Guide to Private Medical Insurance

Transcription

1 Guide to Private Medical Insurance

2 Contents About the Exeter 4 Why private medical insurance? 5 Product highlights 6 Cover and benefits 10 Getting the right premium 15 How to apply 16 Claims overview 21 Further information 22

3 Welcome to Private Medical Insurance by The Exeter There s nothing more important in life than your health. By choosing private medical insurance, you re choosing not to compromise on the speed, quality or comfort of your healthcare. By choosing The Exeter, you re in the safe hands of a mutual insurer that combines market-leading cover with an efficient, personal service. Private Medical Insurance 3

4 About The Exeter At The Exeter, we re passionate about private medical insurance and the important role it can play in securing your long term health. Over half of our members have been with us for more than 10 years, a statistic which is the envy of many of our competitors. There are some good reasons why people stay loyal to The Exeter. Our plans are designed to deliver, our customers are not penalised for using their policies. When you call The Exeter, you talk to a real person at our UK office, first time, every time. We provide membership benefits that provide you with valuable reassurance in addition to our core cover. We paid 99% of private medical insurance claims in the true test of any insurance. We re consistently recognised in the industry for our product and service excellence, winning numerous awards. 4

5 Why private medical insurance? Private medical insurance is designed to give you quick and convenient access to quality private medical facilities with the highest levels of cleanliness. By choosing private medical insurance, you are getting reassurance that you and your family are in the best possible hands if your health takes a turn for the worse. Beat the queues For consultation and diagnosis, for admission and a bed. Respect and dignity Private hospitals scored 99% for respect and dignity in the 2013/2014 State of Health Care report by the Care Quality Commission. Hundreds of hospitals You re rarely more than a short journey away from quality care, at a location you choose. Home comforts All private hospitals have private rooms and en-suite facilities, offering privacy and comfort. There s nothing more important in life than the health of you and your family. Choose private medical insurance today and: Get access to quality, comfortable and cutting edge private facilities Be in control of your own appointments, arrange consultations and treatment at times that suit you Be confident in the knowledge that you won t have to wait for the treatment you need Get access to types of treatments and drugs that may not be available on the NHS. Private Medical Insurance 5

6 Product highlights We offer a range of products and options to suit every budget and need. In patient and day patient treatment Our range of comprehensive plans all include unlimited cover for in patient and day patient treatment - unlike some insurers who impose time or financial limits that might leave you out of pocket after a claim. After an in patient stay, any drugs or medical aids taken home from hospital to help your recovery are always covered with The Exeter. Cancer cover Cancer cover is one of the most reassuring aspects of having private medical insurance. So, with The Exeter you will either have unlimited cover for cancer included as standard or have the option to include unlimited cancer cover as part of your policy. No penalty for claiming We don t employ no claims discounts on any of our private medical insurance plans. The result is cover that you can use safe in the knowledge that we will never increase your premiums as a result of any claim you make - regardless of its length or cost. 6

7 Hospital lists Each of our plans has just one hospital list, detailing over 300 NHS and private hospitals throughout the UK that you have access to with your cover. The result - you can visit a hospital that offers the very best treatment and procedures for any particular claim. Unique underwriting option We have a full range of underwriting options. So whether you re new to private medical insurance or switching from another insurer, you can choose the right options for your circumstances. Our fixed moratorium underwriting option gives you a unique way to apply. For the lowest monthly premiums apply through our Full Medical Underwriting option. Please see How to apply on pages for more details. Health discounts Your premiums will be 20% cheaper if you are a non-smoker and have a healthy body mass index (BMI). If only one of these discounts applies, your premiums will still be discounted by 10%. Hospice donation We make a donation of 250 to your hospice if you are admitted for care. We know the vital role that hospices play for people later in life and we think it s only right that we support them. Private Medical Insurance 7

8 Additional benefits All of our plans offer a range of additional benefits as standard which provide you with increased care, support and flexibility. Health Cover for Me Health Choices for Me Health Essentials for Me Private ambulance Medically essential travel to, between or from hospital in a private road ambulance in connection with inpatient or day-patient treatment. Home nursing Home nursing following authorised in-patient & day-patient treatment. Parental accommodation (children up to 18) You can stay in hospital with your child (up to the age of 18) if they are having treatment under the policy. NHS Cash benefit 250 per night Paid if you have free in-patient treatment under the NHS that would be covered under your policy. 8

9 Focus on cancer cover We know how important offering quality cancer cover is, which is why we have focused our energy getting our cancer cover right. We were one of the first private medical insurers to offer truly unlimited cover for cancer. We re proud of a benefit which delivers when our members need it most. We ve gone into full detail of what is included in the table below but it is important to also highlight a few crucial features: Our unlimited cancer cover includes: Cover for all clinically approved chemotherapy, even if the NHS has rejected a drug on the grounds of cost. No limits to cover, including NICE approved treatments such as biological and hormonal therapy Stem cell and bone marrow transplants. Treatment Place of treatment Surgery Drug therapy Radiotherapy Palliative End of life care Monitoring Limits What does this include? Treatment in hospitals and at home if you need to have chemotherapy. Surgery including the removal of a tumour and consequent reconstructive surgery that you need. All types of drug therapy for your cancer, including chemotherapy & drugs to maintain any remission, providing they have received NICE approval for clinical effectiveness. Radiotherapy including when it is given for pain relief. Palliative treatment of cancer. Treatment of terminal cancer. Follow up reviews related to the continuing care of your cancer. We do not place a time or financial limit on your cancer cover. Unlimited cancer cover comes as standard on Health Cover for Me and is a choice on Health Choices and Health Essentials for Me. If you select Health Choices for Me or Health Essentials for Me, the cover you have will be impacted by the choices you make in setting up your policy. Take a look at the individual product s Policy Document for more information. Private Medical Insurance 9

10 Cover and benefits We know that one size of cover doesn t suit everyone, so at The Exeter we offer a range of plans and options to suit different budgets and needs. Comprehensive cover Give you peace of mind that you have private medical treatment covered, whatever life throws your way. We have two comprehensive plans: Health Cover for Me Has one simple theme, if it s covered in our fee schedule there are no financial or time limits to the amount we will pay at claim. The result is total confidence and reassurance in having the flagship plan from one of the UK s leading healthcare insurers. Health Choices for Me Is modular private medical insurance that lets you build the right cover at a premium that works for you. Where some modular plans give you a vast array of confusing choices, Health Choices for Me keeps it simple, giving you confidence in your cover. Treatment insurance A new approach to private medical insurance, we have one plan which is focused on cover for treatment. Health Essentials for Me Covers the cost of treatment, including the big medical bills that are hard to budget for but without the big premiums to match. Health Essentials for Me is a unique, innovative approach to cover - an approach that is designed to limit your premiums, without giving you a policy with too many financial or time limits on cover. 10

11 Comprehensive cover Our comprehensive plans enable you to have full cover from diagnosis to scans, test to treatment, with coverage for all stages of cancer and manipulative treatment. If you want full cover it is always unlimited on our Health Cover for Me plan. However, if you want to add and remove options, or put in place financial limits, then look at Health Choices for Me. This enables you to tailor your cover to get the right price and coverage for your needs. The coverage you get, at any hospital on our hospital list, and the options you can take are set out in 4 key areas: Essential Cover In Patient & Day Patient Treatment, including consultant & specialist fees, diagnostic tests as an in-patient or day-patient, pre-admission tests and hospital charges, including any necessary medical aids and take-home drugs. CT, MRI and PET Scans including professional fees where appropriate. Health Cover for Me Unlimited Health Choices for Me Unlimited Out-Patient Including consultant & specialist fees, diagnostic tests such as X-rays, ECGs and pathological tests. Health Cover for Me Unlimited Health Choices for Me Unlimited 1,000 per year 500 per year No cover Cancer cover Extends the scope of benefits under Essential Cover (such as surgery and scans) to include treatment for diagnosed cancer and adds unlimited benefit for oncology and specialist consultations for cancer. Health Cover for Me Unlimited Health Choices for Me Unlimited No cover Manipulative Treatment Includes costs for physiotherapy, osteopathy, podiatry and chiropractic treatment received as an out-patient. Health Cover for Me Unlimited Health Choices for Me Unlimited 300 per year No cover Private Medical Insurance 11

12 Treatment insurance Health Essentials for Me is a new type of Health Insurance. It enables you to protect yourself against the big costs of treatment, without having to pay the premiums that come with more comprehensive private medical insurance. If you want the reassurance that potential large costs of treatment are covered, but are happy managing the smaller costs yourself or utilising the NHS, Health Essentials for Me could be the policy for you. How does it work? It is very simple: You visit your GP, who may refer you to a specialist to establish a diagnosis. This can take place within the NHS, or by paying yourself for a private consultation and tests. Once you have your diagnosis, if you need treatment, you contact The Exeter. We cover all eligible treatment at any hospital on our hospital list. What is covered? The key elements of your treatment coverage are listed below: In-patient and day-patient Treatment Post-diagnosis CT, MRI & PET Scans Out-patient surgery Post-operative Physiotherapy Consultant & specialist fees, diagnostic tests as an in-patient or day-patient, pre-admission tests and hospital charges (including any necessary medical aids or take-home drugs). CT, MRI or PET scans, ordered by a specialist to further determine or assess your condition after an initial diagnosis has been made. Includes professional fees where appropriate. Surgical procedures performed by a specialist, including any necessary medical aids or take-home drugs. Up to 3 sessions of post-operative physiotherapy as an out-patient following in-patient or day-patient surgery. Cancer cover With Health Essentials for Me you have the option to add unlimited cancer cover to your policy. This extends the scope of benefits under core cover (such as surgery and scans) to include treatment for diagnosed cancer and adds unlimited benefit for oncology and specialist consultations for cancer. 12

13 Membership benefits Whichever plan you choose, as a customer of The Exeter, you will also have access to a number of important membership benefits to make your life easier when it comes to accessing primary care. For some people getting an appointment to see their GP, or simply accessing expert health advice can be a frustrating and lengthy process: 5.8 million patients visit A&E because they cannot get a GP appointment. Over 30,000 calls were made to the NHS 111 service in England each day in June million patients wait 1 week or more for an appointment. 40% of patients are unhappy waiting 10 minutes on the phone to book an appointment. Our current membership benefits, provided by Medical Solutions - an expert in their field, are designed to bring you into more convenient contact with healthcare professionals and give you more convenient access to prescription drugs. These benefits are there for your convenience but it s important to note that they are advisory only and cannot be used as evidence for your claim. GP Helpline Gives you free, unlimited access to a large team of practising GPs, providing information and advice about your health concerns or those of your family. You have the option of a telephone or webcam consultation. Private prescription service During your GP Helpline consultation, your doctor may offer you a private prescription. This service provides a simple way of getting private prescription medication delivered to your home or office without the hassle of waiting for an appointment or taking time off work. Private Medical Insurance 13

14 Exclusions We ve tried to keep our exclusions to a minimum but there are things that we re unable to cover. We ve listed significant exclusions on our products below for a full list take a look at the individual product s Policy Summary or Policy Document. Pre-existing conditions Pre-existing conditions will either be excluded from cover altogether or excluded for the moratorium period of your policy. Emergency treatment Emergency treatment is dealt with by the NHS. You are not covered until you are transferred to private facilities and you have authorisation from us. Ongoing or long term conditions (chronic) We ll pay for the treatment needed to stabilise the condition however we won t pay for the treatment once it has been stabilised. Please note, we do not consider cancer as a chronic condition. Specialist fees in excess of those on our Fee Schedule We publish a schedule which sets out the maximum fees we pay specialists for the treatment they provide to you. Our most up-to-date schedule can be found on our website. Health Essentials for Me only Outpatient treatment, consultations, tests or scans, prior to an initial diagnosis. We do not cover any treatment, consultations, tests or scans received as an out-patient with the purpose of establishing an initial diagnosis. 14

15 Getting the right premium Calculating your premium There are a number of factors that influence your premium: The ages of everyone included on the policy Your address Whether you add a voluntary excess The underwriting option you choose Your height and weight Whether you smoke. The product and cover options you choose Voluntary excesses Each of our plans includes a compulsory excess of 100 per person, per policy year which will be deducted from eligible benefits on your policy. You can choose to add a voluntary excess to this compulsory excess to save you money each month the higher the excess, the lower your premiums will be. The total excess (voluntary excess plus compulsory excess) then applies individually to each person to be covered by your policy in each policy year. If there are multiple claims or conditions for one person within one policy year, then the total excess is only deducted once. Please note that Health Choices for Me does not offer a 500 or 1,000 voluntary excess. Your options are: Voluntary excess Nil Your costs per policy year You have to pay the first 100 of eligible treatment costs for each person covered by your policy each year 100 You have to pay the first 200 of eligible treatment costs for each person covered by your policy each year 250 You have to pay the first 350 of eligible treatment costs for each person covered by your policy each year 500 You have to pay the first 600 of eligible treatment costs for each person covered by your policy each year 1,000 You have to pay the first 1,100 of eligible treatment costs for each person covered by your policy each year Private Medical Insurance 15

16 How to apply Once you ve chosen your plan and, where applicable, personalised your cover, you then need to decide on the underwriting option best suited to your needs. Underwriting options You have a choice of how to apply for cover, depending on the product you select. These are described in more detail on pages Health Cover for Me Health Choices for Me Health Essentials for Me Full Medical Underwriting Standard moratorium Fixed moratorium Continued Personal Medical Exclusions Continued moratorium To apply for our products: You must be a resident in the UK You must be aged between 18 and 79 inclusive. Some of our underwriting options have lower maximum ages, see pages for details. Children from 3 months old to 21 may be included on their parent s policy. Note for Health Cover for Me and Health Choices for Me Children under 25 if still in full time education may be included on their parent s policy. Children aged 5 years and under are covered for free. 16

17 If you are new to private medical insurance If you don t currently have a private medical insurance plan, we ve outlined the ways you can apply on this page. The option that s best for you will depend on your circumstances and needs. If you choose full medical underwriting, your premiums will be cheaper. Full Medical Underwriting Choosing Full Medical Underwriting gives you our best price and certainty of your cover. If you choose this option, you will need to complete a full medical declaration, including details of the medical history of all family applicants. Any preexisting conditions will be excluded unless we agree to accept them. Standard Moratorium Our Standard Moratorium is common to most medical insurers. If you choose this, you will not have to provide full medical details with your application, but if you make a claim we may request information from your GP to determine whether the condition was pre-existing or not. Benefits will not be available for treatment of any condition suffered by an applicant if: the applicant had symptoms, medication, treatment or advice in connection with that condition in the five years before the start of their policy; and there has not been a clear two year period after the start of their policy during which the applicant has been free of symptoms, medication, treatment and advice in connection with that condition. Any condition in the 5 years before joining is excluded Join us Benefits will start after a clear 2 year period 5 Years Free of previous conditions +2 Years Private Medical Insurance 17

18 Fixed Moratorium Unlike most insurers, we offer a fixed length moratorium. Under this option, benefits will not be available for treatment of any condition suffered if you had symptoms, medication, treatment or advice in connection with that condition in the five years before the start of your policy. However, we will cover a pre-existing condition two years after the start of your policy, even if it has recurred during that two year period. If you apply using Fixed Moratorium, your premiums will be higher. See the diagram below. There are a few rules about who can choose this option: All applicants must be 65 years or younger. All applicants must never have suffered from a heart condition, stroke, cancer or had a joint replacement or joint resurfacing. All adult applicants must never have been diagnosed with diabetes. Any condition in the 5 years before joining is excluded Join us Pre-exisiting conditions will be covered following the moratorium 5 Years 2 Years 18

19 If you are thinking of switching your private medical insurance to The Exeter We have two underwriting options designed solely for you. If you are switching your cover from another insurer and want to maintain your underwriting - we ve outlined both below. The option that s right for you will depend on your circumstances and needs. Remember, you can apply with any of our five underwriting options; if you apply using Full Medical Underwriting, detailed on page 17, your premiums will be cheaper. Continued Personal Medical Exclusions This option is designed to allow you the opportunity to carry across the personal medical exclusions from your existing policy. You will need to provide a certificate from your previous insurer with your application. You will also need to answer a few questions about recent or planned medical conditions or treatment. There are a few rules about who can choose this option: All applicants must be covered by a current policy which has been underwritten based on a full medical declaration All applicants must be 70 years or younger All applicants must never have suffered from a heart condition, stroke, cancer, or had a joint replacement or joint resurfacing All adult applicants must never have been diagnosed with diabetes Your cover with The Exeter must commence the same day your cover with your previous Insurer finishes to ensure continuous cover. Private Medical Insurance 19

20 Continued Moratorium This option is designed to let you continue the moratorium period that applies to your existing private medical insurance policy with another insurer. You will need to provide a certificate from your previous insurer with your application. You will also need to answer a few questions about recent or planned medical conditions or treatment. In line with most other insurers, our continued moratorium works on a two year rolling basis, similar to our standard moratorium option explained earlier in this section. The only difference is that the moratorium period will be from the start date of your current policy, not your new policy with The Exeter. If you have had your current policy for more than two years and have not had a recurrence during that time, we will cover that condition immediately subject to the terms of your policy. There are a few rules about who can choose this option: All applicants must be covered by a current policy which has been underwritten on a moratorium basis All applicants must be 70 years or younger All applicants must never have suffered from a heart condition, stroke, cancer, or had a joint replacement or joint resurfacing All adult applicants must never have been diagnosed with diabetes Your cover with The Exeter must commence the same day your cover with your previous Insurer finishes to ensure continuous cover. 20

21 Claims overview We know that the most important thing for you is how we perform when you need us most - at claim. At The Exeter, we make this process as easy as possible to ensure you can concentrate on what is most important, your health. We pride ourselves on the service we provide at claim. Our experienced team are here to make sure that claims are authorised quickly and without fuss. The process is detailed fully in the each Policy Document, but if you need to make a claim you should always contact us before you go ahead - claims must be pre-authorised with us. To register a claim, call us on We re open Monday to Friday, 8am to 6pm. Private Medical Insurance 21

22 Further information Contacting us Members General enquiries: Claims: Financial Advisers All enquiries: Opening times Monday to Friday 8am 6pm Visit our website Making a claim To register a claim, please contact us. Claims must be authorised by us before you go ahead with any consultations, tests or treatment. Telephone: [email protected] 22

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24 Contact us The Exeter, Lakeside House, Emperor Way, Exeter, EX1 3FD Members General enquiries: Claims: Financial Advisers All enquiries: Calls may be recorded and monitored. The Exeter is a trading name of Exeter Friendly Society Limited, which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Register number ) and is incorporated under the Friendly Societies Act 1992 Register No. 91F with its registered office at Lakeside House, Emperor Way, Exeter, England EX1 3FD. 2015/1081