Welcome to Simplyhealth

Transcription

1 Welcome to Simplyhealth

2 We wish you the very best of health and by choosing a cash plan from Simplyhealth it s clear that your employer does too. This booklet sets out the benefits available to you and what you can claim. Your policy document includes your terms and conditions and outlines exactly what is and isn t covered. At Simplyhealth, we re committed to helping you feel better every day. So if you have any queries or questions we d like you to call us. from landlines from mobiles am to 8pm weekdays, 9am to 5pm Saturdays or visit us at 1 Some mobile networks charge for calls to 0800 numbers. Our 0370 number is free if you have mobile inclusive minutes available. If not it s still no more expensive than calling numbers starting 01 or 02. 2

3 Contents Introduction 4 Your table of cover 6 Getting the most from your plan 7 with voluntary upgrades Your benefits in more detail 8 Claiming couldn t be simpler 17 Your questions answered 18 3

4 Simply covered Your company recognises your hard work and wants to help you stay healthy. The Simply Cash Plan which they have arranged for you will help cover the cost of everyday healthcare bills giving you added peace of mind and allowing you to get on with enjoying your life. You can now claim up to 100% immediately on dentist and optician bills, as well as claim money back for the cost of physiotherapy, osteopathy, chiropractic treatment, acupuncture, homeopathy and chiropody/podiatry, all up to an annual limit. You can also claim for health screening and diagnostic consultations, all up to your annual limit. We can be bothered Your membership benefits include access to health and wellbeing advice as well as telephone counselling. If you re feeling stressed, call our 24 hour free advice helpline at any time on and talk to a trained professional. Our commitment to you Simplyhealth is here to make life easier for you. It s why we pay claims directly to you usually within a few days. It s why all Simplyhealth customer documents will be sent within 5 days of issue and it s why we have real people on the other end of the line no answer phones or automated calls. We provide all services from within the UK. 4

5 Access your details instantly At Simplyhealth we want to make using your plan as simple as possible. That s why we provide an online service so you can access and amend your details instantly. All you need is your policy number, which is on your summary of cover, date of birth and postcode, then register your details online and you re ready to manage your plan. What you can do: check your benefit limits and see how much benefit you have left on your plan check your claims history and keep on top of what you ve claimed for request claim forms amend personal details view your policy document and your summary of cover The faster way to get your money back Did you know that we can pay your claims straight into your bank account? It means you will have your money faster than if we sent you a cheque and you don t have to worry about your money getting lost or delayed in the post. To have your claims paid into your bank account, simply call us on or visit 5

6 Your table of cover Your table of cover Dental Payback level Level 1 Level 2 Level 3 Annual limit for each person Includes check-ups, hygienist s fees, fi llings, dentures, 100% crowns and bridges Optical Includes sight tests, prescription glasses, sunglasses and contact lenses Physiotherapy, osteopathy, chiropractic, chiropody/ podiatry, acupuncture and homeopathy Treatment carried out by a qualifi ed practitioner that we recognise Full body health screening A full health screen at a hospital, registered health screening clinic or service provider Diagnostic consultation, tests and scans Includes specialist fees for a consultation, plus consultant referred CT and MRI scans, X-rays and diagnostic tests New child payment (six month qualifying period) Single payment for each child that you or your partner give birth to or adopt Personal Accident cover 1 Permanent total disablement Payment made if you suffer permanent total disablement Accidental death Payment made as a result of accidental death 100% % % % For each child A single payment A single payment up to 10,000 up to 5,000 up to 10,000 up to 5,000 up to 10,000 up to 5,000 6 Additional benefits Gym discount Access to discounted gym membership rates across a network of over 2000 gyms. Online health Provides online information on a wide range of health and wellbeing issues, as well as access to an online health tool to assess your overall health. European Cover You ll receive these benefi ts for stays up to and including 28 days, on business or pleasure, wherever you are in the EEA and Switzerland. Free Helpline Access to a free confi dential helpline to advise you on health and lifestyle issues, as well as an over the phone counselling service. This service is available 24 hours a day, 7 days a week and can be accessed by calling To be eligible for the Personal Accident cover you must be under the age of 66 when you join. Cover for permanent total disablement stops once you reach 66 years of age. Personal Accident cover is administered by FirstAssist Insurance Services Ltd and underwritten by Great Lakes Reinsurance (UK) PLC. Your employer has chosen this policy for you. If you choose to add your partner, the joining age is from 18 years old up to 69. If you, or anyone on the policy, is aged 70 or over you will not be able to increase the level of cover. Premiums include Insurance Premium Tax. For full details of the plan please refer to the Policy Document. ichmatters-post-0613

7 Getting the most from your plan with voluntary upgrades If you would like to increase your level of cover, you can choose to pay an additional premium and enjoy the extra cover the higher levels offer. You can also choose to pay a little extra to cover your partner if they are aged between 18 and 69, and they are not already covered by your company. It s easy to arrange, simply call us on The table below shows the weekly premiums you will need to pay if you choose to upgrade, if your employer is paying for level 1. If your employer is paying for a higher level of cover or have already covered your partner, the costs for upgrading may be different. Please call Customer Services to find out more. Weekly premium Level 1 Level 2 Level 3 Upgrade premium for you, the employee and up to four of your children who live with you n/a Upgrade premium for you, your partner and up to four of your children who live with you Remember, you can cover up to a maximum of four children for free as long as they are under they age of 18 and permanently live with you. You can only upgrade your cover within 30 days of your policy start date or review date. For more details, please refer to sections 3 and 4 of the terms and conditions. 7

8 Your benefits in more detail Here is an easy guide to all the benefits your Simply Cash Plan can offer. Please remember that Simplyhealth will only pay for treatment by registered health care professionals that we recognise, where applicable. For more information about exactly what is and isn t covered, please refer to section 2 of the terms and conditions. Acupuncture Acupuncture can be particularly helpful in treating arthritic and rheumatoid pain in joints, chronic muscle strains and sports injuries. It can also help relieve headaches, period pains, allergic symptoms and insomnia. Simplyhealth will pay up to 100% of your acupuncture bills up to your annual entitlement. There is currently no government legislation in the UK covering acupuncture. This means that anyone can provide acupuncture treatment without any professional acupuncture training. Until the introduction of compulsory registration for this profession, Simplyhealth will continue to pay claims for treatment from professionals who provide acupuncture treatment. For more information or to find your nearest acupuncturist contact the following: The British Acupuncture Council The Acupuncture Association of Chartered Physiotherapists The British Medical Acupuncture Society

9 Chiropody/Podiatry Chiropody/podiatry deals with the care of the feet. Simplyhealth will pay up to 100% of your chiropody/podiatry bills up to your annual entitlement. The chiropodist or podiatrist must be qualified and registered with the Health and Care Professions Council. For more information please contact the following: The Health and Care Professions Council Society of Podiatrists and Chiropodists The Institute of Chiropodists and Podiatrists or Chiropractic By manipulating and adjusting the vertebrae of the backbone a therapist can correct malfunctioning nerves and muscles throughout the body. You can claim up to 100% money back for chiropractic treatment with a chiropractor who is registered with The General Chiropractic Council, up to your annual limit. For more information or to find your nearest registered chiropractor contact the following: The General Chiropractic Council

10 Diagnostic consultation, tests and scans If you are unwell and need to find out what s wrong, this benefit helps you to see a private consultant fast, without the long, uncomfortable wait. Simplyhealth enables you to claim up to 100% towards a diagnostic consultation, test or scan up to an annual limit. If you think something s wrong, your GP will be able to refer you to the appropriate consultant. To find your nearest GP visit NHS Direct (England and Wales) (Scotland) Dental We all know how hard it is to find a dentist on the NHS these days, so there s no need to suffer with toothache or put off going to the dentist because of the cost. Simplyhealth pays up to 100% of your dental bills up to your yearly entitlement, whether you are treated privately or on the NHS. This includes regular check-ups as well as treatment such as fillings. To find your nearest dentist visit NHS Direct (England and Wales) (Scotland) British Dental Health Foundation or British Dental Association 10

11 European Cover Simplyhealth cover applies anywhere in the European Economic Area including Switzerland. Any trip up to and including 28 days in duration is covered, be it business or pleasure. Please refer to section 5.19 of the terms and conditions for more details. Full body health screening This benefit is designed to provide you with a detailed assessment of your state of health. That s why we help cover the costs for health screening which should include a full blood screen, urinalysis, prostate/cervical screen, full physical examination and biometric analysis and tests. You can claim up to 100% towards health screening by qualified staff at a hospital, registered health screening clinic or service, up to the annual limit. 11

12 Gym Discount This benefit giving you access to a network of over 2,000 participating health clubs, gyms and leisure centres, all of which will offer you a discounted rate for the type of membership you require. As part of this benefit you will receive a one day guest pass or trial to view and experience each club prior to joining. If you are an existing member of one of the participating clubs, you may still be able to take advantage of the discounted rate. Please speak to the membership department of your club to check if transferring is possible or contact the Incorpore Customer Helpdesk via at fitness@incorpore.co.uk. Your partner and family members living at the same address are also able to take advantage of discounted gym membership. How do I locate my nearest club? To locate your nearest participating health club please visit and login using Simplyhealth as your member login, or alternatively call the Incorpore helpline on and quote Simplyhealth as your reference. Once logged in, select find a club and enter your post code, the online locator will display the nearest clubs either on a map or list format depending on your preference. How much does the membership cost? To find out the current discount for your membership and indeed all membership options available, the act of downloading your health club pass on the Incorpore website will forward your details to a membership advisor at your selected gym who will contact you to ensure you receive the correct discount and pricing information. They will also be able to arrange for your free day trial and answer any further questions you may have. Please ensure you quote reference Incorpore when speaking with your gym. What do I do once I have chosen the club I want to join? You must download a health club voucher for your chosen gym on the Incorpore website. The act of downloading your health club voucher will forward your details to a membership advisor at your selected gym who will contact you to ensure you receive the correct discount and pricing information. They will also be able to arrange for your free day trial and answer any questions you may have. Please ensure you present your voucher to a member of the club team on arrival. 12

13 We recommend you follow the above procedure to ensure a member of staff is expecting you and available to show you around. If however you wish to simply turn up at the gym, please ensure you present your voucher to a member of the club membership team as proof of eligibility. What should I do if I experience any problems with my health club membership? In the first instance you should report any issues to the Incorpore health club team via to fitness@incorpore.co.uk who will endeavour to contact you regarding your enquiry within the next working day. Alternatively you can report the issue to the Incorpore Customer helpdesk (24hrs) on or contact the Incorpore team directly on (normal working hours only). Important information Simplyhealth will not be held responsible if you experience any delay or failure in the provision of this service that is beyond our, or the service provider s control. Simplyhealth accepts no liability whatsoever should you choose to use, at your own risk, the gym discount or any other products and services offered by the service provider. Please visit for further information about using this service. 13

14 Homeopathy Homeopathy works by using extremely small quantities of drugs that create the symptoms for which the patient is being treated, in order to build up the immune system. You can claim up to 100% of your homeopathic bills, up to your yearly entitlement. There is currently no government legislation in the UK covering homeopathy. This means that anyone can provide homeopathic treatment without any professional training. Until the introduction of compulsory registration for this profession, Simplyhealth will continue to pay claims for treatment from professionals who provide homeopathic treatment. For more information or to find your nearest homeopath contact the following: The Society of Homeopaths Tel: The Homeopathic Medical Association The British Homeopathic Association The Alliance of Registered Homeopaths Online Health Online Health provides immediate, 24 hour information, guidance and support on a wide range of health and wellbeing issues. Comprehensive information is available on issues such as stress and anxiety, life stage events such as pregnancy, caring for others and separation and divorce. By completing the online health risk assessment you ll discover your health risks and what you can do about them. The recommendations generated will show you how many years you could add to your life. 14

15 Using the website you can also: Check symptoms using the in-depth symptom assessment suite Set personal goals, plan your targets and map your progress Access an encyclopedia full of health information To access this service please visit and login using the details shown below. Access code: Password: This service is provided by a third party. Simplyhealth will not be held responsible if you experience any delay or failure in the provision of this service that is beyond our, or the service provider s, control New child payment When you have a child we ll say congratulations with a cash sum, as long as you ve been with us for at least six months! Optical Whether working with computers or driving a car, everyone should still get their eyes tested regularly. Simplyhealth will give up to 100% money back towards your optician bills, including sight tests, new glasses or contact lenses, up to your annual entitlement. To find your nearest optician visit NHS Direct (England and Wales) (Scotland) 15

16 Osteopathy This treatment provides relief for many disorders of the bones and joints, especially back pain. Treatment includes palpation, manipulation and massage. With Simplyhealth you can claim up to 100% towards osteopathy with an osteopath who is registered with The General Osteopathic Council up to an annual limit. For more information or to find your nearest registered osteopath contact the following: The General Osteopathic Council Physiotherapy If you have a strenuous job, suffer from backache or are a sports enthusiast, you ll appreciate this benefit. Physiotherapy uses physical methods to promote healing. The therapist may use a combination of light, infrared and ultraviolet rays, heat, electric current and manipulation. You can claim up to 100% of your physiotherapy bills up to your yearly entitlement. The physiotherapist must be qualified and registered with the Health and Care Professions Council. For more information or to find your nearest physiotherapist contact the following: Health and Care Professions Council Chartered Society for Physiotherapy

17 Claiming couldn t be simpler There are four types of claim: Claims with receipts Pay your bill to the physiotherapist, dentist etc. as normal. Simplyhealth will only pay claims for treatment provided by registered healthcare professionals Keep your receipt see the receipt requirements below Fill in the Claims with receipts section of the claim form, following the guide on the following pages. Don t forget to sign and date the Declaration section You can make four claims per form, if you need more claim forms or need assistance, please call Simplyhealth Customer Services on Send your claim form and receipt back to Simplyhealth in the reply envelope provided within six months of treatment Receipt requirements A completed claim form is required together with a receipt confirming payment. The receipt must be on official headed paper and show the following: The full name, address and qualifications of the person providing treatment The patient s full name A full description of the treatment given, including dates and amounts settled by the patient Simplyhealth does not accept receipts which have been altered, nor do we accept invoices, card payment receipts or photocopies of any accounts. Please note receipts cannot be returned. New child claims Fill in the New child payment section on the back of the claim form Sign and date the Declaration on the front of the form Send your claim form and your child s birth certificate to Simplyhealth in the reply envelope provided within six months of giving birth There is a six month qualifying period for new child payment. 17

18 Your questions answered When can I claim? You can claim immediately for most benefits. Simply use the claim form provided or request another form by calling us on The exception is New child payment which has a six month qualifying period. Specific terms and conditions apply to the Personal Accident cover. Please see the Personal Accident Policy Document for details. When do my annual benefits start and end? Your annual benefits commence from your policy start date and begin again on your employer s review date each year. Please refer to your enclosed Summary of Cover to find your claiming year details. What is the duration of my cover? The cover under your plan is annual and runs from the policy start date until it is cancelled by your employer or otherwise comes to an end. Does cover continue when I reach 69? Yes, cover doesn t cease when you reach a certain age. You can keep your policy for as long as you wish, however, you cannot increase your cover after your 70th birthday. There are some circumstances where cover will end. Please refer to section 7 of your terms and conditions for full details. Please note that under Personal Accident Protection you are no longer covered for Permanent Total Disability once you reach 66 years of age. How are my claims paid? To make life easier for you, Simplyhealth provides a service which pays your money directly into your bank account, sending you confirmation in the post. If you haven t already given us your bank account details call us on or visit When will I receive money back from my claim? We normally settle claims within a few days. 18

19 What if you ve printed my details incorrectly on my claim form? If any of your pre-printed details on the form are incorrect, please update them clearly in blue or black pen before sending the form back to us. What happens if my personal details change? So that your cover remains appropriate for your needs, it is important that you review it regularly and let us know about any significant changes to your healthcare requirements. Where can I get more information or additional help when making a claim? If you have any queries, please call Simplyhealth Customer Services on who will be pleased to help you. What do I do if I have changed my mind? You have 14 days from receipt of your welcome pack in which to change your mind and receive a full refund from Simplyhealth, provided no claims have been made. Simply call Customer Services on After this period our standard cancellation rights apply please refer to section 7 of the terms and conditions for full details. How do I make a complaint? We aim to provide you with the very highest levels of customer service and care at all times. To maintain this service standard, we have a procedure you can use to raise any concern, complaint or recommendation you have by contacting Customer Services on or writing to Simplyhealth Customer Services, at our registered office address of Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ. We will investigate any complaint and issue a final response. If you are not satisfied with our response, or we have not replied within eight weeks, you have the right to refer your complaint to the Financial Ombudsman Service. Please refer to section 8 of the terms and conditions for full details. 19

20 About us and our insurance services Simplyhealth is a trading name of Simplyhealth Access which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. Our Financial Services Register number is You can check this on the Financial Services Register by visiting the Financial Conduct Authority s website or by contacting the Financial Conduct Authority on We can only provide you with information on our own products and you will not receive any advice or a personal recommendation from us for our health plans. We may ask you some questions to narrow down the product option on which we provide you with information, but you will then need to make your own choice about how to proceed. If you have any questions please call us: from landlines from mobiles am to 8pm weekdays, 9am to 5pm Saturdays or visit us at COM-icHMatters-WB Some mobile networks charge for calls to 0800 numbers. Our 0370 number is free if you have mobile inclusive minutes available. If not it s still no more expensive than calling numbers starting 01 or 02. Simplyhealth is a trading name of Simplyhealth Access, which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. Simplyhealth Access is registered and incorporated in England and Wales, registered no Registered office, Hambleden House, Waterloo Court, Andover, Hampshire, SP10 1LQ. Your calls may be recorded and monitored for training and quality assurance purposes.