My Health Cash Plan for Groups. Group Member Handbook

Transcription

1 My Health Cash Plan for Groups Group Member Handbook

2 My Health Cash Plan for Groups My Health Cash Plan for Groups is a product designed to help you with your everyday healthcare needs. Your company has provided you with this cover as an employee benefit that you can use towards everyday healthcare costs. This guide provides you with information about your My Health Cash Plan for Groups policy, so you can start making use of the benefits of your membership. Please refer to your policy schedule for details of the benefits and policy options chosen by your employer. If you d like a copy of the terms and conditions, containing full details of the benefit terms, conditions and exclusions that apply to your cover then please contact your group administrator. They ll also be able to provide you with a copy of the policy summary. Contents Making a claim 3 My Health Cash Plan for Groups what s covered 4 Further policy benefits 7 Other information 9

3 Making a claim To make a claim on your My Health Cash Plan for Groups policy, simply follow the step-by-step guide below. You don t need to tell your group administrator when you make a claim. Step 1 Check this guide and your policy schedule to make sure you re covered for the treatment you ve received. Step 2 Complete a claim form. You can get a claim form from our claims team by calling , you can download one at or, you may be able to download a copy from your intranet site. Step 3 Return the form to us. You should make sure you have: completed all relevant sections and signed it attached itemised receipts for all the costs you are claiming for (these must be originals, however please take a copy for your own records) had the relevant sections completed by the optician, hospital or GP (if required). We ll process your claim and reimburse you up to the benefit limits of your policy. 3

4 What s covered? The information on the following pages details what s covered under your policy. All benefit limits apply per member, per policy year, unless otherwise stated. A one month qualifying period applies to all benefits, unless otherwise stated. The qualifying period starts from the date you join the policy and benefit cannot be claimed for any treatment received during this time. Please refer to your policy schedule to see which cover and benefit levels apply to you. Dental and optical cover All My Health Cash Plan for Groups policies begin with our dental and optical cover, which we will reimburse you for 100%. Dental and optical cover also works as a combined pot, which means that you can choose how you apportion your benefit each year - from 100% dental to 100% optical or anywhere in between. Reimbursement amount Benefit limit Level 1 Level 2 Level 3 Level 4 Dental and optical 100% Core health If you have only the dental and optical option, the policy includes cover for dental and optical costs, the helplines and gym discounts. None of the other following benefits will be available. Please note, the level of cover will depend on that chosen by your company. Please refer to your policy schedule. If your employer has chosen to include core health on your policy, it provides you with a more comprehensive package. We will reimburse you for of treatment available under core health, and it includes services such as stress counselling and GP helplines, as well as gym discounts and prescription charges. Therapies: Physiotherapy Osteopathy Chiropractic Homeopathy Acupuncture Prescriptions and GP charges Benefit limit Reimbursement amount Level 1 Level 2 Level 3 Level Health screens Available for one screen every two policy years 12 month qualifying period Paid for each baby Baby bonus month qualifying period GP helpline 4 Stress counselling helpline Unlimited number of calls (qualifying period does not apply) Unlimited number of calls. This benefit is available to members aged 16 and over. (qualifying period does not apply)

5 GP charges Available for one screen Health screens every two policy years Benefit limit Reimbursement amount 12 month qualifying period Level 1 Level 2 Level 3 Level 4 Therapies: Paid for each baby Baby bonus Physiotherapy Osteopathy 10 month qualifying period Chiropractic GP helpline Unlimited number of calls (qualifying period does not apply) Homeopathy Acupuncture Unlimited number of calls. This benefit is available to members aged 16 and over. Stress counselling helpline (qualifying period does not apply) Prescriptions and GP charges Up to 25% discount at a nationwide network of health and fitness clubs. Gym discounts (qualifying period does not apply) Please note, this cover is only available Available if your company for one has screen chosen this option. The level of cover will depend on that chosen by your company. Health screens Please refer to your policy schedule. every two policy years month qualifying period Hospital extras and/or health enhance Paid for each baby Baby bonus If your company has selected 10 either month of qualifying these options periodthe following benefits will apply. GP helpline Unlimited number of calls (qualifying period does not apply) Hospital Extras Hospital Stress counselling Extras helpline Unlimited number of calls. This benefit is available to members aged 16 and over. (qualifying period does not apply) Benefit limit Reimbursement amount Up to 25% discount at a nationwide network of health Level 1 Level Benefit and 2 limit fitness clubs. Gym discounts Level 3 Level 4 Reimbursement (qualifying period amount does not apply) In-patient cash benefit 15 per night Level 1 Level 2 Level 3 Level 4 Day-patient In-patient cash cash benefit benefit per per night day X-rays Day-patient and scans cash as benefit a 15 per day private patient X-rays and scans as a Specialist private patient second opinion as a private patient Specialist second opinion Child as a private support patient cash benefit 15 per night Child support cash benefit 15 per night Please note, this cover is only available if your company has chosen this option. The level of cover will depend on that chosen by your company. Please refer to your policy schedule. Health Enhance Health Enhance Benefit limit Reimbursement amount Reimbursement amount Level 1 Level Benefit 2 limit Level 3 Level 4 Chiropody Level 1 Level 2 Level 3 Level 4 Podiatry Chiropody Dietician Podiatry Allergy testing Dietician Allergy testing Please note, this cover is only available if your company has chosen this option. The level of cover will depend on that chosen by your company. Please refer to your policy schedule. 5

6 What s not covered The following exclusions apply to your My Health Cash Plan for Groups policy: GP charges War and hazardous substances We don t cover you for treatment or tests required as a direct or indirect result of: war (declared or not), military, paramilitary or terrorist activity (such as the effects of radiological, biological or chemical agents), or We don t cover you for any charges for the completion of a claim form, or for proof of GP referral. Other insurance We don t cover you for any benefits where a claim has already been paid under another cash plan or insurance policy of any kind. use, misuse, escape or the explosion of any gas or hazardous substance (such as explosives, radiological, biological or chemical agents). Overseas treatment We don t cover you for treatment or tests received outside the UK (other than provided under the dental cover). Qualifying period We don t cover you for any treatment received in the first month after you join the policy. In addition, a 10 month qualifying period applies to the baby bonus and a 12 month qualifying period applies to health screens. Sport professional sports We don t cover you for treatment of an injury sustained whilst training for or taking part in a sport for which you re paid or sponsored (unless you receive travel costs only). Unsupported claims We don t cover you for any benefit where we ve not received a fully completed claim form and original receipts where required. 6 J3429-GEN indd 6 21/08/15 5:50 pm

7 Further policy benefits As part of your My Health Cash for Groups policy, you get access to two helplines and a range of health and fitness club membership discounts on a nationwide network of health and fitness clubs. GP helpline Calls may be recorded and/or monitored. We provide a 24 hour, 365 days a year GP helpline to assist you with your healthcare queries. When you need medical advice or information, you can simply call our GP helpline at any time, day or night. In the event of illness, you may speak to a GP who ll give you a consultation over the telephone. This service will benefit you in different ways. If you re feeling ill at work but have busy working schedules you can call for advice and a consultation, rather than waiting for an appointment to speak to your own doctor. If your children are unwell at night you need not wait until the next morning for GP advice. Stress counselling helpline Calls may be recorded and/or monitored. Stress is a growing cause of employee absence. Occasionally everyone feels stress from the pressures of everyday life. We may feel that we cannot cope and need some help to deal with our problems. That s why we ve a 24 hour stress counselling helpline, available to you 24 hours a day, 365 days a year with experienced counsellors providing general counselling as well as advice and information on how to overcome stress. This benefit is available to members aged 16 and over. You can call our stress counselling helpline at any time, day or night. You can talk for as long as you wish and there ll be no pressure to bring the call to an end. The counsellors are always ready to listen, help and advise when things seem too much. There s no limit to the number of calls you may make to the GP helpline and stress counselling helpline and the only cost will be that of the calls themselves. (Calls from UK landlines and mobiles are free). 7

8 Further policy benefits Health and fitness club membership We love looking after your health and wellbeing. After all, when you re fit and healthy, you re far less likely to feel run-down. That s why we ve teamed up with some of the UK s leading health and fitness clubs to offer you up to 25% off gym membership. Aviva Advantages Aviva Advantages gives you a little something extra with your policy, by providing a wide range of offers and discounts for you with partners around the country. We offer discounts on things such as luxury weekend breaks, high street retailers and experience days. To find out more visit and enter your details to find a deal near you. Enter the code HCGLRG to sign up it s as simple as that. Please note, the sign-up process means you ll enter a binding contract, which will include conditions such as minimum term and monthly fees. Please read the terms and conditions relating to your chosen health and fitness club carefully. For more information and to access the offers, visit 8

9 Other information Changes to your details Should your name or address change you should inform your group administrator as soon as possible so they can update us. This will allow us to continue to process your claims without delay. If you leave the company If you leave your company your membership of the policy will cease immediately. Any outstanding claims for treatment received during your policy membership will continue to be processed and you will be reimbursed for any valid claim. If you ve got cause for complaint Our aim is to provide a first class standard of service to our customers, and to do everything we can to ensure you re satisfied. However, if you ever feel we ve fallen short of this standard and you ve got cause to make a complaint, please let us know. Our contact details are: Aviva Health UK Ltd Complaints Department PO Box 540 Eastleigh SO50 0ET Telephone: hccomp@aviva.co.uk We ve every reason to believe that you ll be totally satisfied with your Aviva policy, and with our service. It s very rare that matters cannot be resolved amicably. However, if you re still unhappy with the outcome after we ve investigated it for you and you feel that there s additional information that should be considered, you should let us have that information as soon as possible so that we can review it. If you disagree with our response or if we ve not replied within eight weeks, you may be able to take your case to the Financial Ombudsman Service to investigate. Their contact details are: The Financial Ombudsman Service Exchange Tower London E14 9SR Telephone: complaint.info@financial-ombudsman.org.uk Website: Please note that the Financial Ombudsman Service will only consider your complaint if you ve given us the opportunity to resolve the matter first. Making a complaint to the Ombudsman will not affect your legal rights. 9

10 The Financial Services Compensation Scheme (FSCS) We re covered by the 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. Where you re entitled to claim, insurance advising and arranging is covered for 90% of the claim, with no upper limit. Further information about compensation scheme arrangements is available from: Financial Services Compensation Scheme 10th Floor, Beaufort House 15 St Botolph Street London EC3A 7QU Website: Telephone: or Language All documents or letters relating to this policy will be written in English. 10

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12 Need to make a claim? Call us on Lines are open Monday to Friday 9am-5 pm. Calls to and from Aviva may be monitored and/or recorded. Any questions about your policy? Call us on Lines are open Monday to Friday 9am-5 pm. Calls to and from Aviva may be monitored and/or recorded. GP helpline 24 hours a day, 7 days a week Stress counselling helpline Retirement 24 hours a day, Investments 7 days a Insurance week Health This benefit is available to members aged 16 and over Retirement Investments Insurance Health Retirement Investments Insurance Health Retirement Investments Insurance Health Retirement Investments Insurance Health Aviva Health UK Limited. Registered in England Number Registered Office 8 Surrey Street Norwich NR1 3NG. Authorised and regulated by the Financial Conduct Authority. Firm Reference Number This insurance is underwritten by Aviva Insurance Limited. Registered in Scotland, No Registered Office: Pitheavlis, Perth, PH2 0NH. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm reference number Aviva Health UK Limited, Head Office: Chilworth House, Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire, SO53 3RY. GEN /2015 Aviva plc