Your guide To Benenden Healthcare · This guide aims to make clear the services we provide and the principles we ... medical specialities including orthopaedics, ENT and general surgery

Your guide To Benenden

HealthcareApril 2018

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Welcome to Benenden Health We are a mutual society and have been providing healthcare since 1905. Our original mission in the early 20th Century was to provide treatment for postal workers suffering from Tuberculosis (TB). Fortunately, that disease is relatively rare today, and we’ve since evolved into an organisation which exists to provide a wide range of healthcare services to a membership of over 800,000 people. We were founded on the vision of many people joining together to help pay for medical care to support those in need. This is still core to our values today, and we remain passionate about improving the quality of our members’ lives. In fact, we believe that Benenden Health has stood the test of time because we’ve always been a not-for-profit organisation and a mutual society that exists for the sole benefit of our members.

Being a mutual means that we don’t have any shareholders and therefore all of our resources are committed to serving members. Our members put their trust in Benenden Health to use membership funds appropriately to provide them with private healthcare, when they need it, on a discretionary basis. Trust is a two-way street, so we also put our trust in every one of our members to use their own discretion too, to decide if they need to make use of our services or not.

Our vision is to become the UK’s leading mutual community for health and wellbeing, and we hope that you will not only benefit from our healthcare services, but also play your part in helping us to spend our resources wisely.

Where this guide refers to services using terms such as ‘we will’ or ‘our’ it should be noted that this means either The Benenden Healthcare Society Limited or service partners with whom Benenden Health have a contract to provide the service.

ContentsYour guide to help you get the most from your Benenden Health membership.

Welcome to Benenden Health 3

- What we do 4

- How does Benenden Healthcare work 5

Summary of services 6

How to request services 8

Services in more detail

Services available from day 1 of membership

- GP 24/7 11

- 24/7 Psychological Wellbeing Helpline 13

- Independent Care Advice 14

Services available after 6 months of membership

- Medical Diagnostics 17

- Medical Treatment and Surgery 20

- Physiotherapy 24

- Psychological Wellbeing Support 26

- Financial Assistance 28

Additional benefits 30

General conditions of service 32

Glossary 38

The glossary provides a description of words noted in bold throughout this guide.

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How does Benenden Healthcare work?

How discretion works

We are a friendly society providing benefits from a discretionary fund. This means that the provision of services is subject to the resources we have available through membership contributions. Furthermore, when members request support we have discretion as to whether we provide assistance and the level of assistance to be provided. We manage our funds and the services we provide carefully to ensure that we can continue to provide assistance to members who require our support. This discretionary approach has served our membership well for more than 110 years and will continue to do so into the future.

This guide aims to make clear the services we provide and the principles we consider when determining whether to provide assistance. For the good of the membership as a whole we review our services regularly and make amendments from time to time. However, rest assured that members are kept informed of any changes we make to our services via our website, our quarterly Be Healthy magazine and updates to this guide.

How we helped our members in 2017

as of 31st December 2017

What we do

Benenden Healthcare is designed to be an affordable way to look after your health and wellbeing: complementing NHS services as well as representing a low cost alternative to private medical insurance.

The NHS is one of the most highly respected health services in the world, providing care free at the point of delivery. However, NHS resources often come under pressure and this is where Benenden Health can help with services including:

Medical Diagnostics

Medical Treatment and Surgery

Physiotherapy

GP 24/7

24/7 Psychological Wellbeing Support

Our principle of fairness means that everyone is welcome as a Benenden Health member. We do not exclude anyone on the grounds of pre-existing medical conditions, there is no upper age limit, we do not charge admin fees or excesses, we have no lengthy contracts and we will not increase the price of your membership just because you have used our services.

We helped our members78,733 times

37%Diagnostic

services

30%24/7 adviceand support

22%Surgical

procedures

11%Physiotherapy

Diagnostic Services used in 2017

The above accounted for 53% of all diagnostic services provided in 2017. The remaining 47% covered a variety of services from

psychiatry to podiatry, and everything in-between.

Surgical procedures carried out in 2017

The above accounted for 69% of all surgical procedurescompleted in 2017.

26%Physiotherapy

12%Orthopaedics

8%Dermatology

7% Ear, nose

and throat

Orthopaedics

Ear, nose and throat

22%

8%

Opthalmology

Gynaecology

14%

7%

General Surgery

Dermatology

13%

5%

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Service What is it? Our service includes Where

24/7 Helplines (see pages 11 and 13)

24/7 Helplines to speak to a UK based GP or a Psychological Wellbeing therapist.

Telephone support available 24/7.

Independent Care Advice (see pages 14-15)

Information and advice about care issues including sourcing short or long-term care whether this is at home, residential, convalescent or respite.

Information can be sought to support the individual member, their spouse/partner or their parents.

Assistance is provided via telephone or by a personal meeting with a care adviser local to you.

Additional Benefits (see pages 30-31)

Paying members receive our award winning quarterly health and wellbeing magazine BeHealthy. In addition, members have access to discounts across a range of Benenden Health products and a wide range of discounts on holidays, shopping and other health and wellbeing products.

Medical Diagnostics (see pages 17-19)

Access to consultations with an appropriate consultant, scans requested by the consultant including ECG, EEG, Ultrasound, MRI, CT, PET and X-ray.

Up to £1,800 per authorised case. We have access to a nationwide network of diagnostic facilities providing locations close to you.

Medical Treatment and Surgery (see pages 20-23)

Our service supports over 250 common procedures across medical specialities including orthopaedics, ENT and general surgery.

For all surgical procedures see www.benenden.co.uk/our-procedures

All authorised treatment costs are directly settled in full by Benenden Health. We will only provide support for treatment and surgery contained within our approved list of procedures.

Treatments take place within our network of private facilities across the UK, including our flagship Benenden Hospital. www.benenden.co.uk/hospitals

Psychological Wellbeing Support (see pages 26-27)

Support ranging from guided self-help to face-to-face therapy for conditions such as stress, depression, anxiety and bereavement.

We will assess your needs and can provide telephone support or up to 6 sessions of face-to-face therapy.

Assistance is provided over the telephone or face-to-face through our network of over 700 therapists.

Physiotherapy (see pages 24-25)

Speak to a chartered physiotherapist who will assess your condition and may recommend a course of exercise based self help or face to face physiotherapy.

Telephone based guided self-help or up to 6 sessions of face-to-face physiotherapy per authorised case, based on our assessment of your needs.

Assistance is provided over the telephone or face-to-face through our network of over 700 physiotherapy clinics.

Financial Assistance TB or Cancer (see pages 28-29)

Financial support to purchase a range of items that can assist people who have been diagnosed with cancer or tuberculosis.

Up to £1,500 per case, available for up to 1 year after the date of authorisation.

We will reimburse authorised spend up to £1,500 based on receiving receipts for goods and services from you (or a completed claim form for travel expenses).

Summary of servicesBenenden Healthcare has been designed to provide a low cost alternative to private medical insurance which complements the services provided by the NHS. This means from day 1, members have the reassurance of convenient access to medical experts 24/7 for concerns about their physical or mental health. Then, after just 6 months, members are able to request the full range of services.

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Yes

Meeting the steps on this page does not constitute a guarantee that we can provide assistance. To help us manage our resources, members should consider using the NHS if it is practical for them to do so.

PhysiotherapyGP 24/7 Financial Assistance

Services available from day 1 of membership Services available after 6 months of membership

No

No

No

0800 414 8247 (select option 1)

0800 414 81000800 414 8100

Is your NHS wait over 3 weeks for Medical Diagnostics or 5

weeks for Medical Treatment and Surgery?

0800 414 8100Please wait

for your NHS appointment

0800 414 8247 (select option 2)

0800 414 8247

(select option 2)

If you have been a member for over 6 months, calling the helpline may allow you additional

Psychological Wellbeing Support

Do you have a

consultant’s report and a CCSD Code?

You must obtain these before you can request

services

You must contact your NHS Practice

before you can request

services

Have you been

referred by your NHS

GP Practice?

Independent Care Advice

Medical Diagnostics

24/7 Psychological Wellbeing Helpline

Medical Treatment

and Surgery


Yes

Yes

How to request servicesFurther details of each service including how to request support is included in the following pages.


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New for 2018

Our GPs can also prescribe some medications over the telephone. Please note these are private prescriptions and separate charges apply.

GP 24/7

Overview

We know that many people have to wait to see an NHS GP. Therefore, one of the greatest benefits of Benenden Health membership is the reassurance of knowing that you and your family have access to expert medical advice 24 hours a day, seven days a week, whether you are at home or abroad. In fact, our GP 24/7 service aims to provide the support and advice of a GP practice through the convenience of a phone call or online eConsultation.

Importantly, you can use GP 24/7 whenever you need to at no additional charge. Our appointments are never rushed, allowing you as much time with the GP as you need.

What’s included

You can call GP 24/7 to ask for help and advice for yourself or on behalf of your immediate family (whether they are members or not).

If you have an email address and access to an internet-enabled device, you can request an online eConsultation between 8.30am and 6.30pm on weekdays, excluding Bank Holidays.


How to request this service

Call 0800 414 8247 (select option 1) from the UK, or from abroad1 on +44 800 414 8247 (select option 1). When you call provide your membership number and we will arrange an appointment based on your preference for the telephone service or online eConsultation.

1 Please note: some mobile networks limit access to UK-based free-phone numbers when calling from abroad. Please contact your mobile network provider if you experience issues, or use a landline for your call.


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24/7 Psychological Wellbeing Helpline

Overview

Psychological issues can have as serious an impact on your life as physical health problems, and often require immediate intervention. That’s why we make it as easy as possible for members to reach our Psychological Wellbeing Helpline 24 hours a day, seven days a week. Whether you are suffering from anxiety, depression, bereavement or relationship problems we can make sure you don’t have to handle it alone by providing access to an experienced therapist.

Naturally, not all problems can be solved in a single phone call. So in addition to offering immediate guidance and reassurance our therapists have the experience to guide you to the most appropriate services for your needs.

What’s included

You can call the 24/7 Psychological Wellbeing Helpline 24 hours a day, 7 days a week, from the day your membership begins. When you call the helpline you will be placed in immediate contact with a therapist who can provide telephone support.


Call 0800 414 8247 (select option 2) from the UK, or from abroad1 on +44 800 414 8247 (select option 2). When you call give the therapist your membership number, and they will be able to provide immediate assistance.

1 Please note: some mobile networks limit access to UK-based free-phone numbers when calling from abroad. Please contact your mobile network provider if you experience issues, or use a landline for your call.

What’s excluded

The GP 24/7 service cannot provide a referral that members can use to access any Benenden Healthcare service including Medical Diagnosis or Medical Treatment and Surgery.

Please note

that after 6 months of membership this service expands to incorporate the assistance available under our full Psychological Wellbeing Support, see page 26.


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What’s excluded

Our service does not support paying any fees for care. We can advise you on how to seek further support or information about help with paying for care. If you require further financial assistance Grace Consulting can refer you to independent financial advisers.


1 To request Independent Care Advice you must:

2 Call us on 0800 414 8100 for prior authorisation.

Following authorisation we will arrange for you to have a telephone call with Grace Consulting where a care adviser will discuss the support you require and if necessary schedule further assistance.

Independent Care Advice

Overview

We could all find ourselves with the responsibility for arranging care for ourselves or a family member at some time in our lives. This is never an easy situation, so we have ensured that members can receive independent advice and support from our partner Grace Consulting, who are specialist advisers in this area.

Grace Consulting care advisers can help you to make the right choices by talking you through the financial, legal and practical aspects of arranging both long and short-term care, and may even accompany you on visits to potential care providers.

What’s included

We can provide a telephone consultation or face-to-face consultation with a specialist care adviser who will listen to your needs and discuss your situation in detail. Care advisers have extensive knowledge of care providers in your local area and will send you a report on the most suitable service for you. This might be a shortlist of home carers or suitable care homes, including costs and inspection reports. Your dedicated care adviser will remain available for further follow up, advice and reporting until you have found the solution you require.

As a member you can request this service if care is required by you, your spouse or partner or your parents whether they are members or not. Advice is also available to you if you are a carer requiring assistance with respite as well. We will pay Grace Consulting directly for all services authorised by us.

Although Benenden Health does not fund the actual care that you or a family member may need, this service is designed to help you to understand the potential costs of care, how the system works, and how to apply for any funding you may be entitled to.


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Medical Diagnostics

Overview

After 6 months of membership, you become eligible to request a private diagnosis. To request this service you need to have been referred for diagnosis by your NHS GP practice and must have confirmation that the NHS waiting time for your appointment is more than 3 weeks. When you have this information contact our Member Services team.

Our service can provide support to help you achieve a diagnosis for any symptoms for which you have been referred by your NHS GP practice. Once authorised, we will support your diagnostic costs up to the value of £1,800 when you proceed via one of the facilities or specialists that we propose. Please note, we will not provide funding if you proceed without our authorisation.

What’s included

Our service includes consultations with an appropriate consultant, scans requested by the consultant including ECG, EEG, Ultrasound, MRI, CT, PET and X-ray and associated tests. However, if you require a blood test, we do ask that you consider getting a blood test via your NHS GP practice as these tests can be expensive.

We can assist with diagnostic costs up to a maximum of £1,800 per set of symptoms authorised by us. All authorised medical costs up to £1,800 will be directly settled by Benenden. You will be asked to pay for any additional costs which you incur.

Services available after 6 months of membershipOnce you have been a Benenden Health member for 6 months, you become eligible for the full range of Benenden Healthcare services.

Operating Theatre at Benenden Hospital in

Kent

In 2017 our members spent an average of £624 when authorised for diagnostic support and 80% of members spent under £1,000.


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Hospital Locations

We have a national network of over 500 facilities providing our members with access to diagnostic consultations and tests. This network includes our own Benenden Hospital located in Kent. In 2017, Benenden Hospital received the highest rating of ‘Outstanding’ from the Care Quality Commission (CQC) which is the independent regulator of health and social care in England.

Members living within our calculation of a 2 hour drive time of Benenden Hospital will be required to attend Benenden Hospital for their diagnostic services*. Travel advice can be provided to members who are required to travel to Benenden Hospital.

All other members can choose to use Benenden Hospital should they wish to do so. Please ask us if you would like to attend Benenden Hospital for your diagnostic appointment.

*Subject to availability of the required diagnostic specialty.

What’s excluded

You will be responsible for funding any costs incurred over £1,800. To assist you in managing costs you should request that the consultant and the facility where you have your appointment provide you with a guide price which includes all associated fees such as hospital fees or equipment fees.

Please note that we cannot authorise diagnostic assistance for:

• any appointments which are not for diagnostic purposes

• cosmetic concerns

• specialist assistance for pain management

• complementary therapy

The above list is not exhaustive and you should always contact our Member Services team before arranging any appointments to find out whether Benenden Health can help you.

You should arrange your appointments within six months of our authorisation as we cannot settle any expense that is incurred more than six months after authorisation.

We cannot provide this service for symptoms where we have authorised diagnostic support in the previous two years.


To request Medical Diagnosis you must:

1 Have been a Benenden Health member for a minimum of 6 months.

2 Have been referred for diagnostics by the NHS GP practice of which you are a registered patient.

3 Have been advised of an NHS wait time for your diagnostic consultation or test of over 3 weeks.

4 We also ask that our members consider using the NHS if it is practical for them to wait regardless of the timeframe. Furthermore, it may be practical for members to remain on an NHS waiting list if the diagnosis they require is likely to lead to surgery which we do not provide.

5 Call us on 0800 414 8100 for prior authorisation, at which point we may ask for evidence of the above which your GP practice should be able to provide on your request.

6 If you require further tests or appointments following your initial consultation you must contact us for further authorisation.

YesNo

You must contact your NHS Practice before you can

request the services

Please wait for your NHS appointment

Is your NHS wait over 3 weeks?

0800 414 8100

No Yes

Medical Diagnostics

Have you been referred by your NHS GP Practice?


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Overview

After 6 months, all Benenden Health members become eligible to request assistance for Medical Treatment and Surgery for our approved procedures, should the NHS waiting times be more than 5 weeks for the procedure you need.

To request this service, you need a report from a consultant stating the CCSD* code for the procedure required and confirmation that the NHS waiting time for your appointment is more than 5 weeks.

Once you have this information contact us and one of our Member Services team will be happy to help.

When a private surgical procedure is authorised by Benenden, the procedure will be performed at one of our network of hospitals which includes Benenden Hospital in Kent.

*CCSD stands for Clinical Coding and Schedule Development Group. It is a standard coding system for all private medical procedures and is commonly used in the UK medical sector. Your consultant should provide this code as standard. If you cannot provide this code, please contact us on 0800 414 8100 for further assistance.

What’s included

Importantly, we can support the full cost of any treatment or surgery that we authorise and that takes place in one of our network of hospitals. This may include fees for surgeons, anaesthetists, operating theatres, accommodation, nursing, medical admission and specialist consultants as well as pre-operative tests and post-operative physiotherapy, dressings or other consumables that are necessary.

Your membership covers more than 250 common surgical procedures, and you can see a full list of approved procedures on our website: www.benenden.co.uk/our-procedures

Broadly speaking, we cover procedures in the following specialist areas:

• General surgery (inc. types of hernias and gall bladder removal)

• Ear, Nose and Throat (ENT)

• Opthalmology (cataracts only)

• Gynaecology (inc. hysterectomy)

• Vascular (varicose veins only)

• Paediatrics

• Orthopaedics (primarily day case)

• Urology (inc. TURP)


Reception at Benenden Hospital in

Kent

Treatment of Tuberculosis

Benenden Health was founded in 1905 to provide care for postal workers suffering from tuberculosis (TB). We continue to care for members with TB today. If you are diagnosed with TB we will provide up to 2 weeks inpatient treatment at a hospital local to you. Call us on 0800 414 8100 to access this service.

Members with TB may also benefit from our Financial Assistance service, please see page 28.


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To request Medical Surgery and Treatment you must:


2 Have a report from a consultant stating the surgery required. (This should include a CCSD code which is the procedure code commonly used in private healthcare).

3 Have been advised of an NHS wait time for surgery of over 5 weeks.

4 We also ask that our members consider using the NHS if it is practical for them to wait for their appointment regardless of the timeframe for this appointment.

5 Call us on 0800 414 8100 for prior authorisation, at which point we may ask for evidence of the above.

Hospital Locations

We have a national network of 26 hospital facilities at which we can authorise your surgical and other treatment procedures. This may mean that members do not attend the same facility for surgery as they attend for diagnosis if this was also arranged by us.

Our treatment and surgery network includes our own Benenden Hospital located in Kent. In 2017, Benenden Hospital received the highest rating of ‘Outstanding’ from the Care Quality Commission (CQC) which is the independent regulator of health and social care in England.

Members living within our calculation of a 2 hour drive time of Benenden Hospital will undergo their treatment at Benenden Hospital*. Travel advice can be provided to members who are required to travel to Benenden Hospital.

All other members can choose to use Benenden Hospital should they wish to do so. Please ask us if you would like to attend Benenden Hospital for your surgical procedure.

*Subject to the availability of the required speciality.

What’s excluded

We can only provide surgery from our approved procedures list. Excluded procedures include surgeries related to cancer, heart or brain conditions or anything not on our approved procedures list. A full list of approved procedures is available on our website: www.benenden.co.uk/our-procedures.

We cannot provide this service for symptoms where we have authorised medical treatment or surgery in the previous two years.

The noted exclusions are not exhaustive and you should always contact our Member Services team before arranging any appointments to find out whether Benenden Health can help you.

Check if the procedure for which you have been referred is on our approved procedures list here www.benenden.co.uk/our-procedures.

YesNo

You must obtain this before you can request this service

Please wait for your NHS appointment

Is your NHS wait over 5 weeks?

0800 414 8100

No Yes


Do you have an consultants report and a CCSD code?


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Physiotherapy

Overview

Musculoskeletal problems are all too common affecting millions of us in the UK*. That is why we have tried to make it as easy as possible to request help if you’re experiencing a problem. If you think you would benefit from physiotherapy you can call our Member Services team who may arrange for a chartered physiotherapist to call you to assess your problem.

In some cases the chartered physiotherapist who calls you will provide advice regarding self-management of the problem; but where they believe it clinically appropriate they will arrange a physiotherapist appointment for you. In this case, your membership will cover the cost of physiotherapy sessions as recommended by our physiotherapist, up to a maximum of 6 sessions per authorised condition.

What’s included

Our service arranges telephone access to a chartered physiotherapist who will assess your condition over the telephone and determine if you are likely to benefit from physiotherapy. If they recommend further physiotherapy this will be either via self-managed exercise supported by on-going telephone support, or through face-to-face physiotherapy with a physiotherapist near you.

If face-to-face physiotherapy is recommended for you we will provide this via our national network of more than 700 physiotherapy clinics. (Our network includes Benenden Hospital in Kent which provides physiotherapy to members living within a 30 minute drive time.)

We will pay directly for all services authorised by us.

Based upon guidance from our physiotherapy team, we may authorise up to 6 sessions of physiotherapy per case. The actual number of sessions you receive will be based on clinical guidance from our physiotherapist.

*http://www.arthritisresearchuk.org/~/media/Files/Policy%20files/Reports/State-of-musculoskeletal-health-2017.ashx


To request Physiotherapy you must:


2 Call us on 0800 414 8100 for prior authorisation at which point we may arrange a telephone call where a chartered physiotherapist will discuss your condition and determine what services we can offer. No GP referral is required to access Physiotherapy.

What’s excluded

We cannot provide this service for symptoms where we have authorised physiotherapy in the previous two years.


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Overview

As well as the 24/7 Psychological Wellbeing Helpline, which you can access from day 1 of being a member, after 6 months membership you can access the full Psychological Wellbeing Support service.

What’s included

Our Psychological Wellbeing Support service provides short-term support to help you manage and overcome a mental health issue, or to help support you while you await NHS support. If you are recommended face-to-face therapy, we will provide this for you via our national network of over 700 therapists.

We can provide a course of telephone counselling or face-to-face therapy, for a maximum of 6 sessions.


To request Psychological Wellbeing Support you must:


2 Call our 24/7 helpline on 0800 414 8247 (select option 2). When you speak to our therapist they will ask you for information from your GP to help them decide on the most appropriate form of care for you. If you have this information to hand at the time of your call, it will help to speed up access to further support.

What’s excluded

It is important to note that our Psychological Wellbeing Support service is designed to provide short-term support. As a result, there may be cases where we are unable to support you due to the complexity of your circumstances. In these instances we will provide as much telephone guidance as we deem appropriate for you.

Please also note that we cannot offer support for mental health conditions which our therapist determines are long-term.

Providing psychological wellbeing support to children under the age of 16 is a specialised area which our Psychological Wellbeing Support service cannot provide. In these cases our therapist can provide advice on finding support. If the therapist deems it appropriate Benenden Health will reimburse up to £300 of therapy costs.

All members have 24/7 access to our Psychological Wellbeing Helpline on 0800 414 8247 from day 1 of their membership. You’ll find more information about this helpline on page 13.


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Financial Assistance

Overview

We understand how medical issues can have a serious impact on financial health too. That is why members who are suffering as a result of cancer or tuberculosis (TB) are able to contact us to request financial assistance to purchase a range of items which may help people living with these conditions. We can help up to a maximum value of £1,500 over a 12 month period following our authorisation.

What’s included

We can offer up to £1,500 to support members with active cancer or tuberculosis (TB). Our Financial Assistance service is intended to help purchase specific items that will assist you with issues related to your condition. Please contact us to discuss your requirements. Costs we will fund include:

Travel to medical appointments related to your condition

Specialised medical clothing (e.g. mastectomy bra, colostomy clothing)

Head coverings (including wigs)

Manual Lymphatic Draining (MLD)

Recuperative break within the UK of up to four nights

Dental and optical costs – on receipt of a medical report confirming specific need

Prosthesis

Medical referral fees

Home help and home nursing provided via an agency


To request Financial Assistance you must:


2 Call us on 0800 414 8100 for prior authorisation.

You will be asked to send us original receipts for any item purchased or we will send you a claim form which you must complete for any travel expenses.

We will reimburse you for items that assist you with specific issues related to your condition. For further advice on items we will pay for, you should contact our Member Services team.

We may review cases during the 12 month authorisation period by requesting that you provide us a medical report.

What’s excluded

We will only pay for items purchased within 12 months of your initial authorisation. We will pay up to the maximum limit of £1,500 for all costs.

We cannot provide support when your condition is in remission or when you are receiving maintenance treatment (including endocrine therapy and biological therapy) or your care has moved into a monitoring phase.

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My Benenden

Go to my.benenden.co.uk to register for My Benenden and you’ll be able to manage your account, view all of our exclusive member rewards and discounts, register to become an active member of our democracy and find out more information about the services available through your Benenden Health membership. Registering for My Benenden is free and quick to do; all you need to have ready are your membership number and personal details.

Be Healthy magazine

Our quarterly magazine, Be Healthy, is one of the most widely circulated health and wellbeing magazines in the UK. If you are the paying member, you will be sent a copy, free of charge, to help you keep up to date with the latest thinking and health trends. You’ll also enjoy free access to our online Be Healthy, where you’ll find news, health tips, recipes and much more to help look after the health of you and your family.

You automatically receive Be Healthy by post when you join as a paying member, but you can choose to receive it by email or opt-out completely. Just call Member Services or log on to My Benenden to change your preference.

Rewards and discounts

Benenden Health membership isn’t only great value in the event of illness or injury. We also like to help our members with a host of member rewards.

Information on discounts and rewards can be accessed online at my.benenden.co.uk. Make sure you keep checking back regularly to discover even more ways to make the most of these valuable rewards.

Additional benefits

Add family and friends to your Benenden Health membership

Good health and peace of mind are two of the most valuable things on earth. So while you can do a lot for your wellbeing by having your own Benenden Health membership, you can make life even better by adding others and paying an additional monthly contribution for each person you add.

Just log on to My Benenden or call 0800 414 8470 to add loved ones to your membership.

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General conditions of serviceWe aim to treat all members fairly and provide assistance to members where our membership funds allow. This guide has set out the basis on which we aim to provide assistance to members. The following section details general terms in relation to the provision of our services. Please read this section carefully.

You can only request services if you are current member.

You must keep your contributions and personal details up to date. If your contributions are not up to date, you are not entitled to request services. If your payment method is cancelled, withdrawn or becomes ineffective and no action is taken to re-instate contributions, we will cease to fund services on your behalf (whether these have been previously authorised or not) as from the date to which your contributions have been paid.

If you expect us to fund healthcare services on your behalf you must receive our authorisation. This authorisation is required before arranging any Diagnosis, Medical Treatment and Surgery, Physiotherapy, Psychological Wellbeing Support, Independent Care Advice or purchasing any item under Financial Assistance. We are unable to fund services where they have not been authorised by us.

You can contact GP 24/7 or our Psychological Wellbeing Helpline without prior authorisation from us. Our Psychological Wellbeing Helpline provider may contact us for authorisation on your behalf. This will be confirmed to you.

If you are not resident in the UK, you are entitled to request GP 24/7, Independent Care Advice and Psychological Wellbeing helpline only. If you return to live in the UK, you must register with a UK-based GP and explore NHS support before requesting any other services.

We will only authorise assistance for one set of symptoms at any one time. We may ask you to decide which health concern you wish Benenden Health to support.

Whilst Benenden Health may identify a member as vulnerable this information would not be included in the sharing of sensitive personal data to Benenden Hospital or any other provider of our healthcare services. Benenden Hospital and third party healthcare providers will follow their own processes to accommodate any additional needs based on clinical assessment and/or clinical advice obtained from the member’s own GP.

We do not tolerate the misuse or abuse of our services.

• If you verbally or physically abuse or threaten one of our employees, representatives or providers, you may be refused further services.

• If you fail to attend a medical appointment authorised or arranged by us, you may not be entitled to ask for further services for the same healthcare issue.

• If you are discharged from hospital or another medical establishment for breach of regulations or against medical advice, you may not be entitled to further services for that healthcare issue and you may have your Benenden Health membership cancelled.

• If you misapply the funds of Benenden Health or wilfully supply false information when requesting a service, you may be required to repay sums due to Benenden Health. You may also have your Benenden Health membership cancelled.

• As every service we provide is funded entirely by our members’ contributions, there are some costs and services that we cannot help with in any circumstances. We have listed some of these below. When there are additional exclusions relating to a specific service, we will let you know about these in our letter of authorisation.

Patient room at Benenden

Hospital in Kent

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We are unable to reimburse you for:

• Services obtained before we have given our written authorisation (with the exception of GP 24/7, Psychological Wellbeing Helpline, and Psychological Wellbeing Support).

• Services carried out after any timeframe we have specified to you.

• Services that cost more than the financial limit we agreed with you (you can choose to pay additional sums yourself).

• Any services not documented in this guide.

• Any services that are not undertaken at a facility authorised by us.

• Monitoring of an ongoing diagnosed condition.

• Procedures not recognised by the National Institute for Health and Clinical Excellence.

• Any services provided outside the UK.

• Any services if you are not a UK resident other than GP 24/7, Independent Care Advice and our Psychological Wellbeing Helpline.

• Personal expenses when in hospital.

• Additional consultations, surgery or other support for the same medical symptoms within two years of us first authorising support.

Benenden Health customer service standards

As a mutual organisation we are focused on giving you the very best care and service every time you contact us.

We aim to:

Respond to routine correspondence within three working days, either by letter or email.

Give our names in correspondence and on the phone.

Be welcoming, courteous, respectful and responsive.

Treat you and other members fairly.

Advise you clearly about the services that we can or cannot assist you with.

Keep you informed and communicate with you clearly. Provide good quality information in relation to your membership.

If you have a complaint

We do our best to offer a caring and effective service. If there is a problem with your membership or any of the services we provide or signpost you to, we want to hear about it. We welcome your comments and complaints as they help us to improve our services.

We will deal with your concerns as quickly and effectively as possible and, if we have made a mistake, we will do what we can to put things right.

If you have cause to make a complaint, please contact us. You can call us on 0800 414 8100 or send us a message via our website at www. benenden.co.uk/contact-us

If you remain unhappy after we have investigated your complaint through our internal complaints procedure (available on our website) you may be able to refer your complaint to the Financial Ombudsman Service.

You can contact them at Financial Ombudsman Service, Exchange Tower, London, E14 9SR or call 0300 123 9 123. Calls are free from mobiles and landlines.

www.financial-ombudsman.org.uk

To help us achieve these standards, we ask you to:

• Be courteous and respectful to our staff.

• Have your membership number ready when you contact us.

• Help us by providing any information we request.

• Give us feedback on our performance through our website www.benenden.co.uk/contact-us or consider providing feedback should we request you to do so via our ongoing research activity.

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Privacy noticeThis notice sets out your rights as a Member or customer of Benenden Health.

Benenden Health (`The Benenden Healthcare Society Limited’, also known as `Benenden’, `we’, and `us’) adhere to the requirements of the UK Data Protection Act 2018 and the General Data Protection Regulation (GDPR). This shortened Privacy Notice has been provided to briefly inform you about how we use your information and the rights you have over your personal information. A more detailed Privacy Notice is available on www.benenden.co.uk/privacy-policy or by contacting us on 0800 414 8100.

We process and retain your information so we can deliver the services included in your membership with us, to answer any queries you may have and to fulfil our legal and regulatory obligations as a Friendly Society and an organisation regulated by the Financial Conduct Authority and Prudential Regulation Authority. We also have a legitimate interest to use your information to send you updates about Benenden’s similar products and services (more information is provided in the full Privacy Notice).

We do not share your information with third parties who will market you with non Benenden-products. We do, however, share your information (where necessary) with third parties who provide goods and services to Benenden. This helps us to provide services to you.

You have rights over your information including: the right to have a copy of it, the right to have it kept up to date, the right to have it deleted if we do not have a legal need to keep it, the right to have a copy of it which can be easily passed to another provider, and in certain circumstances the right to restrict or object to our processing of it. Where our processing is based on you providing us with `consent’ you can withdraw that consent at any time. You also have a right to raise a complaint with the Information Commissioner’s Office (ICO).

If you need to contact us about this Privacy Notice or to invoke your rights please contact our Data Protection Officer at [email protected].

We take the security of your personal information very seriously so please be aware that we will not enter into discussions regarding your membership or personal health records with any third party or any person other than you unless you have authorised this in advance. For Members or nominees under the age of 16 we will only discuss medical matters with their parents or guardians.

Our full Privacy Notice is available at www.benenden.co.uk/privacy-policy and changes are occasionally made to the notice, so please visit our website from time to time to read it through or call us for a copy.

We’re a democracy

Benenden Health is a not-for-profit mutual society, which means that we are run exclusively for the benefit of the membership: and that all members get the opportunity to have a say in key decisions about how we are run.

We are always keen to hear the views of members like you. After all, the more members get involved, the more ideas we have, the better the debate and the more informed the final decision.

To help make this happen, we have branches throughout the country where meetings are held to encourage the involvement and input of our members. Each branch is run by a group of volunteer members who give their time to support Benenden Health. These volunteers form a committee which consists of a Chairman, Treasurer and Secretary plus other Committee Members. Each branch organises at least two meetings each year that members can attend.

When you become a Benenden Health member you are automatically allocated to one of our branches, and if you would like to get involved, you can find out how at: www.benenden.co.uk/about-benenden/get-involved or you can email the Society Secretary at [email protected]

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Glossary

Approved Procedures The list of procedures which we will fund through our Medical Treatment and Surgery service. We update this list regularly based on clinical advice and changes in clinical practice.

Benenden Healthcare The name for the services made available to Members and Nominees and described within this guide.

Branches Our branches are groupings of members that form our democratic structure. Each branch holds meetings during the year and through attending meetings, members are able to have a say in how Benenden Health is run.

Care Adviser(s) A specialist employed by Grace Consulting to provide advice to people when considering care.

CCSD Code CCSD is a standard coding system for all private medical procedures and is commonly used in the UK private medical sector. CCSD stands for Clinical Coding and Schedule Development.

Chartered physiotherapist

Our Chartered Physiotherapists must be registered with the Health and Care Professionals Council (HCPC).

Consultant We work with Bupa and Benenden Hospital in Kent to provide both our Medical Diagnostics service and our Medical Treatment and Surgery service. When you are authorised to use these services you may be sent to see a consultant, the consultant will be a specialist in the area of medicine which you require. Both Benenden Hospital and Bupa have criteria which they use to ensure consultants provide a high quality of service. This criteria includes recognised NHS and General Medical Council (GMC) regulatory requirements.

These requirements may include:· The consultant holding or having previously held a substantive NHS consultant post or a

Ministry of Defence post. This may also include those with honorary appointments who areon the Specialist Register for the specialty for which they are practicing.

· The consultant holding a current GMC licence and being listed on the specialist register withno previous hearings or investigations.

Contributions The monthly amount of money paid by each Member, and also paid by each Member on behalf of their Nominees.

CT A computerised tomography (CT) scan uses X-rays and a computer to create detailed images of the inside of the body. CT scans are sometimes referred to as CAT scans. CT scans can produce detailed images of many structures inside the body, including the internal organs, blood vessels and bones.

ECG An electrocardiogram (ECG) is a simple test that can be used to check your heart's rhythm and electrical activity. An ECG may be requested by a heart specialist (cardiologist) or any doctor who thinks you might have a problem with your heart.

eConsultation A consultation which takes place online via a video conferencing facility.

EEG The electroencephalogram (EEG) is a measure of brain waves. It is a readily available test that provides evidence of how the brain functions over time.

Evidence If we do request evidence this may be in the form of a letter from your NHS GP practice which states the medical support you are requesting from us. Where we request evidence we will discuss and confirm with you exactly what we require.

Face-to-Face An appointment which takes place in the presence of the specific specialist.

Grace Consulting An organisation which provides independent advice to people who require advice when considering care.

Immediate Family Where we refer to immediate family we mean yourself, your partner or spouse, your dependent children (below the age of 19 or within full time education) or any person for whom you have a legal power of attorney.

Independent Financial Adviser(s)

Regulated advisers who can provide financial services products including products which can support paying for long term care such as a Care Fees Annuity.

Member An individual who pays a membership contributions to Benenden Healthcare Society to access the benefits of membership.

Member Services Our department which deals with Member enquiries and Member requests for services.

Membership funds The sum of all monies collected by Benenden Health from Membership

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, electric field gradients, and radio waves to generate pictures from angles all around the body and shows up soft tissues very clearly.

Musculoskeletal A term which refers to the muscles and skeleton of the body.

NHS Waiting Time The time you would have to wait to attend an appointment via the NHS. GP’s, Consultants, or others within your GP practise should be able to provide guidance on this.

Nominee An individual whose contributions are paid by a Member and who is nominated by that member to have access to the benefits of Benenden Healthcare. Within this guide the term member and nominee are interchangeable and nominees can access all of the services in the same way as described. The only exceptions within this guide are that nominees have no voting rights in our democratic meetings and can only attend as observers when accompanying a Member, furthermore, nominees are not sent a copy of Be Healthy magazine.

PET Positron emission tomography (PET) scans are used to produce detailed 3-dimensional images of the inside of the body. The images can clearly show the part of the body being investigated, including any abnormal areas, and can highlight how well certain functions of the body are working. They're particularly helpful in dealing with confirmed cases of cancer and can also help diagnose some conditions that affect the normal workings of the brain, such as dementia.

Pre-existing medical conditions

Any condition for which a person has already received medical advice or treatment prior to becoming a member or nominee of Benenden Health.

Referred Provided written guidance as to the further medical services required.

Rules The Rules of Benenden Healthcare Society which are available on request or online at www.benenden.co.uk/our-rules

Self-management Physiotherapy

Self-management in our Physiotherapy services will include our Chartered Physiotherapist providing you a range of exercises which can be easily conducted in your own time to support and improve your condition. You will be able to contact our Physiotherapist for ongoing support.

Self-management Psychological Wellbeing

Self-management in our Psychological Wellbeing service involves taking an active role in managing your own wellbeing. This may involve reading material that improves your knowledge of symptoms and difficulties. It may also involve using self-help resources which provide you with strategies to improve your daily functioning or techniques to improve how you cope with other difficulties.

Society Secretary An elected official who represents the views of the Members to other Benenden Health officials.

Telephone Consultation A consultation which takes place over the telephone.

Therapist Our Psychological Wellbeing Therapists must be either a member of the British Association for Counselling and Psychotherapy (BACP) and registered and listed on BACP’s accredited register or a Member of UK Council for Psychotherapy (UKCP) and be registered and listed on UKCP’s accredited register.

Ultrasound An ultrasound scan, sometimes called a sonogram, is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body. An ultrasound scan can be used to monitor an unborn baby, diagnose a condition, or guide a surgeon during certain procedures.

X-Ray An X-ray is a quick and painless procedure commonly used to produce images of the inside of the body. It's a very effective way of looking at the bones and can be used to help detect a range of conditions.

Please note that your call may be recorded for our mutual security and also for training and quality purposes.

Member Services telephone lines are open 8am-8pm Monday to Friday (except bank holidays). Membership Enrollment lines are open 8am-5pm Monday to Friday (except bank holidays).

Benenden Health is a trading name of The Benenden Healthcare Society Limited.

The Benenden Healthcare Society Limited is an incorporated Friendly Society, registered under the Friendly Societies Act 1992, registered number 480F. The Society’s contractual business (the provision of tuberculosis benefit) is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority, FRN 205351. Verify our registration at register.fca.org.uk. The remainder of the Society’s business is undertaken on a discretionary basis.

No personal recommendation has been given on the suitability of this product, if in doubt you should seek independent advice. Registered Office: The Benenden Healthcare Society Limited, Holgate Park Drive, York, YO26 4GG.

RET/LFT/GUIDE/MOREISH/10/18/V3

0800 414 8100 Member Services

0800 414 8470 Add friends and family

0800 414 8247 (select option 1) GP 24/7

0800 414 8247 (select option 2) Psychological Wellbeing Helpline

Useful telephone numbers

Documents

Your guide To Benenden Healthcare · This guide aims to make clear the services we provide and the principles we ... medical specialities including orthopaedics, ENT and general surgery