elite the natural choice for health insurance

Transcription

1 elite the natural choice for health insurance

2 2 CONTENTS Welcome 3 Handpick your Healthcare 4 The Finishing Touches 5 Benefits Table 6 Hospital Lists 8 Voluntary Excess 8 Underwriting 9 Policy Limitations & Exclusions 10 Chronic Conditions Explained 11 Freedom Elite The Corporate Advantage 14 How to make a Claim 15 Contact Details 15 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

3 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN WELCOME Good health is an asset and one of the most important aspects in life. When things go wrong, often the waiting and the unknown can be the most frustrating factor. Protecting our future to ensure we have the best care at the time we need it most seems a very natural thing to do. Private Medical Insurance gives peace of mind that you can get access to the treatment you need, at the time you need it. Freedom Healthnet is a Private Medical Insurance provider offering innovative healthcare solutions for everyday needs. Our policies for individuals, families and businesses provide flexible benefits for a tailor made health insurance Policy to suit all needs and financial budgets. This brochure outlines the Freedom Elite plan benefits, how to customise your Policy and most importantly how to use your cover when you need it most. Freedom Elite is underwritten by Guardian Life of the Caribbean Limited. Freedom Healthnet Limited is authorised and regulated by the Financial Services Authority. 3

4 4 HANDPICK YOUR HEALTHCARE PLAN The Core In-Patient benefit is the foundation of your Policy. You can then choose from a selection of options to tailor your plan to you or your business needs. Core In-Patient Benefit Cover for Accommodation Charges, Drugs & Dressings, Theatre Charges, Specialists Fees, Diagnostic Tests, Oncology, MRI & CT Scans, Home Nursing, Rehabilitation benefits and NHS In-Patient & Day-Patient cash benefits. Out-Patient Cover Cover for Specialist Consultations and Treatment Fees, X-Rays, Pathology, Diagnostic Tests & Procedures and Physiotherapy. Two levels of Cover are available. Alternative Therapies Cover for Osteopath, Chiropractor, Acupuncturist, Homeopath and Chiropodist/Podiatrist Treatment. Two levels of Cover are available. Psychiatric Cover Cover for In-Patient and Out-Patient Psychiatric Treatment. GP, Dental & Optical Cover Cover for Routine and Accidental Dental Care, Private GP, Optical Consultations and Prescriptions. Executive Option Cover for External Prosthesis, Chronic Conditions, Wellbeing Assessment, Pregnancy Complications, Maternity, Second Specialist Opinion, NHS Prescriptions, Investigations resulting in the Diagnosis of Infertility and London Premier Hospitals. For full details see the Benefit Table on page 6 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

5 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN THE FINISHING TOUCHES You can personalise your Private Medical Insurance Policy with further options: 1. Choose your Hospital List Choose from our Standard, Plus and London Premier Hospital lists. 2. Choose your Excess You can reduce your premiums by up to 35% by choosing an excess. This is paid per year, per person. 3. Choose your Underwriting Depending on whether you are joining a Private Medical Insurance Policy for the first time or transferring from another insurer, we have several methods of underwriting to suit all needs. 5

6 6 BENEFITS TABLE Core Benefits In-Patient and Day-Patient Treatment Hospital charges Consultants & Anaesthetist Fees Diagnostic fees Physiotherapy Cancer Cover Accommodation for parent if child 14 or under Oral Surgery Private Ambulance Home Nursing Benefit Rehabilitation Benefit NHS In-Patient Benefit NHS Day-Patient Benefit Full Cover within your chosen hospital list. All charges for a hospital not within your list will be payable at 250 per night for private treatment as an In-Patient or 200 per private treatment as a Day-Patient. Full Cover within the limits of our fee schedule, if charges exceed those stated then the difference is your responsibility to settle. Full Cover Full Cover Full Cover within our Cancer Guidelines Full Cover Full Cover within listed procedures Full Cover Full Cover up to a maximum of 13 weeks Up to 3 hours per day (maximum of 7 days) 200 per night (maximum of 10 nights) upon receipt of a discharge summary from the hospital 100 per day (maximum of 5 days) upon receipt of a discharge summary from the hospital Out-Patient Treatment MRI/CT/PET scans Chemotherapy/Radiotherapy/Oncologist s Fees Full Cover Full Cover Option 1 Out-Patient Cover Out-Patient Treatment, Diagnostic Tests, Consultations & Physiotherapy (GP referral 6 visits only) A) 1500 B) Full Cover Option 2 Alternative Therapies Osteopath, Chiropractor, Acupuncturist, Homeopath, Chiropodist/Podiatrist (GP referral 6 visits only) A) 750 B) 1500 Option 3 Psychiatric Care In-Patient Cover Up to 10,000 Out-Patient Cover Up to 1000 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

7 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN Option 4 Private GP, Dental & Optical 50 compulsory excess with a 6 month qualifying period Routine Dental Up to 300 Accidental Dental Up to 600 Private GP including Consultations, Investigations & Minor Surgery Up to 300 per year (Minor surgery 70 per procedure within overall limit) Optical Consultations, Prescriptions Up to 200 Option 5 Executive Benefits Only available if all other options selected External Prosthesis recommended by a Specialist Chronic Benefits Consultations and Out-Patient Diagnosis Wellbeing Benefit (Health Assessment) Maternity Cash Benefit Second Specialist Opinion Up to 200 per plan year following an In-Patient stay Up to 500 per plan year upon first diagnosis following the inception of your Policy Up to 300 lifetime benefit following a two year qualifying period 150 per pregnancy following an 11 month qualifying period 1 per Policy year Charged NHS Prescriptions Up to 6 per Policy year (Maximum of 50) Cover for Private Ante-Natal and Post-Natal Care, Specialists consultations, Diagnostic Tests and Investigations and delivery for a Natural Birth Pregnancy complications Investigations resulting in the Diagnosis for Infertility only London Premier Hospitals Up to 3000 lifetime benefit following a two year qualifying period Up to 3000 lifetime benefit within listed procedures Up to 1500 lifetime benefit following a two year qualifying period Cover for Reasonable and Customary charges within London Premier Hospitals as listed in the Hospital guide Please Note: All limits above are per Policy year unless otherwise specified. 7

8 8 HOSPITAL LISTS Freedom Elite allows you to reasonably select the private hospitals you want to include within your chosen plan, with three main lists: Standard, Plus and London Premier. You can access a range of national hospitals or decide to include the more expensive London hospitals giving you a greater choice. We can also provide you with a selected number of premier hospitals in the Executive option. For full details please refer to the Freedom Elite Hospital List. VOLUNTARY EXCESS You can reduce your premium by selecting an excess. The schedule is as follows: Excess Premium Reduction % % % % The excess is payable per person per Policy year. For example, if you choose a 100 excess and your treatment costs 400 you will pay the first 100 and we will pay the rest during that Policy year. FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

9 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN UNDERWRITING How will your Policy be underwritten? Moratorium Underwriting The purpose of the Policy, as with all insurance, is to provide cover for the unexpected. This means cover for the cost of treatment of acute conditions (diseases, illnesses or injuries that are likely to respond quickly to treatment) which arise after the start of the Policy. We exclude any conditions for which you have received medication, advice or treatment or have experienced symptoms whether the condition has been diagnosed or not in the five years before the start of your cover (pre-existing conditions). Related conditions (those which are medically considered to be associated with a pre-existing condition) will also not be covered. However, if you have not had any such symptoms, treatment, medication or advice for a pre-existing condition or any related condition for a continuous period of 2 (two) years after the start date of your Policy for a particular condition, the condition will become eligible for cover under this Policy. This period is known as the Moratorium. Maximum age of entry is 70. Full Medical Underwriting We will ask you to complete a health questionnaire when you apply for cover with us. Based on your medical history, we may apply specific exclusions to your Policy. For example, if you have a pre-existing condition that may need further treatment in the future, we may exclude it and any conditions relating to it. This will be detailed in your Certificate of Insurance. You must disclose all your medical conditions, treatments and procedures. Non disclosure will invalidate future claims. Maximum age of entry is 75. Continued Personal Medical Exclusions & Continued Moratorium If you are currently insured with another provider, we may be able to switch your cover to Freedom Elite on the same personal terms. This can be offered in two ways: 1. Continued Personal Medical Exclusions If you have completed a health questionnaire with your previous insurer and have personal medical exclusions, this will be transferred to your new Policy with us. 2. Continued Moratorium If you are currently insured on moratorium terms with your insurer, you can join Freedom Elite on the same continued terms. This is subject to our acceptance terms, you must disclose previous and pending claims, Private or NHS. Please refer to the application form for full details. Maximum age of entry is 70. Medical History Disregarded (MHD) We do not apply any personal medical exclusion to your Policy as a result of pre-existing conditions. Maximum age of entry is 70. This option is only available on our corporate plans. For more information please contact us on

10 10 Policy LIMITATIONS & EXCLUSIONS There are exclusions you should be aware of under the Elite plan. Some examples of our exclusions are as follows: Drug, solvent and alcohol abuse Pre-existing conditions (unless we have approved treatment relating to them) HIV/AIDS Cosmetic Surgery Excess (Optional) Treatment undertaken by a Specialist without a GP referral Kidney dialysis Professional sports injuries Self inflicted injuries Sexual dysfunction Treatment for verrucas or warts Weight loss surgery Chronic conditions (as defined on Page 11) For a full list of exclusions, please refer to our Policy Document. FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

11 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN CHRONIC CONDITIONS EXPLAINED A chronic condition is a disease, illness or injury which has one or more of the following characteristics: It needs ongoing or long-term control or relief of symptoms; It requires your 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; It needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests. The Policy covers treatment of acute conditions subject to the Policy Document and the Certificate of Insurance. An acute condition is a disease, illness or injury that is likely to respond quickly to treatment, the aim of which is to return you to the state of health you were in immediately before suffering the condition, or which leads to your full recovery. You will usually be covered for the cost of diagnostic tests that may be necessary to diagnose your condition. If you are then diagnosed as suffering from a chronic condition we will not normally pay for further treatment. If, however, you suffer from an unexpected acute exacerbation of your chronic condition, you will usually be covered for short-term treatment necessary to stabilise the condition, provided that no other Policy conditions, limits or exclusions apply. What does this mean in practice? In practical terms this means that you will be covered for the treatment of acute medical conditions, where the condition responds quickly to treatment, with the aim of the treatment being to return you to the state of health you were in immediately prior to suffering from the condition. Should you suffer from a condition which requires regular treatment, tests or consultations to maintain the stability or monitor the condition then this may be classed as a chronic condition. The cover provided by the Policy does not extend to include such costs. You will be covered under the Policy for the initial investigations and diagnostic tests required in order for a diagnosis to be made. If diagnosed as a chronic condition we will usually pay for the initial treatment in order for the symptoms to be stabilised. If further treatment is proposed we will, with your permission, request medical information from the treating doctor or Specialists in order to consider the eligibility of this. Individual circumstances will be considered along with medical advice and if we consider that the condition is chronic then we will write to you and explain why this is the case. In such circumstances we will always give notice before withdrawing cover in order for alternative arrangements to be made. What if my condition gets worse? Being diagnosed with a chronic condition does not mean that no cover will be provided at all for that condition. In the event that there is an acute exacerbation, or flare-up, of a chronic condition we will consider covering the short-term treatment required in order for the condition to be stabilised. Such treatment should be with the intention of returning you to the state of health you were in immediately prior to the onset of the flare-up of the symptoms. Once the condition has stabilised the process set out above will apply. Some chronic conditions, due to their nature, will require regular treatment in order for them to be stabilised. Such conditions are not covered by your Policy. Please contact the Claims Helpline if you are unsure whether your treatment will be covered. 11

12 12 CHRONIC CONDITIONS EXPLAINED (continued) Examples of chronic conditions Below are some examples of chronic conditions with explanations of the cover available, along with details as to how they would be handled under the Freedom Healthnet Policy. Important Note These examples are used to illustrate what Freedom Healthnet would usually cover. If you require treatment under your Policy, please contact the Claims Helpline and forward the appropriate parts of the Claim Form to obtain pre-authorisation. Failure in doing this could result in costs being incurred which are not covered by your Policy. All pre-authorisation in the examples below assumes that the Claim Form has already been received by Freedom Healthnet. Example 1 Alan has been with Freedom Healthnet for many years. He develops chest pain and is referred by his GP to a specialist. He has a number of investigations and is diagnosed as suffering from angina. Alan is placed on medication to control his symptoms. Alan contacted the Claims Helpline and was advised that his Policy covered consultations and tests required to diagnose his condition. He was also advised that any out-patient medication prescribed for his angina would not be covered by the Policy, nor would any monitoring of the condition by his specialist once the condition had stabilised. Two years later, Alan s chest pain recurs more severely and his specialist recommends that he has a heart by-pass operation. Having contacted the Claims Helpline again, Alan was advised that the proposed surgery would be covered in accordance with the rules and benefits of his Policy. In addition to the surgery, he would be covered for one immediate post operative consultation and a further consultation six months later. Example 2 Carole develops a lump in her left breast, which is diagnosed as breast cancer. Her specialist recommends that she has a mastectomy (breast removal) followed by a course of chemotherapy and radiotherapy. Carole contacts the Claims Helpline and is advised that the initial consultation(s) and tests would be covered. When the condition has been diagnosed, Carole contacts the Helpline again and benefit is confirmed for a mastectomy and immediate reconstruction of the affected breast if necessary. Carole is made aware that should reconstruction be carried out at a later stage, only reconstruction of the affected side and reduction of the unaffected side would be covered by the Policy. Augmentation of the unaffected breast would not be covered. Following surgery, Carol was advised chemotherapy and radiotherapy treatment would be eligible for benefit provided that the treatment plans fell within customary clinical practice and therefore pre-authorisation of the treatment at each stage would be mandatory. Once Carole s course of treatment has been completed, her specialist recommends that she has regular check-ups to ensure that she remains free from a recurrence of the disease. Carole is advised by the Claims Helpline that check-ups following treatment of cancer would be covered for a maximum of five years from the date of the completed course of treatment, providing the Policy remained in force. Should there be evidence of recurrence of the disease, her Policy would cover the relevant tests and ongoing treatment subject to the rules and benefits of the Policy. However, costs relating to palliative treatment i.e. treatment given to alleviate symptoms thereby improving the quality of life rather than curing the underlying disease, would not be covered by the Policy. FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

13 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN Example 3 Bob has been with Freedom Healthnet for three years when he develops hip pain. His GP refers him to an physiotherapist who treats him every other day for two weeks and then recommends that he return once a month for additional treatment to prevent a recurrence of his original symptoms. Bob calls the Claims Helpline and is advised that cover will be provided for the initial two-week course of treatment, subject to the benefit limits of his Policy. Bob is advised that his Policy does not cover the subsequent treatment to prevent a recurrence of the symptoms. One year later Bob s symptoms recur and he calls the Claims Helpline again. Benefit is confirmed for a specialist consultation on GP referral. A hip replacement operation is recommended by the specialist. Bob relays this information to the Helpline and benefit is confirmed for the hip replacement surgery. Example 4 Deirdre has been with Freedom Healthnet for two years when she develops symptoms that indicate she may have diabetes. Her GP refers her to an endocrinology specialist who organises a series of investigations to confirm the diagnosis, and she then starts on oral medication to control the diabetes. After several months of regular consultations and some adjustments to the medication regime, the specialist confirms the condition is now well controlled and explains he would like to see her every four months to review the condition. Having contacted the Claims Helpline, Deirdre is advised cover is provided for the initial consultations and tests required to reach a diagnosis of diabetes. Deirdre is advised that out-patient medication is not covered. Consultations with the specialist would be authorised up to the point where the diabetes is brought under control. It is explained to Deirdre that the fourmonthly check-ups are not covered by the Policy. One year later, although she has been following medical advice and taking her prescribed drugs, Deirdre s diabetes becomes unstable and her specialist arranges for her to go into hospital for treatment. Deirdre contacts the Claims Helpline again and is advised that her Policy would provide cover for an admission to hospital and the treatment required for her condition to be stabilised. Deirdre is also advised that we would pay for one post discharge consultation to review the effectiveness of the treatment given. Example 5 Eve has been with Freedom Healthnet for five years when she develops breathing difficulties. Her GP refers her to a specialist who arranges for a number of tests. These reveal that Eve has asthma. Her specialist puts her on medication and recommends a follow-up consultation in three months to see if her condition has improved. At that consultation, Eve states her breathing has been much better. So the specialist suggests she has check-ups every four months. Eve contacts the Claims Helpline and cover is confirmed for the initial consultation, investigations and tests required to reach a diagnosis. Benefit is allowed for the consultation three months later to review the effectiveness of the treatment given. It is explained to Eve that the Policy does not cover routine monitoring of any condition and therefore ongoing consultations are not covered. Eighteen months later, although she has been following medical advice and taking her prescribed drugs, Eve has a bad asthma attack. Eve contacts the Claims Helpline and cover is confirmed for her to be referred to a specialist in order to assess her symptoms and review her medication. Unfortunately, Eve s symptoms progress to a level that she requires an urgent admission to hospital. The purpose of the admission is to stabilise the asthma and return Eve to the level of control she experienced immediately prior to her pre-admission attack. The hospital admission is therefore confirmed if Eve is transferred to a private ward subject to the rules and benefits of her Policy. Following discharge from hospital, Eve calls the Claims Helpline again and is advised that one post discharge consultation would be covered to review the effectiveness of the treatment given. No cover is available for the further follow-up consultations as these are for routine monitoring of the condition. 13

14 14 FREEDOM ELITE THE CORPORATE ADVANTAGE Freedom Healthnet s Corporate Elite Policy offers an excellent range of benefits and the flexibility to choose a plan to suit all businesses. With our versatile options you can personalise each benefit to meet your company and your employees requirements and ensure you only pay for the cover that is needed. We offer a very competitive pricing arrangement. Please contact us if you would like to discuss your options. We understand that employee benefits is a large contribution to maintaining your company profile and with our support you can have the peace of mind that if a key member of staff is off due to sickness they are likely to return to work at the earliest time possible. Freedom is the natural choice for your healthcare solutions. Additional Benefits Freedom Healthnet have an excellent benefits package available through one of our many partners offering a range of health and lifestyle cover. This product is on a non-profit basis and has been designed to cover important issues like health and stress initiatives as well as light hearted benefits such as days out for your employees and their loved ones. Please contact us on for further information. FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN

15 FREEDOM ELITE BROCHURE 01/02/2012 GUARDIAN HOW TO MAKE A CLAIM Our claims procedure is simple: The claims procedure will start at the time your General Practitioner refers you to a Specialist. You must tell your General Practitioner that you wish to have private treatment. Contact our Claims Helpline on A member of our claims team will take your details. Please have your Policy number ready when you phone. Once your membership has been confirmed you will be sent a claim form. Part A of the claim form should be completed by your General Practitioner, and returned to us for pre-certification. In some cases, it may be necessary to obtain additional medical information to enable us to confirm cover for your claim. No benefit will be payable until such additional information has been obtained. Claims are authorised based on information provided. Should additional information be received or disclosed we reserve the right to re-assess your claim. We shall then notify you whether or not the required consultation or treatment is covered by your Policy in writing. Once you receive confirmation, see your chosen Specialist. If your Specialist recommends further treatment or surgical procedure(s), Part B of your claim form should be completed by your chosen Specialist, confirming that the treatment or surgical procedure is medically necessary, and returned to us for approval. We shall notify you whether or not the required treatment or surgical procedure is covered by your Policy, confirmation will be in writing. We shall confirm and settle Reasonable and Customary charges directly to the provider. CONTACT DETAILS Contact us Freedom Healthnet Ltd Bourne Gate 25 Bourne Valley Road Poole BH12 1DY Tel: Fax: info@freedomhealthnet.com Web: Please note telephone calls may be recorded. 15

16 GLC Elite V1 elite Freedom Healthnet Ltd Bourne Gate 25 Bourne Valley Road Poole BH12 1DY Tel: Fax: FSA number: Company Registration Number: Freedom Healthnet Ltd is authorised and regulated by the Financial Services Authority.