SummaryOctober 2014

Business Health SelectSummaryOctober 2014

Private healthcare for small and medium businesses

Business Health Select

This guide provides a brief description of ‘Business Health Select’ private healthcare in-surance from AXA PPP healthcare. It doesn’t contain the full terms and conditions which can be found within your Group Secretary Guide and membership handbook.

The following is a summary of the ‘Core cover’ that comes as standard with Business Health Select:

Benefits Core Cover

If you’re an in-patient and day-patient

Hospital charges so long as you use a hospital or day-patient unit in our Directory of Hospitals.

Specialist fees.

Diagnostic tests when your specialist refers you.

Cash payment of £50 each day or night for in-patient or day-patient treatment at a hospital or day-patient unit that is not in our Directory of Hospitals.

If you’re an out-patient

Surgery.

Active treatment of cancer, including charges for radiotherapy and chemotherapy. Computerised tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) in a scanning centre in our Directory of Hospitals.

Other benefits

Cash payment of £50 a day up to £2,000 a year if you have radiotherapy and chemotherapy to treat cancer free on the NHS.

Dedicated nurse telephone service providing dedicated clinical medical support for employees diagnosed with cancer and their families.

Ambulance transport between facilities when needed for medical reasons.

Accommodation for one parent to stay with a child under 16 covered by your plan.

Expert Help. Direct access to our healthcare experts for you and your family.

Choose from a range of Add-ons

We provide the benefits shown in the table above as a standard level of cover and you can then choose the ‘Add-ons’ you want for your group plan. If you’re looking to insure six or more employees you can personalise your plan even further by selecting different levels of cover for the different categories of employees in your business, such as management and staff. You can set up a maximum of three categories within your group plan as long as each one contains at least three employees.

You then have the option to choose an out-patient benefit level for each employee.

You can personalise ‘Business Health Select’ by choosing the following Add-ons:

Out-patient Add-ons

If you would like out-patient cover there are three levels available. Please choose only one of these for eachemployee.

Standard out-patient Add-on

Specialist consultations & diagnostic tests when yourspecialist refers you.

Up to two specialist consultations per year and noyearly limit for diagnostic tests.

Enhanced out-patient Add-on

Specialist consultations & diagnostic tests when yourspecialist refers you.

These benefits have a combined overalllimit of £1,000 a year.Practitioner fees (dieticians, nurses, orthoptists,

speech therapists) when your specialist refers you.

Full out-patient Add-on

Specialist consultations & diagnostic tests when your specialist refers you.

No yearly limit.Practitioner fees (dieticians, nurses, orthoptists, speech therapists) when your. specialist refers you.

Therapies Add-on

Fees for our-patient treatment by physiotherapists, acupuncturists, homeopaths, osteopaths or chiropractors.

No yearly limit.

We will pay for GP referred therapist, acupuncturist and/or homeopath treatment in any combination up to

a maximum of 10 sessions per year.

Mental Health Add-on

In-patient/day-patient treatment and out-patientspecialist consultations including psychologists andcognitive behavioural therapists.

No yearly limit.

Extra care

Hospital at Home covers the cost of a nurse toadminister intravenous chemotherapy for the treatment of cancer or intravenous antibiotics at home.

Paid in full.

Cash payment when you have free treatment under the NHS as an in-patient.

£100 a night up to £2,000 a year.

Oral surgery. Paid in full for certain oral surgical procedures.

Chiropody fees. Up to £150 a year.

Dentist and Optician Cashback

Dentist fees.Optician fees.

• Covers 80% of the costs up to £300 a year fordentist fees.

• Covers 80% of the costs up to £140 every year forprescribed spectacles and contact lenses.

• Plus up to £25 each year towards an eye test.

Extra Cancer Cover

No time limit on cover for specialist cancer drugs,such as biological therapies (including Herceptin andAvastin) as long as they are used within the terms oftheir licence.Experimental drug treatment, as long as it’s part of anethically approved trial.

No time limit within your plan benefit limits.

Purchase of wigs.Provision of external prostheses.

Up to £150 a year.Up to £5,000 a year.

Hospice donation. £100 a night.

Travel

Travel Cover

Our ‘Travel Cover’ plan will be applied with this Add-on.This provides cover towards the cost of emergencymedical treatment abroad. For more information please see the ‘Travel benefits and exclusions Add-on’ section of this Summary.

What are the main exclusions and limitations of Business Health Select?

As with all insurance plans general exclusions apply. The following is a summary of the

main exclusions and limitations of the plan.

What are the main exclusions and limitations of cover?

• Treatment of medical conditions that existed, or you had symptoms of, before joining. In certaincircumstances, such as if you’re switching to us from another provider, there may be cover for theseconditions. Full details will be given before you join.

• Ongoing, recurrent or long-term treatment of long-term illnesses (usually referred to as ‘chronic conditions’).

• Routine pregnancy and childbirth.

• Treatment costs which are a result of engaging in or training for any sport for which you receive a salary ormonetary reimbursement, including grants or sponsorship (unless you receive travel costs only).

• Fees charged by a practitioner, acupuncturist or homeopath above the level within our published schedule ofprocedures and fees. There are also a small number of specialists who we will only pay up to the level in ourschedule of procedures and fees.

• Emergency or urgent treatment if the 6 Week Option is selected.

Exclusions applied depending on your Add-ons

• Out-patient diagnostic tests and out-patient consultations – unless you have selected the Standard out-patientAdd-on, Enhanced out-patient Add-on or Full out-patient Add-on.

• Out-patient practitioner charges – unless you have selected the Enhanced out-patient Add-on or the Fullout-patient Add-on.

• Therapist (physiotherapist, osteopath and chiropractor), acupuncturist and homeopath treatment chargesunless you have selected the Therapies Add-on.

• Psychiatric treatment – unless you have selected the Mental Health Add-on.

• Any dental procedures – unless you have selected the Dentist and Optician Cashback Add-on.

If you select an excess option, each member must pay the first £100, £250 or £500 ofeligible claims, once each membership year, for each person covered by the plan. You can read the full details of how your excess works in your membership handbook which you’ll receive when you join us. Alternatively please call us and we’ll be happy to explain this further.

Options to reduce the cost of your coverYou can choose to select one or more of the following options to help reduce the cost of

your cover.

6 Week OptionWith the 6 Week Option, if treatment is available under NHS within six weeks of when it

should take place, the treatment will be taken on the NHS and your employee can claim

a cash benefit. If the NHS waiting list is longer than six weeks, eligible treatment will be

covered straight away.

Optional excessYou can choose an excess of £100, £250 or £500 for each employee. The excess is

payable only once every membership year for each member on the plan that claims – not

for each claim.

Annual paymentYou can save a further 5% off your subscription when you pay with an annual Direct Debit or cheque.

Travel benefits and exclusions Add-on

The following is a summary of the medical and travel benefits of our Travel Cover:

Overseas medical coverMedical benefits Description Travel cover

Medical cover Injury and illness medical expenses: £5,000,000

Emergency medicalrepatriation andevacuation

Moving the insured member to another hospital with the necessary medical facilities either in the country where the insured member is taken ill or in another nearby country (evacuation) or bringing them back to the United Kingdom (repatriation):

Yes

Repatriation of mortalremains

Costs for returning mortal remains to the UK, up to£2,000 for local burial/cremation:

Yes

Hospital stay cashbenefit

£25 per night or £75 per night when using an EHIC orstate hospitals (when receiving in-patient treatment for five nights or more in a hospital outside the UK):

Up to £900

Additionalaccommodationexpenses*

Costs for companion to stay abroad with you if required for medical reasons: £5,000

Compassionateoverseas visit

Travelling and accommodation costs for a close relative or friend to join an injured member (where medically necessary):

Yes

UK hospital supportIf hospitalised on return to the UK as a direct result of illness or injury while abroad, £25 per complete 24 hour period:

Up to £150

Emergency dentaltreatment*

For immediate relief of pain and preservation of natural teeth:

£750

Replacement ofprescription medicines*

Emergency replacement of essential prescribed drugs or medication while on journey:

£300

NHS prescription costsPrescription costs directly associated with illness/injury for which overseas medical expenses were paid:

£50

Travel benefits

Benefits Description Travel cover

Personal accidentCompensation for loss of limbs, sight or death caused solely by external accident:

£30,000

Cancellation/loss ofdeposit*

Arising due to illness, bereavement, injury, jury ser-vice or quarantine: £5,000

Curtailment Due to illness, injury or death: £5,000

Emergency return home If the police require your presence at home:Yes

Additionalaccommodationexpenses*

Additional costs to reach destination if due to bad weather strike, mechanical breakdown:

£1,000

Personal possessions

Baggage/personal effectsSingle item limit:Loss or damage to baggage up to a maximum of:

£350£1,500

Personal money/travellers cheques

If lost or stolen up to:Cash limit:

£500£250

Passport replacement Assist with recovery or replacement costs: £250

Personal risks

Legal expensesCosts to pursue legal actions as a result of illness, injury or death, if advised within 90 days:

£25,000

Personal liability*Indemnity against legal liability to the public for accidental injury or damage to persons/property:

£2,000,000

Benefits marked with an asterisk (*) have an excess so you’ll have to pay the first £50 a claim for each person. The medical cover benefit is subject to a £50 excess unless a European Health Insurance Card is used to reduce costs.

What are the main exclusions and limitations of Travel Cover?

The significant and unusual exclusions or limitations are:

• There is no cover under section 1 – Medical benefit and section 4 – Curtailment if the insured member is notmedically fit to travel. If the insured member is terminally ill (by which we mean has a life expectancy of below one year at the start of the overseas journey) we will not pay claims under section 1 – Medical benefit and section 4 – Curtailment caused directly or indirectly by that terminal illness.

• Claims arising from an insured member’s failure to exercise all reasonable care to prevent accident, injury,illness, loss or damage.

• Sports activities listed as excluded in the membership handbook.

• Treatment costs incurred as a result of engaging in, or training for, any sport for which you receive a salary ormonetary reimbursement, including grants or sponsorship (unless you receive travel costs only).

• War and terrorist risks and travel against Foreign and Commonwealth Office advice.

• Routine pregnancy and childbirth. However, we will pay for the treatment of a medical condition which is dueto and occurs during pregnancy subject to all other benefit limitations and exclusions on this travel plan.

• Charges where you travel outside the United Kingdom to obtain treatment (whether or not that is the onlyreason) or travel against medical advice (including the published advice of the Chief Medical Officer of theDepartment of Health of England).

• Any loss or expense which is in any way connected with an insured member’s psychiatric illness.

• Unmarried children cannot be included on Travel Cover after the renewal following their 25th birthday.

Please note, this is only a summary and full details of cover including terms and conditions will be in the membership handbook or can be obtained from us.

Important information

How long will my cover last?Your group plan will be arranged to last for an initial period of 12 months.

How do I complain?We aim to provide you with the highest possible standards of service but accept there may be occasions when you feel that things have gone wrong for you and you are unhappy with us. If you have a complaint about any matter please contact us and we’ll do our best to address your concerns. Your feedback is vital to helping us to improve. Further details on how to complain can be found in the ‘Making a complaint’ section of the membership handbook. If you’re dissatisfied with the outcome of our investigation, you can ask the Financial Ombudsman Service (FOS) to consider your complaint. You should contact the FOS (0845 080 1800) to find out whether you would be eligible to have your complaint considered by the FOS, as you’ll need to meet specific criteria depending on your particular circumstances.

If you have a claim against AXA PPP healthcareIn the unlikely event that AXA PPP healthcare becomes insolvent and is unable to pay benefits under your group plan, you may be entitled to claim compensation from the Financial Services Compensation Scheme (FSCS). You’ll need to meet specific FSCS criteria depending on your particular circumstances. To find out whether you’d be eligible to claim under the scheme you should contact the FSCS (0207 892 7300). Fur-ther information about the operation of the scheme is available on the FSCS website: fscs.org.uk

Do I have the right to cancel the plan?You have a 14 day cancellation period if you’re an unincorporated business (a sole trader or a partnership which is not a Limited Liability Partnership) and you’re purchasing the cover for yourself as well as your employees. The cancellation period begins on the day your contract is agreed or the day you received your full plan terms and conditions (if this is later) and will also apply from each renewal date. The cancellation period does not apply if you’re not an unincorporated business or where you’re purchasing cover that does not include cover for yourself. Full details can be found in your Group Secretary Guide.

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AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PLAXA PPP healthcare Limited. Registered Office: 5 Old Broad Street, London EC2N 1AD United Kingdom. Registered in England No. 3148119.AXA PPP healthcare is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. © AXA PPP healthcare 2013.We may record and/or monitor calls for quality assurance, training and as a record of our conversation

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