Group Secretary plan terms and conditions for Business and Corporate Healthcare www.pruhealth.co.uk
Contents Welcome to PruHealth Welcome to PruHealth 3 Membership 6 1. General conditions 9 2. Plan conditions 9 3. What you need to know about paying your premiums 10 4. Renewing your company plan 11 5. Cancelling or changing your company plan 12 6. Upgrading your plan to include the Personal Health Fund (PHF) 13 7. Vitality linked excess 13 8. Vitality Cashback 13 9. Vitality status 14 10. Vitality 15 Other important information including 17 Data protection (how we use your personal information) Important regulatory information about PruHealth Complaints procedure 19 About PruHealth PruHealth was launched in October 2004 and is a joint venture between Prudential and Discovery Holdings, the South African health insurance leader. About Prudential UK and Discovery Holdings Established in 1848, today Prudential plc is an international financial services group with significant operations in Asia, the US and the UK. Discovery Holdings was founded in 1992 as a specialist health insurance company in South Africa. It is now the market leader in healthcare in South Africa. For more information visit www.prudential.co.uk and www.discovery.co.za Important information about your company plan with PruHealth The application form you filled in is included as part of the contract of insurance between the planholder and us (Prudential Health Limited the insurer that underwrites the plan). This document, together with the certificate of insurance, the hospital list, the *members terms and conditions and any endorsements are all part of the contract and should be read as if they are one document. You will also find reference to our Vitality wellness programme in this document. With the exception of the Personal Health Fund and Vitality linked excess option, the services, discounts and rewards offered under our Vitality wellness programme may change during the course of a plan year. Please take time to read this document carefully as it provides important information about your plan with us, including the duties of the Group Secretary. For all other information, please refer to the members terms and conditions document. In particular, please check to see that all the details on the certificate of insurance are correct and that you fully understand what is covered. *The members terms and conditions contain all of the information your members need about their cover with us, including: Cover options (but they must refer to their certificate of insurance for details of which ones they have) Exclusions Underwriting options Claims conditions General conditions Membership (including continuation options) Definitions How to complain Data protection (what information we hold and how we deal with it) Their rights under the Financial Services Compensation Scheme Terms and Conditions PruHealth 3
Live life well We have tried to make sure that everything is as clear and straightforward as possible by writing the terms in plain English. We/us/our means PruHealth. You/your this means the planholder in this document. However, within the members terms and conditions then you or your means the insured member and insured dependants. We have highlighted the remaining defined words in bold to help you identify them as you read through this document. You ll find a full explanation of each word in the Definitions section of the members terms and conditions. Your guide to managing your plan As Group Secretary, you re the person in control of your company s plan, but we re here to make sure that running it is as simple as possible. This means we ll do everything we can to help, and we re only a phone call away if you need to ask us anything. Each employee who is part of the company plan has their own personalised certificate of insurance which tells them exactly which cover options they have, what excess applies (if any) and details of their underwriting terms. If you are also a plan member, you ll receive a certificate of insurance too. For detailed terms and conditions, members should go online via our Member Zone at pruhealth.co.uk/ member. Unless we re specifically asked to, we don t send out paper copies of the plan documents to anyone other than you, the Group Secretary. This pack is your guide to help you run your plan as efficiently as possible. The first sections deal with the nuts and bolts of membership day-to-day guidance to keep to hand when employees ask questions. We ve included important information on the terms and conditions of the plan please take time to read them carefully and refer to them as and when you need. Certificate of insurance This certificate is for the overall company plan and it gives you a top line summary of the cover you ve selected. Each insured member is given their own certificate which lists their level of cover and any personal exclusions that apply to them. Any members who are covered by our Worldwide Travel Cover will find reference to this in their certificate which they should take with them when travelling abroad. Member details You can view a list of employees, which category they fall under and what cover they have on the Employer Zone on pruhealth.co.uk. It also gives their underwriting terms and chosen hospital list. This lets you see at a glance who is entitled to what. Hospital lists As with the plan terms and conditions, members should go online to find out which hospitals are available to them based on their chosen hospital list. Application forms for new joiners New employees can apply to join your company plan at any time throughout the year but should do so as soon as they are eligible. You ll find the necessary application form online at the Employer Zone and you can submit this online too. If you have any queries, please call our customer services team the number is on your certificate or ask your adviser or sales representative. Helping your employees make a claim As Group Secretary, employees will naturally look to you for help when making a claim, so it s well worth familiarising yourself with our claims process which is available online. Knowing what s involved will let you assist employees quickly and help reassure them during what could be an uncertain time. What to do if an employee wishes to make a claim If one of your employees needs to make a claim, their first step should be to call our customer services team on the number shown on the top of their certificate of insurance. Our specially trained advisers will guide your employee through the claims process and provide advice and reassurance when it is most needed. PURPOSE OF THE COVER This plan is designed to meet the needs of businesses who wish to ensure their employees have access to increased choice and high quality facilities in the event that they require treatment for an acute medical condition. This plan will also reward employees if they make an effort to lead a healthy lifestyle. To ensure you are completely confident that this plan will meet your needs, we would advise you to read the plan documentation to ensure that it meets any specific requirements you might have. PruHealth is committed to a policy of full transparency and as such we highlight any important details we think you ought to pay close attention to with this icon, in order to ensure you understand the cover and don t get any surprises when you or an employee need to make a claim. These plan terms and conditions need your close attention, which is why our Cover Check icon appears on the cover of this document. 4 Terms and Conditions PruHealth Terms and Conditions PruHealth 5
Live life well Membership Who can be covered under your plan? any employee (including any director, partner or owner) over the age of *16 may join this plan. They must join the appropriate employee category based on the eligibility criteria agreed with you for that category the insured member s husband, wife or partner, who live at the same address as the insured member the insured member s children (including adopted children) providing they are under the age of 21 when they first join (they may stay on the plan after age 21 but will be charged an adult rate on our Business Healthcare plan. On our Corporate Healthcare plan, they will continue to be classified as children and charged an agreed child rate). We will accept up to eight dependants per insured member. An insured member and their insured dependants must live in the UK for at least 180 days in each plan year and must be registered with a UK GP who holds their full medical records. An insured member and their insured dependants is/are only eligible for cover if they are not employed in the following occupations: working offshore in the extraction/ refinery of natural/fossil fuels professional or semi professional sports for which a salary, sponsorship, a benefit in kind, or financial support/ incentive of any kind is received armed forces personnel. *Members must be 18 or over to benefit from Vitality. Also, our Worldwide Travel Cover and Emergency Overseas Cover is only available to members providing they are aged 79 or under when you choose this option. Adding new members Employees can apply to be added to your company plan at any time by completing an additional member application form. They should apply to join as soon as they are eligible to do so, and they must join the appropriate employee category based on the agreed eligibility criteria. They can download the form and, once completed, return it to us or the agent who arranged the plan for you. We regret photocopies cannot be accepted. We aim to cover the new member from the date on which we receive their completed application form, unless you ask us to delay the start date (which we can do for up to 30 days). However, if they choose to complete a health questionnaire, then cover may not be available until we ve assessed their answers and offered our underwriting terms. We may accept a person for an extra premium or on special terms (usually this means with personal medical exclusions). Sometimes, we may be unable to offer cover. If immediate cover is required, then this is usually only available providing the new member is joining on the basis of our moratorium clause; we also recommend you use our online facility in these circumstances. Employees wishing to switch to us from another insurer must complete our switch (CPME) application form. Subject to our accepting the member, cover can be backdated by up to 30 days from when we receive the completed form. There must be no break in cover between switching from their previous insurer to us. Also, they must provide evidence of their cover with their previous insurer, such as their latest certificate of insurance. However, switching won t be available on your scheme if you ve specifically asked for all new members to join on our moratorium terms or to be medically underwritten. Please note: Unless we specifically agree otherwise, the moratorium clause relating to pre-existing conditions will apply to all new members from the date on which they join the company plan. New members wishing to switch to us from another insurer with continuous underwriting terms must complete a switch application form and have this approved by our underwriters, and they should not cancel their existing cover until acceptance has been confirmed in writing by us. If your scheme is written on a medical history disregarded basis, then employees (and where applicable their dependants) must join as soon as they are eligible to do so, in order to benefit from these terms. We reserve the right either to underwrite anyone who joins after they were first eligible to do so or to delay their cover start date to the next annual renewal date. Adding dependants An insured member s husband, wife or partner and dependent children may apply to join at any time during a plan year but should do so as soon as they are eligible. If any person applying to join this plan already has cover with another insurer, we recommend that they do not cancel that cover until we have confirmed in writing that we have accepted their application. For insured members covered who are adding newborn children, please note that as long as the parent has been an insured member for at least ten months before the birth, and the child is added within 30 days of their birth, then we will not apply the exclusion for pre-existing medical conditions, or require the child to be medically underwritten. Please note: If notification is not received within 30 days of the child s birth, then this acceptance will be subject to underwriting. In these circumstances, a moratorium or full medical underwriting application form must be completed and cover will only start from the date we confirm acceptance. Removing members and dependants Should you wish to remove an insured member or insured dependant from the company plan you can simply notify us online. There are no specific forms to complete. It s important to notify us of any leavers as they occur during the plan year, and no later than 30 days after their leaving date, as we are unable to backdate these changes beyond this. If you notify us later than this, then we ll only remove the insured member or insured dependant from the date on which we receive your instruction. 6 Terms and Conditions PruHealth Terms and Conditions PruHealth 7
Live life well Please also check your renewal documents thoroughly as no amendments can be made after the annual renewal date. This will help avoid claims being paid for members who are no longer eligible, which could have an adverse impact on your renewal premium. Please note: We cannot delay a leaving date beyond the point where an insured member s employment ends. Continuation option We will only offer continuation of cover to an insured member and their insured dependants if the insured member is leaving your employment and subject to the rules set out below. We do not offer continuation of cover just to insured dependants nor is it available to anyone who is not eligible to be included on this plan. Where an insured member leaves your employment, they (and any insured dependants) will have the right to continue their cover with us on an individual plan, providing they re aged 65 or under and have been covered under your company plan for at least two continuous years (this can include cover with a previous insurer if your scheme has switched to us). Cover must be continuous, starting from the day after their cover ends under this plan, and any existing special terms, such as personal exclusions, will continue to apply. They must also meet the eligibility rules for the new individual plan and it should be noted that the benefits, terms and conditions may be different from those of this plan. If they don t contact us within 30 days, continuation of cover won t be available and they will have to apply for a new individual plan, which will start from a current date, and we may not cover preexisting medical conditions and in some circumstances we may be unable to offer cover. If an insured member or their insured dependant is 66 or over at the date on which cover would need to continue, they will have to complete a health declaration about their medical history. If they can t meet the requirements of the declaration then continuation of cover will not be available and they will have to apply for a new plan with new underwriting terms. No continuation option is available where an insured member or their insured dependant has been covered under your plan for less than two continuous years. Please note that it is the responsibility of the insured member to contact us to arrange continuation of cover. Other changes With the exception of those outlined above, it is not possible to make other changes to your company plan during the course of the plan year. We will, however, be pleased to discuss alterations with you at the annual renewal of your company plan. What happens when there are amendments to your plan You should inform us of changes as and when they occur, and we will confirm such changes at that time. Any amendments to the premiums arising as a result will be detailed in your next adjustment account. This will show either the additional premium due to us or the credit due to your company depending on whether the membership of the company plan has increased or decreased. This debit or credit will then be incorporated into the next premium collection. Any debit or credit will be calculated on a pro rata basis depending on the date a member joined or left the company plan during the year. Please refer to section 5 of the members terms and conditions for further information about membership. 1. General conditions These are the conditions that you must meet as part of this insurance contract. 1.1. What we expect from you: It is your responsibility to: inform us if the planholder s address has changed inform us, in advance, if any insured member or insured dependant is no longer to be covered under this plan. You can do this online ensure that all premiums are paid when due. 1.2. Duties of the Group Secretary You must do all of the following: tell us of any changes to the plan membership listing (you can do this online) and tell any employees who are leaving the employment of the company that cover ceases on the day they leave send completed employee application forms to us confirming the cover start date send promotional literature about the plan to all eligible new employees tell employees of any changes to the plan tell employees of the terms at each annual renewal date send employees any other communication which we wish to make about the plan direct employees to our website if they want to make a claim as this tells them what to do. 1.3. If the plan is switching to PruHealth from another insurer, you must also advise employees of any differences between the benefits, terms and conditions of their previous cover and those of their new cover. 1.4. We are not responsible for any failure by you to carry out your duties as Group Secretary of this company plan. 2. Plan conditions 2.1. This plan lasts for one year at a time. We have the right to alter the terms of your plan at each annual renewal date, including premium rates and cover, but we will always give reasonable notice of any changes. Your plan will only be changed at an annual renewal date unless the legal, regulatory requirements and/or tax treatment applying to your plan change, or in accordance with our rights as expressed in the section called Cancelling or changing your plan. This is with the exception of your hospital list and our Vitality programme, which we may amend at any time. For more information about Vitality please read the separate section on pages 15 to 16. 8 Terms and Conditions PruHealth Terms and Conditions PruHealth 9
Live life well 2.2. We will tell you about any changes to the cover or general procedures by email or in writing to your last address. Even if you do not receive this, the change will still stand. 2.3. You may only apply to change the benefits, hospital list or excess of one or more employee categories at the annual renewal date by using the relevant form. Some changes may be subject to underwriting and may mean that one or more insured members or insured dependants are unable to benefit from the change if, for example, they are in midclaim at the time or they have a condition that has arisen before a benefit upgrade (even though it may have been after their cover start date). 2.4. Insured members and their insured dependants may only move to a different employee category at the annual renewal date. The insured member must meet the eligibility criteria applying to the employee category they are moving to. 2.5. Any changes we tell you about will remain in force at each annual renewal date unless stated otherwise. 2.6. Your plan is bound by English law and comes under the jurisdiction of the UK courts. The language used in these terms and conditions and any communication relating to them will be in English. The contents page and any headings are for convenience only and do not form part of the plan itself and nor do they affect its construction. 2.7. Our liability under this plan is limited to paying for treatment or services in respect of eligible claims under this plan. The choice of provider of the treatment or services ( provider ) is the responsibility of the insured member claiming under this plan. We make no representations or recommendations to any member regarding the availability and standard of any treatment or services offered or provided to them or their insured dependants by any provider. We will not be held liable to the planholder or any insured member or insured dependant for any loss, harm or damage of any description resulting from lack of availability or from a defect in the quality of any treatment or service offered or provided by such provider. This plan represents the whole and only agreement between the planholder and PruHealth relating to the provision of private medical insurance. PruHealth makes use of Vitality partners to offer services and activities relating to the Vitality programme. While these companies are carefully selected, PruHealth cannot be held liable for any loss or harm resulting to the planholder and any insured members or insured dependants arising from any act or omission on the part of a Vitality partner, or as a result of using any service or product provided by a Vitality partner. 3. What you need to know about paying your premiums 3.1. You should pay the first premium on or before the due date in accordance with the invoice we ve sent you. You are responsible for paying premiums to us. If any premiums are outstanding we reserve the right to withhold payment of any claims until the premium has been paid in full. 3.2. You pay premiums in advance. Your entitlement to benefit will end after the last day of the period covered by the final premium payment. In such circumstances, we will only be liable for the cost of eligible treatment that takes place before that date. 3.3. You must pay us the premiums due for all insured members and insured dependants covered under this plan. But you may collect from members the part of the premium that relates to their insured dependants. 3.4. You can choose to pay your premium monthly, quarterly or annually. No matter which basis you choose, you are liable to pay all premiums up until the end of each plan year*. 3.5. Premiums payable by you include any Insurance Premium Tax (IPT) that is payable on the cover provided, as well as other taxes, levies or charges that may be introduced which are payable by law. Premiums must be settled on or before the due date. We reserve the right to pass any outstanding amounts to a debt collection agency. Any additional costs from the debt collection agency will be charged to you. *This does not apply to schemes where the membership consists of three partners or fewer, who may cancel their plan at any time. 4. Renewing your company plan 4.1 Business Healthcare If you re a Business Healthcare customer, at each annual renewal date we will offer to renew your plan. We will invite renewal around eight weeks before this date. We will tell you then what your premium for the next plan year will be but this may need to be revised if there are membership changes between then and the annual renewal date. Factors affecting your premium can include the number and age of the insured members and their insured dependants and our overall claims costs. Premiums are also reviewed each year to take account of medical inflation. By medical inflation we mean, among other things, any rise in the charges made by hospitals and other providers, and medical advances in areas such as technology and drugs that our plans normally aim to cover where appropriate. The amount we paid out in claims for your own plan in previous plan years may also affect your premium. In the unlikely event that you do not receive these terms at least one month before the end of the plan year you should notify Customer Services or your adviser. We reserve the right to convert this plan to an individual plan at renewal if less than two insured members remain on the plan. We will automatically renew your plan unless you tell us not to or we cancel it for any of the reasons stated in paragraph 5.1. 10 Terms and Conditions PruHealth Terms and Conditions PruHealth 11
Live life well 4.2. Corporate Healthcare If you re a Corporate Healthcare customer, we ll contact you, or the intermediary or sales agent who has been appointed to act on your behalf, well before your annual renewal date (usually at least 12 weeks) to discuss the premium rates and plan terms that will apply for the next plan year. At that time, we will also discuss any other changes, such as changes to your cover, that you would like to make for the next plan year. We reserve the right to convert the plan to a Business Healthcare plan at renewal if less than 100 insured members remain on the plan. 4.3. We will only discuss renewal terms with you, or the intermediary or sales agent who has been authorised to act on your behalf. No rights concerning the renewal process are conferred on the insured members or their insured dependants. 5. Cancelling or changing your company plan 5.1. We can cancel, refuse to renew, or vary your plan, or cancel membership for any insured member and their insured dependants at any time if any of the following happens: An insured member or insured dependant has given us incomplete or untruthful answers in any information we have asked for, or attempted to claim benefit that they know they are not entitled to claim, or failed to act with good faith in their dealings with us, or stopped living in the UK 12 You have: not paid your premium on the due date, or stopped paying premiums for all insured members, or offered alternative cover with another insurer to some or all of the insured members or insured dependants covered under this plan, or refused or failed to keep to your duties under the plan, or given us incomplete or untruthful answers in any information we have asked for. You have entered into a composition with your creditors, wound up or gone into liquidation, unless: it is a genuine reconstruction takeover or amalgamation, or you are not an incorporated body and become bankrupt. We end the plan type listed on the certificate of insurance or any part of the plan. If this happens, we will offer a transfer to another plan with similar benefits if one is available. If we cancel this plan, we will write to you at your last known address giving you 14 days notice. 5.2. Change of risk Although we will usually only change premium rates and plan terms at your annual renewal date, we reserve the right to change these during the plan year where there is a significant and material change in the risk profile of your scheme. This includes, for example, changes to: Age profile Number of insured members Location Where we change the terms of your plan, we will advise you as soon as we can of the reasons for any such change. You have the right to cancel your plan if you are not satisfied with these changes. 5.3. Cancellation provisions for any gym membership or other PruHealth Vitality partners depend on the terms and conditions of the relevant Vitality partner. 6. Upgrading your plan to include the Personal Health Fund (PHF) For an extra premium, you can upgrade your plan to include our Personal Health Fund. This provides your members with a pot of money to pay for certain services and treatments that aren t usually covered by health insurance. The amount of money available is dependent on their Vitality status. When your employees join PruHealth, they ll start on Bronze status when they complete their online Health Review, which gives them a starting pot of 75. The pot then increases in line with improvements in their Vitality status as they go through the year. 7. Vitality linked excess Another option that is only available for schemes of 10 or more insured members is Vitality linked excess, which is a different way of rewarding your employees for improving their Vitality status. With this option, your employees start off with an excess of 250. The excess may be per claim or per person per plan year. This excess then reduces as they improve their Vitality status, meaning that they could end up not having to pay any excess at all if they need to make a claim, as the following table shows. Excess Level Bronze Silver Gold Platinum 250 100 Terms and Conditions PruHealth Terms and Conditions PruHealth 13 No excess No excess 8. Vitality Cashback To reward your employees for taking part in our Vitality programme, and improving their status, we pay them a cash reward at the end of every third plan year. The cashback amount is based on their Vitality status in each of the preceding plan years, as follows: Cashback earned each year Bronze* Silver Gold Platinum 25 50 75 100 *Provided that the insured employee has completed their Health Review and that no person on the plan has made a claim. Full details of the PHF and Vitality linked excess options and Vitality Cashback can be found in the members terms and conditions.
9. Vitality status There are four statuses, Bronze, Silver, Gold and Platinum. Everyone starts at Bronze and their Vitality status is then determined by the points they build up throughout the plan year, through activities ranging from exercise and healthy eating to health screens and regular check-ups. The Vitality status they achieve by the end of a plan year will then remain for the whole of the next plan year, unless they improve their status (though for the purposes of the PHF, members start at Bronze again at the beginning of each plan year). They can improve their Vitality status by achieving the required number of points to move from one status to the next; we call this the Vitality status threshold. For example, currently you need 800 Vitality points to reach Silver status and you would need to increase this to 1,600 points to achieve Gold status. When there are two adults on a plan the thresholds are doubled, and so on. A member s Vitality status can go down at each annual renewal date if the number of Vitality points earned during that plan year isn t enough to maintain the status they previously achieved. Vitality status can also change midway through the plan year as new adult dependants are added or removed. Vitality This section tells you a little more about our Vitality wellness programme. With the exception of the Personal Health Fund, Vitality Cashback and Vitality linked excess, the services, discounts and rewards offered under our Vitality programme may change from time to time. Our reason for creating the Vitality programme is simple. If you stay healthy by exercising regularly, eating well and not smoking, you could add years to your life. And that s why we believe our plans shouldn t only benefit people that need to claim. Vitality is our proven wellness programme which includes activities and partner discounts to help your employees get and stay healthy for less. There are discounts with our health partners and half price health screens, as well as useful tools to help them understand and monitor their health, and set goals to improve it. As they take part in the programme, they ll earn Vitality points which count towards their Vitality status, helping them to see their progress. We ve also focused on two key areas that can help improve health exercising and eating well. So we give your employees access to discounted gym membership and we ll support their efforts to eat well. When they buy certain healthy foods from Sainsbury s they ll also get five times the usual number of Nectar points. Vitality Plus makes looking after your health more rewarding the more your employees participate and improve their Vitality status the higher their discounts will be with our reward partners. 14 Terms and Conditions PruHealth
How Vitality can change This section explains how and why our Vitality programme can change at any time. 1. Our Vitality programme naturally changes over time as new opportunities and technologies arise. It is also dependent on our relationship with third party providers and the range of services they offer. 2. We may change the way we award points and/or the eligible activities in the Vitality programme and the Vitality status a member may achieve as a result. We may also change our Vitality partners from time to time and the incentives we offer. There may be instances where other aspects of the Vitality programme, such as particular benefits, may be significantly enhanced, changed or withdrawn. 3. These changes may occur if our Vitality partners offer additional services or become unable to maintain their levels of service to us, or where we add new Vitality partners to the programme. Vitality changes may also be required to prevent the fraudulent use of benefits. Revisions may be required as a result of other factors beyond our control. 4. Vitality benefits are expressed in one of two ways: as a straightforward price, or as a percentage discount off a provider s standard price. We reserve the right to increase the former during the plan year. If we do need to increase these prices, we will increase them for all our members at the same time, to avoid any confusion. Any price increases will only occur once during a plan year. No price increase shall exceed the amount equal to the change in the Consumer Price Index (since our last price increase for that benefit) as calculated against the Bronze price (or the price paid by all members if there is no difference in price according to Vitality status). For example, if the Bronze price (or standard price, if applicable) for a particular benefit is 100, and the CPI increases 3%, the maximum price increase for any Vitality status shall be 3. Therefore, if the Platinum price for that particular benefit is 10, the most someone on Platinum status would pay is 13. 5. The cost of Vitality benefits expressed as a percentage discount off a provider s standard price may vary during the year if that provider changes its standard price. For example, the current discount on our health screens is 50%. If the current standard price is 40, the cost to a member would be 20. If the standard price was increased to 50, the cost to a member would be 25. 6. We will usually tell you about any changes to the Vitality programme, including any price increases, at least six weeks before the changes take effect, unless we re unable to do so due to factors outside our control. If you re not satisfied with the changes, you may cancel your plan. However, please note that your members may still be subject to the notice period of any relevant Vitality partner and to any other relevant terms and conditions of that Vitality partner. 7. Please note that the previous clause refers just to changes to the Vitality programme made within the plan year and does not prevent us from applying changes and price increases at each annual renewal date. 8. New adult dependants or partners who join during a plan year will alter the Vitality status thresholds but can immediately participate in Vitality activities and earn Vitality points up to the renewal of your plan. 9. Insured dependants or partners can be taken off the plan throughout the plan year but you must give us 30 days advance notice. Anyone leaving the plan before the end of the plan year will not be entitled to any share of benefits they may have earned during that plan year. All of an insured dependant s Vitality benefits will cease when their cover ends subject to the notice period of any relevant Vitality partner. Also, all Vitality points they ve earned will be removed from the plan and Vitality status thresholds will be adjusted accordingly, and will result in a change in Vitality status. 10. There will be no refund in respect of any Vitality activities or Vitality points earned once a plan has been cancelled. Other important information PruHealth Data Protection Notice Why should you read this notice? We think it is important for all our customers to be made aware of what information PruHealth Group* holds about them and to have the reassurance of knowing that we comply with the Data Protection Act. How we use your personal information The PruHealth Group will use your information (including information provided about your dependants) for underwriting and administration purposes. By taking out a plan with us, you agree to us processing your personal information and sensitive personal information (e.g. health information). We will also use your information for statistical data analysis, management information and fraud prevention purposes. If you wish to make a claim on your plan, this will inevitably mean that you will have to provide us with information regarding your medical condition which we will then process in order to administer your claim. Calls to PruHealth may be recorded and may be monitored. Who we may give personal information to We may disclose your personal information to our business associates, agents and service providers for the purposes above. Your information may be processed by service providers in a country outside the European Economic Area, which may not have the same standard of data protection as in the UK. We will ensure appropriate safeguards are in place to protect your information. We will pass your information to any legal or regulatory body if required to do so. We may also use your information or give it to others, for research, statistical purposes or to improve our services, but we will remove your name and address from this first. If you have appointed an insurance adviser we will send them copies of correspondence relating to the plan and any renewal documentation. We may disclose information about a claim to them, although no medical information will be provided without your consent. Your information, and that of others also covered by the plan, may be disclosed to other parties (for example other insurance companies) with a view to preventing fraudulent or improper claims. Processing claims In the event of a claim we may have to give some information to those involved in your treatment or care, and/or your representative (if you have chosen one). This will be done Terms and Conditions PruHealth 17
Live life well confidentially. Correspondence about all claims (including those made by dependants) will be addressed to the planholder in respect of individual plans. If a dependant does not wish us to correspond with the planholder in relation to their claim, and if they are aged 18 or over, they should take out a separate plan in their own name. If you have another insurance plan that covers the same costs that you are claiming from us, then we may also disclose your relevant personal information to that other insurer so that we can ensure we only pay our proportion of the claim. Group plans If you belong to a group plan you may want to ask your employer whether an insurance adviser has been appointed, so that you know who may have access to your personal information. We may disclose information about a claim to the administrator/group Secretary of a group plan, but no medical information will be provided without your consent. Correspondence about any claim, (including when made by a dependant of an insured employee), will be restricted to that needed to handle the claim, and will be addressed to the insured employee. Our marketing policy PruHealth, our group of companies and our business associates, service providers and agents may use your personal information to inform you of other services and products that may be of interest to you by telephone, post, email or text. Please call our Customer Services Team if you would prefer not to receive details of other products. Obtaining a copy of the information we hold about you You have the right to request a copy of the information we hold about you (for which we may charge a fee) and to have any inaccurate information corrected by writing to us at the below address. Where information has been supplied by a medical practitioner, you should be aware that we need their consent before we can supply this to you, or alternatively you can request such information direct from the practitioner. Data Protection Co-ordinator Prudential Health Services Limited Marshall Point 4 Richmond Gardens Bournemouth, BH1 1JD Disposal of information We will continue to hold information about your plan for a reasonable period of time after it has ended. We will then dispose of your personal information in a responsible way to maintain your confidentiality. *PruHealth is a joint venture between Prudential in the UK and Discovery Holdings Limited in South Africa. The PruHealth Group includes Prudential Health Limited and Prudential Health Insurance Limited, both trading as PruHealth, and Prudential Health Services Limited trading as PruHealth and/ or PruProtect. Important regulatory information PruHealth is the trading name of Prudential Health Limited and Prudential Health Services Limited. Prudential Health Limited, registration number 05051253 is an insurer that underwrites the insurance products. Prudential Health Services Limited, registration number 05933141, is an insurance intermediary with FSA authorisation to mediate insurance business in the UK. Prudential Health Services Limited acts as an agent of Prudential Health Limited and arranges and provides administration on insurance plans underwritten by Prudential Health Limited. Our registered offices are at Laurence Pountney Hill, London EC4R 0HH. Prudential Health Limited and Prudential Health Services Limited are authorised and regulated by the Financial Services Authority (FSA). You can check our authorisation on the FSA s Register by visiting the FSA s website: www.fsa.gov.uk/register or by contacting the FSA directly on 0845 606 1234. The products we offer Prudential Health Services Limited only offers private medical insurance products underwritten by Prudential Health Limited and Prudential Health Insurance Limited. Prudential Health Services Limited can offer other insurance products from a specific range of insurers. A list of insurers and insurance products is available on request. Complaints procedure Our commitment to you We understand that sometimes things can go wrong. You are important to us, so if you have reason to complain we want to know. We will try to resolve your complaint quickly in a professional and helpful way. How to contact us You can contact us by letter, phone or email. It will help if you give your name, address and plan number. You can either send us a secure message via our Member Zone at pruhealth.co.uk/member or you can call us on the number on your certificate of insurance. You can also write to us at: Prudential Health Services Limited Stirling, FK9 4UE How we will deal with your complaint The time it takes to resolve your complaint will depend on how complex it is and how much investigation we have to do. We will always try to resolve your complaint as quickly as possible, keeping you informed of our progress. We will : Acknowledge your complaint promptly Tell you who is dealing with your complaint so contacting us is easier. This person will be a trained complaint handler not directly involved with your case before the complaint Fully investigate your complaint and send you a detailed report about our findings. We will clearly explain the reasons behind our decision and what action we will take to put things right, if appropriate Update you every four weeks if the investigation is not complete and explain the reason for the delay. 18 Terms and Conditions PruHealth Terms and Conditions PruHealth 19
Notes What to do if you are still not happy with the outcome We want to resolve complaints to your satisfaction whenever possible. If we cannot reach agreement with you, you may have the right to refer your complaint to the Financial Ombudsman Service. The Financial Ombudsman Service is an impartial adjudicator and provides a free, independent service for resolving disputes with financial services firms. If you are going to ask the Financial Ombudsman to review your case, you should do so within six months of our giving you our final decision on your complaint. You can contact the Financial Ombudsman in the following ways: The Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London, E14 9SR Enquiry line: 0800 023 4567 Fax number: 020 7964 1001 Website: www.financial-ombudsman.org.uk Email: complaint.info@financialombudsman.org.uk If you contact the Financial Ombudsman Service, this does not affect your right to take legal action if you are dissatisfied with and do not accept the outcome of the review. 20 Terms and Conditions PruHealth
Notes
www.pruhealth.co.uk PruHealth is a trading name of Prudential Health Limited, Prudential Health Insurance Limited and Prudential Health Services Limited. Registered numbers 05051253, 02123483 and 05933141 respectively. Prudential Health Limited and Prudential Health Insurance Limited provide and manufacture benefits under the PruHealth product. Prudential Health Services Limited distributes and services the PruHealth product and issues the documentation. The companies are registered in England and Wales. Registered offices at Laurence Pountney Hill, London EC4R 0HH. All authorised and regulated by the Financial Services Authority. Calls may be recorded/monitored to help improve customer service. Call charges may vary. PRUHB19700_09/12