your policy explained

8/14/2019 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

[email protected]

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

[email protected]

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?


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?


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.


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.


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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17

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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19

Example 5 - Beverley


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


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


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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20

Example 8 - Monica


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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21

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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22

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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23

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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26

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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27

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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