Download - Your Policy Explained
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HealthcareDeposit Account
Your policy explained
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Understanding your policy
Its important that you have all the inormation you
need about the Healthcare Deposit Account.
Part 1 Policy Summary gives you the main points
about the Healthcare Deposit Account. It does not
count as the terms o the policy, these are covered
in ull in Part 2 Terms and Conditions.
I you have any questions about this product,
please call us ree on 0800 195 9245
(8am 6pm weekdays).
What does the Healthcare Deposit
Account offer?
The Healthcare Deposit Account provides
private medical insurance and aims to give you
and your amily the choice between NHS and
private treatment i you become ill or
are injured.
It oers comprehensive cover, including
covering the costs o private consultation,
surgery, recognised alternative therapies,
cancer and heart treatment, hospital ees,
dental and optical bills and cash payments or
NHS overnight hospital stays.
Your monthly premiums will be fxed or lie.
You simply pay a greater proportion o eachclaim as you get older though we always pay
the majority. The amount you pay depends on
the level o cover you choose and your age.
Hal o each fxed monthly premium goes
towards the running o the scheme including
paying the majority o each claim. The other
hal goes into your personal deposit account.
Your personal deposit account makes this
healthcare dierent to other providers
healthcare plans. It means you can build up
a und to pay or healthcare cover at your
own pace. When you need to claim, your
personal deposit account will pay a share o
the cost. The table on page 7 in the terms and
conditions shows you how much this will be.
The more you have in your personal deposit
account, the more o your chosen level o
cover youll be able to claim.
To be sure your treatment is paid in ull, you
will need to have chosen a high enough annual
medical limit and have enough in your personal
deposit account to pay your share o the claim.
For the frst ten years your top-up cover will
give you immediate extra medical cover in case
you dont have enough money in your deposit
account to meet your share o a claim. You have
the choice o either 10 a month which givesyou an extra 30,000 o medical cover, or 15
a month which gives you 45,000.
You can boost your personal deposit account
balance at any time by paying in extra money
which will increase the amount you can claim
in the uture rom your chosen level o cover.
You can make withdrawals rom your deposit
account i you wish, but this will reduce the
amount you can claim.
Part 1Policy summaryThis is your key facts guide to the Healthcare Deposit Account fromNational Friendly. It is only a summary of the main features, so to fullyunderstand the Healthcare Deposit Account please read our terms andconditions in Part 2.
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What else should I know?Your right to change your mind
You have the right to cancel the Healthcare
Deposit Account within 30 days o receiving
the welcome pack without giving any reasons.
Providing you have not made a claim, we will reund
any premiums you have paid. I you have made a
claim within the frst 30 days we will reund your
premiums minus the cost o your claim.
To cancel your Healthcare Deposit Account, please
write to us at National Friendly, 4-5 Worcester
Road, Cliton, Bristol BS8 3JL.
I you have a complaint
We are a mutual association that exists to support
our customers and we aim to provide the highest
standards o service. I we all short at any time
and you wish to make a complaint, please
contact us by:
Telephone
0808 168 7775 (8am to 6pm weekdays,
calls are recorded or quality purposes)
Email
Fax
0117 980 9358
Post
Compliance Department National Friendly,
4-5 Worcester Road, Cliton, Bristol BS8 3JL.
A copy o our complaints procedure is available onrequest or rom www.nationalriendly.co.uk.
I you make a complaint and are dissatisfed
with our response, you can ask the Financial
Ombudsman Service or an independent review.
You can contact them by:
Telephone
0845 080 1800
Email
Websitewww.fnancial-ombudsman.org.uk
Post
Financial Ombudsman Service, South Quay Plaza,
183 Marsh Wall, London E14 9SR.
The Ombudsman Service cannot deal with your
complaint until you have frst raised it with us.
In making any complaint, your right to take legal
proceedings is not aected.
The Financial Services CompensationScheme
The Financial Services Compensation Scheme
(FSCS) protects customers o nearly all fnancial
services in the UK, including customers o
this policy. Depending on your policy and the
circumstances o any claim, you may be entitled
to compensation rom the FSCS i we cant meet
our obligations, or example to pay what we owe.
I you are entitled to a claim, most insurance
policies are covered or 100% o the frst
2,000 o the claim and 90% o the rest.
You can ask or more inormation rom the
FSCS on 020 7892 7300 or at www.scs.org.uk.
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Part 2Terms and conditionsThis is your complete summary of the Healthcare Deposit Accountfrom National Friendly. Along with your application, it forms theterms and conditions of your policy.
Please let us know as soon as possible if any personal details onyour policy change.
Your Healthcare Deposit Account
Providing you are a UK resident you can take a
plan rom National Friendly.You can take out an account or yoursel i you are
aged 18 - 70. Each adult will have their own plan
which will be in their name.
Child plans
You can apply or an account or up to 5 children.
You have the choice to cover them all on one
policy with one top-up, or on individual policies
with their own top-ups. You will be the account
holder until they turn 21, at which point well
invite them to move to an adult level o cover.
The account holder
The account holder will be responsible or:
owning the Healthcare Deposit Account the personal deposit account and the money
in it
making sure the monthly premiums are paid
on time
making sure a claim is paid i we cannot
pay the treatment provider directly (this will
be reunded)
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Choosing your level of cover
The level o cover or each monthly premium is
set out in the table below. These are the maximum
levels o cover available each year, but the amount
you can claim will also depend on your deposit
account balance. You simply choose how much
cover you require and this tells you how much your
monthly premium will be. Your premiums are fxed
or lie. I we change them in the uture or new
customers you will not be aected.
How your deposit account works
Your fxed monthly premium is divided in two. Hal
helps und the cost o this healthcare scheme. The
other hal goes into your own deposit account. So
i you decide on a fxed monthly premium o, say
60, youll be building your deposit account by
30 a month.
When you need to claim, your personal deposit
account will pay part o the cost, but well always
pay the majority share. The more money you have
in your personal deposit account, the more o
your chosen level o cover youll be able to claim.
Any money used rom your personal deposit
account to pay your share o a claim will show as a
deduction on your annual statement.
1Available or the frst ten years o policy only 2Maximum ten nights per annum
Choose your premium Maximum cover available each year
Fixed monthly premium basedon your joining age
Top-up1premium
Medicalcover
Top-up1medicalcover
Dental &opticalcover
NHSpaymentsper night2
A ge 0-17 18-29 3 0-49 50 -60 61-64 65-70
10 7 7 7 7 7
Either
10
or
15
5,000
Either
30,000
or
45,000
150 10
20 7 7 7 7 7 10,000 300 20
30 7 7 7 7 15,000 450 30
40 7 7 7 20,000 600 40
50 7 7 25,000 750 50
60 7 30,000 900 60
70 35,000 1,050 70
80 40,000 1,200 80
90 45,000 1,350 90
100 50,000 1,500 100120 60,000 1,800 120
140 70,000 2,100 140
150 75,000 2,250 150
200 100,000 3,000 200
How the plan works
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Own share percentages
The own share percentages are not fxed orever and we reserve the right to change them. However, we
will only change them in exceptional circumstances, or example i claims across the scheme turn out to besignifcantly higher than expected. We will never change the percentage you have to pay just because you
have personally made a lot o claims.
For more inormation on the claims process please see page 15
Your age How much can you claim? How much does your personaldeposit account pay?
Under 65 = 10 x your personal deposit account + top-up cover = 10% o each claim
65 or over = 4 x your personal deposit account + top-up cover = 25% o each claim
Heres how the top-up cover works
Miss Lane, aged 47, has been a policyholder or 18 months.
Her fxed premiums are 40 per month and she pays 10 per month or the top-up. Shes not made any
previous claims or any additional deposits. So her deposit account balance is 360 (=40 per month x 18
months 2).
Her share o any claim is 10% so each 1 in her account will buy 10 cover. Miss Lane now needs surgery
which will cost 5,000 to be done privately. From her Healthcare Deposit account she would be entitled
to claim:
360 x 10 = 3,600 towards her treatment made up o:
360 rom her deposit account and
3,240 rom us.
However, because she has the 10 top-up, we can pay the outstanding 1,400 (5,000 - 3,600)
rom her top-up cover.
Miss Lanes surgery bill is paid in ull and her 30,000 top-up is reduced by 1,400 to 28,600.
The top-up cover doesnt include cover or optical or dental treatment or NHS hospital stay payments.
Its not part o your personal deposit account, so you wont be able to withdraw it in cash.
The sum is divided by 2 as 50% goes into her deposit account, 50% goes into running the scheme.
Top-up cover
The more money you have in your personal deposit account, the more o your chosen level o cover youll
be able to claim. I you need to make a signifcant claim at the start o your policy, its possible that you
wont have enough money in your personal deposit account to pay your share o the claim.
Thats why we provide immediate top-up cover. You have the choice o either 10 a month which gives
you an extra 30,000 o medical cover, or 15 a month which gives you 45,000. This does not include
NHS, dental or optical cover. It lasts or ten years or until it runs out, whichever is sooner. At this point you
should ensure your personal deposit account balance is enough to cover your own share o any claims.
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Boosting your balanceYou can make additional deposits at any time or use
towards uture claims. So, while youre healthy, it
might make sense to boost your balance so there is
enough in your account when you need it most.
None o these additional deposits go towards the
cost o running the scheme; they all go into your
personal deposit account.
Please note, you wont be able to use any additional
lump sum deposits to cover a claim or a complaint
that you knew about when you paid them in. This
is to protect the und that we use to pay all claims
and to make sure that all our Healthcare Deposit
Account holders are treated airly and get the cover
they are eligible or.
Payment options
We preer your monthly premiums to be paid
by direct debit. Additional lump sums can be
paid by direct debit, debit card or cheque.
Loyalty rewardsThe deposit account is not a savings account so
does not pay interest. However, at the end o the
fth calendar year o your policy, and every year
ater that, we will calculate a loyalty reward based
on your personal deposit account balance.
Loyalty rewards are a discount on the part o
your fxed monthly premium that goes to und
the scheme. This means that less o your monthly
premium will und the scheme and more will go
into your personal deposit account. Your monthly
premium will stay the same.
Each year our Board will decide on and monitor
the discount rate and will take into account all
claims made and likely to be made against the
healthcare scheme, in some circumstances it may
not be possible to grant a loyalty reward.
Any discount will be applied on 31 December,
based on your deposit account balance on
1 January o that year.
Keeping track of your personal
deposit account
We will send you a statement once a year. You can
also ask or your balance over the phone or or an
extra statement whenever you wish.
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How you can apply for cover
The Healthcare Deposit Account is a private
medical insurance (PMI) product. PMI policies
provide cover or the cost o private medical
treatment or unoreseen medical conditions
arising ater your policy starts. Your policy is not
intended to cover conditions which you already
have beore your policy starts these are called
pre-existing conditions. Conditions which are
related to pre-existing conditions are also not
usually covered. A related condition is one that
is caused by, or could be the cause o, another
condition. Your policy will not cover all medical
treatments.
This chapter explains what is and isnt covered.
Your underwriting options
Underwriting is the process by which we decide
on what terms we will accept a person or cover,
based on the inormation they supply. You have
a choice between three ways o applying or
a Healthcare Deposit Account rom National
Friendly. You can decide which best suits your
requirements:
n Full medical underwriting
This is based on you completing a health
questionnaire (also called a Medical History
Declaration). I you choose this option, you
will be asked a number o questions about
your health. These will enable us to understand
your medical history. It is important that
you consider the questions careully andanswer them ully. We will ask i you have had
any signs or symptoms o a list o medical
complaints.
We will review your details and decide the
basis on which we can accept you or cover.
I necessary, we may need to ask your doctor
or any urther inormation we need to help us
to do this. I you have a pre-existing condition
that may need treatment in the uture, we
will usually exclude it rom the cover along
with any conditions related to it. We will show
any exclusions on the policy schedule you
receive rom us when we have processed your
application.
I we exclude treatment or a pre-existing
condition at the time your policy starts we will,
in some cases, review the exclusion in uture
should you wish us to do so.
O course, any new medical conditions arising
ater the start o your policy will be covered
immediately subject to the policy terms andconditions.
Please note: You must ensure that you provideull and accurate inormation in answer to
the questionnaire. Failure to do so may mean
that we cannot cover a claim or even that
your policy is void. I you are unsure whether
we would want to know about a particular
condition, you should tell us about it.
What is the advantage o ull medicalunderwriting?
Although this option involves more o your
time when completing your application, it
does mean that, when you receive your policy
documentation, you will know which pre-
existing conditions are excluded rom cover.
n Moratorium
With this option you do not need to fll in a
health statement. Instead, we automatically
exclude any pre-existing conditions or
which you have received treatment and/or
medication, or asked advice on, or had signs
or symptoms o (whether or not diagnosed),
during the fve years immediately beore your
cover started.
However, i you do not have any signs,
symptoms, treatment, medication, or advice
or those pre-existing conditions, and any
directly related conditions, or two continuous
years ater your policy starts, then we will
reinstate cover or those conditions.
Your healthcare coverin detail
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You should understand that long-term medical
conditions, which are likely to continue to need
regular or periodic treatment, medication
or medical advice, will never be covered by
your policy. You should not delay seeking
medical advice or treatment or a pre-existing
condition simply to obtain cover under
your policy. O course, as with ull medical
underwriting, new medical conditions arising
ater the start o your policy will be covered
immediately subject to the policy terms andconditions.
What is the advantage o moratorium
underwriting?
I you choose this option you will only be asked
to provide basic inormation about you and
any children you wish to insure. You will not
be asked to disclose details o your medical
history, but it relies on you to understand that
i you have any medical conditions these will
be excluded rom cover. Also, i you can satisy
the criteria o two years outlined previously
or a pre-existing condition, then treatment
or that condition will automatically be covered
i it recurs, subject to the policy terms and
conditions. This option may be suitable i
youre generally well.
I you are switching rom another provider.
Continued personal medical exclusions.
I you have private medical insurance cover
with another insurer and wish to switch to
our plan, we will ask you to complete a shortapplication orm in which 4 simple questions
are asked about your recent health conditions.
We will also need to see a healthcare
certifcate rom your current insurer.
I any medical conditions were not covered
(excluded) under your previous plan, these
exclusions will continue under our plan.
Likewise, i any serious condition is ongoing
and requires urther treatment soon, we may
delay or reuse cover.
Example 1: I had an operation on my right knee recently. Will I be covered or any urther treatment
on it ater my policy starts?
n Full medical underwriting
I the operation was recent, there is a chance that we would exclude uture claims relating to your
right knee. However, we could put a temporary exclusion on claims or the knee, so as long as there
are no problems in the two year period ater joining, you can apply to us to have the exclusion
removed.
n MoratoriumI the operation was perormed in the 5 years prior to you taking out the policy you will need
to have had a period o two consecutive years ater the policy has started where you have not
required any treatment, advice or medication or this condition.
n Continued personal medical exclusion
Only i there was an exclusion on claims or your right knee under your previous cover with another
insurer or i you had treatment planned when you joined, would we not pay or this.
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Example 4: How do regular check-ups aect the moratorium?
n Moratorium
I you have a condition beore your policy starts and your doctor or specialist recommends that
you continue to have regular check-ups or that condition then we will not cover the cost o the
consultations or any treatment received or this condition. Cover or this condition will be available
once you have had 2 years where you have not had any signs, symptoms, treatment or advice or
this condition.
Example 2: Some time ater my cover begins, I go to the doctor or a routine visit. A heart condition
is diagnosed and it must have started to develop beore my cover began. What is the position?
n Full medical underwriting
I the condition was diagnosed ater the start o your policy and i you had not had any signs,
symptoms, treatment or advice or this condition beore your policy started then cover would be
available even i it was proved that the condition existed beore you took out the policy.
n Moratorium
I the condition was diagnosed ater the start o your policy and i you had not had any signs,
symptoms, treatment or advice or this condition in the fve years prior to you taking out your
policy then cover would be available even i it was proved that the condition existed beore you
took out the policy.
n Continued personal medical exclusion
As your visit was unplanned and not known about when you applied, we will pay or your
treatment.
Example 3: What i I suspect I am suering rom a condition (or example, I have a lump) but have
not seen a doctor about it , nor received any frm diagnosis beore my cover starts? Will I be covered i
I need to have any investigations or treatment or the condition once my policy has started?
n Full medical underwritingI you had a lump, this could reasonably be considered a sign or symptom o a complaint that
you should report on your application. As long as you do so, we will let you know beore you join
whether an exclusion will apply. So you will know beore your treatment whether or not this will be
covered.
n Moratorium
As an obvious sign or symptom which existed in the fve years prior to taking out the account
treatment or the lump would not be covered. We would, as usual, take advice rom the GP/
treatment provider as to whether the lump existed prior to you taking out the plan.
n Continued personal medical exclusion
Only i there was an exclusion on claims or the problem under your previous cover with another
insurer we will not pay or this.
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What we coverLets take a look at which treatments we cover and which we dont
Medical Cover
Included
Acupuncture, alternative medicine and homeopathy
rom accredited providers.
Heart surgery.
Acute medical conditions other than those on the
excluded list or conditions that are directly linked
to those on that list.
Consultations, diagnosis, pathology and other
hospital tests that your GP or other treatment
provider has recommended.
Operations (including minor ones or ear, nose and
throat, carpel tunnel, adenoids and tonsil removal),
surgeons ees, anaesthetic, scans o all types (CT,
MRI, etc.), physiotherapy and other manipulative
treatments such as chiropractic and osteopathic
work by qualied practitioners.
Nursing at home by a qualied nurse, provided this
is required as part o your treatment or an acute
condition or or treatment o an acute worsening
o a chronic condition, that is, one which is long-
term with no likely cure, up to a maximum o six
weeks a year.
Chiropody and podiatry or acute conditions. Oral surgical procedures.
In-patient or day-patient treatment o acute
conditions.
Cancer treatment, including chemotherapy,
radiotherapy, oncology and cancer surgery.
Private ambulance where medically necessary. Pre-authorised consultants and treatment rom a
specialist or psychiatric conditions we deem to be
acute (curable within 6 outpatients consultations).
7 Excluded
Any costs in connection with childbirth, ertility
testing or inertility treatments, or any treatment to
help prevent, or help recover rom pregnancy.
Residential stays in a hospital, or or convalescence
o any kind. We will only pay or short-term stays
necessary because o an acute medical condition
or injury.
Day-patient drugs and dressings. Gender re-assignment (sex change).
Preventative screening and tests or inherited
conditions, cervical smears, mammograms, well-
person checks, vaccinations, immunisation and
musculoskeletal screenings such as those or
osteoporosis.
Cosmetic treatment or plastic surgery, unless this
is medically required, while you are an account
holder. This extends to any operation to improve
physical characteristics which does not benet
your physical health, e.g. breast enlargement.
Any costs that have already been paid rom another
source, such as another insurer or through another
injury claim.
Congenital abnormalities (abnormalities you were
born with).
Continued
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Medical Cover - continued
7 Excluded
Hormone replacement therapy (HRT). Organ transplants and donations.
Medical appliances, unless these have been inserted
or attached as part o a medical procedure.
Kidney dialysis in either chronic or end stage kidney
ailure.
Routine testing, treatment or any other service rom
your GP.
Treatment or any injury deliberately inficted on
yoursel.
Treatment rom a specialist i your GP does not
support your claim.
Treatment such as hydrotherapy and detoxication
in health clinics, spas or clinics that promote general
health rather than curing specic conditions.
Treatments or remedies carried out by bodies we do
not recognise or approve in advance (see glossary or
accepted denitions).
Treatments you receive while living abroad or staying
overseas.
Treatment or conditions not medically necessary
(e.g. or obesity, contraception etc.).
Dental Cover
Included
Fillings, extractions, bridges, dentures, crowns, inlays,
implants.
Dental operations or treatment outside those shown
as included, eg. wisdom tooth extractions, will be
treated as part o your medical cover.
Any other dental treatment that is not cosmetic.
7 Excluded
Check-ups (unless they are part o the same bill as
other covered treatments).
Cosmetic dental treatments including braces, scale
and polish and whitening.
Claims in the rst six months o joining.
Optical Cover
Individual account holders can make one optical claim every other calendar year. All other account holderscan make one optical claim per account each calendar year. One claim means one bill on one receipt
assessed using the date o your treatment.
Included
New glasses or contact lenses. Prescription sunglasses.
Repairs to glasses. Corrective eye treatments by lasering. Other eye
operations will be treated as part o your medical
cover.
7 Excluded
Claims in the rst six months o joining. Laser eye treatments in the rst 24 months.
Eye tests.
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NHS hospital stay payments
Included
You can claim a cash payment or up to ten overnight
stays in an NHS hospital each year in circumstanceswhere you could have chosen a private hospital
(i.e. not A&E admissions).
I you are on an account with children, one parent
and a child can claim or a stay when an adult stayswith their child in hospital overnight. This counts as
two nights out o your maximum o ten.
7 Excluded
Claims or NHS hospital stays where you have
received treatment or which you are not eligible
under the terms o your policy i.e. pregnancy, pre-
existing conditions, treatment o chronic conditions.
General exclusions
Any condition that has come rom being
inected by human immunodefciency virus
(HIV) and/or any related illness, including
acquired immune defciency syndrome (AIDS).
Alcoholism, alcohol abuse, solvent abuse, drug
abuse or addictive conditions o any kind or the
treatment o any condition developed as a result
o such abuse.
Accident and emergency admissions.
Injuries or illness arising rom war, or war-like
operations (civil or otherwise and whether ornot war has been declared), military, paramilitary
or terrorist activity (including the eects o
radiobiological, biological or chemical agents).
Injuries or illness sustained as a result o criminal
activity and/or public-order oences.
Injuries or illness sustained or related to taking
part in a dangerous sport or activity such as
scuba-diving, gliding, parachuting, parascending,
paragliding, mountaineering, and motor sports.
I you are not sure what we class as a dangerous
sport, please contact us.
Any incapacity sustained while taking part in any
proessional or semi-proessional sport (one you
are paid or).
Learning difculties, including dyslexia,
development problems, or behavioural problemssuch as attention defcit hyperactivity disorder.
Treatment o chronic conditions. These are
conditions that are long term with no likely cure.
Sexually transmitted disease or sexual
dysunction.
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Making a claim
We aim to make our claims process as simple and
quick as possible. Our medical claims team will
guide you through the process, making sure that
the price o your treatment is air and reasonable.
Claiming for medical cover
Claims start with a visit to your doctor (GP)
1 When your GP makes a reerral, you should
let them know that you have a policy with
National Friendly, and ask or the name oa private consultant or treatment as an
alternative to the NHS.
2 Ater being reerred by your GP, call our Claims
Helpline frst on 0808 168 2912 to check that
your condition and any potential treatment are
covered and to request a medical consent orm
(available on our website www.nationalriendly.
co.uk/healthcare). We will ask your doctor to
submit a copy o your reerral and so will need
your permission to view their comments, plus
those o any attending practitioner. I you dontlet us know about your treatment and we dont
authorise it in advance, you may well have to
pay the bill yoursel. Once we have confrmed
you are covered we can speak directly with
your GP or treatment provider.
3 Your GP will most likely give you the name o
a private specialist. I not, we will let you have
the details o someone close to your home or
workplace. We dont have preerred lists o
hospitals or providers, so we can help you get
the quality and convenience you expect romthe specialist or provider you want.
4 We will check details o your condition against
your application.
5 Our trained sta will make everything as easy
as possible or you throughout the process.
We will keep you inormed about our
discussions with your treatment provider and
will authorise payment to them. Please help us
by inorming them you have cover with us and
that we, and not you, will pay or treatment
(unless there is a shortall which we would tell
you about well in advance). Plus well always
try to make sure the price o your treatment is
air and reasonable.
6 We will try to pay your medical provider direct
upon receipt o their original invoice without
your involvement.
Claiming for physiotherapy, chiropractic
treatment etc.
I you are likely to need multiple visits to your
treatment provider, please call us to check that
youre covered. You will need to get a GP reerral
beore each course o treatment.
Once we have given you the go ahead on your
claim and, i the treatment provider is happy or
us to do so, we will settle your bill at the end o
your treatment. You wont need to contact us
about each session o treatment, but we may
check with your provider ater eight sessions.
This is to establish what extra treatment may be
necessary to cure you and to ensure that your
uture needs can be met.
Claiming for dental or optical cover
First, please check you are covered beore you
book your appointment.
You probably wont know how much your bill is
going to be, so youll need to pay the dentist or
optician yoursel and claim the cost back rom us.
Please ask or an itemised bill as without it payment
o your claim could be delayed. The bill should then
be sent to us and we will reund your costs directly
to your bank account. To enable us to do this you
will need to provide us with your bank account
details i we dont already have them.
Please note, the top-up cover is or medical cover
only and does not cover dental or optical claims.
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Claiming for NHS overnight hospital stays
I youre admitted to an NHS hospital, please
get an admission or discharge sheet signed by a
doctor or senior nurse. Youll need to send this to
us with your completed claim orm.1 Check youre covered beore your stay.
2 Complete the patients section o the NHS
overnight stay claim orm.
3 Ask your hospital to complete their section o
the orm.
4 Return your orm so we can arrange payment.
Claims will be paid in circumstances where
you have a choice between NHS and private
treatment, so accident and emergency admissions
will not be covered.
Please note, the top-up cover is or the medical
cover only and does not cover NHS overnight
hospital stays.
Work out how much you can claim
The amount you can claim depends on:
How much cover you have chosen
Your own share o each claim
How much money you have in your personaldeposit account
How much top-up you have
Whether you have already been paid, or youre
due to be paid, in ull by another insurer or
the same claim. I this happens, we will not pay
the claim.
The own share percentages are not fxed orever
and we reserve the right to change them.
However, we will only change them in exceptional
circumstances, i claims across the scheme turnout to be signifcantly higher than expected. We
will never change the percentage you have to
pay just because you have personally made many
claims. We will write to you i any eature o your
plan changes so you can assess your options.
The top-up cover comes to an end ater 10 years,
during which time we hope you will have built up
your deposit account balance enough to cover the
cost o private medical treatment. However, i you
dont have enough in your account or your share
o a claim, we will pay a smaller proportion o the
amount you are claiming.
Mrs Jackson wanted up to 30,000 annual
cover and chose to pay 60pm, even though
at 55, she could have chosen 50pm. She
selected the 10 top-up option to cover
medical claims in the frst 10 years.
Hal her monthly premium went into her
personal deposit account. Ater 12 months she
had 360 in her account.
Ater 5 years, when Mrs Jackson needed to
make her frst claim, she had built up 1,800 in
her deposit account.
As Mrs Jackson was under 65, she was required
to pay 10% o the claim rom her deposit
account, and so was entitled to ten times the
amount in her deposit account in total.
Mrs J could thereore claim up to 18,000
without dipping into her 30,000 top-up und.
Mrs Js actual claim was or 8,000, so she paid
800 rom her deposit account and we paid
the balance o 7,200.
Her claim was paid in ull, she had 1,000 let
in her deposit account (10,000 cover) and
still had her 30,000 top-up available.
The example below can help you
understand how much you can claim.
Your age How much can you claim? How much does your personaldeposit account pay?
Under 65 = 10 x your personal deposit account + top-up cover = 10% o each claim
65 or over = 4 x your personal deposit account + top-up cover = 25% o each claim
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When we will and wont pay out
Your Healthcare Deposit Account aims to return
you to health when you get a condition that
will respond quickly to treatment whether
that involves a major operation or a ewphysiotherapy sessions. These are known as
acute conditions. We will pay out or acute
conditions covered by your policy.
I an acute condition develops into a chronic
condition, we will stop paying the claim. Chronic
conditions are diseases, illnesses or injuries that:
Continue indefnitely and have no known cure.
Come back or are likely to come back.
Need ongoing or long-term control or relie
o symptoms.
Need you to have specialist rehabilitation
or training, or regular tests, check-ups or
consultations to monitor the condition over
a long time.
We will always write and let you know i, ater
getting advice rom your specialist, we believe
that your acute condition has become chronic.
The Healthcare Deposit Account does not cover
you or chronic conditions. We do however viewcancer dierently rom other chronic conditions
please see page 21 or ull details. When you
make a claim, we decide whether the condition
you are claiming or is chronic or acute. I we
decide, using the medical inormation available,
that the condition is chronic, we will not pay or its
treatment.
I however, you have a chronic condition and
suddenly develop acute symptoms, we may
cover you or treatment to return you to a more
controlled state o health.
Example 1 - AlanCondition We will pay for We wont pay for
Alan develops chest pains and is
reerred by his GP to a specialist . He is
diagnosed with angina and placed on
medication to control his symptoms.
Investigations leading to the
diagnosis o angina.
Ongoing monitoring,
medication or routine ollow-
ups, as this is a chronic
condition.
Two years later, Alans chest pain
recurs and his specialist recommends a
heart-by-pass operation.
Alans heart by-pass surgery as
it is an acute worsening o his
condition.
Example 2 - Sandra
Condition We will pay for We wont pay for
Sandra develops hip pain. Her GP
reers her to an osteopath who treats
her every other day or two weeks
and recommends that she return once
a month or additional treatment to
prevent a recurrence.
The osteopathy until Sandras
hip pain is cured.
Treatment i her condition is
subsequently diagnosed as
chronic.
How this works in practice
These examples assume there is enough money in the account holders personal deposit account to cover
their own share o each claim. All payments are subject to the maximum level o cover chosen.
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Example 5 - Beverley
Condition We will pay for We wont pay for
Beverley has been with National
Friendly or ve years when sheis diagnosed with breast cancer.
Following discussions with her
specialist she decides to have the
breast removed ollowed by breast
reconstruction. Her specialist also
recommends a course o radiotherapy
and chemotherapy.
In addition she is to have hormone
therapy tablets or several years. Will
her insurance cover this treatment and
are there any limits to the cover?
Any private consultations,
surgery, radiotherapy andchemotherapy until Beverley
has reached remission or is
cured.
Example 6 - Cara
Condition We will pay for We wont pay for
Cara has previously had breast cancer
which was treated by lumpectomy,
radiotherapy and chemotherapy under
her existing policy. She now has a
recurrence in her other breast and
has decided to have a mastectomy,
radiotherapy and chemotherapy. Will
her insurance cover this treatment and
are there any limits to the cover?
This is considered to be a
new condition and we would
thereore pay or Caras
operation, the radiotherapy and
the chemotherapy.
Example 7 - Sharon
Condition We will pay for We wont pay for
Sharon would like to be admitted to
a hospice or care aimed solely at
relieving symptoms. Will her insurance
cover this and are there any limits tothe cover?
We do not pay or hospice care.
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Example 8 - Monica
Condition We will pay for We wont pay for
Monica, who was previously treated
or breast cancer under her existingpolicy, has a recurrence which
has unortunately spread to other
parts o her body. Her specialist
has recommended the ollowing
treatment:
n A course o six cycles o
chemotherapy, aimed at destroying
cancer cells, to be given over the next
six months.
n Monthly inusions o a drug to help
protect the bones against pain and
racture. This inusion is to be given
or as long as it is working (hopeully
years).
n Weekly inusions o a drug to
suppress the growth o the cancer.
These inusions are to be given or as
long as they are working (hopeully
years).
Will her insurance cover this treatment
plan and are there any limits to thecover?
We will pay or Monicas
treatment i its aim is curativeor to achieve remission. This
would include consultations,
chemotherapy, radiotherapy
and surgery.
However i at any stage
Monicas consultant conrmedthat the aim o her treatment
became palliative, cover would
cease.
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Our approach to cancer claims
At National Friendly, we wont treat cancer like other potentially chronic conditions.
In general, we will pay towards any treatment you have rom your diagnosis until remission or a cure is
reached. This is what we will and wont pay or:
You must remember
With any medical treatment you have, the amount you receive rom us will be determined by:
The annual medical limit o your policy.
The amount your personal deposit account will und.
The top-up cover you choose.
We will help you manage the cost o your treatment, but you will need to know how much your treatment
could cost in total and what your options are at the beginning o your care.
Cancer claims
We will pay for We wont pay for
Active treatment. This is dened by Cancerbackup
as treatment intended to aect the growth o the
cancer by shrinking the cancer, stabilising it to slow
the spread o the disease and not given solely to
relieve symptoms.
Preventative treatment, routine testing or screening.
Consultations, surgery, chemotherapy and/or
radiotherapy i you are being investigated or are
diagnosed with cancer.
Clinical trials.
Scans and tests required to monitor your condition
during active treatment, unless they are part o a
screening programme or routine testing.
Experimental treatment not licensed by the EMEA or
the MHRA.
Consultations, scans and tests or up to two years
ollowing successul treatment or during a period o
remission.
Hospice care.
Drugs pre-licenced and recommended by your
cancer specialist. Please be aware that some o
these treatments are extremely expensive.
Bills incurred in hospital or at home.
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Changing your account details
You can apply at any time to add another child to
an existing child account (subject to a maximum
o 5 children on the child account). Please contact
us on
0808 168 7775 and well send you an
application orm.
Additional children will be covered once:
You have given us their details
We have written to you to confrm they are
now included on the account
You have paid the next monthly payment
which will include the extra premium.
Well only decline to add a amily member i they
dont match our application criteria.
You can also ask to remove a child rom a child
account at any time.
Changing your level of coverEach year you can increase your monthly premium
by 10 without giving us any more inormation
about your health as long as it does not exceed
the maximum monthly premium. We reserve the
right to reuse an application to increase fxed
premiums.
I you wish to increase your level o cover by
more than 10 a month you will need to provide
inormation about your health. I you have
suered a new condition since joining you may
only be able to claim your original level o coveror it.
You can also choose to decrease your monthly
premium as long as it doesnt all below the
minimum monthly premium or your age.
The amount you can claim will still be limited by
your deposit account balance.
I you fnd that your account balance is growing at
the right pace to give you the medical cover you
may need, you can end your top-up cover at any
time during the ten years.
Missing a payment
I you miss a monthly premium, your Healthcare
Deposit Account will not cover you or any claim
until you pay it. We will write to tell you i we have
not received your monthly premium.
I you owe three months premiums at any
stage, your Healthcare Deposit Account will
automatically close and you will not be able to
re-open it.
Once your account has been closed, we willwrite to tell you how to withdraw any money
in your deposit account. I you do not claim the
balance within 28 days, we will move it to a
holding account which does not pay interest.
I you miss a premium on your top-up you will not
be able to claim the extra medical cover until you
pay it. I you owe three months top-up premiums
at any stage, this extra cover will automatically
stop and you will not be able to re-start it.
Withdrawing cash from your personaldeposit account
You can withdraw money rom your personal
deposit account whenever you wish, but please
remember that the more money you have in your
personal deposit account, the greater the amount
you can claim.
The only time you will not be able to withdraw
cash is i it reduces the amount o cover you need
to pay a pending claim.
I you would like to withdraw cash without closingyour Healthcare Deposit Account, please contact
us on 0808 168 7775 (8am to 6pm weekdays,
calls are recorded or quality purposes) quoting
your policy number. Any cash you withdraw will
show on your statement as a deduction.
Changing your account
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Your right to change your mindYou have the right to cancel the Healthcare Deposit
Account within 30 days o receiving the welcome
pack without giving any reasons. Provided you have
not made a claim, we will reund any premiums you
have paid. I you have made a claim within the frst
30 days we will reund your premiums minus the
cost o your claim.
To cancel your Healthcare Deposit Account, please
write to us at National Friendly, 4-5 Worcester
Road, Cliton, Bristol BS8 3JL.
Closing your account
We hope you see the benefts o keeping your
Healthcare Deposit Account throughout your lie,
but i at any time you would like to close it, please
write to us.
We will return any balance in your deposit
account, less any money you owe (such as missing
premiums or your own share o any claims).
The account holder
A plan taken out or a child aged under 18 willhave a named parent or guardian as account
holder until aged 21, when the child will be
oered an adult plan.
The account holder will be responsible or:
Owning the Healthcare Deposit Account.
The personal deposit account and the money
in it.
Making sure the monthly premiums are paid
on time.
The actions o anyone else on the policy.
Paying a claim i we cannot pay the treatment
provider directly (this will be reunded).
If the account holder diesAs soon as we hear rom the executors or next o
kin, we will explain to them what we will do with
the account.
The remaining balance in their personal deposit
account can be paid to those entitled to receive it.
The account holder has the right to nominate one
or more people to receive the combined value o
their National Friendly policies i they die. This is
currently limited to a total o 5,000 and would
be paid without needing to wait or the Grant o
Probate or Letters o Administration. The sum
payable on death orms part o the estate or
inheritance tax purposes and we will need to see
the death certifcate and policy schedule or it to
be claimed.
Any amount over 5,000 will be paid out once
weve received proo o title rom the executors
or administrators.
For more inormation, please call us on
0808 168 7775 (calls are recorded or quality
purposes).
If we lose contact with you
I we lose contact with an account holder or do
not hear rom the representatives o an account
holder who has died, we will move that persons
personal deposit account balance to a non-
interest bearing holding account. The account
holder or their representatives can claim the
money once they give us proo that they are
entitled to it.
Transferring or assigning a Healthcare
Deposit Account
This Healthcare Deposit Account is a legal
contract between us and the account holder.
You cannot transer it or give it to anyone else.
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Our right to cancel your policyWe have the right to expel any policy holder who,
in connection with this or any other National
Friendly policy has:
Provided alse inormation with the aim o
gaining money rom us.
Not acted in a air and reasonable way.
I we plan to expel a policy holder, we will frst
explain what will happen and their right to appeal. I
a policy holder is expelled, we may end their policy
at any date ater that and will return all money, less
any money obtained raudulently and all reasonable
expenses incurred in expelling the member.
Applicable law
I there is a legal dispute, English law will apply.
Language and currency
All correspondence will be in English and all
currency will be sterling. All literature is available
in Braille, large print or audio. To request a copy,
please call us on 0808 168 7775 (8am to 6pmweekdays).
Alterations to the policy termsThese terms and conditions may change as a
result o a new law or regulation. We also have
the right to change the terms and conditions
at any time as a result o product or system
development, or changes in the cost o providing
a service or product to you, or to remove any
ambiguities. We will write to you and let you know
o any changes. I you do not accept the changes
then your policy will be cancelled.
Our regulator
We are authorised and regulated by the Financial
Services Authority (FSA). Our FSA register number
is 110008. Our permitted business is sickness,
medical, income replacement and term assurance,
lie assurance, investment bonds and personal
pension annuities.
You can check this on the FSAs register by visiting
www.sa.gov.uk/register or by contacting the FSA
on 0845 606 1234.
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Words and phrases explained
Accident or Emergency Treatment
I you need to go to hospital immediately because
youre suering acute symptoms rom an illness
or accident, or i you go to a hospital ward or
unplanned urgent treatment.
Acupuncture
A treatment involving inserting needles in the
skin or muscle to relieve conditions such as pain,
anxiety, allergic reactions, sinus and skin problems.
Acupuncturist
A doctor who is also a Medical Member or
an Accredited Member o the British Medical
Acupuncturist Society and recognised by us as
being ft to carry out such treatment.
Acute condition
A disease, illness or injury that is likely to
respond quickly to treatment that aims to returnyou to the state o health they were in beore or
which leads to your ull recovery.
Cancer
A malignant tumour, tissue or cells characterised
by the uncontrolled growth and spread o
malignant cells and invasion o tissue.
Chiropody
The treatment o eet, nails, corns and bunions.
Chiropractic treatment
A treatment that involves gentle hand
movements, known as adjustments, which
concentrate on the spine and associated nerves.
Chiropractor
A practitioner on the Register o Chiropractors
kept by the General Chiropractic Council as
required as part o the Chiropractors Act 1994,
and recognised and agreed by us.
Chronic condition
A disease, illness or injury that has at least one o
the ollowing characteristics:
It continues indefnitely and has no
known cure.
It comes back or is likely to come back.
It needs ongoing or long-term control or relie
o symptoms.
You need to be rehabilitated or specially
trained to cope with it.
It needs long-term monitoring through
consultations, check-ups, examinations
or tests.
Consultation
A meeting with a medical specialist to fnd out
more about a medical condition and decide how
to treat it.
Day-patient treatment
Treatment or which you have to go into a hospital
or day-patient clinic/unit because you need time
to recover under medical supervision, but or
which you do not need to stay overnight.
Words & phrases
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Deposit accountSee Personal Deposit Account.
Diagnostic tests
Any investigation, such as a blood test or x-ray,
which might fnd or help to fnd the cause o
your symptoms.
EMEA
The European Medicines Agency.
GPA general medical practitioner (doctor) who has
a Certifcate o General Practice Training and is
registered with the General Medical Council in
the UK.
Hospital
A private hospital in the UK which is
registered in accordance with UK law and
which has specialist acilities or major
surgical operations.
An NHS pay-bed. This is a bed and treatment
in an NHS hospital that you pay or.
Any hospital or establishment that we agree is
appropriate or providing treatment.
Hospital charges
Charges or accommodation, nursing care, drugs
and dressings, diagnostic tests, prosthesis and
operating costs.
In-patient treatmentTreatment which, or medical reasons, means
you have to stay in hospital overnight or longer.
MHRA
The Medicines and Healthcare products
Regulatory Agency.
MoratoriumThe period during which we will not pay or pre-
existing conditions that you knew about when
you joined.
Nurse
A nurse on the register o the Nursing and
Midwiery Council (NMC) and who holds a valid
NMC personal identifcation number.
Nursing at home
I you have difculty getting to in-patient orout-patient appointments, you may need to get
treatment at home. You are covered to receive
treatment at home by a qualifed nurse.
Oncology
The feld o medicine specialising in the study,
diagnosis and treatment o cancer.
Osteopath
A practitioner on the Register o Osteopaths kept
by the General Osteopathic Council as required as
part o the Osteopaths Act 1993, and recognised
and agreed by us.
Out-patient treatment
Treatment given at a hospital, consulting room
or out-patient clinic where you do not go in or
day-patient or in-patient treatment.
Own share
Your set percentage paid towards each claim rom
your personal deposit account.
Personal Deposit Account
Your own account that 50% o your fxed monthly
premium goes into.
Podiatry
Treatment o lower extremities including oot,
ankle, knee and hip.
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PhysiotherapistA physiotherapist regulated by and registered as
practising with the Health Proessions Council and
recognised by us.
Policy schedule
The document containing details o the Healthcare
Deposit Account. We will give you your policy
schedule when you join, and we will update it
whenever your account or other details change.
Pre-existing condition
Any disease, illness or injury that you have had
medication, advice or treatment or, or that
has produced symptoms, whether or not it was
diagnosed, in the fve years beore joining this
Healthcare Deposit Account.
Private ambulance
A purpose-built vehicle run by a recognised
private ambulance service approved by us.
Sign
Any objective evidence o disease which can
reasonably be recognised by a patient, healthcare
proessional or other.
SpecialistA medical practitioner, under the age o 70, who
is registered under the Medical Acts and is a
specialist in the treatment you are reerred or.
They must hold a certifcate o Higher Specialist
Training in their speciality that is issued by the
Higher Specialist Training Committee o the
appropriate Royal College or Faculty. They will
be or will have been a National Health Service
Consultant and must be recognised as a specialist
by our claims team.
Symptom
A sensation (e.g. pain) elt by the patient and
caused by a disease.
Treatment
Surgical or medical services (including diagnostic
tests) to diagnose, relieve or cure a disease, illness
or injury.
UK
For the purpose o this plan this means England,
Scotland, Wales, Northern Ireland, the Channel
Islands and the Isle o Man.
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You can apply to join the Healthcare Deposit Account by printing off and
completing one of the applications forms listed here. Either send it to the
address below or fax to 01794 330 090.
Use this application form if you are generally well and have no existing
medical conditions - apply here
Use this application form if you have some existing medical conditions
to declare - apply here
Use this application form if you have existing medical conditions and
also currently have private medical insurance cover - apply here
PO Box 273 Romsey SO51 9WZ
T: 0800 083 4116
F: 01794 330 090E: [email protected]
www.healthtrust.uk.com
P R I V A T E M E D I C A L I N SU R ANC E A DV I C E
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