Associates Private Medical Trust Guide

Transcription

1 Associates Private Medical Trust Guide Effective from 1 April 2012

2 Welcome to the Honda Associates Private Medical Trust This guide provides an overview of the benefits available to you under your Private Medical Trust, as well as the process you should follow to use them. If you have any questions relating to any aspect of the Honda Associates Private Medical Trust, please call Your Private Medical Trust has been designed by Honda to provide you with fast access to treatment in the event of an illness or injury, supporting the NHS. Your Private Medical Trust is administered by Simplyhealth, a leading medical benefits provider that specialises in managing the corporate healthcare schemes of major organisations. The Honda Associates Private Medical Trust Helpline There is a dedicated Helpline available to make accessing private treatment and the claims process as easy as possible. As there are some healthcare costs that are not covered by your Private Medical Trust, it is important that you contact the Helpline before arranging treatment. If you undergo treatment that has not been authorised by the Helpline, you will have to pay some or all of the costs. When you call the Helpline, you will be asked some questions to confirm your cover, such as: What medical condition are you suffering from? When did your symptoms begin? When did you first see your GP about this condition? What is the name of your specialist/therapist? What treatment has been recommended? When is your treatment due to take place? What are you covered for? Your Private Medical Trust is designed to cover treatment for curable short term illnesses or injuries, known as acute conditions. Your scheme does not cover long term chronic conditions. There are also a number of conditions and treatments which are not covered such as normal pregnancy and child birth, psychiatric conditions and cosmetic treatment, other than as a result of an accident or illness. You must contact the Helpline before undergoing treatment to ensure the cost of your treatment will be covered. If you do not do this, you may have to pay for some, or all, of the cost of your treatment. Call the Helpline before arranging any treatment Helpline Monday to Friday 8 am to 6 pm

3 Table of benefits Benefits payable subject to the terms and conditions and the annual maximum Annual maximum Cash benefit Member contribution In-patient and day-patient treatment Out-patient treatment Other services Overall maximum benefit When elective in-patient treatment is received as an NHS patient without charge 1 Charges made by a private hospital for accommodation and nursing Charges made by a private hospital for: Operating theatre, drugs, dressings, eligible surgical appliances and prostheses used in connection with treatment, physiotherapy, other ancillary charges and diagnostic tests including pathology, X-rays, ECGs and all medical scanning and imaging techniques Oncology including radiotherapy and chemotherapy Fees for consultations and treatment charged by specialists including surgeons and anaesthetists Physicians fees Consultations, treatment, physiotherapy provided by a state registered physio-therapist, chiropractic treatment, osteopathy and podiatry provided by a therapist and diagnostic tests including pathology, radiology, ECGs and ultrasound scans Computerised tomographic and magnetic resonance imaging scans (CT and MRI) Radiotherapy and chemotherapy, including chemotherapy given at home when arranged by a specialist Nursing at home arranged by a specialist for medical reasons following in-patient or daypatient treatment Transport by private ambulance in the UK when medically necessary for the purpose of treatment Contribution towards the completion of a claim form by a GP, if required 25,000 per associate per rolling 12 month period 100 per night subject to an aggregate annual maximum of 2,500 per benefit year 100 per claim The BMI Ridgeway Hospital 2 Other Hospitals 3 Up to a maximum of 235 per day up to the amount shown in the fee schedule 4 up to the amount shown in the fee schedule 4 to an aggregate annual maximum of 13 weeks up to the amount shown in the fee schedule 4 up to the amount shown in the fee schedule 4, subject to an aggregate annual maximum of 575. up to the amount shown in the fee schedule 4, subject to an aggregate annual maximum of 13 weeks up to the amount shown in the fee schedule 4 subject to an aggregate annual maximum of 575 subject to an aggregate annual maximum of 1, per claim form 15 per claim form 1 Emergency treatment is not elective and therefore not eligible for NHS cash benefit. 2 Your Private Medical Trust has specially negotiated rates with the BMI Ridgeway Hospital, Swindon. 3 The limits for using another hospital are applicable if you live within 30 miles of the BMI Ridgeway Hospital but choose to attend an alternative hospital where treatment is available. 4 Fee schedule: Please go to the Healthcare Professionals section of to check fees ahead of your treatment.

4 Cash plan If you are a member of a cash plan, please be aware that you will not be able to claim back the Medical Trust member contribution via your cash plan as a diagnostic consultation. Which hospitals can be used? All treatment should take place at The BMI Ridgeway Hospital in Wroughton, Swindon. However, if you live more than 30 miles away from the BMI Ridgeway Hospital, or treatment is not available at this hospital, then you may use an alternative hospital. Please contact the Helpline for confirmation of this. NHS 4 week waiting period Where an Associate needs to be admitted to hospital for eligible in-patient or day-patient treatment, this will only be funded privately by the Honda Private Medical Trust if NHS admission cannot be made within four weeks of diagnosis. NHS cash benefit If you choose to be treated as an NHS patient for which no charge is made, you may be able to claim a tax free cash benefit for each night you spend in hospital. NHS cash benefit is not payable for emergency admissions. Musculoskeletal treatment As a Honda Associate you have access to fast, convenient treatment through your on-site physiotherapy service. Appointments with an on-site therapist can be arranged through Occupational Health at HUM and you will not require a referral from your GP. If on-site physiotherapy is unavailable to you then Occupational Health may refer you for treatment through Simplyhealth s managed network of physiotherapists. Cover for existing medical conditions All Associates are able to join the Private Medical Trust without the need to declare their medical history. However, Associates registered after 1st July 2005 will not be covered for the treatment of a medical condition for which they have sought medical advice, received treatment, or were aware existed (known as a pre-existing condition) prior to joining. Example Your joining date was 2nd July 2011 and on 27th October 2011 you wished to make a claim for a heart condition, will the claim be accepted? The claim would only be eligible if you were unaware of any previous problems, and did not receive any treatment, medication, tests or advice prior to joining. Call the Helpline before arranging any treatment Helpline Monday to Friday 8 am to 6 pm

5 Private Medical Trust For advice and treatment authorisation telephone the Helpline on (8am 6pm Monday to Friday) Calling the Helpline Contact the Helpline before you receive private medical treatment or if you are unsure of any aspect of your cover. Monday to Friday 8 am to 6 pm Your calls may be recorded and monitored for training and quality assurance purposes. Full details about the Honda Limited Healthcare Plan, including details of your benefits, copies of Plan literature, how to contact Simplyhealth and make a claim, as well as links to other useful websites can be found on the Plan Microsite

6 Please call the Honda Helpline before booking any treatment, if: Your GP refers you for private medical care Your specialist/therapist recommends further treatment or investigations You need to be admitted to hospital You need to make a claim You can also view the complete terms and conditions of your Private Medical Trust, including details of your claim, by registering for Simplyhealth s online service, myplan. To register, dataservices@simplyhealth.co.uk Once registered simply logon to

7 How to use your Healthcare Scheme It is important that you call the Helpline on before you receive any medical treatment you think you may need to claim for. Failure to do so could result in you having to pay the cost of any treatment that is not covered by the Scheme. Where an Associate needs to be admitted to hospital for eligible in-patient or day-patient treatment, this will only be funded privately by the Honda Private Medical Trust if NHS admission cannot be made within four weeks of diagnosis. Be guided by your General Practitioner (GP). They should always be consulted first, except in the case of emergencies, or where you require musculoskeletal treatment which has been authorised by the Helpline If you are suffering from a musculoskeletal injury and think you may need treatment such as physiotherapy: Please seek advice from Occupational Health as you may be able to see an on-site physiotherapist without the need for a GP referral. If your GP refers you for diagnostic tests or to see a specialist/therapist: Ask your GP for the name of your specialist/therapist. Call the Helpline on Member contribution per claim. When you see the specialist: Take the authorisation letter (claim form) with you. If your specialist recommends treatment, diagnostic tests or referral to a therapist: Call the Helpline on prior to arranging treatment. If you need to be admitted to hospital: Call the Helpline on who may arrange for your treatment to be monitored by our clinical care managers. When you leave hospital: You will need to settle any personal expenses such as newspapers, telephone calls, alcoholic beverages or visitors meals. If your specialist recommends nursing at home or out-patient treatment: Call the Helpline on to obtain authorisation. Call the Helpline before arranging any treatment Helpline Monday to Friday 8 am to 6 pm

8 Data Protection Simplyhealth Data Protection Notice Simplyhealth fully complies with the Data Protection Act Full details can be found in your Associate Handbook. Administration of the Private Medical Trust The administrator of the Honda Private Medical Trust is Simplyhealth. Simplyhealth is the trading name of Simplyhealth Administration Services Ltd. Medical information All medical information will be kept confidential. Information will only be given to those involved with your treatment or care, your GP or their agents or any other organisation or individual who may be responsible for meeting the cost of your treatment. Member communication All documents regarding your membership or any claim will be sent to the principal member. Telephone calls Your calls may be recorded and monitored for training and quality assurance purposes. Contact Questions and Complaints We have every reason to believe that you will be totally satisfied with the Honda Private Medical Trust. However should you have any questions or cause for concern relating to your Private Medical Trust or service, please write quoting your full name and your company name, together with full details of your query or complaint, to: The Customer Services Manager Simplyhealth James Tudor House 90 Victoria Street Bristol BS1 6GH Fax: Simplyhealth is a trading name of Simplyhealth Administration Services Limited, registered and incorporated in England and Wales, No Registered office: Hambleden House, Waterloo Court, Andover, Hampshire, SP10 1LQ. Simplyhealth Administration Services Limited is an appointed representative of Simplyhealth Access which is authorised and regulated by the Financial Services Authority. Your calls may be recorded and monitored for training and quality assurance purposes. SP0043/0412