The everyday health cash plan · 2020. 3. 26. · You can see the wide range of cover HSF health plan provides in the benefit summary opposite. So you know exactly what your HSF health

The everyday health cash plan

Funded Company & Group SchemesPolicy Terms & Conditions 2017

This brochure explains your cover in more detail. Please retain for future reference and claims guidance.

2

Head Office24 Upper Ground, London SE1 9PDTel: 020 7928 6662 Fax: 020 7928 0446

Cover enquiries: 020 7202 1380Email: [email protected]

Claims enquiries: 020 7202 1381Email: [email protected] *Source: Band 2 Course of Treatment

NHS Charges April 2017

Like most things today, the cost of leading a healthy lifestyle isn’t cheap.

If you take a moment to think about how much you have to pay just to visit the dentist,even if you are with an NHS dentist, you can still have a large bill to pay. Just a simplefilling can cost up to £56* and if you require more major treatment the bill can run intohundreds of pounds.

With HSF health plan, you can have an affordable way to cover the costs of everydayhealthcare. HSF health plan covers you and your family for the simple day to dayhealth costs like dental and optical bills as well as providing over 35 valuable benefitsthat help you get cash back for a wide range of treatments and out of pocket expenses.You can see the wide range of cover HSF health plan provides in the benefit summaryopposite.

So you know exactly what your HSF health plan includes, you will find the terms ofthe plan in this brochure from page 17.

HSF health plan is the trading company of the charity, The Hospital Saturday Fund. Our heritage means we have no ostentatious head office building and no overloadedadministration. Instead there is a culture of care for you and your family and a policyof sharing any surplus with medical charities, local hospitals and hospices as well asindividuals with a serious illness or a disability.

We look forward to providing you and your family with the benefits of HSF health planfor many years to come.

To find out more information about HSF health plan, contact us on:

0800 917 2208

3

100£1.00 a week£4.33 a month

2£2.45 a week£10.62 a month




A£7.25 a week£31.42 a month

B£10 a week£43.33 a month

C£12 a week£52 a month

D£15.50 a week£67.17 a month

£50 £100 £200 £275 £350 £400 £550 £700 £850

£100 £200 £300 £400 £500 £600 £800 £1,000 £1,200

Dental and Optical

Dental Trauma

Or after 15 nights

After 7 nights

Permanent Disability– up to

Practitioner: Physiotherapy, Osteopathy, Chiropractic, Acupuncture, Homoeopathy, Chiropody/Podiatry

50% cover 100% cover


£200 £400 £600 £700 £800 £1,200 £1,400 £1,600 £1,800

Specialist and Investigations – Including Allergy Testing and Health Screening


£125 £250 £375 £500 £625 £750 £1,000 £1,250 £1,500

Home Care Assistants and Home Help

£5,000 £7,500 £10,000 £12,500 £15,000 £20,000 £25,000 £30,000 £40,000

Fracture– up to maximum per accident

Not Included Not Included £375 £575 £775 £950 £1,450 £1,950 £2,450

Facial Disfigurement– up to maximum

Not Included Not Included £600 £900 £1,200 £1,500 £2,300 £3,100 £3,900

Accidental Death £2,500 £3,750 £5,000 £6,250 £7,500 £10,000 £12,500 £15,000 £20,000Temporary Disability Not Included Not Included £30

per week£40per week

£50per week

£60per week

£90per week

£120per week

£170per week

Personal Accident – Including Dental Trauma

Permanent Disabil


£100 £200 £300 £400 £500 £600 £800 £1,000 £1,200

Birth Grant / Adoption Grant (per child)

£16 £32 £50 £66 £80 £75 £100 £120 £150

£16 £32 £50 £66 £80 £75 £100 £120 £150

Hospital: General and Hospice, Accident, Elderly and Mental Illness (Amounts per night up to a maximum of 40 nights)

Day Case Surgery and Treatment (Amounts per day up to a maximum of 8 occasions)

HSF Assist® - Available on all schemes

HSF PerkBox - Available on all schemes - web based service only

£40 £80 £100 £120 £150 £150 £180 £225 £300

£60 £120 £150 £170 £200 £225 £255 £300 £360

Recuperation – Grant after 7 nights Or after 15 nights

GP Advice Line, Virtual Doctor, Counselling Service, Medical Information and Legal Advice.

Money saving offers, Discounted Gym Membership, Special Priced Cinema Tickets, Everyday Shopping Discounts plus much more. (Internet connection and email required for access).

£250 £375 £500 £625 £750 £1,000 £1,250 £1,500 £2,000

Primary Schemes Extra Cover Schemes

Spouse/Partner and dependent children (under 18) covered at no extra cost!

Some people have private medical insurance in case they become ill. However,not enough people consider the value of planning for the cost of stayinghealthy.

Everyday expenses that you and your family incur can be easily budgeted forby having a cash plan from HSF health plan.

HSF health plan is not private medical insurance, we pay you cash sumstowards medical expenses often not covered by health insurance or the NHS.

Dental check-ups and treatment, sight tests, glasses, contact lenses are allcovered and on some of our schemes even eye laser surgery is covered. The costs of keeping healthy can put a huge strain on your household budget.Add the cost of visits to see a chiropodist, a physiotherapist or an osteopath,and the expenses grow even more.

HSF health plan can save you literally hundreds of pounds a year on these verynecessary costs and reduce the impact of large health care bills on youreveryday finances.

With HSF health plan you simply decide how much you wish to put aside eachweek or month, and when you pay your bill you can claim back cash for up to100% of the cost.

Think of it as a cash payment to keep you healthy from head to toe – inside andout. And if you or your family needs to visit hospital, we can help there too!

a cash plan to helpyou stay healthy

4

true value for moneyHSF health plan offers a wide range of schemes to choose from, so you can besure there is a plan to suit your needs and your budget.Plans start from as little as £4.33 a month. That’s less than 15p a day, anachievable cost for most of us. Depending on the scheme you choose you canget up to 100% cash back!For example, if your new spectacles cost £200 and you were on one of ourExtra Cover schemes, you could get the full £200 back, so your new spectacleswould cost you nothing!

Having a HSF health plan encourages you to seek and receive early medicalinvestigation and treatment. Our HSF Assist which is included on all schemesprovides a valuable service at a time that suits you, and can be used as often asneeded and by anyone covered on your plan. Our Schemes are divided betweenPrimary and Extra Cover. The weekly and monthly costs are as follows:

5

Scheme 100 Scheme 2 Scheme 3 Scheme 4 Scheme 5

Weekly cost £1.00 £2.45 £3.65 £4.85 £6.25Monthly cost £4.33 £10.62 £15.82 £21.02 £27.08

Scheme A Scheme B Scheme C Scheme D

Weekly cost £7.25 £10.00 £12.00 £15.50Monthly cost £31.42 £43.33 £52.00 £67.17

Primary

Extra Cover

6

Our Schemes

Primary Extra Cover

Practitioner: Physiotherapy, Osteopathy, Chiropractic, Acupuncture, Homoeopathy, Chiropody / Podiatry

Help towards the cost of consultation and treatment (not including medication orappliances) by a qualified and registered practitioner up to the maximum shown. Thisbenefit may be used flexibly according to requirements for all categories. Payable betweenall eligible registered persons in any 12 consecutive calendar months.Qualifying period – 3 months.

Dental and OpticalHelp towards the cost of all dental treatment including check-ups, and the cost of a sighttest and optical appliances, up to the maximum shown. This benefit may be used flexiblyaccording to requirements for both categories. It is payable between all eligible registeredpersons in any 12 consecutive calendar months. Qualifying period – 3 months. The cost of Eye Laser Treatment, Implantable Contact Lenses (to correct long or shortsightedness) and assessments is included in Schemes 3, 4, 5 and the Extra Cover Schemes.Qualifying period – 12 monthsDental TraumaFor details on Dental Trauma, please refer to the Personal Accident Section on pages 10,11, 18 and 19.

Our Primary Schemes 100 to 5 offer a wide range of health categories at affordable prices.With Primary Schemes we reimburse you 50% of your professional treatment costs up tothe maximum amounts shown below.

Our Extra Cover Schemes A to D are for those who want to pay a little more in order to gethigher benefits in return. With Extra Cover Schemes we reimburse you 100% of yourprofessional treatment costs up to the higher maximum amounts shown below.All of our schemes include HSF Assist which provides : GP Advice Line, Virtual Doctor, Counselling,Medical Information and Legal Advice.

Scheme 100

£50

Scheme 4

£275 Scheme 5

£350

Scheme 2

£100 Scheme 3

£200

Scheme C

£700

Scheme A

£400

Scheme D

£850

Scheme B

£550

Primary Extra CoverScheme 100

£100

Scheme 4

£400Scheme 5

£500

Scheme 2

£200 Scheme 3

£300

Scheme C

£1,000

Scheme A

£600

Scheme D

£1,200

Scheme B

£800

The advantages of having a HSF health planNo medical required before joining.

Flexible benefit amounts between dental and optical.

Spouse/partner and dependent children under 18 included free.

Premiums do not increase with age.

Unlike private medical insurance, the premiums you pay are not based on your age orclaims history, and once you join you are covered for life.

7

Specialist and InvestigationsHelp towards the cost of specialists’ consultation fees, allergy testing, vaccination, healthscreening, pathology tests, x-rays, scans, electrocardiograms and other investigations listedin the rules, all undertaken on an outpatient basis, up to the maximum shown. Payablebetween all eligible registered persons in any 12 consecutive calendar months.Qualifying period – 3 months.

Birth and Adoption GrantPayable to the policyholder, whether the mother or father of the baby, for each registeredbirth in hospital or at home. Hospital benefit is payable for the mother in addition to thegrant from the sixth night onwards. The grant is also payable for a registered adoption upto the age of 10. Qualifying period – 10 months.


£200

Scheme 4

£700 Scheme 5

£800

Scheme 2

£400 Scheme 3

£600

Scheme C

£1,600

Scheme A

£1,200

Scheme D

£1,800

Scheme B

£1,400


£100

Scheme 4

£400 Scheme 5

£500

Scheme 2

£200 Scheme 3

£300

Scheme C

£1,000

Scheme A

£600

Scheme D

£1,200

Scheme B

£800

RecuperationFollowing each stay in a hospital or hospice for which benefit has been paid for a minimumof 7 nights, a recuperation grant is payable for each eligible registered person.

8

Primary Either after 7 nights Extra Cover Either after 7 nights

Primary Or after 15 nights Extra Cover Or after 15 nights

HospitalGeneral and Hospice: For an inpatient admission to a hospital or hospice to receivemedical treatment. Payable to each eligible registered person for up to 40 nights in any12 consecutive calendar months. (See pages 17 and 18 for full details). Qualifying period – 3 months.

Accident: For an inpatient admission to a hospital immediately following an accident.Payable to each eligible registered person for up to 40 nights in any 12 consecutivecalendar months. (See pages 17 and 18 for full details). No Qualifying period.

Elderly and Mental Illness: For an inpatient admission to a hospital for elderly medicalcare / long stay / rehabilitation / respite / GP care or for a mental illness. Payable to eacheligible registered person for up to 50 nights elderly and 50 nights mental illness fromfirst registration, but not for more than 40 nights in a 12 month period. (See pages 17 and18 for full details). Qualifying period – 3 months.

Primary per night Extra Cover per nightScheme 100£16 £8

Policyholder

Partner or Child

Scheme 2£32 £16

Policyholder

Partner or Child

Scheme 3£50 £25

Policyholder

Partner or Child

Scheme 4£66 £33

Policyholder

Partner or Child

Scheme 5£80 £40

Policyholder

Partner or Child

Scheme 2£80 £40

Policyholder

Partner or Child

Scheme 100£40 £20

Policyholder

Partner or Child

Scheme 3£100 £50

Policyholder

Partner or Child

Scheme 4£120 £60

Policyholder

Partner or Child

Scheme 5£150 £75

Policyholder

Partner or Child

Scheme 2£120 £60

Policyholder

Partner or Child

Scheme 100£60 £30

Policyholder

Partner or Child

Scheme 3£150 £75

Policyholder

Partner or Child

Scheme 4£170 £85

Policyholder

Partner or Child

Scheme 5£200 £100

Scheme A£75 £50

Policyholderor partner

Child

Scheme B£100 £66


Child

Scheme C£120 £80


Child

Scheme D£150 £100


Child

Scheme A£225 £150


Child

Scheme B£255£170


Child

Scheme C£300 £200


Child

Scheme D£360 £240


Child

Scheme A£150 £100


Child

Scheme B£180 £120


Child

Scheme C£225 £150


Child

Scheme D£300 £200


Child

Policyholder

Partner or Child

Day Case Surgery and TreatmentFor a planned admission to occupy a bed for a day in a hospital or clinic to undergo surgery,treatment or a procedure. Limited to 8 occasions within any 12 consecutive calendar monthsfor each eligible registered person. Qualifying period – 3 months.

Home Care Assistants and Home HelpShort term assistance towards the cost of Local Authority services and some privatelyarranged assistance with organisations if supported by a doctor, up to the maximum shown.Payable between all eligible registered persons in any 12 consecutive calendar months.Qualifying period – 3 months.

9

Primary per day Extra Cover per day


£125

Scheme 4

£500 Scheme 5

£625

Scheme 2

£250 Scheme 3

£375

Scheme C

£1,250

Scheme A

£750

Scheme D

£1,500

Scheme B

£1,000

Scheme 100£16 £8

Policyholder

Partner or Child

Scheme 2£32 £16

Policyholder

Partner or Child

Scheme 3£50 £25

Policyholder

Partner or Child

Scheme 4£66 £33

Policyholder

Partner or Child

Scheme 5£80 £40

Policyholder

Partner or Child

Scheme A£75 £50


Child

Scheme B£100 £66


Child

Scheme C£120 £80


Child

Scheme D£150 £100


Child

If an Accident results in Permanent Disability or death the financial consequences can beenormous. Even less serious injuries can result in a lengthy period off work or confinementto the house. Whilst you may be able to cope in the short term, a longer period of disabilitycan put severe pressure on family finances.

Lump sum cash payments (shown opposite) when they are needed most could ease thefinancial burden. Policyholders and their partner and dependent children are covered 24hours a day, every day of the year, whether at work, at home or at play.

Permanent Disability: A lump sum cash benefit depending upon the type and degree ofPermanent Disability following an Accident.

Facial Disfigurement :A lump sum payment for Permanent facial disfigurement as a resultof an accident.

Accidental Death: A lump sum payment if the Accident is fatal.

Dental Trauma: A lump sum payment for dental treatment required as a direct result of ablow to the head.

Temporary Disability: (not applicable to children under 16 years of age) A weekly sumpayable (normally by direct credit, monthly in arrears) if following an Accident, you are:a) unable to take up your normal paid occupation or any other paid employment; orb) confined to the home (applicable only if you are not in paid employment at the timeof the Accident) as certified by a qualified medical practitioner. Payable from the 31st day of your disability for up to 52 weeks. Odd days will be paid at 1 ⁄ 7 th of the weekly rate.Although there is no qualifying period under this section, the Temporary Disability benefitis not payable for the first 30 days (Deferment Period) of each period of temporary disablement.

Fracture Benefit:A lump sum payment for a fracture or fractures to one or more bones ofthe arm or leg following an Accident.

10

Ietc

Personal Accident BenefitAll claims must be submitted within 6 months of the accident occurring.

11

Scheme Scheme Scheme Scheme Scheme Scheme Scheme Scheme Scheme100 2 3 4 5 A B C D

Permanent Disability up to up to up to up to up to up to up to up to up to

A proportion of this sum will be paid £5,000 £7,500 £10,000 £12,500 £15,000 £20,000 £25,000 £30,000 £40,000depending upon the degree of permanent disability in accordance with the following scale:

Permanent Total Disablement £5,000 £7,500 £10,000 £12,500 £15,000 £20,000 £25,000 £30,000 £40,000

Loss of sight in one or both eyes £5,000 £7,500 £10,000 £12,500 £15,000 £20,000 £25,000 £30,000 £40,000

Loss of hearing in both ears £3,750 £5,625 £7,500 £9,375 £11,250 £15,000 £18,750 £22,500 £30,000

Loss of hearing in one ear £750 £1,125 £1,500 £1,875 £2,250 £3,000 £3,750 £4,500 £6,000

Loss of the use of:

a) an arm, hand or leg above £5,000 £7,500 £10,000 £12,500 £15,000 £20,000 £25,000 £30,000 £40,000the knee

b) a leg below the knee or a foot £2,500 £3,750 £5,000 £6,250 £7,500 £10,000 £12,500 £15,000 £20,000

c) a shoulder or elbow £1,250 £1,875 £2,500 £3,125 £3,750 £5,000 £6,250 £7,500 £10,000

d) a hip, knee, ankle or wrist £1,000 £1,500 £2,000 £2,500 £3,000 £4,000 £5,000 £6,000 £8,000

e) a thumb £1,000 £1,500 £2,000 £2,500 £3,000 £4,000 £5,000 £6,000 £8,000

f) any finger or big toe £500 £750 £1,000 £1,250 £1,500 £2,000 £2,500 £3,000 £4,000

g) any other toe £250 £375 £500 £625 £750 £1,000 £1,250 £1,500 £2,000

Facial Disfigurement £600 £900 £1,200 £1,500 £2,300 £3,100 £3,900

Accidental Death £2,500 £3,750 £5,000 £6,250 £7,500 £10,000 £12,500 £15,000 £20,000

Dental Trauma £250 £375 £500 £625 £750 £1,000 £1,250 £1,500 £2,000

For Insured Persons aged 66 to 75 and under 16 years of age the Personal Accident benefits payable shall be reducedby 50%. For Insured Persons aged 76 and over the benefits payable shall be reduced by 75% and the Permanent TotalDisablement category shall not apply. Please see pages 18 and 19 for Definitions and Exclusions.

All claims must be submitted within 6 months of the accident occurring.

Temporary Disability £30 £40 £50 £60 £90 £120 £170per week per week per week per week per week per week per week

Fracture Grant - only payable forthese specified bones:

Leg – ankle, tibia and fibula, £150 £225 £300 £375 £575 £775 £975kneecap, femur and hip

Arm – wrist, radius and ulna, £75 £125 £175 £200 £300 £400 £500humerus and shoulder

Overall limit per Accident £375 £575 £775 £950 £1,450 £1,950 £2,450

NotAvailable

NotAvailable

NotAvailable

NotAvailable

NotAvailable

NotAvailable

NotAvailable

NotAvailable

NotAvailable

NotAvailable

In addition there are the following payments for Temporary Disability and a Fracture of the specified bone or boneslisted below:

Primary Extra Cover

If you or any other eligible person (Insured Person) suffer Bodily Injury as a direct result of an Accidentwhich within 24 months of the Accident results in Permanent Disability, Facial Disfigurement or Death,or requires treatment within 12 months of Dental Trauma occurring, the following will be paid:

Fractured fingers/thumbs/toes orhand/foot bones are NOT covered.

12

HSF Assist®

HSF Assist provides unlimited access to a variety of assistance helplines and services which are available to all policyholders and their families. The services available are:

GP Telephone Advice - 24 hour access to a DoctorVirtual Doctor - a webcam based “face to face” consultation service with a DoctorHealth Information Website - a medically validated and regularly updated websiteCounselling Service - a telephone and, if needs be, a face to face counselling service Legal helpline - telephone access to Solicitors and Barristers You can use any part of the HSF Assist service as many times as you need.HSF Assist is currently provided for HSF health plan by Medical Solutions UK Limited.

GP Advice LineThis service is available 24 hours a day, 7 days a week and the telephone number will begiven to you in your registration pack. The service allows you to speak with a qualifiedpractising GP free of charge and at a convenient time. After making the initial call thedoctor will telephone you. Every call is confidential and your details will not be passed onto anyone without your prior consent.

You can ask about all sorts of things including:• an ache or pain that won’t go away• sensitive or confidential concerns• explanations of diagnosis or treatment you may have been prescribed• possible after-effects of surgery• side-effects of any medication you are taking• vaccinations you may need when you are travelling abroad and other health precautionsrelevant to your own personal medical history

The GP Advice Line is complementary to your NHS GP. In an emergency situation, youshould contact your own NHS GP or the emergency services directly so as not to delaythe appropriate treatment.

Virtual Doctor. HSF Assist provides you with the next generation in GP services: Virtual Doctor - an online doctor to see you at a time to suit you. Now you don’t need to leave home or work to see a qualified GP. With HSF Virtual Doctor, the UK’s first online webcam GP consultation service, you can arrange an online face to face consultation at a time that fits with your busy life between Mondayto Friday 8.30am to 6.30pm (telephone consultations are available 24/7). � At home – you don’t need to wait days for an appointment and travel to a busy surgery and wait for your appointment.

� At work – imagine your own company doctor service without having to leave the office.

The Virtual Doctor Service is further enhanced by using state of the art explanatory 3Dmedical images and health information enabling you, the patient, to have a more complete understanding of your condition.

Health Information WebsiteThese days we are all lucky to have a wealth of general information available to usabout looking after our health. But it can get a bit confusing knowing which sourcesyou can completely rely on.

The HSF health plan Health Information Service offers medically validated and regularly updated information on health and medical matters, including new treatments, drugs or surgical procedures. If you’re trying to overhaul your lifestyle youcan also get guidance on areas such as nutrition, exercise or avoiding sports injuries.

There’s a travel section too, so you can check on vaccinations needed for your destination and other useful advice on: protection from sun, food hygiene and insectbites etc. If you’re not online, don’t worry, just call and we will print off the information and post it to you.

13

24/7 Counselling ServiceOur team of experienced, professionally trained counsellors are available to assist youexplore and resolve your issues 24 hours a day, 7 days a week. You can discuss any aspects that are worrying you including; Home, Family, Relationships, Work, Bereavement, Trauma, Substance abuse or any stress related issue.

You can call the service as often as you need or arrange a series of regular telephone counselling sessions with the same counsellor (week day service). Should you need face to face sessions, then the telephone counselling service willidentify local counsellors in your area for you to meet with.

With HSF Assist you can receive, from first registration, up to 6 face to face counsellingsessions after your telephone counselling. If you then use the face to face counselling,you will pay the counsellor direct and then submit the receipted invoices to HSF healthplan for reimbursement under the Practitioners category. We cannot consider any faceto face counselling claims that have been organised independently by you. All face toface counselling must follow helpline counselling sessions undertaken via HSF Assistand be on their recommendation. (Please note that up to a maximum of 6 sessions for each person named on your policy, for the lifetime of your policy may be claimed. There is no pre-existingcondition rule applicable to HSF Assist including the face to face counselling).

Legal HelplineOur lawyers can advise on any matter relating to UK and European law. Staffed by solicitors and barristers specially selected for their skill in explaining complex legal matters in everyday language, the advice line has helped many thousands of policyholders through a multitude of legal problems.

Together they are able to provide specialist knowledge in the areas of personal injury,negligence, property, contract disputes and consumer law to name but a few. Where we do not have the specialised skills in-house, we can call on our panel oflawyers and, for European legal advice, lawyers in our sister offices across Europe.

The Legal helpline is available 24 hours a day, 7 days a week and can be called as oftenand for as long as needed.

Advice about the law in England and Wales is available 24 hours a day, seven days aweek. Legal advice for the other areas is available 9am - 5pm, Monday to Friday, excluding public and bank holidays. If you call outside these times, we will arrange tocall you back.

14

Access GP Advice LineTelephone access to 24 hour GP service

Access Legal & CounsellingTelephone access to otherservices

Access validated Fitness, Wellbeing andNutrition InformationMobile Web Optimised sitesprovided by NHS and MedicalSolutions Professionals.

Connect to NHS Symptom CheckerMobile Web Optimised siteprovided by NHS

Feedback FormUser experience feedback toMedical Solutions.

Health Information In-App Access to medicallyvalidated Health InformationSite

Notes & ContactsUser input Medical Recordsfor Allergies, Medication andHistory. Medical Contacts andLocation based search ofServices

GP Services Summary of the servicesavailable on the HSF GP Surgery App.

Online ServicesAccess Virtual Dr. MessageDr service and AppointmentRequest.

HSF Assist®

HSF Assist GP Surgery is a multi platform web based application which gives you access to all the HSF Assist services. You can book an appointment with the GP Advice Line or Virtual Dr service, message aDoctor with a question, store medical records and medical history and access medicalservices near you. You can even store medical contacts for quick reference.

There is a fitness section where you can access validated advice from the NHS on thebenefits of exercise and how to lead a healthier lifestyle. The Wellbeing section is an in-depth directory providing information on a vast range of subjects. The Nutrition section links you to NHS Choices giving you practical advice on losing weight, Food & Diet, your 5 A Day, Healthy Recipes and a weight loss forum.

The Health Information section gives you access to Health, Disease, Lifestyle and Travel information and the Health Conditions section gives you information on more than1,100 health conditions and treatments which is searchable by using either an A-Z listing or Body Map.

The Assist Services section gives you access to the other HSF Assist Services; 24 hours7 days a week Counselling and Legal Advice.There is also a feedback link to let us know how you are finding the service

GP in Your Pocket

15

HSF PerkboxWith HSF Perkbox you get access to hundreds of discounts from all your favourite places. With all these great opportunities,it makes sense for you to be able to access them wherever andwhenever, with whatever device you wish to use. This is a Web based service only. You will need an internet connectionand email to access this benefit.

WebsiteHead to HSFperkbox.co.uk/join and activate your account using the Activation Codeshown on your Policy Document. Then discover the many benefits available. Redeeming benefits couldn’t be easier. Simply follow the instructions on the site.

PhoneFeeling a bit lost? Have some questions? Don’t hesitate to give the HSF Perkboxhelpdesk a ring on 0203 743 1247 - we’re a friendly bunch and will endeavour to helpyou in the best way we can.

Free HSF Perkbox appOnce you have activated your account search for ‘Perkbox’ in the App Store andGoogle Play to get all the Perkbox benefits on-the-go.

Text & EmailWe want you to know about all the benefits you could be getting hold of, so we’ll keepin touch when we come across anything new or important.

Online Savings AssistantWe don’t want you to miss a deal so when you’re perusing online, we’ll let you know. All you need to do is download the plugin by typing ‘Perkbox’ into the Chrome WebStore.

Start SavingOnce you have access to the HSF Perkbox Site, you can start saving money on diningout, going to the cinema, your daily coffee and your weekly shop. Offers are updated regularly and it is worth visiting the site to make sure your are notmissing out on saving money for something you are already using.

HSF perkboxPowered by

HSF Perkbox is provided for HSF health plan by Huddlebuy.

HSF health plan Limited is the provider of this cash plan. ThePersonal Accident benefits outlined are underwritten for HSFhealth plan by Chubb European Group Limited. The underwriter of the Personal Accident Benefits may bechanged occasionally.

About the HSF health schemes in this brochureThey provide cover for you and your family (a partner andall children up to the age of 18 who live permanently at thesame address with you) against the everyday costs of suchthings as a visit to the dentist, optician and variouspractitioners, and make grants for hospital admission andthe birth of a baby. Access to helplines offering legalinformation, medical information and counselling is alsoprovided.Some benefits relate to the cost of the services you have

received which are payable when you send in your paidreceipts. Other benefits are a fixed rate, for example a fixedamount for each night spent in hospital or for the birth of ababy, or bodily injury from an accident. The benefits providedby the various schemes are explained in this brochure. Anumber of benefit conditions apply with the main ones being(and explained fully in the relevant section of the ‘Rules andfurther explanations of benefit categories’ or ‘General termsand conditions’):• There is a total limit on benefits calculated on a rollingbalance over a 12 month basis with a further limit fromregistration on some hospital benefits. See ‘Claims’ onpage 21 and ‘Hospital’ on page 17.

• The qualifying period shown for each benefit is explainedin ‘Qualifying periods and restrictions’ on page 20.

• Pre-existing conditions and health problems when youjoin or increase premiums, or which arise during thequalifying periods, are not covered under many schemebenefits. See ‘Qualifying periods and restrictions’ and‘Increasing scheme cover’ on pages 20 and 21.

• The maximum scheme entry age is 70. See ‘Registration’on page 20.

• Switching between schemes is allowed. See ‘Increasingscheme cover’ and ‘Decreasing or ceasing scheme cover’on pages 20 and 21 for the terms.

Full policy terms and conditions, and the benefits provided,are shown in this brochure.

Paying premiums and changing your mindDetails of the prices of each scheme are shown in thisbrochure. Payment can be made by payroll deductionthrough your employer. When your application is acceptedyou will receive a registration pack. This will include details ofany restrictions which will need to be placed if you or amember of your family have any existing medical conditions.On receiving confirmation of registration, you have 14 daysin which to change your mind and withdraw your application(telephone or write to the HSF office in London – details onpage 20). If any premiums have been paid you will receive afull refund providing no claims have been settled. See

‘Decreasing or ceasing scheme cover’ on page 21 forcancelling after this period.

Duration of cover in the planCover is provided continuously from month to month,beginning with your registration date, until it is cancelled orotherwise comes to an end. It is automatically renewed.

Making a claimAt the conclusion of the stated qualifying periods you maystart claiming. Forms are provided on request by telephoning020 7202 1381, writing to HSF health plan, 24 Upper Ground,London SE1 9PD or by downloading from our websitewww.hsf.eu.com. If you telephone or write you may enquireabout how much benefit you will receive. Please quote yourpolicy number. Original receipts must be sent with the claimform. Your payment will be made by direct credit paymentinto your Bank account (a current account in your name orjoint names).

Compliments and ComplaintsWe endeavour to provide a high standard of service to ourPolicyholders and welcome comments and suggestions.Should you find it necessary to make a complaint, youshould in the first instance contact our Customer ServicesDepartment at our London address. If your complaint is notresolved to your satisfaction, you may write to HSF’sManaging Director. There are appeal options available andany complaint which cannot be settled may ultimately bereferred to the Financial Ombudsman Service at ExchangeTower, London E14 9SR or telephone them on 0800 023 4567.Their website address is www.financial-ombudsman.org.uk.Full details of our complaints procedures are automaticallysent on receipt of a complaint and at each stage relevantaddresses are provided. Such details are available onrequest at all times. These procedures do not prevent youfrom taking legal action.

Regulation and CompensationHSF health plan Limited (No 202182) and Chubb EuropeanGroup Limited (No 1112892) are authorised by the PrudentialRegulation Authority and regulated by the Financial ConductAuthority and the Prudential Regulation Authority. (This maybe checked on the Financial Services Register by visiting thePRA website). In the unlikely event of our going out ofbusiness, the Company is covered by the Financial ServicesCompensation Scheme. The Group Policyholder or InsuredPerson may be entitled to compensation should theCompany be unable to meet its financial obligations. You canobtain further information from the Company at 24 UpperGround, London, SE1 9PD or from the Financial ServicesCompensation Scheme at the following address: FinancialServices Compensation Scheme, 10th Floor, Beaufort House,15 St Botolph Street, London EC3A 7QU.

16

Policy summary

This product meets the demands and needs of individuals and families who wish to manage their healthcare expenses suchas dental and optical, hospital admissions, consultations and investigations, and personal accident. Advice is not availablefrom HSF, and applicants should choose the scheme to suit their personal circumstances and review in future whether thisremains suitable .

Statement of demands and needs

May 2017

Dental and OpticalThe dentist or optician must be suitably qualified andregistered with the General Dental Council or GeneralOptical Council. Sundry items purchased at DentalSurgeries and Opticians premises, eg. solutions,cleaners, contact lens removers, floss, are not coveredand prescription charges for any kind of medication arenot covered under this category. Claims cannot beaccepted for the purchase of spectacles or contact lensessupplied without prescription. Any dental treatment(including teeth whitening) not carried out at a dentalsurgeon’s practice (eg. if undertaken or purchased at acosmetic/retail outlet) is not covered.Consultations with Consultant Oral Surgeons,

Consultant Facio-Maxillary Surgeons, ConsultantOrthodontic Surgeons and Consultant OphthalmicSurgeons are not covered under this category. Theseshould be claimed under the Specialist andInvestigations category. The cost of treatment oroperative procedures undertaken by these Consultants isnot included in any category. If eye laser treatment or apermanent contact lens implant (to correct long or shortsightedness) is carried out by a Consultant OphthalmicSurgeon or undertaken in hospital as a day case patientor an inpatient, claims cannot be accepted for Specialistand Investigations or for Hospital or Day Case in additionto the Optical category.Rules concerning pre-existing conditions do not apply

to this particular category.

Practitioner: Physiotherapy, Osteopathy, Chiropractic,Acupuncture, Homoeopathy, Chiropody / PodiatryThe maximum payable between all eligible registeredpersons is also between the above six headings. It is not,for example, £1,000 for each of the six. Claims will onlybe accepted with receipted invoices from qualifiedpractitioners of the six professions above. Policyholdersand dependants, in their own interests, should onlyconsult properly qualified practitioners who areregistered with that profession’s governing body/councile.g. The Health and Care Professions Council - HCPC. Thecost of any appliances or medication supplied orprescribed by the practitioners is not included. Claimscannot be accepted for reflexology, reiki healing orhypnotherapy nor for prophylactic/maintenancetreatments or sports/general massage or therapy. Consultations with Consultant Podiatric Surgeons (of

hospital consultant status) are not covered under thesebenefits. These should be claimed under the Specialistand Investigations category. The cost of treatment oroperative procedures undertaken by these consultantsis not included in any category.Rules concerning pre-existing conditions do not apply

to Chiropody/Podiatry.

Specialist and InvestigationsClaims must be for consultations in a hospital or clinic onan outpatient basis only and carried out by a doctor ofconsultant status. Treatment (including radiotherapy) andoperative procedures (including delivery of a baby) arenot covered, neither is any radiography during suchtreatment / procedures. Reimbursement is only on theinitial consultation with a Consultant Psychiatrist,subsequent visits are classified as treatment. Claims

cannot be accepted for examinations / investigationscarried out while an inpatient or as a day case or formedico-legal reports, possible legal evidence (includingpaternity testing), or for insurance, employment fitness/occupational assessments or immigration /emigrationpurposes.The following are covered under investigations:Any investigations undertaken, on an outpatient basisonly, in a hospital x-ray, scanner, pathology or nuclearmedicine / medical physics department (or its equivalentelsewhere); electrocardiogram, electroencephalogram;electromyogram, audiogram and orthopticinvestigations. Minor invasive investigations carried outat the same time as an out-patient consultation, and notrequiring the use of a separate treatment room, are alsocovered. Claims are accepted for: visits to healthscreening clinics if a letter or certificate from thepolicyholder’s/dependant’s General Practitioner isprovided prior to the appointment and indicates that thescreening was on his / her recommendation; the cost ofa vaccination administered at a GP surgery or clinic; orthe issue of a prescription for a vaccination (which maybe in the form of vaccine or medication). For allergy testing the initial consultation and

diagnosis of problems by a qualified practitioner with apersonal consultation in a clinical environment (not aretail outlet) is covered but not any subsequentconsultation, therapy or treatment.The following are NOT coveredInvasive investigations, such as endoscopies, carried outwith some form of anaesthetic, and requiring the use ofan out-patient treatment room (for which the hospital orclinic charges an additional fee) or occupancy of a bed ona day stay basis. The Day Case benefit may be claimedin these circumstances if applicable.

Birth Grant and Adoption GrantThe qualifying period relates to inpatient treatment andall other categories for consultation, investigation andtreatment associated with the pregnancy. Hospitalbenefit relating to the mother or baby is not payable tomale policyholders who do not reside at the sameaddress as their partner. The Birth Grant is also paid fora still birth if an official certificate is submitted. Adoptionis included in this category, however, a claim under thiscategory may not be submitted until HSF cover has beenof at least 10 months’ duration. The adoption certificateshould be dated after the end of this qualifying periodand before the child’s 10th birthday. Children alreadyregistered may not subsequently be the subject of anAdoption Grant by either parent. Claims for overseasbirths and adoptions are not covered, but may beconsidered at our discretion.

HospitalThe hospital or hospice must be in the United Kingdomor Ireland and its name and admission and dischargedates should be clearly stated on the claim form. Benefitis payable to each eligible registered person for up to 40nights in any consecutive 12 calendar months. Theamount payable is the stated grant and no direct costs(e.g. Consultants fees, room charges,medication/dressings involved with the hospitaladmission, including consultants’ fees) are covered.

Rules and further explanations of benefit categories

17

May 2017

Benefit is restricted to 50 nights in total in a period ofcontinuous cover, regardless of scheme, for each eligibleregistered person to whom it applies for admissions: forcongenital and prematurity disorders in babies andchildren for whom a Birth Grant has been paid to aparent; to mental illness and geriatric (elderly medical /long stay / rehabilitation / respite care/ GeneralPractitioner care) wards. These 50 nights are counted aspart of and not in addition to the ruling in the sentenceabove eg. within a 12 month period the number of nightsfor which benefit is payable will not exceed 40 regardlessof the reason for admission.In accordance with the usual practice, the date of

admission is counted as the first night but the date ofdischarge is not counted. Time spent within an Accidentand Emergency Department (A&E) is not considered aspart of an admission unless the hospital declares it to beso in accordance with their records. Claims must besubmitted after each discharge from hospital. Weekendleave or longer periods of home leave do not count as adischarge, although no amounts will be paid for nightsspent at home. Transfers from one hospital to anotherwithout a period at home in between are counted as acontinuous period in hospital. In cases of long stay admissions a claim may be

submitted after 40 nights and an amount will be paid upto the number of nights due within the rules.Recuperation only, as appropriate, will be payable upondischarge. However, if an admission extends beyond 12months a further claim may be submitted. There arespecial rules for these unusual circumstances. If, on thedate of admission to hospital, the benefit limit is shownto have been reached in the preceding 12 months thenno payment is made for that admission at all unless thecurrent admission is of a duration which takes it past theanniversary of the discharge date 12 months earlier. Inthese cases the balance of nights due will be paid.Adults staying with their children at the

hospital/hospice are not entitled to Hospital or Day Casebenefit; nor are children who are staying with theirparents.

RecuperationThis grant is paid automatically, subject to qualifying forthe appropriate number of nights in the hospitalcategories and actually having been discharged. There isno requirement to make an additional claim. Ifreadmissions occur after less than seven nightsfollowing discharge, and the second or subsequentadmissions by virtue of their length would also qualifyfor a grant, only one such grant will be paid at the rate setfor the longest of the admissions. The grant is notpayable when the patient dies in hospital or anadmission includes a confinement and qualifies for theBirth Grant.

Day Case Surgery and TreatmentThe claim form must be signed by an official at thehospital and bear the official stamp to verify theinformation given by the policyholder. Anyone admittedovernight following a Day Case attendance will beentitled to the Hospital and not the Day Case benefit. Thefollowing are not included: Geriatric, psychiatric orrehabilitation day hospitals or units; an unplanned day orperiod spent in an Accident and Emergency or CasualtyDepartment; minor surgery, treatment or procedures

undertaken in outpatient or similar departments. Theamount payable is the stated grant and no direct costs,e.g. Consultants fees, room charges,medication/dressings involved with the hospitaladmission including consultants’ fees are covered.

Home Care Assistants and Home HelpThis category does not include home nursing and isdesigned to give short term assistance only (no longerthan a period of 6 months) with the costs of housework(cleaning and cooking) for those incapacitated by anillness, and being unable to work, or recuperating athome following a hospital admission. All claims mustbe submitted with receipts from the Local Authorityproviding the service. Claims may also be submittedwith receipts for home help from private companies ororganisations whose businesses provide such services,and these must be accompanied by a letter or certificatefrom the General Practitioner stating the reason for theassistance and the length of time for which it wasrequired. Claims for child care, shopping or gardeningare not covered. We do not accept claims fromindividual cleaners/service providers paid or employedby you or any insured person.

Personal Accident1. Payment for any Permanent Disability not shown inthe table on page 11 will be based on a medicalassessment of the disability in relation to the table andnot in relation to the Insured Person’s ability to work.

2. If the Insured Person was already disabled before anAccident or already had a condition which is graduallydeteriorating, the payment will be reduced. Thereduced payment will be based on a medicalassessment of the difference between:a) the Permanent Disability after the Accident; andb) the extent to which the Permanent Disability isaffected by the disability or condition before theAccident.

3. If the Insured Person claims for loss of limb, he / shecannot also claim for parts of that limb.

4. The most an Insured Person can receive forPermanent Disability resulting from any one Accidentis the amount specified for Permanent TotalDisablement.

Definitions1. Accident means a sudden unforeseen and fortuitousidentifiable event and the word accidental shall beconstrued accordingly.

2. Bodily Injurymeans injury to an Insured Person whichsolely and independently of any other cause results inthe Insured Person's Death, Permanent Disability,Temporary Disability, fracture of a specified bone orbones, or Dental Trauma. Bodily Injury excludes anycondition resulting from any gradually operatingcause or degenerative process.

3. Permanent Disability means disablement which haslasted for at least 12 months and from which it isbelieved the Insured Person will never recover.

4. Permanent Total Disablement means disablementcaused other than by loss of limb or Sight which,having lasted for at least 12 months, will in allprobability entirely prevent the Insured Person fromengaging in or giving attention to a profession oroccupation of any and every kind for the remainder ofhis / her life.

18 May 2017

5. Loss of Sight means total and irrecoverable loss ofsight when an Insured Person’s name has been addedto the Register of Blind Persons or when the degree ofsight remaining after correction is 3/60 or less on theSnellen Scale.

6. Dental Trauma means Bodily Injury resulting from anAccident which is as a direct result of a blow to thehead. Payments will be made only for DentalTreatment required following the Accident. Paymentwill be up to the amount shown in the Dental Traumabenefit for the scheme chosen. In any case the amountwill not exceed 5% of the Permanent Disability Benefitof the cover selected. The Maximum for this onScheme D is £2,000. The benefit will only be paid inrespect of treatment an Insured Person receives within12 months of the date of the Accident. This benefitcovers dental treatment directly relating to anAccident such as a sports injury or a fall and includesanaesthetic fees, Dental crowns, bridges and whitefillings, Dental veneers and Replacement dentures orrepairs. It is a condition of this policy that the dentistconfirms on each receipt that the treatment is only torepair the damage to the Insured Person’s teeth as adirect result from a blow to the head. In addition tothe Exclusions stated under Personal Accident thefollowing exclusions also apply to this benefit:1. Cancellation charges made by the dentist (forexample, for missed appointments).2. Damage to dentures when not being worn.3. Dental consumables (for example, toothbrushes,mouthwash and dental floss).4. Dental prescription charges.5. Dental insurance, premiums and joining fees for apractice’s dental plan.6. Any treatment an Insured Person receives 12months or more after the date of the accident.7. Dental treatment an Insured Person receives for anaccident which happened before joining the plan.8. Bodily Injury caused by eating and drinking.

7. Permanent facial disfigurement means to the extentof not less than one square centimetre of scar tissueor a scar of not less than two centimetres in length ineach case in the area from the hairline to andincluding the lower jaw and ears.

8. Temporary Disability means disablement whichprevents the Insured Person from engaging in orgiving attention to his / her normal, gainful occupationor which confines the Insured Person to his / her homeon medical grounds.

9. Benefit Period means the total period (but notnecessarily consecutive period) for which theTemporary Disability Benefit is payable in respect ofany one Accident to any Insured Person. Note: Odddays will be paid at 1⁄ 7 th of the specified weekly rate.

10.Deferment Period means a period of temporarydisablement during which the Temporary DisabilityBenefit shall not be payable.

ExclusionsNo Benefits will be payable:1. If the Bodily Injury is caused by; war or any act of war;the Insured Person serving full-time in the armedforces of any country or international organisation;suicide, attempted suicide or deliberate self-inflictedinjury by the Insured Person (even if they are insane);the Insured Person taking part in air sport or air travel,unless as a passenger; a sickness or disease;

Repetitive Stress (Strain) Injury or Syndrome or anyother condition or injury which develops over a periodof time.

2. For any disabilities caused by or arising from PostTraumatic Stress Disorder or related syndromes orany psychological or psychiatric condition.

The Personal Accident categories are underwritten onbehalf of HSF health plan by Chubb European GroupLimited whose registered office is at 100 LeadenhallStreet, London, EC3A 3BP and is a European Companyincorporated in England & Wales under Companynumber 1112892, which is authorised by the PrudentialRegulation Authority and regulated by the FinancialConduct Authority and the Prudential RegulationAuthority for the conduct of business in the UK. HSFhealth plan is an intermediary acting on behalf of thepolicyholder dealing exclusively with Chubb EuropeanGroup Limited. The entire administration of the PersonalAccident benefits, which may include medical and otherenquiries, is carried out by Chubb as soon as receipt ofyour claim has been acknowledged. The address andcontact telephone number will be indicated in theacknowledgement letter.

HSF Assist ®

There are no additional charges to use the services inHSF Assist (except for the cost of the phone call to theservice). There is no limit on how many times you usethe services except for face to face counselling. If youare advised by the telephone counselling service thatyou would benefit from face to face counselling, theycan arrange for you to have a session or sessions witha local counsellor. HSF Assist will cover up to 6 sessionswith a face to face counsellor which you will pay for andthen claim back by submitting the receipts for thesession(s) you have (up to a maximum of 6 per namedperson on the policy, for the lifetime of your policy).There is no limit on how many times you use thetelephone counselling service.

HSF PerkboxThe HSF Perkbox is provided and facilitated byHuddlebuy Limited. All offers are subject to availabilityand the terms and conditions as stated on the HSFPerkbox website. Access to these offers is only via thewebsite and HSF Perkbox Application for MobileDevices. Use of HSF Perkbox website and applicationis included in your Policy. Access to the site can be canbe Wi-Fi, or provided by your mobile network provider,but HSF health plan or Huddlebuy Limited cannot takeresponsibility for the app not working at fullfunctionality if you do not have access to Wi-Fi, and ifyou do not have any of your data allowance left.If you are using the app outside of an area with Wi-Fi,you should remember that your terms of agreementwith your mobile network provider will still apply. As aresult, you may be charged by your mobile provider forthe cost of data for the duration of the connection whileaccessing the app, or other third party charges. In usingthe app, you are accepting responsibility for any suchcharges, including roaming data charges if you use theapp outside of your home territory (i.e. region orcountry) without turning off data roaming. If you are notthe bill payer for the device on which you are using theapp, please be aware that we assume that you havereceived permission from the bill payer for using theapp.

19 May 2017

20

RegistrationAnyone may join up until their 71st birthday (providingthey satisfy health requirements). Cover will continue forlife, if the policyholder so wishes, and if premiumpayments are kept up-to-date and the rules andconditions are adhered to.Cover is provided continuously from month to month

until it is cancelled or otherwise comes to an end. Youwill renew your policy every time your premium is paid,so unless we change the terms and conditions of yourpolicy you will not receive renewal documentation.When your application is accepted you will receive aregistration pack. Upon its receipt you have 14 days inwhich to change your mind (telephone 020 7202 1380 orwrite to HSF health plan, 24 Upper Ground, London, SE19PD). If any premiums have been paid you will receive afull refund providing that no claims have been settledduring this period.One registration also covers a partner (under 71 at the

time of joining) and dependent children under 18,residing at the same address on a permanent basis. Thenamed policyholder and / or partner must be a parent ofthe stated children under 18 or be the legal guardian ofthem. Children in a fostering arrangement are noteligible for inclusion, and neither are children who areon weekend/school holiday stays.Couples in a marriage / partnership may each have a

separate Primary Scheme Policy. Young people aged 16and 17 may join in their own right but if either parent isa policyholder as well, the young person will cease to bea dependant for cover on the parent’s scheme.

Qualifying periods and restrictionsClaims may be submitted at the conclusion of thequalifying periods stated under each benefit heading inthis brochure. The symptoms relating to theconsultation/episode of treatment must have startedafter the qualifying period has ended. There is aqualifying period of 10 months for the Birth and AdoptionGrants and this time also applies to other benefitcategories if the claim is related to pregnancy.You must complete the Application form and Medical

Information form with as much detail as possible andread the Declaration carefully before signing it. Somemedical conditions make it necessary to offer limitedcover in our plans and you will be advised if this appliesto you. These restrictions include any conditions whichexisted or for which symptoms were present beforeregistration or which began during the qualifyingperiods; any development of existing conditions; anyrecurrence of conditions which have existed in the past;any hereditary or congenital conditions which mayalready exist but which manifest symptoms only aftercover commences and any which previously existed butwere not disclosed. It may also be necessary to refuseclaims relating to a particular area or structure of thebody where there has been a problem in the past. Claimscannot be accepted for anything related to plasticsurgery and consultations / treatment for cosmeticreasons; addictions (e.g. misuse of alcohol or drugs); selfharm or self inflicted injuries or HIV / AIDS. Conditionswhich begin during the qualifying period should benotified in writing and you will then be advised if any

restrictions apply. Optical, Dental, Dental Trauma, Chiropody/Podiatry,

HSF Assist and Personal Accident are the only categoriesnot subject to the pre-existing condition rules, althoughsome Personal Accident benefits may be limited if adisability or medical condition existed before theAccident.No policyholder or dependant may be registered in

both an Extra Cover and a Primary Scheme. It is,however, permissible to be a policyholder in one PrimaryScheme and a dependant in another Primary Scheme.These rules are based on the insurance principle of notbeing able to make a profit from the reimbursement ofany expenditure.

Change of circumstancesWhen a policyholder marries or re-marries, and wishesto include his or her partner (and any children under 18residing permanently at the same address) a furtherapplication form must be completed and submitted toHSF for approval and registration. The policy numbershould be shown and the form marked ‘Change ofCircumstances’.A common-law or civil partner residing at the same

address is accepted by HSF providing that an applicationform, which also shows the full name of that partner, iscompleted and submitted for approval and registration.Children born in the first 10 months of cover (when it hasnot been possible to pay a Birth Grant) may be added asdependants on completion of an application form withmedical information. An application form is also requiredfor children for whom an Adoption Grant has been paid.A policyholder will be able to make a claim relating to

a partner or child when acceptance has been confirmedand the terms and conditions will be as for a newpolicyholder.Any change of address must be notified in writing to

HSF so that our records remain up-to-date.

Death of a policyholderWhen a policyholder dies, the partner may become thenamed policyholder if already covered by HSF andqualify for continuity as a full policyholder. Anyoutstanding claims at the time of death will be settled asappropriate, payments being made on production of therequired proof of entitlement.

Payment of premiumsPolicyholders should check that payments havecommenced in order that they are received regularly byHSF. If premiums fall into arrears for more than threemonths, a qualifying period of one month will beimposed from the date of payment before entitlement toclaim is resumed. Policyholders who fall into arrears formore than six months will normally be required to rejoinunder the usual conditions of enrolment.If your employer pays your premiums before

assessment of PAYE tax, you will be subject to tax onsuch payment

Increasing scheme coverAny existing policyholder is able to apply to increase toa higher scheme up until their 71st birthday bycompleting an application form. Acceptance may be

General terms and conditions

May 2017

subject to a proviso or restriction for any new healthcondition which may have arisen.In transfers to any scheme, qualifying periods are

waived in all categories except the following: Birth andAdoption Grants; all other categories if the claim isassociated with pregnancy; Eye Laser Treatment orImplantable Contact Lenses in the Dental and Opticalcategory only when transferring from a Primary Schemeto an Extra Cover Scheme. If it is less than three monthssince registration at the time of any scheme transfer allqualifying periods will apply.

Extra Cover Schemes are entirely separate from thePrimary Schemes and policyholders transferring to anExtra Cover Scheme from a Primary Scheme will besubject to rules for new joiners, particularly relating tomedical conditions existing or likely to recur, at the timeof transferring.Within the range of Primary Schemes, and separately

within the range of Extra Cover Schemes, claims relatedto medical conditions existing at the time of increasingor linked to previous medical conditions will be paid atthe appropriate former scheme rate. There may becircumstances where categories are grouped togetherfor flexibility (eg. Practitioners) when it is necessary tosettle claims at a former scheme rate for all categories inthat group. Due to scheme groupings being separate it isnot possible for an Extra Cover Scheme policyholder tohave a claim settled at a former Primary Scheme rate.

Decreasing or ceasing scheme coverWhile it is possible to reduce payments by transferringto a lower scheme, cover at the higher scheme shouldhave been of at least six months’ duration before such anapplication is made. Entitlement at the higher rate thenceases immediately upon transferring. If the maximumhas been reached in any category in the higher ratescheme, there will be a qualifying period of six monthsbefore claims may be submitted under the new lowerrate scheme. Cover at the new lower rate scheme mustbe of at least 12 months duration before increasing ordecreasing again.Policyholders who wish to cease payments should

provide written notification to HSF. Past payments willnot be refunded. Entitlement to claim will continuethroughout any period of time covered by premiums.Any errors in premium payments must be notified to

HSF within two years of the occurrence for refunding tobe possible.

ClaimsClaims must be made within six months from the dateof the treatment/purchase or discharge from hospital orthe accident taking place. It may be necessary to ask youfor additional medical or supporting information inconnection with any claim.All benefits are tax free and easy to claim with forms

provided on request by telephoning 020 7202 1381,writing to HSF health plan, 24 Upper Ground, London,SE1 9PD or by downloading from our website at:www.hsf.eu.com.

Reimbursement of most claims is made on a rollingbalance principle over any 12 consecutive months. Thisperiod starts from the date we pay your claim (not fromyour joining or scheme increase date or from a calendaryear).

For example: a Scheme A policyholder, after serving thequalifying period, who has up to £400.00 to claim fordental/optical expenses in any 12 consecutive months;could have the following claim record:

Within any consecutive 12 month period, the claim paidamount has not exceeded £400.00. After each claim ispaid the amount becomes available again 12 monthslater.Balances available in each category can be checked bytelephoning the claims department who will giveguidance on when to submit a claim.Claims will only be accepted where accumulated

receipts total £5 or more. Benefit payments which relateto amounts paid for a service provided will be up to 50%of the cost in the Primary Schemes and up to 100% ofthe cost in the Extra Cover Schemes, depending on themaximum shown in the brochure. Payment will be bydirect credit into your own or joint Bank account. Claimswill not be paid unless the appropriate premiums are up-to-date, even if the hospital stay or treatment date wasbefore premiums fell into arrears.

The receipts (which will not be returned unlessspecifically requested) must:a) be originals, not photocopies;b) include the practitioner’s stamp / name, qualificationsand date of issue;

c) include the patient’s full name and address;d) state the type of service and items provided;e) be for a service for which payment has been metdirectly by a person registered as a policyholder ordependant;

f) be for a service covered by the HSF categories onlyand not for any insurance premiums paid to cover thatservice.

In circumstances where part or all of of the amountstated on the receipt has been met by anotherorganisation or insurance company, HSF will limit ordecline benefit payment to ensure that overall apolicyholder does not receive more than the amountpaid as to do so would be an illegal act.

Claims cannot be accepted for purchases or treatmentor services provided outside the United Kingdom andIreland. Claims cannot be accepted for treatment orpurchases from service providers who are related to theinsured person(s). There are no location restrictionsunder the Personal Accident categories. Should anyoverpayment be made in respect of any of the benefits,the amount in question will be set against any futureclaims, or a repayment may be requested. Any fee paidby a policyholder to a practitioner for any type of medicalstatement or to a hospital for a statement concerningadmission /attendance cannot be reimbursed by HSF.

May 201721

Date Claim Paid

17 June 2017

5 October 2017

11 August 2018

Claim Paid Amount

£350.00

£50.00

£250.00

Remaining Balance in the Scheme A

Dental/Optical Category

A balance of £50.00 remains.

Now a nil balance is left. The next available amount willbe £350.00 on 17 June 2016.

A balance of £100.00 remains.

22

Payment from Chubb for Personal Accident & DentalTrauma claimsAny money due will be paid to the policyholder, if living,otherwise to his / her personal representative(s) within21 days of the claim being substantiated to thesatisfaction of Chubb. Any receipt which the policyholderor anyone acting on the policyholder’s behalf or his / herrepresentative(s) may give to Chubb for benefits payableshall be deemed final and complete discharge of allliability of Chubb in respect of such benefit.

General ConditionsRegardless of any amendments, the Birth and AdoptionGrants will remain available to all policyholders in theform outlined in the brochure for a minimum of 13calendar months from the date of joining or changingschemes. This applies to all existing policyholders.In the interest of the majority of the policyholders, the

Board of Directors of HSF health plan reserves the rightto:a) vary the premium rates by giving at least 28 days’notice to the policyholder’s last known home address;

b) vary the range and rates of benefit and the conditionsand terms relating thereto;

c) restrict or decline further payments;d) refuse a new application or to refuse to increase ordefer increase to a higher premium without givingreasons for doing so;

e) terminate the cover of any policyholder who is inbreach of the rules and conditions, has refused tocooperate in the process of settling a claim or whoseconduct has, in the opinion of the Board, beenunacceptable;

f) take legal action against anyone who makes afraudulent claim and terminate cover immediately;

g) use information provided on application and claimforms for the prevention and detection of crime;

h) make amendments to these rules with such changesapplying at the time of registration or from anysubsequent written notification to the policyholder.

Compliments and ComplaintsWe endeavour to provide a high standard of service toour Policyholders and welcome comments andsuggestions. Should you find it necessary to make acomplaint, you should in the first instance contact ourCustomer Services Department at our London address.If your complaint is not resolved to your satisfaction,you may write to HSF’s Managing Director. There areappeal options available and any complaint whichcannot be settled may ultimately be referred to theFinancial Ombudsman Service at Exchange Tower,London E14 9SR or telephone them on 0800 023 4567.Their website address is www.financial-ombudsman.org.uk. Full details of our complaintsprocedures are automatically sent on receipt of acomplaint and at each stage relevant addresses areprovided. Such details are available on request at alltimes. These procedures do not prevent you from takinglegal action.

Data ProtectionInformation which you provide to HSF or Chubb atregistration and in support of any claim will be used inthe processing of claims and maintaining your records.The information may be passed to our service providersto assist in the continuity and provision of benefits, andto third parties to prevent and detect fraud. For a smallfee you may request a copy of the details andinformation which we hold about you. You may apply toData Request, HSF health plan, 24 Upper Ground,London, SE1 9PD.

Governing LawCover in your scheme within this HSF health plan will begoverned by and interpreted in accordance with EnglishLaw.

May 2017

If you have a question about a claim you can call HSF health plan Claims Team on

020 7202 1381or email them on

[email protected] you have a question about your cover you can call

HSF health plan Customer Care Team on

020 7202 1380or email them on

[email protected]

23

YourQuestionsAnsweredQ Can I increase to a higher scheme at any

time?

A You may change schemes before the age of 71.

Q Do I have to have a medical before I join?

A No. You need only complete and sign thehealth declaration on the application form.

Q Do older people pay higher rates?

A No, all ages pay the same rates.

Q How do I pay?

A Through a pay deduction facility operated byyour employer.

Q Can I get cover for my partner and family?

A Yes. Give details of your partner anddependants on your application form and they will be included for free.

Q Are benefits taxable?

A No. You keep all you receive from HSF.

Q What qualifying periods are imposed?

A For most benefits claims will be acceptedafter 3 months, any exceptions are clearly indicated in the brochure.

Q How do I make a claim?

A Claim forms are available on request bytelephoning the number indicated on the reverse of your certificate of cover or from our website.

Q How do I receive my money?

A By direct credit into your Bank account.

Q When would my cover begin?

A Cover begins on the date printed on your certificate of cover for some benefits and qualifying periods begin on that date as well.

MD037 UK Comp Funded NR T&C’s May 2017

benefitsfor everyone’shealth

Head Office24 Upper Ground, London SE1 9PDTel: 020 7928 6662Fax: 020 7928 0446Cover enquiries: 020 7202 1380Email: [email protected] enquiries: 020 7202 1381Email: [email protected]

HSF health plan Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulated Authority.

Documents

The everyday health cash plan · 2020. 3. 26. · You can see the wide range of cover HSF health plan provides in the benefit summary opposite. So you know exactly what your HSF health