Saga HealthPlans. Policy Summary

Transcription

1 Saga HealthPlans Policy Summary Super and Super 4 Week Wait Secure and Secure 4 Week Wait Saver Plus and Saver Plus 4 Week Wait Saver and Saver 4 Week Wait Support and Support 4 Week Wait

2 Policy Summary The Policy Summary on pages 2-9 provides a brief description of these Saga Health Insurance policies. It does not contain the full terms and conditions, which can be found in the Membership Handbook. This is available on request by calling or or by downloading a copy online at saga.co.uk/health-insurance. It is important that you read all the policy documentation carefully when you receive it. Who is the underwriter? AXA PPP healthcare Limited is the underwriter for all Saga HealthPlans. How long will my cover last? Your policy is an annual insurance contract and lasts for one year. What do I do if I want to make a claim? If you need to make a claim simply call the Saga Claims Personal Advisory team on Full details of how to make a claim are included in the Arranging treatment and making a claim section in the Membership Handbook. Please note: we may record and/or monitor calls for quality assurance, training and as a record of our conversation. The Financial Services Compensation Scheme In the unlikely event that AXA PPP healthcare becomes insolvent and is unable to pay the benefits under your policy, you are protected by the Financial Services Compensation Scheme (the FSCS). Further information about the operation of the scheme is available on the FSCS website: What if I change my mind? The policyholder may cancel this policy by contacting Saga during the 14 day cooling-off period. The 14 day cooling-off period commences on the day that the contract is concluded or the day that full policy terms and conditions are received, whichever is the later. The 14 day cooling-off period also applies from each renewal date. If the policy is cancelled during the 14 day cooling-off period we will return any premium paid for the policy providing no claims have been made on the policy in relation to the period of cover before cancellation (being no more than 14 days cover). After the 14 day cooling-off period, if the premium is being paid monthly the policyholder may cancel the policy by providing 14 days notice to Saga, providing no claims have been made in the policy year, and we will return any premium paid in relation to any unused period of cover. If the premium is paid annually a pro rata refund of premium will only be made in circumstances where the policyholder dies. 2

3 What should I do if I have a reason to complain? For queries and complaints related to a claim Please contact our Complaints Resolution Department, AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells TN1 2PL.Tel The Complaints Resolution Department will investigate your complaint and respond to you as soon as possible. To allow your complaint to be investigated fully, the Financial Conduct Authority (FCA) gives us up to eight weeks to get back to you. However, we will respond sooner than this if we are able. Financial Ombudsman Service If it looks as though our review of your complaint will take longer than eight weeks, we will let you know the reasons for the delay and will keep you updated. If we cannot respond fully to your complaint within eight weeks, or you are unhappy with our final response, you can refer your complaint to the Financial Ombudsman Service for an independent review. The Financial Ombudsman Service will only consider your complaint once we have issued a final response, or if eight weeks has passed since you first notified us of your complaint. How to contact the Financial Ombudsman Service The Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London E14 9SR By telephone: complaint.info@financial-ombudsman.org.uk Website: financial-ombudsman.org.uk None of these procedures affect your legal rights. 3

4 A summary of the cover we include In-patient and day-patient treatment Saga HealthPlan Super and Super 4 Hospital charges for treatment in a hospital on the Saga Countrywide Hospital List 4 Consultant/specialist fees and diagnostic tests 4 Psychiatric treatment Up to a total of 28 days per year Out-patient treatment Surgical procedures 4 Consultations with a consultant/specialist and diagnostic tests Clinical practitioner charges (including physiotherapy) Complementary practitioner charges Unlimited Unlimited Up to 1,500 per year Cancer treatment, including charges for radiotherapy and chemotherapy 4 CT, MRI and PET scans in a scanning centre on the Saga Countrywide Hospital List Unlimited Treatment of psychiatric illness Up to 1,500 per year Additional benefits NHS cash benefit of 100 per night up to 2,000 per year 4 Home nursing following in-patient treatment covered by the policy (on specialist recommendation) Up to 13 weeks per year Recuperative care following in-patient surgical treatment covered by the policy Up to 1,500 per year, with a maximum of 14 hours of care per week, 30 days per year Ambulance transport (on specialist recommendation) 4 Major dental cash benefit for specified dental procedures Treatment for accidental dental injury Up to 1,500 per year Up to 5,000 per year Overseas evacuation and repatriation service 4 Saga GP Telephone Consultation Service 4 Saga Health Information Line 4 4

5 Saga HealthPlan Secure and Secure 4 Saga HealthPlan Saver Plus and Saver Plus 4 Saga HealthPlan Saver and Saver 4 Saga HealthPlan Support and Support These benefits have a combined limit of 1,200 per year. Additional 400 per year for post-operative physiotherapist and complementary practitioner charges These benefits have a combined limit of 500 per year These benefits have a combined limit of 500 per year and must be related to in-patient or day-patient treatment Unlimited One scan, plus unlimited follow-up scans within 8 months of related in-patient or day-patient treatment One scan before related in-patient treatment, plus unlimited follow-up scans within 8 months of related in-patient or day-patient treatment Up to 13 weeks per year Up to 2 weeks per year Up to 2 weeks per year Up to 500 per year, with a maximum of 14 hours of care per week, 30 days per year

6 What are the key benefits of Saga HealthPlans? Saga HealthPlans offer you cover as a UK resident, for private medical treatment in the UK. They cover new medical conditions that arise after you join and in some cases, depending on your underwriting method, they cover pre-existing conditions too. We offer a comprehensive range of plans as detailed below. What is Saga HealthPlan Super and Super 4? These plans include in-patient and day-patient treatment, associated specialists charges, out-patient surgical procedures, radiotherapy, chemotherapy and treatment of psychiatric illness. In addition, they provide cover for CT (computerised tomography), MRI (magnetic resonance imaging), and PET (positron emission tomography) scans as well as diagnostic tests, out-patient consultations, clinical practitioner and complementary practitioner charges. Specific to Saga HealthPlan Super 4: If the NHS can give you the hospital treatment you need within four weeks of the specialist confirming that it is needed, then you must use the NHS. However, you have immediate access for those operations listed in Our 4-week plans explained opposite, and for radiotherapy or chemotherapy performed as day-patient treatment or out-patient treatment. What is Saga HealthPlan Secure and Secure 4? These plans include in-patient and day-patient treatment, associated specialists charges, out-patient surgical procedures and radiotherapy and chemotherapy. In addition, they provide you with full cover for CT (computerised tomography), MRI (magnetic resonance imaging) and PET (positron emission tomography) scans. There is an additional combined benefit of 1,200 for out-patient diagnostic tests, out-patient consultations, clinical practitioner and complementary practitioner charges, and also an additional benefit of up to 400 of out-patient physiotherapy and complementary practitioner charges, which is available to you following related, eligible hospital treatment covered by the policy. Specific to Saga HealthPlan Secure 4: If the NHS can give you the hospital treatment you need within four weeks of the specialist confirming that it is needed, then you must use the NHS. However, you have immediate access for those operations listed in Our 4-week plans explained opposite, and for radiotherapy or chemotherapy performed as day-patient treatment or out-patient treatment. What is Saga HealthPlan Saver Plus and Saver Plus 4? These plans include in-patient and day-patient treatment, associated specialists charges, out-patient surgical procedures and radiotherapy and chemotherapy. They provide cover for one CT (computerised tomography), MRI (magnetic resonance imaging) or PET (positron emission tomography) scan, even if it doesn t result in in-patient treatment. Unlimited follow-up CT, MRI and PET scans are covered when they are received within eight months following related, eligible in-patient or day-patient treatment or an out-patient surgical procedure. There is also a combined cover of up to 500 a year for specialist consultations and diagnostic tests, clinical practitioner and complementary practitioner charges. Specific to Saga HealthPlan Saver Plus 4: If the NHS can give you the hospital treatment you need within four weeks of the specialist confirming that it is needed, then you must use the NHS. However, you have immediate access for those operations listed in Our 4-week plans explained opposite, and for radiotherapy or chemotherapy performed as day-patient treatment or out-patient treatment. 6

7 What is Saga HealthPlan Saver and Saver 4? These plans include in-patient and day-patient treatment, associated specialists charges, out-patient surgical procedures and radiotherapy and chemotherapy. They provide cover for one CT (computerised tomography), MRI (magnetic resonance imaging) or PET (positron emission tomography) scan before related, eligible in-patient treatment, and unlimited follow-up CT, MRI and PET scans when they are received within eight months following related, eligible in-patient or day-patient treatment or a related out-patient surgical procedure. Also included is cover of up to 500 a year for specialist consultations and diagnostic tests provided such treatment is received before, or within eight months after, related in-patient treatment, day-patient treatment or an out-patient surgical procedure. Clinical practitioner charges and complementary practitioner charges, which are included in the above 500 benefit, must be received within eight months after related, eligible in-patient or day-patient treatment or a related out-patient surgical procedure. Specific to Saga HealthPlan Saver 4: If the NHS can give you the hospital treatment you need within four weeks of the specialist confirming that it is needed, then you must use the NHS. However, you have immediate access for those operations listed in Our 4-week plans explained below, and for radiotherapy or chemotherapy performed as day-patient treatment or out-patient treatment. What is Saga HealthPlan Support and Support 4? These plans include in-patient and day-patient treatment, associated specialists charges and out-patient surgical procedures. Specific to Saga HealthPlan Support 4: If the NHS can give you the hospital treatment you need within four weeks of the specialist confirming that it is needed, then you must use the NHS. However, you have immediate access for those operations listed in Our 4-week plans explained below. Our 4-week plans explained If you choose one of our 4-week plans, you ll be treated by the NHS if the treatment you require is available within four weeks of diagnosis. You can then claim a 100 cash benefit for each night you spend in an NHS hospital. If the NHS wait exceeds four weeks, you ll be treated privately under your Saga HealthPlan. Our 4-week plans offer reduced premiums because you might be treated by the NHS. However, there are nine common conditions for which we always arrange prompt access to private treatment. These are: Cataract surgery n Varicose vein removal n Gall bladder removal n Haemorrhoidectomy n Removal of bunions n Correction of squint n Insertion of grommets n Tonsillectomy n Adenoidectomy. Some other providers do offer an NHS option, but they make you wait six weeks before their private cover steps in. So you re more likely to be treated promptly and privately with Saga Health Insurance. 7

8 Some things we don t cover As with all insurance policies, there are some things that Saga HealthPlans do not cover. The table below shows the main exclusions and limitations that apply to all Saga HealthPlans. The table opposite shows those that apply to specific plans. Main exclusions and limitations of all Saga HealthPlans For more information refer to the following sections in the Membership Handbook Treatment of medical conditions that existed, or you had symptoms of, before joining. On-going, recurrent or long-term treatment of long-term illnesses (usually referred to as chronic conditions ). Routine pregnancy and childbirth. Professional sports injuries In-patient or day-patient treatment or MRI, CT, or PET scans not received in a hospital or scanning centre listed in the Saga Countrywide Hospital List. We pay most consultants /specialists fees in full, but we only pay charges up to the level within the published Schedule of Procedures and Fees. If we will not pay the fee in full we will tell you how much we will pay towards the cost of your treatment from the Schedule of Procedures and Fees. 5: Existing medical conditions 7: Recurrent, continuing and long-term treatment 8: Where you are covered for treatment 9: Who we pay for treatment Existing medical conditions Your cover is restricted for treatment of conditions you had prior to joining. How this applies to your cover will depend on the basis on which you join. Whichever method you join on will be confirmed on your Membership Statement. Further details can be found in the Existing medical conditions section in the Membership Handbook. 8

9 Main exclusions and limitations of specific plans For more information refer to the following sections in the Membership Handbook Saga HealthPlan Super and Saga HealthPlan Super 4 Dental procedures other than the major dental cash benefit or the dental injuries benefit. Saga HealthPlan Secure and Saga HealthPlan Secure 4 Dental procedures Treatment of psychiatric illness Saga HealthPlan Saver Plus and Saga HealthPlan Saver Plus 4 Dental procedures Treatment of psychiatric illness Saga HealthPlan Saver and Saga HealthPlan Saver 4 Dental procedures Treatment of psychiatric illness Out-patient treatment that does not lead to, or is not related to, in-patient or day-patient treatment or an out-patient surgical procedure Saga HealthPlan Support and Saga HealthPlan Support 4 Dental procedures Treatment of psychiatric illness Out-patient specialist consultations, diagnostic tests, clinical practitioner charges (including physiotherapy) Out-patient complementary practitioner charges Out-patient CT, MRI or PET scans Non-surgical treatment of cancer, including charges for radiotherapy and chemotherapy 7: Recurrent, continuing and long-term treatment 9

10 Important information for customers Saga Services Limited is a wholly owned subsidiary of Acromas Holdings Limited and is registered in England and Wales (Company No ). Registered Office: Enbrook Park, Sandgate, Folkestone, Kent CT20 3SE. Saga Services Limited is authorised and regulated by the Financial Conduct Authority. You can confirm Saga Services Limited s address and statutory status on the Financial Conduct Authority website at or by contacting the Financial Conduct Authority on We offer health insurance underwritten only by AXA PPP healthcare Limited. Registered in England, Number Registered Office: 5 Old Broad Street, London, EC2N 1AD. AXA PPP healthcare Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Saga Services Limited and AXA PPP healthcare Limited are covered by The Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Further information about compensation scheme arrangements is available from the FSCS website: Complaints Our customer service commitment to you Saga aims to provide you with high levels of service at all times. However, there may be instances when you feel that service has fallen below the standard you expect. If this is the case and you want to complain, Saga will do its best to try to resolve the situation. Whether you are phoning or writing, please remember to quote your name, address and policy number as it will help your enquiry or complaint to be dealt with quickly. For queries and complaints not related to a claim Please contact the Customer Relations Department at Saga Services Limited, Middelburg Square, Folkestone, Kent CT20 1AZ or call How we handle your money When collecting or returning premiums, Saga Services Limited acts as the agent of the insurer. This means that your money is protected, as any premiums you pay to us are treated by the insurer as having been paid directly to them. 10

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12 This leaflet is also available in large print, audio and Braille. If you require any of these formats please contact us on If you have a hearing or speech impairment, you can also contact us by ing dda@saga.co.uk Saga Services Limited has arranged for its health insurance to be underwritten by AXA PPP healthcare Limited, 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 AXA PPP healthcare Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. CSL-HE0754 November 2013 PM/LE/PS/A5/n13