Welcome to Simplyhealth HEALTH CASH PLANS
We wish you the very best of health and by choosing a cash plan from Simplyhealth it s clear that you do too. This booklet sets out the benefits available to you and what you can claim. In a separate booklet accompanying this one you will also find the terms and conditions which outline exactly what is and isn t covered. At Simplyhealth, we re committed to helping you feel better every day. So if you have any queries or questions we d like you to bother us. Contents Introduction 4 Your table of cover 6 Your benefits in more detail 7 Claiming couldn t be simpler 14 How to fill out your claim form 16 Your questions answered 18 Customer Services 0800 980 7890 www.simplyhealth.co.uk 2 3
Simply covered You can now claim up to 100% immediately on dentist and optician bills as well as up to 75% towards the cost of physiotherapy, osteopathy, chiropractic treatment, acupuncture, homeopathy, chiropody/podiatry 1 and consultations, all up to an annual limit. For example, if you are on the 16.25 per month option, you can claim up to 115 money back towards your dental bills every year. So if a dental bill comes to 50 we ll refund you the total bill, leaving you 65 to use towards other dental fees. If you are an in-patient or a day case on the NHS or being treated privately, we can help cover the cost of everyday bills too. 1 Please note that chiropody/podiatry, hospitalisation and the new child payment are not covered under level 1. We can be bothered Your membership benefits include access to health and wellbeing advice as well as telephone counselling. If you re feeling stressed or would like advice on health or lifestyle issues, call our 24 hour free advice helpline at any time on 0800 975 3345 and talk to one of our trained professionals. Our commitment to you Simplyhealth is here to make life easier for you. It s why we pay claims directly to you usually within a few days. It s why all Simplyhealth customer documents will be sent within five days and it s why we have real people on the other end of the line no answer phones or automated calls. We provide all services from within the UK. Simply flexible The following table shows your annual entitlement for each benefit under each payment option. Please refer to the column which represents your selected monthly payment to see how much you can claim. If you d like to increase your cover, just call us on 0800 980 7890. There are a few things you should be aware of before you increase your payment option. Please see section 4 of the terms and conditions for more information. Simply claim We take the bother out of claiming so you can start right away (with the exception of new child payment and pre-existing conditions under the hospital benefit). Ask for a receipt when you pay for your treatment Send us your completed claim form (enclosing your receipt) within six months of treatment Receive money back from Simplyhealth To make life easier for you, we even pay the funds directly into your bank. 4 5
Your table of cover Your table of cover Level 1 Level 2 Level 3 Level 4 Monthly premium for you 10.85 16.25 21.70 32.50 Monthly premium for you and your partner Payback level 21.70 32.50 43.40 65.00 Monthly premium for up to four of your children under the age of 18 who live with you Free Free Free Free Annual limit for each person Dental Includes check-ups, hygienist s fees, fi llings, dentures, 100% crowns and bridges 90 115 140 190 Optical Includes sight tests and fi tting fees, prescription glasses, sunglasses and contact lenses Physiotherapy, osteopathy, chiropractic, acupuncture and homeopathy Treatment carried out by a qualifi ed practitioner that we recognise Chiropody / podiatry Treatment for your feet carried out by a qualifi ed practitioner that we recognise Diagnostic consultation cover Diagnostic consultations with a specialist, including allergy testing and blood tests Hospital benefit Cash amount for each day or night to help towards everyday expenses if you need to stay in hospital, including day-case, in-patient and parental stay. Preexisting conditions are excluded for the fi rst 12 months New child payment (12 month qualifying period) Single payment for each child that you or your partner give birth to or adopt 100% 90 115 140 190 75% 50 100 150 200 75% - 50 100 150 75% 150 200 300 400 20 days/ nights max per year - 10 15 20 Per child - 100 200 300 Free helpline Your plan gives you access to a free confi dential helpline to advise you on health and lifestyle issues, as well as an over the phone counselling service. This service is available 24 hours a day, 7 days a week and can be accessed by calling 0800 975 3345. European Cover You ll receive these benefi ts for stays up to and including 28 days, on business or pleasure, wherever you are in the EEA and Switzerland. The joining age for this policy is from 18 years old up to 69. If you or anyone on the policy are aged 70 or over you will not be able to increase the level of cover. Premiums include Insurance Premium Tax. For full details of the plan please refer to the Policy Document. dcashplan-post-0412 Your benefits in more detail Here is an easy guide to all the benefits your Simply Cash Plan offers. Please remember that Simplyhealth will only pay for treatment by registered health care professionals that we recognise, where applicable. For more information about exactly what is and isn t covered, please refer to section 2 of the terms and conditions. Acupuncture Acupuncture can be particularly helpful in treating arthritic and rheumatoid pain in joints, chronic muscle strains and sports injuries. It can also help relieve headaches, period pains, allergic symptoms and insomnia. Simplyhealth will pay up to 75% of your acupuncture bills up to your annual entitlement. There is currently no government legislation in the UK covering acupuncture. This means that anyone can provide acupuncture treatment without any professional acupuncture training. Until the introduction of compulsory registration for this profession, Simplyhealth will continue to pay claims for treatment from professionals who provide acupuncture treatment. For more information or to find your nearest acupuncturist contact the following: The British Acupuncture Council Tel: 020 8735 0400, www.acupuncture.org.uk The Acupuncture Association of Chartered Physiotherapists Tel: 01733 390007, www.aacp.uk.com The British Medical Acupuncture Society Tel: 01606 786782, www.medical-acupuncture.co.uk 6 7
Chiropody/Podiatry Chiropody/podiatry deals with the care of the feet. Simplyhealth will pay up to 75% of your chiropody/podiatry bills up to your annual entitlement. Please note that chiropody/podiatry treatment is not covered under payment level 1. The chiropodist or podiatrist must be qualified and registered with the Health Professions Council. For more information please contact the following: The Health Professions Council Tel: 020 7582 0866, www.hpc-uk.org Chiropractic By manipulating and adjusting the vertebrae of the backbone a therapist can correct malfunctioning nerves and muscles throughout the body. You can claim up to 75% money back for chiropractic treatment with a chiropractor who is registered with The General Chiropractic Council, up to your annual limit. For more information or to find your nearest registered chiropractor contact the following: The General Chiropractic Council Tel: 020 7713 5155, www.gcc-uk.org Dental We all know how hard it is to find a dentist on the NHS these days, so there s no need to suffer with toothache or put off going to the dentist because of the cost. Simplyhealth pays up to 100% of your dental bills up to your yearly entitlement, whether you are treated privately or on the NHS. This includes regular check-ups as well as treatment such as fillings. To find your nearest dentist visit www.nhs.uk/servicedirectories NHS Direct Tel: 0845 4647 (England & Wales), Tel: 08454 242424 (Scotland) www.nhsdirect.nhs.uk British Dental Health Foundation Tel: 01788 546365 / 0845 063 1188 www.dentalhealth.org British Dental Association www.bda-findadentist.org.uk Diagnostic consultation cover If you are unwell and need to find out what s wrong, this benefit helps you to see a private consultant fast, without the long, uncomfortable wait. Simplyhealth enables you to claim up to 75% towards a diagnostic consultation up to an annual limit. If you think something s wrong, your GP will be able to refer you to the appropriate consultant. To find your nearest GP visit www.nhs.uk/servicedirectories NHS Direct Tel: 0845 4647 (England & Wales), Tel: 08454 242424 (Scotland) www.nhsdirect.nhs.uk 8 9
European Cover Simplyhealth cover applies anywhere in the European Economic Area including Switzerland. Any trip up to and including 28 days in duration is covered, be it business or pleasure. Please refer to section 5.21 of the terms and conditions for more details. Homeopathy Homeopathy works by using extremely small quantities of drugs that create the symptoms for which the patient is being treated, in order to build up the immune system. You can claim up to 75% of your homeopathic bills, up to your yearly entitlement. There is currently no government legislation in the UK covering homeopathy. This means that anyone can provide Homeopathic treatment without any professional training. Until the introduction of compulsory registration for this profession, Simplyhealth will continue to pay claims for treatment from professionals who provide homeopathic treatment. For more information or to find your nearest homeopath contact the following: The Society of Homeopaths Tel: 0845 450 6611, www.homeopathy-soh.org The Homeopathic Medical Association Tel: 01474 560336, www.the-hma.org Hospital Cover If you need to go into hospital either as an in-patient or a day case, whether you are treated privately or by the NHS, Simplyhealth will pay you money for a maximum of 20 days/nights in a claiming year. This could help cover the cost of everyday bills. Please note pre-existing conditions are not covered for the first 12 months of your cover. Simply refer to the benefit table to see how much you can claim. Please note that hospitalisation is not covered under payment level 1. New child payment When you have a child we ll say congratulations with a cash sum, as long as you ve been with us for at least 12 months! New child payment is not covered under payment level 1. Optical Whether working with computers or driving a car, everyone should still get their eyes tested regularly. Simplyhealth will give up to 100% money back towards your optician bills, including sight tests, new glasses or contact lenses, up to your annual entitlement. To find your nearest optician visit www.nhs.uk/servicedirectories NHS Direct Tel: 0845 4647 (England & Wales), Tel: 08454 242424 (Scotland) www.nhsdirect.nhs.uk Alliance of Registered Homeopaths Tel: 01825 714506, www.a-r-h.org 10 11
Osteopathy This treatment provides relief for many disorders of the bones and joints, especially back pain. Treatment includes palpation, manipulation and massage. With Simplyhealth you can claim up to 75% towards osteopathy with an osteopath who is registered with The General Osteopathic Council up to an annual limit. For more information or to find your nearest registered osteopath contact the following: The General Osteopathic Council Tel: 020 7357 6655, www.osteopathy.org.uk Physiotherapy If you have a strenuous job, suffer from backache or are a sports enthusiast, you ll appreciate this benefit. Physiotherapy uses physical methods to promote healing. The therapist may use a combination of light, infrared and ultraviolet rays, heat and electric current. You can claim up to 75% of your physiotherapy bills up to your yearly entitlement. The physiotherapist must be qualified and registered with the Health Professions Council. For more information or to find your nearest physiotherapist contact the following: The Health Professions Council Tel: 020 7582 0866, www.hpc-uk.org 12 13
Claiming couldn t be simpler There are three types of claim: Claims with receipts Pay your bill to the physiotherapist, dentist etc. as normal. Simplyhealth will only pay claims for treatment provided by registered healthcare professionals Keep your receipt see the receipt requirements below Fill in the Claims with receipts section of the claim form, following the guide on the following pages. Don t forget to sign and date the Declaration section You can make four claims per form, if you need more claim forms or need assistance, please call Simplyhealth Customer Services on 0800 980 7890 Send your claim form and receipt back to Simplyhealth in the reply envelope provided within six months of treatment Receipt requirements A completed claim form is required together with a receipt confirming payment. The receipt must show: The full name, address and telephone number of the practice Hospital claims Turn to the Hospital claims section on the back of the claim form Fill in the Patient s details yourself Ask a hospital representative to complete the Admission details section or send your discharge letter from the hospital Sign and date the Declaration on the front of the form Send your claim form back to Simplyhealth in the reply envelope provided within six months of discharge Pre-existing conditions are not covered for the first 12 months. New child claims Fill in the New child payment section on the back of the claim form If you stayed in hospital for over 14 nights following the birth of your baby, please also complete the Hospital claims section as instructed above Sign and date the Declaration on the front of the form Send your claim form and your child s birth certificate to Simplyhealth in the reply envelope provided within six months of giving birth There is a 12 month qualifying period for new child payment. The patient s full name and address A description of the treatment given, including dates and amounts settled by the patient Simplyhealth does not accept receipts which have been altered, nor do we accept invoices, credit card receipts or photocopies of any accounts. (Please note receipts cannot be returned.) 14 15
How to fill out your claim form The front for healthcare claims with a receipt We ve already included a claim form in this welcome pack. When making a claim, please complete your form in blue or black ink, and remember to enclose the original receipt for your treatment. The back for hospital claims The reverse of the form is for hospital and new child payment claims only. Please remember to sign and date the declaration on the front of the form. If we ve got your details wrong, please correct them in this box Each person covered under your plan has their own personal code Each benefit has its own benefit code 78725_1 SHCFV1:72053 ALL CFPV10 1007 13/08/2009 13:42 Page 1 704 A / 0 Policy no. 123456789 Mr & Mrs Sample Sample address Sample Road Sample Town Postcode Please provide your current contact details below E mail: Tel No: Your personal details Claim Form Customer Services Hambleden House Waterloo Court Andover Hampshire SP10 1LQ Minicom service: 0800 0725840 (For hearing or speech impaired members only) Opening hours: 8am to 9pm weekdays9am to 5pm weekends The codes shown below are for use when completing your claim form. If you need any help with your claim or any of your personal information shown is incorrect, just call us free on the number above. PERSONAL PERSON COVERED DATE OF BIRTH TREATMENT TREATMENT DESCRIPTION TREATMENT TREATMENT DESCRIPTION CODE CODE CODE 100 Mrs Sample 03/10/1959 045 Optical 085 Chiropody/Podiatry 201 Mr Sample 05/06/1961 052 Dental 302 Charlie Sample 11/10/2000 080 Physiotherapy 081 Chiropractic 082 Osteopathy 083 Acupuncture Your details For a new child payment, fill in this section, enclose your child s birth certificate, then sign and date the declaration For all hospital claims, fill in your details, then sign and date the declaration 78725_1 SHCFV1:72053 ALL CFPV10 1007 13/08/2009 13:42 Page 2 Hospital claims Patient s details First name Surname Please note that you may only claim for cover that is specified in the Policy Document of your Plan New-child payment For New-child payment just complete below and enclose each child s birth certificate/adoption papers, then simply sign the declaration overleaf. If a hospital stay of more than 14 nights was needed, also ask a hospital representative to complete the Hospital claims section below. I wish to claim for New-child payment (4) To assist the hospital in completing this form, please complete the Patient s details yourself, then ask the hospital representative to complete the Admission details where appropriate. Admission details I certify that the above patient was admitted to this establishment for the period and reason shown below: Your establishment (4) Hospital Convalescent Home Nursing Home Duration of admission As a day case: admitted on As an in-patient: admitted on discharged on number of nights D D M M Y Y D D M M Y Y D D M M Y Y Number of birth certificates/adoption papers enclosed Personal code (see front of form) Date of birth D D M M Y Y Establishment stamp and details of representative New child payment only Hospital claims For all claims, except hospital or new child payment, please enter the personal code and the treatment code Enter the treatment date and the full amount paid Claiming details (See overleaf for claims not listed above) Please complete a separate line below for each treatment, selecting the PERSONAL CODE and the TREATMENT CODE from the above lists. Then enter the treatment date and if applicable the amount paid from your receipt. Please use black or blue ink and complete the form in BLOCK CAPITALS and always submit your claim within 6 months of treatment. PERSONAL CODE TREATMENT CODE TREATMENT DATE FULL AMOUNT PAID EXAMPLE 1 0 0 0 8 0 0 9 0 1 0 8 5 0 9 5 EXAMPLE (The example above shows a claim for physiotherapy for the person coded 100 who received treatment on 9th January 2008 and paid 50.95). D D M M Y Y D D M M Y Y. D D M M Y Y. D D M M Y Y.. All claims (except hospital or new child payment) The relevant hospital authorities must complete this section Reason for admission (4) Please always confirm nature of condition/procedure below If a parent stayed with a child Parent s first name Care for the elderly Mental/Psychiatric Ante/Post natal Other (Excluding home visits) Signature: Position: Date: Personal code (see front of form) For all claims, the policy holder must sign and date here Please enclose your original receipts in the envelope provided (do not staple them to the claim form). Please note that receipts will not be returned, only scanned images are retained on our records. Declaration I consent to Simplyhealth seeking medical information in respect of this application and any subsequent claim under this membership, from any relevant doctor, professional or hospital representative. I consent to Simplyhealth processing sensitive information about me (and anyone covered under my policy) including health information. I understand that any charges levied for completing this form are my responsibility and are not refundable by Simplyhealth. I declare that the information given is to the best of my knowledge and belief, true and complete. I understand that any false statements may disqualify me from membership and/or reimbursement of any claim. Your signature Parent s surname D D M M Y Y D D M M Y Y Stayed from to Number of nights Simplyhealth Data Protection Notice: We will keep information about you confidential and as the data controller we will store and process your data in accordance with the Data Protection Act 1998. However, we may give information about you and how you use our products to fraud prevention agencies, regulatory bodies or other specified groups as set out in our Terms and Conditions. Simplyhealth is a trading name of Simplyhealth Access, registered and incorporated in England and Wales, No. 183035. Registered office: Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ. Authorised and regulated by the Financial Services Authority. Your calls may be recorded and monitored for training and quality assurance purposes. Customer s signature: Date: SHCFV1 09/09 16 17
Your questions answered When can I claim? You can claim immediately. Simply use the claim form provided or request another form by calling us on 0800 980 7890. The only exceptions are the new child payment which has a 12 month qualifying period and hospital cover which excludes pre-existing conditions for the first 12 months. Please refer to section 2 of the terms and conditions. When do my annual benefits start and end? Your annual benefits commence from your policy start date and begin again on the same day every year. Please refer to your enclosed Summary of Cover to find your claiming year details. What is the duration of my cover? The cover under your plan is monthly and runs from month to month until it is cancelled or otherwise comes to an end. Are existing conditions covered? The great thing about Simplyhealth is that you can start claiming straight away, even if you already have a problem that needs treatment when you join. However, hospital cover excludes pre-existing conditions for the first 12 months. Once you have been with us for 12 months then you can claim for these pre-existing conditions. Does cover continue when I reach 69? Yes, cover doesn t cease when you reach a certain age. You can keep your policy for as long as you wish, however, you cannot increase your cover after your 70th birthday. There are some circumstances where cover will end. Please refer to section 8 of your terms and conditions for full details. How are my claims paid? To make life easier for you, Simplyhealth provides a service which pays your money directly into your bank account via direct credit, sending you confirmation in the post. You will need to provide us with your bank account details if you haven t done so already. When will I receive money back from my claim? We normally settle claims within a few days. What if you ve printed my details incorrectly on my claim form? If any of your pre-printed details on the form are incorrect, please update them clearly in blue or black pen before sending the form back to us. What happens if my personal details change? So that your cover remains appropriate for your needs, it is important that you review it regularly and let us know about any significant changes to your healthcare requirements. Where can I get more information or additional help when making a claim? If you have any queries, please call Simplyhealth Customer Services on 0800 980 7890 who will be pleased to help you. What do I do if I have changed my mind? You have 14 days from receipt of your welcome pack in which to change your mind and receive a full refund from Simplyhealth, provided no claims have been made. Simply call Customer Services on 0800 980 7890. After this period our standard cancellation rights apply please refer to section 8 of the terms and conditions for full details. How do I make a complaint? At Simplyhealth we aim to provide you with the very highest levels of customer service and care at all times. In order to maintain this service standard, we encourage feedback from our customers and have put in place a procedure that you can use to raise any concern or complaint that you may have. In the first instance you should write to: Customer Services, Simplyhealth, Hambleden House, Andover, Hampshire SP10 1LQ or contact customer services direct on 0800 980 7890. If you are not satisfied with our response, or we have not replied within eight weeks, you have the right to refer your complaint to: Financial Ombudsman Service. Please refer to section 9 of the terms and conditions for full details. 18 19
About us and our insurance services Simplyhealth is a trading name of Simplyhealth Access which is authorised and regulated by the Financial Services Authority (FSA). Our FSA register number is 202183. You can check this on the FSA s Register by visiting the FSA website at www.fsa.gov.uk/register or by telephoning the FSA directly on 0845 606 1234. We can only provide you with information on our own products and you will not receive any advice or a personal recommendation from us for our health plans. We may ask you some questions to narrow down the product option on which we provide you with information, but you will then need to make your own choice about how to proceed. If you have any questions please call us on 0800 980 7890 from landlines 0370 908 3481 from mobiles 1 8am to 8pm Monday to Friday, 9am to 5pm Saturday or visit www.simplyhealth.co.uk 1203089-dCashPlan-WB-03/12 ¹Some mobile networks charge for calls to 0800 numbers. Our 0370 number is free if you have mobile inclusive minutes available. If not it s still no more expensive than calling numbers starting 01 or 02. Simplyhealth is a trading name of Simplyhealth Access, registered and incorporated in England and Wales, No.183035. Registered office: Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ. Authorised and regulated by the Financial Services Authority. Your calls may be recorded and monitored for training and quality assurance purposes.