Dental
Dental accident
Optical
Hospital inpatient
Hospital day-case admission
Parental hospital stay
Maternity antenatal appointment
Physiotherapy, chiropractic and complementary therapies
Specialist consultation fees, electrocardiogram (ECG), X-ray, allergy testing and pathology fees
Chiropody
Health and wellbeing
Health screening
Personal accident protection
Prescriptions - per item
Fitness benefit
Worldwide cover
Family care counselling helpline
Family planning (Prestige level only)
Critical illness (Prestige level only)
Sickness and accident protection cover (Prestige level only)
Hearing aids & surgical appliances (Direct Plus Members only)
Home help & home nursing (Direct Plus Members only)
We will pay benefit for dental treatment, at the appropriate rate and up to the appropriate maximum in any one calendar year.
When you send the claim form, you must also send us an original, fully-itemised receipt, showing the separate dates of your treatment.
What is covered:
Anaesthetic fees
Check-up charges
A dental brace or gum shield provided by the dentist
Dental practice plan premiums and joining fees (for example, Denplan)
Dental crowns, bridges and white fillings
Dental veneers
Dentures, or repairs to dentures at dental laboratories
Hygienist fees
Orthodontic and periodontic treatment
Tooth whitening treatment provided by the dentist
X-rays
What is not covered:
Cancellation charges made by the dentist (for example, for missed appointments)
Dental consumables (for example, toothbrushes, mouthwash, dental floss and so on)
Dental prescription charges. We cover these charges under the 'Prescriptions' benefit.
We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, for dental treatment you need as a result of an accidental injury to your teeth. The injury must have been caused by a direct impact to the head.
When you send us the claim form, you must also send us an original, fully-itemised receipt, showing the separate dates of your treatment. You must also provide full details of the accident. Your dentist must fill in and sign the claim form confirming the date of the accident and that the treatment received is as a result of that accident. We treat dental accident claims in a calendar year according to the date of accident.
What is covered:
Dental treatment directly related to an accident (for example, a sports injury or a fall), including the following.
Anaesthetic fees
Dental crowns, bridges and white fillings
Dental veneers
Replacement dentures or repairs
What is not covered:
Cancellation charges made by the dentist (for example, for missed appointments)
Dental prescription charges. We cover these charges under the 'Prescriptions' benefit.
Dental practice plan premiums and joining fees (for example, Denplan)
Any treatment you receive 12 months after the date of the accident
Dental treatment you receive for an accident which happened before you joined the plan
We will pay benefit for optical treatment, at the appropriate rate and up to the appropriate maximum in any one calendar year.
When you send us the claim form, you must also send us an original, fully-itemised receipt.
What is covered:
Contact lenses (permanent or disposable)
Contact lenses (permanent or disposable), when you buy them by monthly direct debit
Contact lens check-ups
Contact lens solutions (including if you buy these separately)
Eye laser surgery to correct long- and short-sightedness
Eyesight tests
Frames you buy separately
Lenses you buy separately to fit to existing frames
Lenses supplied under an optical insurance plan
Prescribed glasses
Prescribed magnifying glasses
Repairs to glasses
Sunglasses, safety glasses and swimming goggles (as long as they have prescribed lenses)
What is not covered:
Insurance premiums
Non-prescribed glasses and contact lenses (for example, ready-made glasses and coloured lenses)
Optical consumables (for example, contact lens and glasses cases)
We will pay benefit at the appropriate nightly rate for the period a person entitled to benefit is admitted for inpatient treatment in a recognised hospital or hospice.
You must fill in your claim form yourself. The hospital must then check it and stamp it with its official stamp.
What is covered:
Any period of overnight stay in a hospice, an NHS hospital, a private hospital or a registered treatment centre, from one to 25 nights, for a medical condition to be treated or investigated
Fees for filling in claim forms or certificates, as long as you provide an official hospital receipt with your claim
What is not covered:
Attending accident and emergency
Child inpatient benefit for the first 10 nights after the birth
Clinics, medical centres or nursing homes
Hospital accommodation for an elderly person who is not able to live independently
Maternity cases – we will only pay benefit after the first 10 overnight stays as an inpatient
Maternity-related admissions for dependent children
Outpatient treatment
Permanent stays in hospital
Having a pre-existing medical condition treated or investigated
We will pay benefit at the appropriate day-case rate for the period a person entitled to benefit is admitted for day-case treatment in a recognised hospital without an overnight stay.
You must fill in your claim form yourself. The hospital must then check it and stamp it with its official stamp.
What is covered:
Any day-case admission in an NHS hospital, private hospital or registered treatment centre, from one to 25 days, to have a medical condition treated or investigated under anaesthetic
Operations which are cancelled after you have been admitted to hospital
Invasive investigative procedures (for example, a colonoscopy)
Fees for filling in claim forms or certificates, as long as you provide an official hospital receipt with your claim
Outpatient treatment carried out under anaesthetic
Outpatient treatment for chemotherapy
Outpatient treatment for kidney dialysis
Outpatient treatment for oncology
Outpatient treatment for radiotherapy
What is not covered:
Attending accident and emergency
Clinics
Elderly care
Hospice day care
Maternity admissions
Outpatient appointments or treatments that are not covered above
Pre-admission appointments (appointments before you are admitted to hospital)
Medical centres
Nursing homes
Psychiatric treatment
Having a pre-existing medical condition treated or investigated
We will pay benefit at the appropriate nightly rate for one adult to stay overnight with a registered child who has been admitted for inpatient treatment in a recognised hospital or hospice.
You must fill in your claim form yourself. The hospital must then check it and stamp it with its official stamp.
What is covered:
Any period of overnight stay in a hospice, an NHS hospital, a private hospital or a registered treatment centre, from one to 25 nights, where one parent stays with their registered child and is entitled to hospital benefits
An adoptive parent staying with their registered child
Fees for filling in claim forms or certificates, as long as you provide an official hospital receipt with your claim
What is not covered:
Attending accident and emergency
Clinics, medical centres or nursing homes
More than one parent staying with their child
All maternity-related admissions
Outpatient treatment
Permanent stays in hospital
Having a pre-existing medical condition treated or investigated
We will make a one-off payment, up to the appropriate maximum in any one calendar year, for an NHS or private antenatal scan carried out by medically qualified staff at a hospital, GP surgery, registered clinic or service.
You must fill in the claim form yourself. The hospital or surgery must then check it and stamp it with its official stamp.
What is covered:
An NHS or private antenatal scan carried out by medically qualified staff at a hospital, GP surgery, registered clinic or service
Fees for filling in claim forms or certificates, as long as you provide an official receipt with your claim
We will only make one payment in any one calendar year.
What is not covered:
Attending accident and emergency
Antenatal appointments for dependent children
Medical centres
Nursing homes
A partner who is not registered with us
We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, when a person entitled to benefit receives treatment to relieve and prevent an illness or pain, from a practitioner who is a member of an approved professional organisation.
When you send us the claim form, you must also send us an original, fully-itemised receipt, showing the separate dates of the treatment. The claim form must include the reasons for the treatment, and the type of treatment provided.
What is covered:
Acupuncture
Appliances (for example, lumbar rolls and back supports) prescribed and supplied by your practitioner as part of the treatment
Chiropractic
Homoeopathy
Osteopathy
Physiotherapy
X-ray, when necessary as part of the treatment
What is not covered
Any treatment, provided by a practitioner who is recognised by us, which is not listed above
Appliances (for example, lumbar rolls and back supports) not prescribed and supplied by your practitioner as part of the treatment
Having a pre-existing medical condition treated or investigated
We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, when a person entitled to benefit has a specialist consultation or treatment from a medically qualified person who specialises in a field of medicine. The specialist does not have to hold a consultant position in a hospital, but must be a member, fellow or licentiate (licence-holder) of one of the Royal Colleges (or their international equivalent). This benefit also refunds costs you would have to pay for an ECG or X-ray, and pathology fees charged to you at the appropriate department of a hospital or as part of a consultation.
You must send us an original receipt, showing the qualifications of the physician or surgeon. On the claim form, you must fill in the reason for the consultation, treatment or tests.
What is covered:
Counselling fees
Hearing aids provided by a registered hearing-aid supplier
Investigative procedures (for example, colonoscopy, sigmoidoscopy)
Medical tests, including ECG, EEC and lung function tests
Pathology and biopsy fees
Physicians’ or surgeons’ operation fees
Speech therapy, dyslexia and dyspraxia treatment
X-ray, including mammograms, CT scans, ultrasounds and MRI scans
What is not covered:
Anaesthetists’ fees
Medical examinations and reports
Private antenatal scans
Private hospital charges (for example, theatre and room fees)
Having a pre-existing medical condition treated or investigated
We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, for chiropody treatment from a practitioner who is a member of an approved professional organisation.
When you send us the claim form, you must also send us an original, fully-itemised receipt, showing the separate dates of your treatment.
What is covered:
Assessments (for example, gait analysis, which is an analysis of how you walk)
Chiropody treatment
Orthotics supplied by the chiropodist or podiatrist at the time of the treatment (for example, arch supports)
Podiatry treatment
What is not covered:
Consumables (for example, corn plasters or insoles) that are not bought as part of the treatment
Surgical footwear
X-rays
We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, when a person receives treatment related to their health and wellbeing, or treatment to relieve and prevent an illness or pain, from a practitioner who is a member of an approved professional organisation.
When you send us the claim form, you must also send us an original, fully-itemised receipt, showing the separate dates of the treatment. The claim form must include the reasons for the treatment, and the type of treatment provided.
What is covered:
Acupressure
Allergy testing, including food intolerance and nutrition tests
Aromatherapy
Bowen and Alexander techniques
Chair massage
Colonic hydrotherapy
Hopi ear candles
Hypnotherapy
Indian head massage
Kinesiology
Massages (for example, sports and remedial)
Naturopathy
Nutritional therapy
Reflexology
Reiki
Shiatsu
What is not covered:
Vega testing
Laboratory testing not referred by a doctor
Hair analysis
Home testing kits
Any treatment, provided by a practitioner recognised by us, which is not listed above
Appliances (for example, lumbar rolls and back supports)
Stop-smoking patches, gum and so on
Weight management programmes (for example, Weight Watchers)
We will pay benefit, at the appropriate rate and up to the appropriate maximum in any one calendar year, for a full health screen. The health screen must be used to help prevent an illness.
When you send us the claim form, you must also send us an original, dated and fully-itemised receipt.
What is covered:
A full health screen carried out by medically qualified staff at a hospital, registered health screening clinic or service
Well Man and Well Woman clinics
What is not covered:
Home testing kits
Screening for employment services
Tests not included within the full health screen (for example, X-rays and blood tests)
Please call the claims department on 01270 588555 for a separate personal accident claim form. Under the following conditions, we will only consider the amount of benefit we will pay under this section if a bodily injury results in death or permanent total disablement within one year of the accident. We will pay the sum insured in line with the level of contribution you have paid. Protection will end on your 70th birthday. You must write to us within six months of an accident to let us know about it.
We will not pay more than £25,000 as a result of any one accident.
‘Bodily injury’ means an injury caused only by an accident and not by any sickness, disease or gradual cause. ‘Bodily injury’ does not cover post-traumatic stress disorder.
‘Permanent total disablement’ means a permanent disability that prevents the insured person from carrying out a job.
We will decide, based on medical advice, if we will pay benefit.
Personal accident protection does not cover death or permanent total disablement caused by:
radioactive contamination;
taking part in professional sports or flying as a pilot or crew member (that is, aircraft, gliders, hang-gliders, microlights, parachuting, paragliding, ballooning);
suicide or deliberate injury;
war, hostilities, invasion or civil war, and full-time active military service; or
drug, alcohol or solvent abuse, or taking drugs (unless you are told to by a registered medical practitioner).
We will pay benefit to you and your partner (if they are covered), at the appropriate rate and up to the appropriate maximum number of items in any one calendar year, for NHS prescription charges (or the NHS cash equivalent).
When you send us your claim form, you must also send us an original, dated and fully-itemised receipt, which you can get from your chemist.
What is covered:
NHS prescription charges or the NHS cash equivalent for private prescription charges
An NHS prepayment certificate up to the appropriate maximum
Dental prescription charges
What is not covered:
Charges above the current rate set out in the NHS prescription pricing
We do not pay prescription benefit for dependent children.
Incorpore's Corporate Fitness Network will give you and your family access to preferential rates for a network of health clubs and hotels. You can join a health club at the lowest corporate rate available and enjoy special discounts and take advantage of preferred rates on leisure, relaxation and pamper breaks at hotels around the world.
Visit www.incorpore.co.uk or phone Incorpore`s Customer Support Line on 0845 6024601 (quoting reference HEA).
Also, if you are a Prestige level member we will contribute up to £100 towards the cost of your yearly health club membership. You must send us an original, dated receipt with the claim form.
All benefits apply during business visits and holidays abroad that last up to 28 days. The terms and conditions (including what is and what is not covered) will apply to any claims you send in, and you must send the details translated into English, if necessary. We will convert the amount of your claim into pounds sterling using the currency exchange sell rate, supplied by our bank, on the date we process your claim.
You and your family can use our professional telephone service, 24 hours a day, seven days a week. This service provides counselling, support and guidance on a whole range of lifestyle, health and medical and legal problems. You can get advice and counselling from specialist teams of counsellors, lawyers and medical staff. (This service is provided by First Assist Services Ltd.)
If you want to speak to a family-care counsellor, lawyer or medical advisor, call 0800 1079042 and quote scheme number 70840. (This call is free.)
We will pay family planning benefit to you and your partner (if they are covered), at the appropriate rate and up to the agreed maximum. We will only pay family planning benefit to you and your partner (if they are covered) once during your lifetime.
You must send us an original receipt, showing the qualifications of the physician or surgeon. On the claim form, you must fill in the reason for the consultation, treatment or tests.
What is covered:
Private family planning clinics
Private fertility treatment and examinations
Private IVF treatment
Private sterilisation fees
Private vasectomy fees
What is not covered:
Family planning benefit for dependent children
Pregnancy terminations
Contraceptives
If you, your partner (if they are covered) or your dependent children are diagnosed with a critical illness after the end of the 13-week qualifying period, we will pay benefit at the appropriate rate. We will not pay more than £2,000 as a result of a critical illness. We will only pay critical illness benefit to any person once during their lifetime. Critical illness benefit does not apply to anyone aged 65 or over.
Please call the claims department on 01270 588555 for a separate critical illness claim form. To support your claim, you will need to provide medical evidence from a registered medical practitioner. You must pay any costs involved in providing this evidence.
What is covered:
Cancer – a malignant tumour caused by malignant cells growing and spreading uncontrollably to other tissue. The term ‘cancer’ includes leukaemia and Hodgkin’s disease, but the following are not included in the cover.
- All tumours which are histologically described as being ‘pre-malignant’, ‘non-invasive’, or ‘cancer in situ’
- All forms of lymphoma present in HIV
- Kaposi’s sarcoma present in HIV
- Any skin cancer, other than malignant melanoma
Heart attack – when a part of the heart muscle dies as a result of not receiving enough blood. It will cause chest pain, new electrocardiograph changes and an increase in cardiac enzymes.
Coronary artery bypass surgery – open heart surgery, recommended by a consultant cardiologist, that uses bypass grafts to correct one or more coronary arteries that have narrowed or become blocked. Non-surgical procedures, such as balloon or stent angioplasty or laser treatments, are not included.
Kidney failure – where both kidneys fail to work and, as a result, you begin regular kidney dialysis or have a kidney transplant. We will pay critical illness benefit if you need a kidney transplant and you have been included on an official UK waiting list.
Major organ transplant – the transplant of a heart, liver, lung, pancreas or bone marrow, or being included on an official UK waiting list to receive an organ.
Motor neurone disease – confirmation by a consultant that you have been diagnosed with motor neurone disease.
Multiple sclerosis – a definite diagnosis by a consultant neurologist of multiple sclerosis that meets all the following conditions.
- The movement of your muscles, or your physical senses, must currently be weakened, and have been weakened for a continuous period of at least six months.
- The diagnosis must be confirmed by diagnostic techniques that are widely used at the time you make your claim.
Stroke – permanent neurological (nerve) damage to the brain caused by an interruption to its blood supply. Transient ischaemic attacks (temporary interruptions to the brain’s blood supply) or episodes resulting in temporary neurological symptoms are not included
What is not covered:
If you suffered from that critical illness (or a related condition) or had surgery at or before the end of the 13-week qualifying period.
If you die within 28 days of being diagnosed with a critical illness or having surgery.
If the critical illness or surgery is in any way caused by being exposed to chemicals or nuclear material.
If the critical illness or surgery is in any way caused by drug, alcohol or solvent abuse, or taking drugs (unless you are told to by a registered medical practitioner).
We will not pay critical illness benefit for claims caused directly or indirectly by you being infected by, or treated for, HIV or any HIV-related illness, including AIDS.
Please call the claims department on 01270 588555 before you make a claim. Your Prestige-level contributions are covered for up to 12 months when you or your partner (if they are covered) are continuously off work for at least 30 days due to one of the following.
Sickness
Accidental injury
Sickness and accident protection cover only applies if you or your partner (if they are covered):
have completed a qualifying period of 13 weeks;
are in full-time employment and between the ages of 16 and 64;
are not aware of any medical treatment or advice you are due to receive; and
are in good health.
If you suffer a disability, we will pay 1/30th of your monthly contribution, after the first 30 days of your disability, for each consecutive day you are disabled. We will refund benefit every 30 days during your disability, up to a maximum of 12 payments for any one claim.
By ‘disability’, we mean being totally prevented from carrying out your normal job or work as a result of an accidental bodily injury or sickness, as confirmed by a registered medical practitioner, that takes place after the start date. ‘Normal job or work’ means paid work of at least 16 hours a week that you carry out immediately before the start of your disability, and any similar job that you may reasonably be expected to carry out.
We will not pay disability benefit for any period you are disabled after you have reached the age of 65 (or your retirement date, if earlier).
When we assess the maximum benefit period, we will treat periods of disability resulting from the same cause as being the same period of disability, as long as they are not separated by at least three calendar months before you return to work.
Exclusions to sickness and accident protection cover
An exclusion period of 30 days applies to all claims.
We will not pay any amount where the disability happens within the 13-week qualifying period.
We will not pay for any period of disability caused by any physical or mental disorder, any chronic (severe) illness, or any recurring or continuing disease which you had received treatment or advice for before your cover began.
We will not pay for any period of disability that a registered medical practitioner has not provided medical evidence for. You must pay all the costs involved in getting medical evidence.
We will not pay for any period of disability caused by:
war;
attempted suicide;
you deliberately injuring yourself;
you being under the influence of alcohol or drugs (other than drugs taken under medical supervision, but not for treating a drug addiction);
pregnancy, childbirth or any complication connected to these;
a mental disorder, unless it is investigated and diagnosed by a consultant;
HIV (human immunodeficiency virus) or any HIV-related illness, including acquired immune deficiency syndrome (AIDS); or
cosmetic surgery.
We will pay benefit, at the appropriate rate, for hearing aids and surgical appliances up to the appropriate maximum in any one calendar year.
You must send us an original, dated and fully-itemised receipt with the claim form.
What is covered:
New hearing aids supplied by a registered hearing-aid dispenser
Repairs to hearing aids
Surgical appliances which are prescribed or supplied by your GP or healthcare practitioner
Please contact the claims department to check what surgical appliances we cover before making a claim.
What is not covered:
Batteries for hearing aids
Contract schemes for hearing aids
We will pay benefit, at the appropriate rate, for home-help and home nursing services, up to the appropriate maximum in any one calendar year.
You must send us an original, dated and fully-itemised receipt with the claim form.
What is covered:
Home-help services provided by a local authority
Home-help services provided by an agency contracted directly by a local authority
Home nursing provided by a state registered nurse arranged with an agency, on the recommendation of your GP
What is not covered:
Home-help services provided for maternity cases