Hospital charges & medical fees |
Therapy fees |
In patient cancer treat ment |
In patient psych iatric treat ment |
Consult ation before hospital stay |
Consult ation after hospital stay |
Out patient physio therapy |
Out patient cancer treat ment |
Out patient psych iatric treat ment |
Minor surgery by a GP |
Parent accomm odation |
Private ambul ance |
Home nursing |
NHS cash benefit |
Maternity benefit |
World wide emerg ency cover |
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In-patient and day-patient treatment |
Nationwide network of hospitals | | - Nationwide network of hospitals
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Hospital charges | Full refund | - Day-patient hospital accommodation charges
- In-patient hospital accommodation charges
- Operating theatre charges including surgical dressings and drugs
- Surgical appliances needed as a vital part of an operation
- All hospital fees if the hospital is listed by your policy (Refunds in accordance with reasonable and customary fees for treatment)
- Prostheses and appliances (artificial body parts - eg. hip replacement) when implanted as an integral part of a surgical procedure
- Intensive care, nursing care, drugs and surgical dressings
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Medical or surgery fees | Full refund | - Surgeons and anaesthetists fees
- Surgical procedures performed on an in-patient or day care basis
- Nursing care
- After a specialist advises a hospital stay for treatment, individuals have the choice to go private or receive treatment under the NHS and get money back (see NHS Cash payments)
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Therapy fees e.g physiotherapy | Full refund | - In-patient pathology, physiotherapy and diagnostic procedures. Applies equally to day-patient treatment
- Diagnostic procedures which include pathology, radiology, CT and MRI scans
- In-patient and day-patient physiotherapy, radiotherapy and chemotherapy
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In patient cancer treatment e.g. radiotherapy and chemotherapy | Full refund | - In-patient and day-patient radiotherapy and chemotherapy charges in full
- Consultant oncologists fees in full including treatment when received in a listed or approved hospital
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Out-patient treatment |
Consultation before a hospital stay | Full refund | - Expenses for specialist consultations and diagnostic procedures such as pathology and radiology
- Physicians' fees and specialist consultations available to both in-patient and day care treatment patients
- Diagnostic tests such as pathology and radiology fully covered
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Out patient physiotherapy | Full refund | - In-patient, day-patient physiotherapy fees in full
- Out-patient physiotherapy fees fully refunded when referred by a Specialist or GP unless otherwise stated herein
- GP only, referral is limited to 10 sessions per annum for out-patient treatment only
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Out patient radiotherapy/ chemotherapy | Full refund | - Out-patient radiotherapy and chemotherapy charges as part of a diagnosed treatment
- Diagnostic procedures which include pathology, radiology, CT and MRI scans
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Out patient psychiatric treatment | Annual limit: £750 | - Specialist consultations and diagnostic procedures for psychiatric and mental conditions
- Treatment in respect of specialist consultations, ECT, diagnostic procedures including pathology and radiology
- Benefits apply to each insured member per year and is the maximum cover under the scheme
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Additional benefits |
Minor surgery by a GP | Full refund | - Up to a maximum of £70 for each procedure will be paid for minor surgery performed by your GP
- Surgery undertaken at a specialists' consulting rooms or your local GP
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Hospice | Annual limit: £700 | - A daily contribution of £70 will be made to the hospice for care and for a maximum of 10 days
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Parent accommodation if child needs an overnight stay | Full refund | - The hospital's charges where it is medically necessary for a parent to accompany a child under 14 in hospital
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Private Ambulance | Full refund | - Private ambulance where medically necessary during the course of treatment
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Post discharge home nursing | Full refund | - If it is necessary to replace hospital nursing
- If it immediately follows in-patient treatment covered by the policy
- If it is prescribed by a specialist for medical reasons (not domestic reasons)
- If it is under the direction of a specialist
- If it is performed by a qualified nurse
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Cash benefit if treated by the NHS | Annual limit: £10,000 | - Cash benefit when you are treated in a public ward under the NHS (and not as a private patient)
- These benefits are paid for overnight stays and when you are a day care patient
- Policy gives you the choice between going private or receiving substantial money back payment for eligible treatment under the NHS
- Children under 18 years of age will receive money back payments for NHS treatment at half the adult daily entitlement
- Treatment elected under the NHS instead of Private will receive £250 for every night spent in hospital. Remuneration for day patients £250 for each treatment
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Maternity benefit | Full refund | - Complications of pregnancy cover only - available after 10 month membership
- Obstetric procedures listed in the policy booklet
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Free medical help line | Full refund | - A 24 hour advice and help line manned 365 days a year. Calls answered by qualified Doctors. Unlimited access
- Helpline offers guaranteed access to a GP who will answer questions and offer medical advice over the phone
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Cover available for existing conditions | | - Any Pre-existing Condition is any medical condition which an insured person has received from the following list:
- 1. Treatment from any source
- 2. Medication or medical advice from any source
- 3. Was aware of or has had symptoms during the five years prior to commencement date
- Cover for many stable pre-exisiting conditions may be available following medical underwriting and subject to additional subsciption payment
- Treatment of pre-existing conditions are not covered unless full employee details are given at time of joining and we agree to cover them
- Depending on the size and profile of your group, there are a number of underwriting/ acceptance options available to you
- Continuing medical exclusions can be chosen if your company is transferring from an existing underwritten medical plan
- Medical History Disregared is available for groups with 20 or more employees, and thus may any enable pre-existing conditions to be covered providing they fall within the terms of the plan
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Specialist consultations and diagnostics such as pathology and radiology | Full refund | - Full cover in-patient and day-patient treatment
- Full cover for out-patient treatment when recommended by a specialist
- Unique cover benefit. Provision of up to £150 cover per person per policy year for consultations for Non-acute conditions
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Consultations for acupuncture, osteopathy, chiropractic and homeopathy | Annual limit: 10 sessions |
- Policy limit quoted applies to all alternative medicines included within the policy
- Referal by a GP for out-patient treatment including osteopathy, chiropractic, and physiotherapy is limited to 10 sessions per year in total
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Osteopath | Annual limit: 10 sessions |
- Upon referral by a GP out-patient treatment including osteopathy, chiropractic, and physiotherapy limited to 10 sessions per year in total
- Upon referral by a Specialist (not GP), out-patient is fully covered
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Chiropractor | Annual limit: 10 sessions |
- Upon referral by a GP out-patient treatment including chiropractic, osteopathy and physiotherapy limited to 10 sessions per year in total
- Upon referral by a Specialist (not GP), out-patient treatment is fully covered
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Children | | - Children are covered providing they remain un-married
- Children may remain on policy until they are 24 (if they are in full time education) and will remain covered until the next annual policy review date
- Single premium of eldest child under the age of 20 covers all younger children named on the policy
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Overall Policy Limit | | - No overall limit to claims except where particular benefits have maximum levels applied
- Travellers Care (world wide travel insurance) - optional extra
- Optional increase for psychiatric cover.Your plan can provide up to £10,000 of combined cover for in-patient, day-patient and out-patient psychiatric treatment
- Pre-authorisation for treatment by phone (ClaimCall). A detailed confirmation letter will be sent within 24 hours for your use in consultations with specialists
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