provides counselling, support and guidance on a whole range of lifestyle, health and medical and legal problems. You can get information and counselling from specialist teams of counsellors, lawyers and medical staff. (This service is provided by Capita.) If you want to speak to a family-care counsellor, lawyer or medical advisor, call and quote scheme number (This call is free from BT landlines.) 24/7 GP telephone consultation service You and your family can speak with a GP at a time that is convenient for you. This service allows you to talk in confidence to a qualified practising GP. Each call is confidential unless you give your permission for details to be passed on to anyone else. The service is available 24 hours a day, every single day of the year from anywhere in the world. Your call will be answered by a specially trained operator who will take some details and arrange for a GP to call you back at a convenient time. If the GP advises, and you agree, we will send a record of your consultation to your own doctor. This service is not a replacement for your own doctor or the emergency services. It can give you advice and support for routine queries. For urgent medical problems, you should get advice from your own doctor or the emergency services. There is no limit to the number of calls you can make to the service. To use the service, all you need to do is call and quote scheme number (This call is not free.) The GP telephone consultation service is provided on behalf of Health Shield by Medical Solutions UK Ltd. EXTRA BENEFITS EXCLUSIVE TO PRESTIGE-LEVEL MEMBERS Family planning (Prestige-level only) We will pay family planning benefit to you and your partner (if they are covered), at the appropriate rate and up to the agreed maximum. We will only pay family planning benefit to you and your partner (if they are covered) once during your lifetime. You must send us an original receipt, showing the qualifications of the physician or surgeon. The physician or surgeon does not have to hold a consultant position in a hospital, but must be a member, fellow or licentiate (licence holder) of one of the Royal Colleges (or their international equivalent) or be included on the register of specialists maintained by the General Medical Council. On the claim form, you must fill in the reason for the consultation, treatment or tests. 13 Private family planning clinics Private fertility treatment and examinations Private IVF treatment Private sterilisation fees Private vasectomy fees Family planning benefit for dependent children Pregnancy terminations Contraceptives Critical illness (Prestige-level only) We will pay critical illness benefit at the appropriate rate, if critical illness is diagnosed after the end of the 13-week qualifying period. We will not pay more than 2,000 as a result of a critical illness. We will only pay critical illness benefit to any person once during their lifetime. Critical illness benefit does not apply to anyone aged 65 or over. You must make the claim within 12 months of the critical illness being diagnosed. Please call the claims department on or for a separate critical illness claim form. To support your claim, you will need to provide medical evidence from a registered medical practitioner. You must pay any costs involved in providing this evidence. Cancer a malignant tumour caused by malignant cells growing and spreading uncontrollably to other tissue. The term cancer includes leukaemia and Hodgkin s disease, but the following are not included in the cover. All tumours which are histologically described as being pre-malignant, non-invasive, or cancer in situ All forms of lymphoma present in HIV Kaposi s sarcoma present in HIV Any skin cancer, other than malignant melanoma Heart attack when a part of the heart muscle dies as a result of not receiving enough blood. It will cause chest pain, new electrocardiograph changes and an increase in cardiac enzymes. Coronary artery bypass surgery open heart surgery, recommended by a consultant cardiologist, that uses bypass grafts to correct one or more coronary arteries that have narrowed or become blocked. Non-surgical procedures, such as balloon or stent angioplasty or laser treatments, are not included. Kidney failure where both kidneys fail to work and, as a result, you begin regular kidney dialysis or have a kidney transplant. We will pay critical illness benefit if you need a kidney transplant and you have been included on an official UK waiting list. Major organ transplant the transplant of a heart, liver, lung, pancreas or bone marrow, or being included on an official UK waiting list to receive an organ. Motor neurone disease confirmation by a consultant that you have been diagnosed with motor neurone disease. Multiple sclerosis a definite diagnosis by a consultant neurologist of multiple sclerosis that meets all the following conditions. The movement of your muscles, or your physical senses, must currently be weakened, and have been weakened for a continuous period of at least six months. The diagnosis must be confirmed by diagnostic techniques that are widely used at the time you make your claim. Stroke permanent neurological (nerve) damage to the brain caused by an interruption to its blood supply. Transient ischaemic attacks (temporary interruptions to the brain s blood supply) or episodes resulting in temporary neurological symptoms are not included. If you suffered from that critical illness (or a related condition) or had surgery at or before the end of the 13-week qualifying period. If you die within 28 days of being diagnosed with a critical illness or having surgery. If the critical illness or surgery is in any way caused by being exposed to chemicals or nuclear material.

14 If the critical illness or surgery is in any way caused by drug, alcohol or solvent abuse, or taking drugs (unless you were told to by a registered medical practitioner). We will not pay critical illness benefit for claims caused directly or indirectly by you being infected by, or treated for, hiv or any hiv-related illness, including AIDS. Sickness and accident protection cover (Prestige-level only) please call the claims department on or before you make a claim. your prestigelevel contributions are covered for up to 12 months when you or your partner (if they are covered) are continuously off work for at least 30 days due to one of the following. Sickness Accidental injury Sickness and accident protection cover only applies if you or your partner (if they are covered): have completed a qualifying period of 13 weeks; are in full-time employment and between the ages of 16 and 64; are not aware of any medical treatment or advice you are due to receive; and are in good health. If you suffer a disability, we will pay 1/30th of your monthly contribution, after the first 30 days of your disability, for each consecutive day you are disabled. We will pay the benefit every 30 days during your disability, up to a maximum of 12 payments for any one claim. by disability, we mean being totally prevented from carrying out your normal job or work as a result of an accidental bodily injury or sickness, as confirmed by a registered medical practitioner, that takes place after the start date. Normal job or work means paid work of at least 16 hours a week that you carry out immediately before the start of your disability, and any similar job that you may reasonably be expected to carry out. We will not pay disability benefit for any period you are disabled after you have reached the age of 65 (or your retirement date, if earlier). When we assess the maximum benefit period, we will treat periods of disability resulting from the same cause as being the same period of disability, as long as they are not separated by at least three benefit months before you return to work. Exclusions to sickness and accident protection cover An exclusion period of 30 days applies to all claims. This means that we will not pay any benefit for the first 30 days of your sickness or accidental injury. We will not pay any amount where the disability happens within the 13-week qualifying period. We will not pay for any period of disability caused by any physical or mental disorder, any chronic (severe) illness, or any recurring or continuing disease which you had received treatment or advice for before your cover began. We will not pay for any period of disability that a registered medical practitioner has not provided medical evidence for. you must pay all the costs involved in getting medical evidence. We will not pay for any period of disability caused by the following. War Attempted suicide you deliberately injuring yourself you being under the influence of alcohol or drugs (other than prescribed drugs that are not for treating a drug addiction) pregnancy, childbirth or any complication connected to these A mental disorder, unless it is investigated and diagnosed by a consultant hiv (human immunodeficiency virus) or any hiv-related illness, including acquired immune deficiency syndrome (AIDS) cosmetic surgery A pandemic disease Also see the Exclusions section on page 8 The Crystal mark only applies to the terms and conditions section, and does not apply to the design and layout of this leaflet. questions and answers Who are Health Shield? Health Shield is a Friendly Society that has been helping its members with the cost of everyday healthcare for over 135 years. How can Health Shield afford to make such generous cashback refunds? We are a non-profit making Friendly Society, which means that our income is used for the benefit of our members. Who can become a member of Health Shield? Anyone aged between 16 and 64. What if I leave my current job? You may call our Customer Services Department on who can advise if your new employer offers a payroll deduction facility. Alternatively you can join the Health Shield Connect Scheme. Do I need a medical? No. Your application form simply contains a declaration of good health. If you have any existing condition (except optical or dental) then you ll be asked to complete a health declaration form. Is the healthcare cash plan scheme the same as private medical insurance? No. Health Shield protects members from the increasing costs of everyday healthcare. It can be used on its own or as a complementary addition to PMI. The Direct Debit guarantee - if applicable to your scheme The guarantee is offered by all banks and building societies that accept instruction to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit health Shield will notify you (normally 10 working days) in advance of your account being debited or as otherwise agreed. If you request health Shield to collect a payment, confirmation of the amount and date will be given to you at the time of the request. If an error is made in the payment of your Direct Debit, by health Shield or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. - If you receive a refund you are not entitled to, you must pay it back when health Shield asks you to. you can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. please also notify us.

15 MOISTEN AND SEAL HEALTH SHIELD CORPORATE APPLICATION PLEASE FILL IN AND SIgN THIS APPLICATION FORm PART A (PLEASE USE BLOCK CAPITALS) 1 YOUR DETAILS I WANT TO become A NEW health ShIELD corporate MEMbEr MEMbEr NuMbEr (if known) I WANT TO change My LEvEL OF contribution 4 AccESS LEvEL PLEASE TICK THE LEVEL YOU HAVE CHOSEN AND INDICATE WHETHER YOU REQUIRE COVER FOR YOU OR YOU AND YOUR PARTNER LEvEL 1 LEvEL 2 LEvEL 3 LEvEL 4 prestige YOU YOU & PARTNER please circle Mr, MrS, MS, MISS SurNAME FOrENAME(S) DATE OF birth FuLL postal ADDrESS postcode NATIONAL INSurANcE NuMbEr DAyTIME TELEphONE NuMbEr ADDrESS I want to be paperless, please send all my health Shield membership information by . (Only fill in section 2 if you want Cover for You and Your Partner) 2 YOUR PARTNER S DETAILS please circle Mr, MrS, MS, MISS 5 medical HISTORY health Shield does not cover any pre-existing medical conditions that have arisen before the time of joining or increasing cover. Examples of pre-existing medical conditions that may lead to the exclusion of certain benefits are as follows: diabetes, epilepsy, respiratory conditions (e.g. asthma), skin disorders (e.g. eczema, psoriasis), arthritis, heart problems (e.g. angina), circulatory problems (e.g. thrombosis), gynaecological disorders, digestive disorders (e.g. liver, bowel or stomach), kidney disorders, cancer, back/neck/shoulder problems, or mental or physical disability. have you (or your partner or dependent children where applicable) ever suffered from a medical condition? yes NO If you tick the yes box, we will send you a health declaration form to request further information. by ticking the NO box, you declare that you (or your partner or dependent children where applicable) have not: received medication, advice or treatment experienced symptoms for any disease, illness or injury, whether the condition has been diagnosed or not before the start of your cover. SurNAME FOrENAME(S) DATE OF birth 3 DEPENDENT CHILDREN COVERED BY YOUR membership (If you have more than two children please give their details on a separate sheet and provide it with your application). SurNAME FOrENAME(S) DATE OF birth MALE FEMALE SurNAME FOrENAME(S) 6 I agree to abide by the rules of membership described in health Shield s memorandum and rules, the terms and conditions of my membership plan, and with regard to the key facts document applicable to my scheme. I accept health Shield s right to vary any of the rules and regulations it considers necessary, and that I will be informed of any changes applicable to my membership. I accept that health Shield s benefits, benefit levels and contribution rates may also change in future years. I give my consent to all processing of personal and sensitive data. I declare that all of the information I have provided is accurate, true and complete to the best of my knowledge and belief. SIgNATurE DATE / / DATE OF birth MALE FEMALE health Shield can use my details to inform me about new products and services that are available. please tick box if you do not require further information. if your ComPAny offer PAyRoll DeDuCTion facilities, PleAse fill out PART B only. if you ARe PAying By DiReCT DeBiT PleAse fill out PART C only. HEALTH SHIELD CORPORATE PAYROLL DEDUCTION AUTHORISATION PART B (PLEASE USE BLOCK CAPITALS) PLEASE TICK THE LEVEL YOU HAVE CHOSEN AND INDICATE WHETHER YOU REQUIRE COVER FOR YOU OR YOU AND YOUR PARTNER 1 YOUR EmPLOYER S DETAILS I AM paid WEEkLy FOur-WEEkLy MONThLy FuLL NAME OF your EMpLOyEr yes NO ThIS IS A change TO My previous health ShIELD DEDucTIONS 2 AccESS LEvEL LEvEL 1 LEvEL 2 LEvEL 3 LEvEL 4 prestige YOU YOU & PARTNER WOrk LOcATION please circle Mr, MrS, MS, MISS your SurNAME FuLL postal ADDrESS OF pay centre your FOrENAME(S) your pay Or EMpLOyEE NuMbEr postcode I authorise you to deduct, and pay to health Shield, the appropriate amount corresponding to my level of cover, or any other contribution that may later apply. TELEphONE NuMbEr SIgNATurE DATE / / OFFICE USE ONLY Member s national insurance number Total amount to be paid Weekly Four-weekly Monthly PART C DIRECT DEBIT (PLEASE USE BLOCK CAPITALS) INSTRUCTIONS TO YOUR BANK/BUILDINg SOCIETY TO PAY BY DIRECT DEBIT. Direct Debit is only available where payroll deduction facilities are not provided by your employer. please complete to instruct your branch to make payments direct from your account. Then return this form to: Health Shield Friendly Society, Electra Way, Crewe Business Park, Crewe, Cheshire, CW1 6HS 1 YOUR EmPLOYER S DETAILS FuLL NAME OF your EMpLOyEr WOrk LOcATION SERVICE USER NUmBER NAME OF AccOuNT holder choose your preferred DIrEcT DEbIT MONThLy collection DATE 1st 7th 14th 21st SOrT code NuMbEr AccOuNT NuMbEr 7 YOUR INSTRUCTIONS TO THE BANK/BUILDINg SOCIETY AND SIgNATURE 6 2 bank/building SOcIETy NAME bank/building SOcIETy ADDrESS please pay health Shield from the account detailed in this instruction subject to the safeguard assured by the Direct Debit guarantee. I understand that this instruction may remain with health Shield and, if so, details will be passed electronically to my bank/building Society. BANK/BUILDINg SOCIETIES may REFUSE TO ACCEPT INSTRUCTIONS TO PAY DIRECT DEBITS FROm SOmE TYPES OF ACCOUNT. SIgNATurE DATE postcode FOr branch use ONLy - NO AckNOWLEDgEMENT required / / MOISTEN AND SEAL MOISTEN AND SEAL

16 RESPONSE SERVICE LICENCE No. NWW16574 Health Shield Electra Way CREWE CW1 6ZZ 10mm + 5mm from right hand sid No more than 6mm from top of p

17 Over 94% of our members agree that their calls are answered quickly SEE YOUR INCREASE OPTIONS ON PAGE 3 Cashback is excellent Well worth the money Excellent value for money Very happy First class service Increase your level of cover and get lots more cashback for a little more each week Corporate Scheme Membership Plan 2014 CMP/JANUARY2014

18 We believe that Health Shield offers an excellent package of benefits. Take a look at what we offer our members: 100% refund on healthcare bills, subject to annual review Dependent children covered FREE up to the age of 21 in full-time education Separate annual maximums for you and your partner (if covered), refreshed every year Separate annual maximums for dependent children No medical required to join No GP referral required before having treatment Health & wellbeing covers 19 alternative therapies PMI excess claims covered under specialist consultation Quicker cash when you need it - maternity-antenatal paid on the date of the scan and not on the birth of the baby Fast payment of claims by cheque or direct credit GP telephone consultations - speak to a GP at a time that suits you Instant access to a range of online health risk assessments Discounted rates on health clubs and hotels around the world Stress related information via our health, legal and counselling helplines Paperless you can now choose to receive your membership information by Members Area register for the Members Area where you can check benefit allowances, amend your personal details, and download claim forms online Worldwide cover New for Home Assistance Cover to help you recuperate at home after a pre-planned hospital stay Health Shield Friendly Society Ltd., Electra Way, Crewe Business Park, Crewe, Cheshire, CW1 6HS. Telephone: Fax: Opening hours: 8.00am to 6.00pm, Monday to Friday Website: Established in Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. As part of our on-going quality control programme, calls may be monitored or recorded. The paper in this literature is made from sustainable certified forests. CMP/JANUARY2014

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