1 Private Medical Insurance Flexible medical benefits designed for today's world UK Changing the image of insurance.
2 Quick access to private hospitals... If you were diagnosed with an illness, wouldn't you want quick access to diagnostic tests and advice from the best consultants? Private medical insurance puts you in control over when and where you receive your care. Gain access to quality healthcare at private hospitals throughout the UK
3 APRIL UK Private Medical Insurance Plan Our private medical insurance plan offers a fresh and truly affordable approach to medical insurance by putting you in control. You can design your own bespoke policy to match your needs and budget, by choosing from a menu of comprehensive benefits and discount options. You will have immediate access to the very best medical care at local private and NHS hospitals. What are the key benefits? Gain access to hundreds of private hospitals throughout the UK, including Spire, BMI, Nuffield hospitals, as well as private wings at NHS hospitals. Benefit from high quality patient care from the country s most experienced consultant surgeons and specialists. Cut waiting times - NO NHS waiting lists to contend with. Convenience - see a specialist or receive treatment at a time that suits you. On our plan you will benefit from... Whenever possible, members will enjoy the comforts of a private room offering all the facilities that would normally be expected from a luxury hotel, including, where available, en suite facilities, television, telephone and a relaxed and friendly approach to visiting hours. A wide range of treatments, consultations and tests covered with NO limits on day & in-patient benefits - peace of mind that treatment costs will be covered in full. Important cancer cover - specialist drugs such as Herceptin (breast cancer) and Avastin (bowel, kidney and colon cancer) which prolong and save lives are covered. Some NHS trusts do not provide these drugs. No built-in 'No Claims Discount' - your premiums will never increase just because of your personal claims history. Access to our complimentary range of Lifestyle Benefits: Best Doctors - a highly respected second medical opinion service Discount Portal - helping you save money on everyday shopping and dining. 2
4 What is covered? You can rest assure that all in-patient and day-patient costs which are customary and reasonable will be paid in full. This includes costs for hospital accommodation, nursing care, specialist attention, tests, therapies and operating theatre fees. Please note that there is an aggregate limit of 1m per person per policy year on total benefits payable under this plan. Benefits are payable during the policy period only. FOUNDATION COVER FOUNDATION & LIMITED OUTPATIENT COVER FOUNDATION & FULL OUTPATIENT COVER IN-PATIENT & DAY-PATIENT BENEFITS Hospital Accommodation and Nursing Care PAID IN FULL PAID IN FULL PAID IN FULL Prescribed Drugs and Dressings PAID IN FULL PAID IN FULL PAID IN FULL Operating Theatre Fees PAID IN FULL PAID IN FULL PAID IN FULL Radiotherapy & Chemotherapy PAID IN FULL PAID IN FULL PAID IN FULL Consultations, Radiology, Pathology PAID IN FULL PAID IN FULL PAID IN FULL Diagnostic Tests including MRI/CT/PET Scans PAID IN FULL PAID IN FULL PAID IN FULL Physiotherapy PAID IN FULL PAID IN FULL PAID IN FULL Surgeons, Physicians & Anaesthetists Fees PAID IN FULL PAID IN FULL PAID IN FULL Oral Surgery (non dental) PAID IN FULL PAID IN FULL PAID IN FULL Parent Accommodation PAID IN FULL PAID IN FULL PAID IN FULL Prosthesis PAID IN FULL PAID IN FULL PAID IN FULL OTHER BENEFITS Private Ambulance PAID IN FULL PAID IN FULL PAID IN FULL Home Nursing 13 weeks per policy year 13 weeks per policy year 13 weeks per policy year NHS Cash Benefit 75 per night up to 30 nights per policy year OUT-PATIENT BENEFITS 75 per night up to 30 nights per policy year 75 per night up to 30 nights per policy year Specialist Consultations, Pathology, X-Rays, Diagnostic Tests, Physiotherapy 500 per policy year PAID IN FULL Physiotherapy is limited to 500 per policy year MRI/CT/PET Scan PAID IN FULL PAID IN FULL 3
5 Freedom to pick and choose additional benefits In addition to in-patient, day-patient and out-patient benefits, here are further options to enhance your cover OPTION 1: COMPLEMENTARY MEDICINE This option provides you with access to these alternative therapies. These types of treatment are becoming more and more popular and will provide you with greater choice for your treatment. Acupuncture Chiropractic Care Osteopathy Homeopathy Combined limit of 500 per policy year OPTION 2: HEALTH CASH BENEFITS Free Child Cover If you choose joint cover, your partner and any number of your dependants covered between the age of 3 and 18 will be covered. On single parent, half the benefits will be payable to their dependants. If you are over the age of 65 when the claim is made, half the benefits will be payable. This option provides you with cash benefits when you require selected medical care, including dental and optical attention. Dental Treatment Optical Care Hospital Out of Pocket Cash Maternity Cash Recuperative Care Cash Home Help Cash Serious Accident Lump Sum Accidental Death Lump Sum 150 per policy year 100 per policy year 25 per night 150 per child 350 per policy year 250 per policy year 10,000 lump sum 10,000 lump sum OPTION 3: PSYCHIATRIC BENEFITS This option provides you with access to psychiatric care including consultations, medication and overnight stays in a psychiatric unit. In-patient, day-patient and out-patient cover 8,000 per policy year OPTION 4: EXTENDED HOSPITALS (LONDON) As standard, the vast majority of private hospitals throughout the UK are covered. This option provides access to a handful of exclusive London hospitals. Please see our Hospital List for more details. 4
6 Your cancer benefits explained... Cancer is a real concern for many people. Our Private Medical Insurance Plan provides important cover for you... Comprehensive Cancer cover Whichever level of cover you choose, you will have the peace of mind that many of your cancer benefits will be paid in full with no time limits on treatment during the policy period. That means all your costs that are reasonable and customary will be covered in full and paid for as long as you need it. It's comforting to know that the plan will be there when you need it most for life changing cancer related scans, consultations, drugs and treatment. YOUR OUT-PATIENT CANCER BENEFITS Please note that there is an aggregate limit of 1m per person per policy year on total benefits payable under this plan. Benefits are payable during the policy period only. Consultations & Specialist fees Diagnostic tests and scans - including Bone/CT/MRI/PET scans Cancer drugs & therapy - including Chemotherapy, Hormone Therapies, Transplants, Biophosponates Biological Therapies ('super drugs') Radiotherapy Surgery & Hospital charges Palliative treatment - including side effects and sickness drugs PAID IN FULL PAID IN FULL PAID IN FULL PAID IN FULL subject to pre-authorisation after 12 months PAID IN FULL PAID IN FULL Up to 10,000 during the lifetime of the plan ADDITIONAL CANCER RELATED BENEFITS Wigs External prostheses Up to 100 during the lifetime of the plan Up to 5,000 during the lifetime of the plan 5
7 Helping you beat cancer... Please read the Policy Document which contains more information about our extensive range of cancer related benefits. Every year thousands of people have their lives changed irrevocably by cancer, either through a relative, friend or directly themselves. At APRIL UK we understand the importance of providing effective cancer benefits. Best Doctors - through their expert second medical opinion service, they can: - identify world-leading cancer specialists to review your condition - provide reassurance that your diagnosis is correct and you are receiving the appropriate treatment - where required, help identify alternative specialists, facilities and treatment It s reassurance that you are receiving the support and information to make the right medical decisions. Choice of specialist and hospital - freedom to choose from our extensive list of hospitals and facilities throughout the UK. NO financial or time limit on many benefits - peace of mind that all eligible treatment costs will be covered in full. Access to specialist drugs - drugs such as Herceptin (breast cancer) and Avastin (bowel, kidney and colon cancer) which prolong and save lives are covered. Some NHS trusts do not provide these drugs. 6
8 Additional Lifestyle Benefits Expert second medical opinion service As an APRIL UK policy holder you will receive Best Doctors, an expert medical consultation and secondary opinion service. Best Doctors provides access to the world s best medical experts who can review your diagnosis and get you the right answers about your condition and treatment. Best Doctors has a database of over 50,000 world-leading specialists - rated by their peers as the best in their field of expertise - who can conduct an in-depth review of a medical condition. Best Doctors can ensure the diagnosis is accurate and identify the most appropriate treatment options available. They provide support and information to help people make the right medical choices. The Best Doctors service is provided independently by Best Doctors UK Ltd. It s valuable peace of mind to help you make the right medical decisions 7
9 The APRIL UK Discount Portal Discounts on everyday shopping & dining We ve teamed up with a leading discount specialist to provide you with discounts at over 20,000 sites and locations - both on the highstreet and online. Just some of the big brands included... Through the APRIL UK Discount Portal you will be able to access discounts on the following: Groceries, Clothes, Dining, Electronics, Gym membership, DIY and Travel. Providing that you do not opt out of this service, a company called Logbuy who provide this service, will you with further details once your APRIL UK plan has been set up. The APRIL UK Discount Portal is provided independently by LogBuy Ltd. Brands illustrated correct at February
10 How to reduce your premiums Our excess bonus options are a great way to reduce premiums, whilst providing generous medical benefits What are the excess options? There is no mandatory excess on this plan, however you can choose from 2 excess options to reduce your premiums: Starting at 250 Starting at 500 For every year that you remain claim free, you will be rewarded by a reduction in your excess. If a claim is made, there is no penalty in subsequent years. Instead, you will remain at the same excess level until the next claim free year when you will be rewarded by a further reduction in your excess. The excess is payable per person per policy year. Each person will not have to pay more than once in any policy year, regardless of the number of claims. EXCESS OPTIONS AVAILABLE Starting point Year 2 Year 3 Year 4 Year 5 NIL NIL NIL NIL NIL NIL 250 For every year that you remain claim free you will be rewarded by a reduction in your excess. The above example assumes no claims are made in the first 5 years of cover. If the 500 excess option is chosen the maximum reduction is
11 Transparency & clarity We do not believe in penalising you for using your insurance. This is why we promise that your inspire premium will never increase because of your own claims history Our premiums are NOT claims related to your own claims, providing greater pricing stability. We look to create long term business relationships with all our customers by providing a high quality service and value for money, year after year. It s how we like to do business. Premiums for private medical insurance can go up in-line with medical inflation and your age. This simply reflects the increasing costs of providing your cover. However, some healthcare providers use a claims related pricing method. This can often see your premiums increase substantially if claims are made on your plan. We do not believe in penalising you for using your insurance. This is why we promise that your premium will never increase because of your personal claims history. Even if you were diagnosed with cancer, which could lead to thousands being paid for your hospital treatment and cancer drugs - you would not be charged a higher premium just for this. We find this is a fair and transparent approach to private medical insurance and will help you budget your costs and protect against unexpected premium increases. 10
12 Your underwriting options explained... You have a choice of 3 options... Our plan is designed to cover new medical conditions... Moratorium (ages 16-64) This means any medical issues you have experienced or had symptoms of, at any time in the 5 years prior to the start of cover, will be covered by the plan once you remain 2 consecutive years from the start date completely clear of symptoms, tests or medication for the condition or anything relating to it. Full medical underwriting (ages optional, compulsory) You will complete a medical questionnaire regarding your medical history. Our underwriters will review it and confirm if there are any medical conditions that will not be covered by the plan. Unless stated, all other medical conditions would be covered. Continued Personal Medical Exclusions (ages 16-64) If you wish to transfer your existing plan over to us you can choose this option. We will continue to provide cover for all medical conditions that were covered under your previous policy. However any medical exclusions would also continue to apply. Under this underwriting option you must declare if you have ever suffered from, or are currently being investigated for any type of heart (including hypertension), psychiatric or cancer condition. In addition, you must also declare whether you are currently undergoing or expected to undergo in-patient, day patient or out-patient treatment for any medical condition. We will require your previous medical insurance certificate during the application. 11
13 Some frequently asked questions Can I apply for this plan? How do I make a claim? What isn t covered? You must be between the ages of 16 and 74 inclusive and resident in the UK, Isle of Man or Channel Islands. Simple No Fuss Claiming once referred for treatment by your GP, just call our Claims Helpline where dedicated professionals are available to provide assistance and guidance. Our Private Medical Insurance Plan does not cover you for the following: Children between the ages of 0 and 21 (25 if in full time education) can be covered under a Single Parent or Family plan. Flexible medical benefits designed for todays world... What hospitals are covered? You have the freedom to choose any private or NHS hospital in the UK for your treatment, other than a small number of inner London hospitals. Please see our Hospital List for some of the most frequently used hospitals. If you choose the Extended Hospital option, you will also have access to the additional inner London hospitals. Chronic conditions Pre-existing conditions which have occurred before joining the plan (unless agreed at time of joining) Routine GP visits Normal pregnancy and childbirth Cosmetic surgery Alcoholism, drug abuse and other addictive conditions Regular renal dialysis Self inflicted injury Professional sports injuries HIV, AIDS and related conditions Some types of dental treatment, unless Health Cash Benefit option has been chosen Preventative treatment Please read the Policy Document for full details and exclusions. 12
14 How do I make a claim? It's quick and simple to claim on your Private Medical Insurance plan. 1 Request a claim form 2 Complete claim form As soon as you feel you may want to claim on your Private Medical Insurance plan, contact our claims handler EMR to request a claim form: Complete the claim form as instructed on the first page. Your GP will also need to complete one of the sections Return claim form 4 Assessment Send the completed claim form back to EMR for assessment. This can be done by post or . Your claim will be assessed by EMR and you will be notified of the outcome. 5 Go for treatment Subject to acceptance - consultation or treatment can take place and the invoice goes directly from the hospital/consultant to EMR. 13
15 Contact us... Claims helpline (EMR) Call this number once you have been referred by your GP. Open Monday - Friday, 8am - 5pm (charged at local rate, may cost more from mobiles) Customer services (APRIL UK) All calls will be answered by a person within 3 rings. Open Monday - Friday, 9am - 5pm (free from a UK landline, charges may apply from mobiles) UK 14
16 APRIL - changing the image of insurance APRIL UK is part of APRIL, a global insurance provider. They were formed in 1988 and set out to change the image of insurance by putting the customer at the heart of the organisation. Today, APRIL has a market value in excess of 538 million and operate in 37 countries, looking after some 6 million policyholders worldwide. They have consolidated revenues exceeding 657 million and paid out claims totalling 157 million in 2012*. This plan is underwritten by Arch Insurance Company (Europe) Limited. They are part of Arch Capital Group, a global insurance provider who is listed on the US stock exchange with a book value in excess of 3 billion and rated A+ (Strong) for their financial strength by Standard & Poor s. *All figures correct at Cancellation rights If for any reason you are not satisfied with your Private Medical Insurance Plan, you may cancel it within 30 days from its start date for a full refund, provided that you have not made a claim. Extra Protection - The Financial Services Compensation Scheme In the unlikely instance that Arch Insurance Company (Europe) Limited is unable to meet its obligations under the Private Medical Insurance Plan, you will be protected by the Financial Service Compensation Scheme (FSCS). More details about the FSCS can be found on their website: Contact your advisor on: APRIL UK Registered Office: April House, Almondsbury Business Centre, Bradley Stoke, Bristol BS32 4QH - Tel: Fax: Arch Insurance Company (Europe) Limited Registered Office: 6th Floor, Plantation Place South, 60 Great Tower Street, London, EC3R 5AZ. APRIL UK is a trading name of APRIL UK (Insurance Services) Ltd (registered in England No ), who is authorised and regulated by the Financial Conduct Authority, registered number Arch Insurance Company (Europe) Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. The company is registered in England and Wales under registered No PMIBR 05/14 APRIL UK All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of APRIL UK. UK Changing the image of insurance.