Vhi Dental Healthy, happy smiles that last a lifetime

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1 Jan 2015 Vhi Dental Healthy, happy smiles that last a lifetime Dental insrance at the right price from Ireland s No.1 Health Insrer

2 Smile, yo re covered Never worry abot a trip to the dentist again with comprehensive cover from Vhi Dental. Enjoy cover for rotine treatment inclding check-ps and cleanings as well as great benefits for more costly dental treatments inclding fillings, crowns and root canals. Check-ps covered? Check! Strong, healthy teeth need reglar check-ps. Vhi Dental has the benefits yo need! Hassle-Free Claiming With Dentist Direct Pay yo only have to pay the dentist for the treatment costs which are not covered by yor plan when visiting a Vhi Network dentist*. Never delay treatment again Whether it s a filling, crown, root canal or even an emergency, yo ll have peace of mind knowing yo have cover with Vhi Dental. * Visit vhi.ie/dental for the list of Vhi Network dentists

3 Dental Plan benefits inclde Investigative and preventive treatment - Immediate cover 100% cover for p to 2 rotine and 1 comprehensive dental exam per year 100% cover for 2 dental cleanings per year 100% cover for most x-rays Basic treatment - Covered after 3 months 70% cover for basic treatment, sch as fillings, simple extractions and treatment of gm disease 70% cover for children s treatments, sch as sealants, space maintainers and stainless steel crowns Emergency dental treatment - Immediate cover 100% cover for emergency treatment worldwide once per year Major treatment - Covered after 12 months 50% cover for major treatments, sch as crowns, inlays, onlays and root canals 25% cover for dentres Policy excess of 100 applies 500 annal max on crowns, inlays & onlays Orthodontic benefit - Covered after 2 years Lifetime orthodontic benefit of 500 Policy maximms - Sbject to waiting periods Annal maximm for crowns, inlays and onlays per member per year 500. Annal maximm for all other services per member per year 1,000. This increases to 1,200 after 2 years continos cover, and increases to 1,500 after 4 years continos cover. Lifetime maximm for orthodontic treatment 500. Upgrade to Dental Plan Pls Get all of the great benefits listed above AND cover for dental implants when yo pgrade to Dental Plan Pls! Cover for dental implants applies only where it is as a direct reslt of a dental injry following an accident. This leaflet is issed as a gide only and does not form part of a contract. Terms and conditions apply. Fll details of cover are inclded in the Rles of Membership which yo will receive on joining. Alternatively, yo may reqest a copy of the Rles at any time.

4 Vhi Dental Application form Post to: Vhi Healthcare, IDA Bsiness Park, Prcellsinch, Dblin Road, Freepost, Kilkenny Are yo crrently a Vhi Healthcare member? Yes No If YES, please spply yor policy no. Personal details Mr Mrs Miss Ms Gender M F First name Address Srname Date of birth Occpation PPS no. (mst be completed for application to be processed) Only sed for allowing Tax Relief at Sorce to yor sbscriptions by arrangement with Revene Tel: Mobile Other Grop name Grop nmber Nmber needed for salary dedction (Staff/Personnel/Payroll/Teacher/Other) Level of cover reqired Dental Plan Dental Plan Pls Additional persons to be insred First name/srname Date of birth Relationship Vhi policy no. PPS no. To be signed by the applicant I agree to be bond by the Rles of Vhi Dental*. I declare that to the best of my knowledge and belief the information provided is tre and complete and the applicant has not concealed anything material from the insrers. X Signatre: Date: *Will be sent on registration or may be had, in advance, on reqest Method of payment Throgh yor bank or bilding society To pay by direct debit please complete the SEPA mandate opposite. For office se only S.P.I.N. Date: Policy no.: Comp. by:

5 Yor Details Vhi Membership nmber: Contact phone nmber: address: Payment Option: Monthly Yearly SEPA Direct Debit Mandate Creditor name: Vhi Healthcare Creditor address: Vhi Hose, Lr., Abbey Street, Dblin 1 Creditor identifier: IE46SDD By signing this mandate, yo athorise: (a) Vhi Healthcare to send instrctions to yor bank/bilding society to debit yor accont (b) Yor bank/bilding society to debit yor accont in accordance with the instrctions from Vhi Healthcare. As part of yor rights, yo are entitled to a refnd from yor bank nder the terms and conditions of yor agreement with yor bank. A refnd mst be claimed within 8 weeks starting from the date on which yor accont was debited. Uniqe Mandate Reference (UMR): (to be completed by Vhi Healthcare) Type of payment : Recrring P Cstomer Details (Please complete all reqired fields, marked below *) *Name *Address *IBAN *BIC *Signatre(s) Signed Signed Date D D M M Y Y Y Y Date D D M M Y Y Y Y Yor rights regarding this mandate are explained in a statement that yo can obtain from yor bank. Please send to: Vhi Healthcare, IDA Bsiness Park, Prcellsinch, Dblin Road, Kilkenny. For information prposes only: Vhi Healthcare will notify yo at least 7 days in advance of the first direct debit on yor accont and any time the amont to be debited changes.

6 Dentist Direct Pay Taking the hassle ot of claiming If yo attend a Vhi Network Dentist yo can avail of Dentist Direct Pay. This means that yo only pay the dentist for costs not covered by yor plan. Simply call s before yor dental appointment and we ll arrange it with yor dentist. With Vhi Dental yo can get money back for all of these treatments Check-ps Fillings Crowns Root Canal Treatment X-rays

7 New Vhi cstomers We will contact yo as necessary abot the prodcts yo crrently hold with s. We wold like yor permission to contact yo abot other Vhi prodcts or services. Please indicate yor preferences below. Do phone me abot other Vhi prodcts or services Do /sms me abot other Vhi prodcts or services Don t send me post abot other Vhi prodcts or services Existing Vhi cstomers Yor crrent commnication preferences held for sending yo information abot other Vhi prodcts or services will contine to apply. If yo wish to change these preferences, please contact s at or online at vhi.ie/contact/. Data Protection The information which yo provide to the Vhi Grop ( Vhi ) in this form will be sed within the Vhi grop of companies and by the insrer and their representatives for processing yor application and claims, cstomer services and for the administration of any healthcare related prodcts and services of which yo and any other person on yor policy avail. Data may also be sed for statistical analyses and the detection and prevention of frad. We may share yor data with trsted third parties who process data on or behalf, inside and otside of the Eropean Economic Area. We may also share yor data with other insrers to verify yor cover, and with state bodies as reqired by law. By inclding yor details in this form, yo explicitly consent to Vhi processing yor details for these prposes. Yo also confirm that yo have explained to each person who is inclded on yor policy why we may ask for this information and what we will se it for, and that each person has agreed to this. Yo have the right, sbject to certain exemptions, to access any personal data that we hold abot yo (for which we may charge yo a small fee) and to have inaccracies corrected. If yo wish to avail of these rights, please write to the Data Protection Office, Vhi Hose, 20 Lower Abbey Street, Dblin 1. Vhi s Data Protection Statement contains a frther detailed breakdown of the personal data we collect in relation to or cstomers and how we se that personal data. The Data Protection Statement can be fond at or shold yo wish to contact s on , yo can reqest a hard copy. The Volntary Health Insrance Board trading as Vhi Healthcare is reglated as an intermediary by the Central Bank of Ireland. Vhi Healthcare is tied to Aria Insrance Services Limited for Vhi Dental Insrance. This policy is nderwritten by Great Lakes Reinsrance (UK) PLC.

8 Age Dental Plan annal rates Standard Rate Standard Rate with discont for Upfront Payments % discont off the annal standard rate applies to those who opt to pay the annal premim p-front in one lmp sm. Dental Plan annal rates for Vhi Healthcare members Age Vhi Members Rates Vhi Member Rate with discont for Upfront Payment % discont off the standard annal rate applies for crrent Vhi Healthcare hospital plan members. A frther 10% discont off the standard annal rate applies to those who opt to pay the annal premim p-front in one lmp sm. Dental Plan Pls annal rates Dental Plan Pls annal rates for Vhi members Age Standard Rate Standard Rate with discont for Upfront Payments Age Vhi Members Rates Vhi Member Rate with discont for Upfront Payment VDGenSales4 Rates shown are net of tax relief and are correct from 1st Jan th and sbseqent children* are free *Children are defined as those aged 17 or nder at the time of joining or renewal. Join today! Call or visit vhi.ie/dental

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personal and public liability insurance personal and pblic liability insrance personal and pblic claim report Insrer CGU Insrance Limited ABN 27 004 478 371 CGU Insrance Limited ABN 27 004 478 371 Please keep this page for yor information Abot