A guide to Health Select/Health Select 6

Transcription

1 Private healthcare insurance A guide to Health Select/Health Select 6 Put your health first with private healthcare insurance from AXA PPP healthcare healthcare

2 Nothing is more important than your health We all know it s important to keep healthy, and we all do our bit to maintain a healthy lifestyle. But it s also important that if you do fall ill, you can access treatment quickly and feel in control. Why choose AXA PPP healthcare? Private healthcare insurance brings you peace of mind Private healthcare insurance is designed to make you feel secure when you require medical treatment. It makes sure that when you need treatment covered by the plan you will be cared for comfortably, quickly and given a greater choice about where and when you receive treatment. It also offers you flexibility around appointment times, and a choice of expert specialists, consultants and surgeons. If you do need to have hospital treatment, maintaining your privacy during stressful times is of real importance with private rooms usually offering the comfort of en-suite facilities and your own TV and telephone. It s often the little things that our members and those close to them really appreciate when they re in a private hospital; typically from a choice of nutritionally balanced meals to the flexibility of free hospital parking for visitors who are unrestricted by set visiting hours. Choosing the right plan for you will depend on your budget and the level of cover you select to meet your needs but you can be confident that you will receive a high quality of service from AXA PPP healthcare. Member satisfaction It is vitally important that our members are satisfied with the service they receive. That s why 86% of recently surveyed* members are very satisfied with AXA PPP healthcare. Fast Track Appointments Our Fast Track Appointments team gives you prompt access to specialists. We ll find up to three specialists for you to choose from, getting you seen as quickly as possible. Prompt access to our extensive hospital network We have a network of over 250 hospitals throughout the UK and access to over 24,000 recognised consultants and other practitioners. Enhanced support for cancer and heart patients We provide a special Dedicated Nurse helpline for all members who have been diagnosed with cancer or a heart condition. From the moment you are diagnosed, your dedicated nurse will be available to provide you and your family with telephone support, guidance and information. Health at Hand our medical information line is there for you, 24/7 You ll have telephone access to our Health at Hand team of experienced health professionals. They ll be available via our 0800 helpline to answer any questions on your health and wellbeing. Award winning private healthcare insurance Winners of Your Money Best Healthcare Provider for 2012 and *May 13 Oct 13 survey of 303 members.

3 Your plan cover What s included in our Health Select cover? With our Health Select plan you get the core cover Essentials detailed below. You then pick from any of our Add-ons on the next page to tailor your cover exactly how you want to. Benefits Essentials In-patient and day-patient treatment for day treatment and overnight stays in hospital. Hospital charges for treatment in a hospital listed in the Directory of Hospitals. Specialist fees. Diagnostic tests on specialist referral. Cash benefit of 50 each day towards the cost of day-patient treatment and 50 each night towards the cost of in-patient treatment in a hospital not listed in the Directory of Hospitals. Out-patient treatment for treatment that does not require a day or overnight stay in hospital. Surgical procedures. Active treatment of cancer including charges for radiotherapy and chemotherapy. Computerised tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) on specialist referral in a scanning centre listed in the Directory of Hospitals. Additional benefits providing you with extra support and care. Day-patient and out-patient NHS radiotherapy and chemotherapy cash benefit of 50 a day up to 2,000 year. Parent accommodation for one parent to stay with a child under 16 receiving private treatment covered by the policy. Ambulance transport when medically necessary to transfer you between facilities. What isn t covered? Our plans are not intended to cover all eventualities and are designed to complement rather than replace all the services provided by the NHS. The following show some of the treatments and conditions not covered by this plan. Treatment for medical conditions that existed, or you had symptoms of, before joining (please see page 8). Ongoing, recurrent or long term treatment of long term illnesses, also known as chronic conditions. Routine pregnancy and childbirth Any treatment costs that are a result of engaging in or training for any sport for which you receive a salary or monetary reimbursement, including grants or sponsorship (unless you receive travel costs only) Charges when treatment is received at a facility not listed in our Directory of Hospitals. 2

4 Choose your Add-ons If you d like more out-patient cover there are three levels available. Please choose only one of these. Core out-patient Cover for up to two specialist consultations each year and no yearly maximum for diagnostic tests on specialist referral. Enhanced out-patient 1,000 combined overall entitlement each year for specialist consultations, diagnostic tests on specialist referral and practitioner charges including dieticians, nurses, orthoptists and speech therapists. Full out-patient No yearly maximum for specialist consultations, diagnostic tests on specialist referral and practitioner charges including dieticians, nurses, orthoptists and speech therapists. Therapies 1,000 combined overall entitlement each year for therapists (physiotherapist, osteopath and chiropractor), acupuncturists and homeopaths charges. You can claim for a maximum of ten sessions each year for GP referred treatment. Any further therapist, acupuncturist or homeopath treatment must be under the control of a specialist. Dentist and Optician Cashback Dental care covers 80% of the costs up to a maximum of 300 a year. Optical cover covers 80% of the costs up to a maximum of 140 a year for prescribed glasses and contact lenses. Plus up to 25 towards an eye test each year. Extra Cancer Cover Drug treatment is extended to include cover for as long as the drug is being used within the terms of its licence. Experimental drug treatment is covered if it is agreed with us in advance and is part of an ethically approved clinical trial. This benefit includes specialist consultations and diagnostic tests that are directly related to your cancer treatment. Out-patient specialist consultations and diagnostic tests directly related to your active cancer treatment won t affect any out-patient treatment limits that may apply on your plan. We also pay for additional expenses to support you during your active treatment of cancer. For example, we help towards the cost of wigs, external protheses and we also make a donation to your hospice if you need end-of-life hospice care. Mental Health Cover for in-patient, day-patient and out-patient treatment of mental health conditions including stress and depression. Also includes cover for out-patient psychologists and cognitive behavioural therapists treatment charges. Extra Care Hospital at Home full cover for the cost of a nurse to give you intravenous chemotherapy for the treatment of cancer or antibiotics in your own home where clinically appropriate. NHS cash benefit 100 a night up to 2,000 a year. Oral surgery paid in full for treatment of certain operations. Chiropody charges up to 150 a year. Travel Cover This provides cover towards the cost of emergency medical treatment abroad. The Travel Cover Add-on has the major benefits of other travel insurance plans such as medical costs, additional expenses and delayed departure. Please refer to the Travel Cover Membership Handbook for further information. Special offer Get the Extra Care Add-on free when you purchase Therapies and Mental Health Add-ons. Depending on your medical history some of the Add-ons might not be available. 3

5 Ways to reduce your subscription The 6 week option This option is a great way to save up to 25% on your subscription yet still avoid long NHS waiting times. The 6 week option means that if in-patient or day-patient treatment or any operation is available on the NHS within six weeks from the date it should take place then you will use the NHS. However, if the wait for treatment is longer than six weeks then you can go private straight away. Excess levels You have the option of including an excess to reduce your subscription. If you choose to have an excess, the minimum excess is 100. This means you will pay the first 100 of eligible claims but only once per membership year for each person covered. To reduce your subscription further you can add an excess of 250, 500 or 1000*. * 1,000 excess is not available with the Core out-patient Add-on or the Enhanced out-patient Add-on. No Claims Discount (NCD) There are 12 steps of No Claims Discount (NCD), from 0% to 65%. When you join we will tell you the NCD level to which you are entitled. If you don t make a claim you will be entitled to a further discount each year, up to 65%, see below. However, if you make a claim your discount will drop for that year. How to protect your NCD If you need to make a claim, you have the option of paying for treatment yourself, and keeping your no claims discount. You might choose to do this if your claim is small. If you or anyone on your plan chooses to make a claim, the level of discount for that person drops by three levels. But it will go up again by one level if that person doesn t make a claim for the following year. No claims discount steps Discount 10% 20% 27.5% 35% 40% 45% 50% 55% 57.5% 60% 62.5% 65% Level

6 Already have private health insurance? Switching is easy You can transfer your existing cover from another health insurer with just one phone call. We understand that comparing cover between private medical insurers can be difficult. So whether you re looking to match your previous cover or need to discuss a more affordable subscription, your options will be explained. Private healthcare insurance covers you for new conditions that arise after you join but there are occasions where you could be covered for existing conditions. You ll be asked a few additional questions and we will let you know what options are available to you. 93% of all new members surveyed said they were extremely or very satisfied with the overall ease of joining AXA PPP healthcare.* *Source: Feedback from 303 members surveyed between Apr 13 Oct 13. It s quick and easy to switch to AXA PPP healthcare. Simply call: Monday to Friday 9am to 8pm. 5

7 Keeping you well informed Health information The innovative health information section of our website is constantly being updated with the latest health news and medical information. There are lots of tasty, healthy recipes for you to try and you ll also have access to over 900 medical fact sheets. It s your own health resource on hand 24 hours a day! Health centres If you are concerned about a specific condition, such as heart disease or cancer or want to find out about childhood illnesses, then you ll really appreciate the condition specific centres on our website. You ll find videos of members experiences, lifestyle articles, advice from our experts and plenty more to help support you or a family member before, during and after treatment. We have regular live chats online with a variety of experts, so if you need to get a quick answer to a problem, then simply join in it s free. If you cannot make one of the live chat sessions, then you can post a question online and one of our panel of experts will respond, usually within 24 hours. You can also sign up for our monthly e.newsletter so you can keep up to date with the latest news and live chat reminders. Superb service from start to finish. 100% every time from phone call to advisers to treatment received to claim settlement. Keep up the good work. Cheshire 6

8 Keeping you well looked after Our Personal Advisers are at your service when you need to claim AXA PPP healthcare s highly skilled team of Personal Advisers based in the UK are on hand ready to help you: Understand the full benefits of your plan Give you guidance when arranging treatment Complete a claim form (if required) Confirm claims have been paid Their job is to make life easier for you so that you can focus on getting better and making a full recovery. Health at Hand medical helpline Health at Hand is our 24/7 members service designed to give you medical information and peace of mind whenever you need it. Our Health at Hand team includes nurses, midwives, pharmacists and counsellors who are all experts in their field. Nurses and Counsellors: Available 24 hours a day, 7 days a week. Midwives and Pharmacists: Available 8am to 8pm Monday to Friday, 8am to 4pm Saturday, 8am to 12pm Sunday. You can also access all the Health at Hand services if you re abroad on holiday especially useful if you need to source a local English speaking doctor, dentist or optician. They can even provide travel vaccination information before you leave. Dedicated Nurses for members diagnosed with cancer or a heart condition If you are diagnosed with cancer or a heart condition you will have access to our Dedicated Nurse telephone helpline. Our trained nurses will provide you with one-to-one support when you need it. They can provide practical guidance about your condition, explain the treatment options available to you, or offer comfort if you simply need emotional support. Your family can also benefit from the helpline if they have concerns or need guidance about your care. The cancer advice nursing service was absolutely excellent and I was grateful for their support. Bristol 7

9 About your medical cover What is medical underwriting? This is the process where we look at your membership application and decide the terms of your cover. Moratorium underwriting A moratorium is a set period of time during which you will not be covered for treatment for any medical conditions that you had suffered from before you took out the plan. There s no need to provide information about your medical history when you join. For the first two years of membership, we won t cover medical conditions you ve had in the five years before joined, and there are also some other specified conditions that we won t cover. However, as long as you re completely free of any form of treatment or advice for that condition for two years in a row once you join, you will be covered for it in the future within the benefits of your plan. You will be provided with more information about this when you join. How does a moratorium work? Below is an example of a member who had a back operation before joining. Back operation in April 2008 Joined AXA PPP healthcare in March 2009 No cover for back condition for a two year period Now covered from March 2011 for this pre-existing condition as 24 continuous months have passed trouble free of the condition Please note If you are 74 years of age or over, moratorium underwriting isn t available to you and we will ask you to declare your full medical history. For further information, please refer to the range of underwriting options explained in the ABI guide enclosed in your pack. Information on specified conditions If you have the following pre existing condition: Have been diagnosed with diabetes Are currently undergoing treatment for raised blood pressure (hypertension) Are under investigation, having treatment or undergoing monitoring as a result of a prostate specific antigen (PSA) test You will not be covered for treatment for the following specified conditions whatever their cause: diabetes ischaemic heart disease cataract diabetic retinopathy diabetic renal disease arterial disease stroke hypertension ischaemic heart disease stroke hypertensive renal failure any disorder of the prostate 8

10 We invite you to become a member Here are some great reasons to join us n We believe that our private healthcare plans should be accessible to everyone, so we ve developed a range of options to suit a wide variety of budgets n Over 70 years experience providing private healthcare insurance and we now cover over two million members n We offer market leading heart and cancer cover and care n Our Fast Track Appointment team can find you a suitable specialist and book an appointment at a time convenient to you, providing support if you need help looking for a specialist n We ll pay in full for all eligible specialist diagnostic scans including CT, MRI and PET 9 n Most of our call handlers are based in the UK n If your child is on your plan and falls ill, and you need to stay overnight with them in hospital, we will pay for your stay if they are under 16 years old n The NHS continues to be under pressure to meet people s healthcare demands. So it s reassuring to know that we also offer options giving you access to private medical treatment if the NHS can t provide eligible treatment within 6 weeks of when it should take place. This option can reduce your overall price by up to 25%. n As an added extra, we have negotiated discounts for all members, from health assessments to leisure breaks all from carefully selected companies n You will benefit from discounts on other selected products from AXA.

11 Frequently asked questions Here are the answers to some questions we are often asked. If you would like any more information, please call There are so many health insurers in the market, why should I choose AXA PPP healthcare? We re one of the largest UK healthcare companies with over 70 years experience. We want our members to feel confident and secure when they take out our healthcare plans, so our members satisfaction is at the heart of everything we do. Do I have to declare my medical history? No when you join us you can choose to be placed on Moratorium underwriting. This simply means you ll be covered for eligible treatment of new medical conditions that arise after you join. If you are 74 years of age or over when you join, you will be asked to declare your full medical history. Please see page 8 for more information. How often can I claim? There is no limit to the number of times you can claim for new conditions that arise after you join, as long as it is for treatment covered by your plan and is within your plan limits. What is the 6 week option and why should I add it to my plan? This is a way to reduce your subscription. If you have no objection to using the NHS, but worry about long waiting times, then the 6 week option could be for you. If the in-patient or day-patient treatment or operation you need which would normally be covered by your plan is available on the NHS within six weeks of the date treatment should take place, then you ll use the NHS. However, if the wait for treatment is more than six weeks then you can go private straight away. Can you help me if I need medical information? When you join, you will have access to Health at Hand, our around-the-clock medical helpline. We have a wide range of medical professionals on hand to give you information about medicines, pain relief, pregnancy, cancer, stress, menopause, and much more. We also provide a wealth of online services. Do I have to pay for treatment and then claim the money back? No, as we normally receive invoices directly from the specialists or hospitals and settle them directly. How can I be sure that I m covered before I go ahead with treatment? Simply call our team of Personal Advisers with the details of your proposed treatment and specialist. They will confirm if your treatment is eligible so you can go ahead knowing that you are covered. What happens if I have hospital treatment without checking with a Personal Adviser first that it s covered? We would strongly recommend that you get authorisation for your proposed treatment before you go ahead, to make sure that it is covered. However, if you don t get authorisation we will pay for the claim provided it is eligible under the terms of your plan. 10

12 Choose AXA PPP healthcare: because not all health insurance is the same Trust your future health and wellbeing to experts: we have over 70 years experience in the provision of private healthcare insurance and now cover over two million people. Our Fast Track Appointments team makes sure you get seen as quickly as possible. You ll have the choice of up to three specialists and we can book your appointment for you. Call today for immediate cover on and become a member today. Our lines are open Monday to Friday 9am to 8pm. Calls may be recorded and/or monitored for quality assurance, training and as a record of the conversation. PB52236/04.14 DIRECT Telegraph Media Group Limited (TMG) are an Introducer Appointed Representative of AXA PPP healthcare limited. AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL. AXA PPP healthcare Limited. Registered Office: 5 Old Broad Street, London EC2N 1AD, United Kingdom. Registered in England No Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. AXA PPP healthcare We may record and/or monitor calls for quality assurance, training and as a record of our conversation. healthcare