UK Healthcare - Cash Plan Terms & Conditions

1. You must fully complete and sign a claim form and send it to us with original receipts. The receipt must include your name and be submitted within 3 months of the date of any treatment.
2. Pre-existing conditions are not permissible with the exception of dental and optical
3. Make sure that you check the length of your qualifying period before claiming
4. Check that you have sufficient level of benefit remaining before submitting a claim

General terms and conditions
Welcome to UK Healthcare. We’ve tried to make this policy as simple to understand as possible. Please take time to read this document carefully and keep it safe for future reference. This policy is contractually binding whether or not you have signed the application form or any other document.

Insured persons are covered for the benefits shown in the policy schedule of cover, which in turn are governed by the following policy wording.

This policy is underwritten by Bolton & District Hospital Saturday Council, a company limited by guarantee and registered in England 518573. The registered office is Ground Floor, Regent House, Fold’s Point, Fold’s Road, Bolton, BL1 2RZ. Bolton & District Hospital Saturday Council is authorised and regulated by the Financial Services Authority, registration number 202043.

Joining UK Healthcare
Anyone aged 18 to 70 can join UK Healthcare and can use the policy for as long as they wish. You will not be required to have a medical to join our scheme. The only exclusion on joining UK Healthcare is that any pre-existing medical condition will not be covered. This does not apply to dental cover or optical cover. Your qualifying period commences on payment of your first premium. You can change your level of cover once every two years between the ages of 18 - 70.

Payments
Payments are made in advance on a rolling basis and are non-refundable. For a claim to be honoured your payments must be fully up to date. Should payment fall into arrears we reserve the right to refuse your claim, even if the treatment date was before the date of arrears.

Occasionally it will be necessary for us to increase the premium, alter the benefits available or amend the rules relating to your policy. If this happens you will receive one-month notice in writing. Notifications of address changes are your responsibility and we cannot be held responsible for any correspondence failing to reach you. We promise to notify you immediately if legislation which is outside of our control (e.g. Insurance Premium Tax) results in any change to your payments.

If you wish to change to a lower level of cover, the previous higher level will cease with immediate effect. Once your policy has been operating for 13 weeks you can upgrade to a higher level. You can only do this once a year and you will find information on how to do this at www.ukhealthcare.org.uk or by calling 0845 2088 632. The level of cover you have chosen sets the premium that is payable by you as detailed in the table of cover which you can find in your welcome pack.

All new customers will be required to make their payments by Direct Debit and pay in advance. We may request your first payment by debit or credit card. It is your responsibility to keep us informed of any change in bank details where you require us to pay claims.

When you can start claiming
You will be able to claim benefits 13 weeks after we receive your first payment, unless you have joined through your employer where a different qualifying period may apply. If you upgrade your cover you will not be eligible to claim at the higher benefit rate for 13 weeks. For all benefits in respect of pregnancy the qualifying period is 52 weeks from joining.

How to make a claim
Every claim must be accompanied by a fully completed and signed claim form and will be paid in full at 100% of the claim, subject to the appropriate policy limit. Copies of our claim form can be downloaded at ukhealthcare.org.uk or by calling 0845 2088 632. The following criteria must be applied:

• Original receipts are required
• The receipt must be in the name of the person claiming
• Details of the treatment must be outlined
• Details of the practitioner performing the treatment must be provided
• All claims must be submitted within 3-months of the treatment date as shown on the receipt otherwise they will be ineligible for consideration
• If your premium is paid via payroll deduction you need to forward a copy of your most recent salary slip at the time of any claim.

For prescription claims we require a Form FP57 which is available from the chemist where you collect your prescription. If this is unavailable we will require a receipt from the chemist and the corresponding prescription label which must include the patient’s name, date provided and details of the drug. For hospital claims, completion of a separate claim form is required, which must be signed and endorsed by the relevant hospital.

We have the right to request a medical report to validate any claim. We promise to adhere to the Access to Medical Records Act 1988 and Personal Files and Medical Reports (Northern Ireland) Order 1991 should such information be requested. We also reserve the right to request a second opinion for any claim. We will accept the costs incurred should such action be taken. This may result in an appointment with a healthcare professional of our choice. Failure to attend this appointment may result in your claim being refused. We do not cover prepaid certificates.

On occasion it may also be necessary for us to request a medical declaration from your GP or other medical practitioner. You must pay all costs related to obtaining this report. Payments made outside of the UK will be honoured at the current exchange rate on the date that the claim is paid. All payments will be made in pounds sterling with the exchange rate used being made in that country’s official currency. Payments will not be made for any treatment received in advance. Photocopied claim forms or receipts are not accepted. Amended or altered receipts will result in a claim being rejected.

Claims should be posted directly to:
UK Healthcare Limited,
Regent House,
Folds Point,
Folds Road,
Bolton
BL1 2RZ

What you can't claim for

• Any condition/illness that was in existence prior to the policy commencing (excluding dental or optical). This condition also applies when customers upgrade their policy to a higher level of cover
• Any medical advice or treatment you received prior to joining
• Any type of missed appointment
• Any claims that arise as a result of self-injury or abuse
• Activities related to hazardous sports injuries. A full list of these is available on request
• Examinations at a medical centre
• GP fees for private treatment
• Pregnancy terminations, contraceptives or gender reassignment operations
• Cosmetic surgery
• Drug, alcohol or solvent abuse

Maximum payments
All payments are provided in respect of a twelve month period, other than optical which is provided over a 2 year benefit period. Each individual benefit period begins on the date of the first treatment, goods purchased or service that you have received. Each claim for a different treatment starts a new commencement period for that particular benefit. After each benefit period has expired the next benefit period will commence on the date of the next hospital admission or receipted claim request. Should you be charged by a doctor or practitioner for completing any claim such costs will be at your expense.

Overpayment
Should any overpayment of benefit be paid by our underwriter the amount in question must be reimbursed.

Children
You can include up to four of your children or those of your partner up to the age of 18. They must live with you. Only biological and adopted children are covered and we may request original birth certificates at the time of application. Adopted children are only eligible if they were adopted when under 3 years old. Claims for dependant children, including maternity benefit, can be made by either contributing parent or guardian but not both. Should you wish to add an additional child to the policy we will require such a request in writing. Unless we have received written notification no benefits will be payable. New children joining the scheme will have a 26-week eligibility period before any claim can be made.

Medical Practitioners, Consultants and Specialists
Claims will only be paid if the person providing your treatment or care is a qualified practitioner who meets the following criteria. They must be (depending on their field):

• Named on the register of specialists maintained by the General Medical Council and/or Dental Council
• In a position of substantive appointment in a National Health Service Hospital or Armed Service (locums are excluded)
• In possession of a certificate of Completion of Training from the Royal College of Nursing
• A qualified dental practitioner
• A qualified Optician or ophthalmic surgeon
• Registered with the Health Professionals Council
• Registered with the British Acupuncture Council or The Modern Acupuncture Association or British Medical Acupuncture Society
• Registered with the General Chiropractic Council
• Registered with the General Osteopathic Council
• Registered with The Faculty of Homeopathy or The Society of Homeopaths or the Alliance of registered Homeopaths BETEC qualified
• Registered with ITEC, MISPA or MICHT
• Registered with MCSP or SRP

Leaving us
You can cancel your policy by giving us one-month notice. We will not refund any premiums paid and we reserve the right to prevent individuals from joining again for three years from the date of termination. If you or anyone paying premiums on your behalf misses two consecutive monthly payments we will immediately terminate the agreement. We reserve the right to cancel your Policy by providing one month’s written notice, unless any claim is fraudulent in which case it will be cancelled with immediate effect. We reserve the right to refuse membership or upgrade to a higher level scheme without giving a reason.

Fraudulent Claims
The contract between UK Healthcare and yourself is based on mutual trust. If we are suspicious that a claim may be fraudulent we have rigorous anti-fraud measures in place. If proven, fraudulent claims may result in legal action against offenders and cancellation of the policy. Abuse of the policy in any other way may result in cancellation of the policy. We have the right to immediately suspend or cancel your policy and refuse to pay any monies requested. We always prosecute fraudulent claimants and look to recover any costs incurred as a result of action taken. Fraud is a criminal offence that can result in a fine or prison sentence. We monitor claims behaviour on all policies and may request an appointment with you to discuss your claims.

Keeping your details safe
We will store and process your personal data in accordance with the Data Protection Act 1998. We will use your information for providing our services, for handling your claims, for improving our service and assessing premiums and risks. We may also provide your information if we have a duty to do so, or if required by law, or if the person requesting the data has in our opinion a legitimate reason to do so. You can ask for a copy of the information we hold and to remedy any inaccuracies at any time. This will incur a small fee. Calls to UK Healthcare may be recorded for training and/or monitoring purposes.

Complaints procedure
Our aim is to provide you with a great customer experience. If for any reason you do have need to complain you should contact our customer service team on 0845 2088 632. If you are not satisfied with our response your complaint would, at your request, be escalated to the board at UK Healthcare. Should you remain dissatisfied with our decision you have the right to refer your complaint to Financial Services Ombudsman, South Quay Plaza, 183 Marsh Wall, London E14 9SR. Full details of our complaints procedure are available upon request.

Changing your mind
You have 14 days from receipt of your membership certificate to cancel your policy and receive a full refund of any premiums you have paid. Either email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call our customer services team on 0845 2088 632.

Financial Services Compensation Scheme
In the unlikely event of us being unable to meet our financial obligations you can claim compensation from this scheme. You can contact FSCS on 0800 6781100 or visit www.fscs.org.uk.
UK Healthcare Limited is a wholly owned subsidiary of Bolton & District Hospital Saturday Council who is responsible for the administration and payment of claims.

Your benefits explained

Dental (NHS & private)
We cover:

• Dental treatment, check-ups, hygienist fees
• X-Rays
• Full or partial dentures
• Denture repairs
• Dental consultation fees

We don't cover:

• Cosmetic dentistry
• Non prescribed items and consumables
• Dental maintenance schemes
• Premiums paid to a dental care contract
• Laboratory fees and dental technician fees

Optical
We cover:

• Eye tests
• Prescribed spectacles, contact lenses
• Payments you make for prescription lenses, supplied under a monthly scheme, when you obtain an itemised receipt confirming payment has been made (to be submitted quarterly)
• Sunglasses with prescribed lenses
• Repairs
• Laser eye surgery
• Disposable contact lenses

We don't cover:

• Non prescribed spectacles or contact lenses
• Optical sundry items / consumables
• Spectacle contact lens insurance premiums
• Part payment of prescriptions
• Ophthalmic consultation fees
• Off-the-shelf reading glasses

Wellbeing (physiotherapy, osteopathy, chiropractic, acupuncture)*
We don't cover:

• Any treatment provided by a practitioner not registered with the appropriate professional body
• X-Rays and scans
• Appliances for lumbar support, books, flexiband, tape, ice or heat packs

* Check benefit table for maximum level of cover


Specialist consultation
We cover:

• Consultations recommended by your GP
• Diagnostic tests
• Pathological examinations
• Blood tests in relation to diagnostic consultation

We don't cover:

• Cost of a referral
• Treatment charges
• Ambulance charges
• Fees incurred other than during illness
• Dietician or nutritional services
• Visits to GPs or clinics
• Operation fees
• Investigative charges: CT scans/ultrasounds
• Anaesthetic fees
• Speech therapy services
• Biopsy
• Counselling services e.g. bereavement, psychiatric, psychological
• Assisted conception, fertility treatment or pregnancy care
• Check-ups including cancer remission

Health screening
We cover:

• Well man/woman screening
• Osteoporosis screening
• Mammogram screening
• All screening that helps prevent an illness

We don't cover:

• Home testing kits
• Screening for employment services
• Legal insurance or similar matters
• X-Rays and blood tests not included in the full health screen

Staying in hospital
Up to 56 nights can be claimed in a 12-month period for any NHS, hospice or private hospital stay.
We cover:

• Maternity admission after 10 nights
• Immediate cover following an accident even if the qualifying period has not been met
• Outside of UK benefit is limited to a maximum of 28 nights in a EU country and 7 nights elsewhere in the world

We don't cover:

• Respite care
• Nights when patients are allowed to leave for any reason
• Outpatient treatment
• Any stay relating to a pre-existing condition
• Attendance at A&E

Accompanying your child in hospital
We cover:

• Any period of stay between one and 24 nights for one parent accompanying a child up to the age of 18 who is covered by this policy.

We don't cover:

• More than one accompanying parent
• The post natal period after the birth
• Any other relative accompanying the child

Hospital day case admission
We cover:

• When a customer has signed an admission form for admission to a day care ward for investigation or treatment of an acute or chronic medical condition where you experienced these conditions whilst a policyholder
• Up to 10 times in a benefit year to the maximum shown
• Outpatient treatments for radiotherapy, chemotherapy or oncology

We don't cover:

• Attending as a general outpatient
• Casualty patients
• Maternity/geriatric/psychiatric/hospice care
• Attendance for any pre-existing conditions
• Cancelled operations
• Pre-admission appointments
• Respite care
• Kidney dialysis
• Treatment not carried out in a hospital

Complementary therapies
We cover:

• Homeopathy, reflexology and aromatherapy. All treatment received must be validated by a letter of referral from your GP

We don't cover:

• Sports massage, Indian head massage, reiki, Alexander technique and Hopi ear candles

• Cosmetic pedicure
• X-Rays
• Consumables: corn plasters / insoles / dressings
• Surgical or corrective footwear
• Check benefit table for maximum level of cover

Maternity, Paternity, Adoption
We cover:

• Each child born in hospital
• Adopted children under the age of 3
• The birth of a stillborn child after 24 weeks

We don't cover:

• A miscarriage up to 24 weeks
• Foster children
• Termination of pregnancy
• Dependant children

Prescription charges
We cover:

• Upon production of form FP57 up to 12 prescription charges in a calendar year dependent upon level of cover
• All items relating to a medical condition
• Prescriptions from a GP or dentist

We don't cover:

• Annual prescription certificates
• Items not related to a medical condition e.g. holiday inoculations, fertility treatments, nicotine replacements, weight loss control unless medically prescribed

Personal accident life cover
If any insured person suffers death as result of a personal accident, benefits will be payable on a sliding scale in relation to the level of cover held. Our aim is to provide the broadest and most appropriate cover possible. However there are some limitations for which the following exclusions and limitations are applicable:

• Attempting to commit suicide or intentionally inflicting self-injury
• Engaging in flying or other aerial activity except as a passenger
• Participating in any hazardous sport. A full list of these is available on request
• Engaging in active service of any of the armed forces in any nation.
• Radioactive contamination
• Being in a state of insanity or any psychiatric, mental, or nervous disorder
• Deliberate exposure to exceptional danger (except in an attempt to save a human life)
• Participation in a criminal act
• Only payable on the event of death
• Pregnancy or child birth

Should you require a claim form in respect of this benefit, please contact UK Healthcare on 0845 2088 632.

Helplines - 0844 338 5513

These services are provided by Europ Assistance Holdings Ltd. Confidential 24 hour, 365 days-a-year helplines providing telephone advice in respect of:

Legal
Advice on any private problem relating to laws of the UK and covering relationships, tax, employment and bereavement.

Medical
General medical advice that can be provided reasonably by telephone. This line is staffed by trained nurses who will provide information in a sympathetic manner, with no restrictions on the frequency of calling.

Counselling
Stress
Are you stressed? We can help you identify and recognise emotional or stressful personal problems and provide telephone counselling support to help you.

Crisis Counselling
Available to you in respect of a range of issues:

• Debt. How to meet the demands of creditors and renegotiate revised terms of payment
• Domestic relationship breakdown
• Terminal or serious illness
• Bereavement. Policyholder help with the trauma of the loss

If you believe you may have become a victim of identity theft we can help you resolve the situation. We will appoint your own Personal ID Theft Advisor who will provide you with practical help and advice over the phone.

Home Assistance
You will be provided with access to approved trades people to assist you in the event of loss or damage to your home. You will be responsible for all repair costs and call out costs, but can be assured you will only be provided with approved and price controlled trades people.

Full policy details are available on request. To access these services call 0844 338 5513 and select the service you require.

Fitness
You and your family covered will be eligible to participate with Incorpore, who provide a range of gym and health club policyholder discounts. You can join a health club convenient to you at the lowest membership rate available and take advantage of preferred rates on leisure, relaxation and pamper breaks around the world. To take advantage of these discounts please visit our website at www.ukhealthcare.org.uk or phone Incorpore on 0845 6024601. Our reference number is enclosed in the terms and conditions booklet issued upon joining.

Worldwide cover
The benefits of your plan apply to holidays and business trips abroad up to a maximum duration of 28 days. Any documentation submitted must be translated into English for us to process the claim.

Governing Law
The law of England and Wales applies to this contract. A person who is not party to this contract has no right under the Contracts (Rights of Third Parties) Act 1999 to enforce any terms of this policy.