EY member guide Making the most of your private health scheme Effective from 1 January 2019 - Aviva
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Making the most of your private health scheme
Effective from 1 January 2019
AV122410_GEN5026_0918.indd 1 05/11/18 7:58 AM
Contents
About your cover 4
BacktoBetter 6
Mental health pathway 7
Making a claim 8
Health EY 10
MyAviva 12
Cover guide 13
- What’s covered 14
- Benefit for cancer treatment 16
- Benefit for treatment overseas 17
Wellbeing 18
Aviva Digital GP 19
- What’s not covered 20
Your questions answered 21
Use of personal information 22
Common terms 24
About Aviva
Aviva is the largest insurer in the UK and provides 33 million customers with
insurance, savings and investment products worldwide as well as expertise in
administering private medical insurance and trust schemes.
Your private health scheme with Aviva provides you with the peace of mind
that you’ll receive prompt access to diagnostic tests and eligible medical
treatment, should you need it. Along with your comprehensive healthcare
cover, we also provide you with additional benefits to help you look after your
health and wellbeing.
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AV122410_GEN5026_0918.indd 2 05/11/18 7:58 AM
Welcome to your Aviva scheme
This member booklet contains information about your
scheme. Within these pages you’ll find details about your
cover, including your cover guide and contact information,
should you need to make a claim.
Proudly
Please keep this information somewhere safe – you may need it in the future, working
especially if you make a claim. A copy of the policy wording containing full
alongside
details of the definitions, benefit terms, conditions and exclusions that apply
to your cover is available at aviva.co.uk/healthzone/ey.
Health EY
If you’ve any questions about your
scheme or want to make a claim, call
the customer service helpline:
0800 404 9454
8:00am - 8:00pm Monday to Friday
8:00am - 1:00pm Saturday
Calls to and from Aviva may be monitored
and/or recorded.
Did you know? You can ask a range of questions
as well as start a claim, update an existing claim or
arrange a callback with the customer service helpline
using MyAviva. See the 'MyAviva' section of this
booklet for further information
Aviva are proud winners of:
Health Insurance Awards Money Marketing Awards
• Health Insurance Company of the Year 2010, 2011, •• Company of the Year 2017
2012, 2013, 2014, 2015, 2016 and 2017 Cover Excellence Awards
• Best Group Private Medical Insurance Provider 2010, •• Best Group PMI Provider 2014 and 2015
2011, 2012, 2013, 2014, 2015, 2016 and 2017
• Best Customer Service 2012, 2013, 2016 and 2017
• Most Innovative New Product - GuideWell 2014
Defaqto 5 Star Rating
5 Star rating for quality of cover by independent financial researcher Defaqto.
Defaqto have given our Optimum product their highest rating, 5 Star, meaning that it is one of
the most comprehensive products in its class within the private health insurance market.
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About your cover
About your cover
Your scheme is designed to cover acute symptoms and
conditions. An acute condition is a disease, illness or injury
that’s likely to respond quickly to treatment which
aims to return you to the state of health you were in
immediately before suffering the disease, illness or injury, or
which leads to your full recovery.
Where to find your hospital list Networks
We offer a range of hospitals that are conveniently To help manage costs and drive consistent quality
located and provide access to top-class facilities. of care, we’re developing a number of networks
Our hospital lists are updated frequently as we of facilities, specialists and other practitioners for
work to ensure we get the best possible service for specific conditions. If we have a network for your
our customers. EY members are covered under condition or suspected condition, we'll tell you.
Aviva’s Extended hospital list. We recommend You can choose whether to have your treatment
you check your hospital list before you see your GP, through the network or, you can continue to use
so you know which hospitals you can be referred to. a recognised specialist and one of the hospitals on
Details of the hospitals available to you under the the Extended hospital list.
terms of your healthcare scheme are provided online
A list of the conditions or suspected conditions for
at aviva.co.uk/hospital-lists. Alternatively you can
which we have networks in place can be found at
call the customer service helpline to find out which
aviva.co.uk/health-network
hospitals are covered.
Your policy excess
Your scheme includes the BacktoBetter
service and mental health pathway An excess of £75 applies per member per policy
year. Benefits will only be paid once the excess
This means that if you need to claim for pain
amount has been exceeded and this should
in the back, neck, muscles or joints (commonly
be settled directly with the relevant provider,
referred to as musculoskeletal conditions) or need
for example a hospital or specialist.
some support with your mental health, you don’t
need to see your GP. Call the customer service The excess does not apply to treatment
helpline and, providing it’s an eligible claim, we’ll received through the mental health pathway
facilitate contact with the independent clinical or to physiotherapy for pain in the back, neck,
case management providers who will assess your muscles or joints (musculoskeletal conditions)
symptoms and arrange the most appropriate managed by the BacktoBetter service.
treatment. Please see the 'BacktoBetter' and
'Mental health pathway' sections of this booklet
for more information about these services.
The claims process is explained in more detail in
the ‘Making a claim’ section of this booklet.
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About your cover
Points to remember
Claims for children Benefits outside the UK
Children aged 12 and older can use the BacktoBetter The EY healthcare scheme provides benefit for
service and the mental health pathway without treatment in the United Kingdom with only limited
seeing their GP. Please see the 'BacktoBetter' and benefit for emergency treatment overseas (more detail
'Mental health pathway' sections of this booklet for is available in the ‘Benefit for treatment overseas’
further information. section).
Change of personal details If you need to travel outside of the United Kingdom,
Please advise EY immediately should any of your you should consider taking out a travel insurance policy.
personal details change e.g. address, name, etc.
If you have family cover and wish to add new
dependants, for example, a newborn baby, please Member offers
notify EYHelp HR on 0141 226 9555 (option 2) as Did you know that because your company
soon as possible. provides medical benefit through Aviva, you
could save on your first year’s home, car and
Income tax liability annual travel insurance when you buy direct
Under current UK tax rules, the contribution that’s from Aviva?
paid to us for your inclusion on the scheme arises
To find out more about car, home and travel
from your employment and is therefore a taxable
insurance visit aviva.co.uk/healthy-discount
benefit. Please contact your HR team if you require
further information.
If you leave your company
If you leave EY, your membership of the scheme
will cease immediately, even if treatment was
pre-authorised by Aviva. However, having been a
member of a company scheme, you’re entitled to
benefit from continued private healthcare on an
individual plan without further personal medical
exclusions being applied. Benefits, exclusions, terms
and conditions on an individual plan may be different
to those on this scheme.
If you’d like to discuss this further, please contact our
sales advice line on: 0800 142 142 (calls to and from
Aviva may be monitored and/or recorded).
To qualify for continued cover you need to apply
within 45 days from the date your cover ceases.
If more than 45 days elapse, you’ll be required to
complete a member health declaration which may
affect your underwriting.
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BacktoBetter
BacktoBetter
We know that back, neck, muscle and joint pain (otherwise known as musculoskeletal pain) can stop
you in your tracks and prevent you from enjoying life to the full. BacktoBetter is Aviva’s independent
clinical case management service for musculoskeletal conditions. It gives you access to a clinical case
manager who will help guide you down the right treatment pathway. There’s no need to see a GP,
just call the customer service helpline to access BacktoBetter. Members aged 11 and under will need to
get a GP referral before contacting the customer service helpline.
Telephone clinical assessment
This is an in depth assessment of your symptoms and medical history by a clinical case manager from
one of the carefully selected independent clinical providers, to determine the most appropriate treatment
pathway for you. The assessment will include questions about the nature and duration of your symptoms,
the impact they are having on your daily activities, and the presence of any serious symptoms which require
urgent treatment.
Providing advice and support
If you need face-to-face physiotherapy or to be seen by a specialist, you’ll be referred to an
appropriate facility or clinic close to your work or your home. Even if you don’t need a course of
treatment after your assessment, a clinical case manager will ensure that you have all the tools to
manage your recovery yourself, including a detailed exercise and advice programme. You’ll receive
follow up calls from a clinical case manager to ensure that your recovery remains on track and that
you have the support you need.
The benefits of BacktoBetter
• BacktoBetter offers quick access to a telephone clinical
assessment with one of our carefully selected clinical
providers, who can help you deal with the pain of a
musculoskeletal injury Remember:
• Getting you the right treatment at the right time, which There’s no
can lead to a faster recovery need to see
• There’s no need to see a GP, and that means less time to
wait before accessing treatment and/or advice
a GP first
• It’s an end-to-end service that delivers best clinical practice
no matter how complicated the problem
• Your excess won’t apply to physiotherapy provided through the BacktoBetter service.
The excess will apply at the point you need to see a specialist.
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Mental health pathway
Mental health pathway
As we're all unique, with individual needs, we believe that mental health treatment should be tailored
to your personal requirements. That's why we’ve introduced a clinical, results-driven approach to mental
health treatment.
Our innovative mental health pathway enables us to tailor the support you receive - ensuring that your
treatment is guided by clinical need. Members aged 11 and under will need to get a GP referral before
contacting the customer service helpline.
Telephone clinical assessment
If you want some support with your mental health, call the customer service helpline in the first instance – you
don’t need to see your GP. If your claim is eligible, our claims team will facilitate contact with our independent
case management provider for a clinical assessment.
The pathway provides a detailed clinical assessment with a mental health practitioner, before making
recommendations on the most appropriate treatment for you.
Your bespoke treatment plan
Following your clinical assessment, the dedicated case manager will arrange the most appropriate treatment. This
could be online Cognitive Behavioural Therapy, remote (telephone or video link) or face-to-face talking therapies,
or psychiatrist assessment. Where clinically appropriate, they can offer a relapse prevention programme, giving you
access to up to 12 months’ online self-help support.
The benefits of the mental health pathway
• Offers quick access to a telephone clinical assessment with our carefully selected
clinical provider
• Getting you the right treatment at the right time, which can lead to a faster Remember:
recovery There’s no
• There’s no need to see a GP, and that means less time to wait before accessing need to see
treatment and/or advice
a GP first
• It’s an end-to-end service based on clinical need; guided by clinical expertise
and insight
• Your excess won’t apply to any treatment provided through the mental health
pathway.
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AV122410_GEN5026_0918.indd 7 05/11/18 7:59 AM
Making a claim
Making a claim
BacktoBetter for musculoskeletal claims Mental health pathway
The following outlines how a claim for a musculoskeletal The following outlines how a claim for a mental health
condition works in three simple steps: condition works in three simple steps:
1 Step 1 – If you’re unwell with any 1 Step 1 – If you need some support for
back, neck, muscle or joint pain your mental health
The BacktoBetter service is your first port of call with no need If you’re worried about your mental wellbeing, our clinical case
to contact your GP. Just call the customer service helpline. management approach can help. There’s no need to contact your
GP, just call the customer service helpline.
If you’ve already seen your GP, you can move to step 2 of the
standard claim process overleaf, if: If you've seen your GP, you must still follow the mental health
pathway to access assessment and treatment covered by your policy.
• your
GP has recommended osteopathy or chiropractic
treatment, or
• your
condition does not relate to your back or neck (spine),
and
• your GP has recommended radiology, pathology, or
referral to a specialist.
Otherwise you must continue to follow the BacktoBetter
pathway.
2 Step 2 – Calling the customer service 2 Step 2 – Calling the customer service
helpline – 0800 404 9454 helpline – 0800 404 9454
Calls to and from Aviva may be monitored and/or recorded. Calls to and from Aviva may be monitored and/or recorded.
Please have the following information to hand when you call: Please have the following information to hand when you call:
• your policy number 951CGZ to help us to confirm your identity • y our policy number 951CGZ to help us to confirm your identity
• details of your symptoms and when they started. • details of your symptoms and when they started.
One of our advisers will assess your claim and if eligible, arrange One of our advisers will transfer you to the independent clinical
for a clinical case manager from one of the independent clinical provider, where a therapist will conduct a thorough assessment with
providers to contact you at a convenient time to assess your you. Or, if you prefer, we can arrange a suitable time to call you
symptoms. back.
In some instances we may require more information before
confirming cover but we’ll talk this through with you when
you call.
3 Step 3 – Telephone clinical 3 Step 3 – Telephone clinical
assessment assessment
Using evidence-based medical guidelines, a clinical case manager From a range of treatment options, the therapist will agree what’s
will conduct a thorough assessment of your problem and the most appropriate help for you, these options include:
recommend the most effective course of treatment. If clinically
• s elf-directed online services
appropriate, this will include being referred to an approved
physiotherapist from one of the clinical providers’ networks for • t elephone or video based therapy
treatment within two working days and/or onward referral to a • face-to-face treatment, or
specialist.
• further assessment by a psychiatrist, if clinically necessary.
The clinical case manager will provide advice to help you
manage symptoms and pain, how best to remain active with a All treatment is led by experienced mental health therapists working
tailored home exercise programme and will continue to monitor in conjunction with the independent clinical provider. At the end
your progress throughout your claim. of treatment you’ll be provided with a plan to help manage your
symptoms in the longer term.
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AV122410_GEN5026_0918.indd 8 05/11/18 7:59 AM
Making a claim
For all other claims
For any other symptoms, you’ll need to follow
the standard claims process:
1 Step 1 – Consult your GP Payment of bills
All eligible bills will be settled by us directly with the treatment
If you feel unwell, go and see your GP in the usual way. provider. If you do receive a bill for your treatment, please send
If your GP recommends you need to see a specialist for further us a copy together with your policy number, so that we can
assessment or treatment, they’ll give you a referral. This may either be: arrange payment.
• a named referral - where the GP recommends a particular Please send this to:
. specialist and/or hospital Bill Payment Team
• a n open referral - where the GP just states which type of Aviva Health UK Limited
specialist you need to see or the type of treatment you need, Chilworth House
without stating a specialist’s name or hospital. Hampshire Corporate Park
All claims have to be authorised in advance by Aviva. Templars Way
Eastleigh
Hampshire
SO53 3RY
2 Step 2 – Calling the customer service We’ll contact you to advise if you need to pay any part of the
bills for example, your £75 excess.
helpline – 0800 404 9454
Calls to and from Aviva may be monitored and/or recorded.
Please have the following information to hand when you call:
If you don’t contact the customer service helpline and you
• your policy number 951CGZ to confirm your identity
continue with any recommended diagnostics or treatment,
• medical specialism and sub-specialism of the specialist you need to see you may have to pay the costs for these services yourself if
• details of your condition, including symptoms, dates and they’re not covered by your healthcare policy.
diagnosis if known.
To make the process as quick and easy as possible, most claims
If we have a network for your condition or suspected condition, you will be telephone assessed by our experienced claims advisers.
can choose to use the network or:
This means we can take all the necessary medical information
• if you’ve been given a named referral, we’ll check to make sure the
from you over the telephone to assess your claim and no
specialist is recognised by us.
claim form will be required (some situations will require more
h • if it’s an open referral, we’ll use our specialist finder database to select information from your specialist or GP).
an appropriate specialist and/or hospital.
Where possible we'll let you know whether your claim is authorised,
there and then over the phone. The more information you're able to
give us at this point, the easier it'll be for us to make the decision. Private Healthcare Information
Network
You can find independent information about the quality and
cost of private treatment available from doctors and hospitals
3 Step 3 – Diagnosis, treatment or from the Private Healthcare Information Network: phin.org.uk
surgery
If your specialist recommends hospital treatment please ask for a
description of the treatment and a procedure code, if there is one.
Please call us so that we can confirm:
Once you’ve called us again with these details, we can confirm
• the details of your membership
whether or not your treatment is covered.
• the treatment you require is eligible under the terms of
your policy
• if we have a network in place for your condition or
suspected condition
• if there are any limits that apply to your benefit which you
should be aware of
• for symptoms requiring GP referral, that your recommended
specialist and hospital are recognised by us.
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AV122410_GEN5026_0918.indd 9 05/11/18 7:59 AM
Health EY
Health EY
Health EY is EY’s firm-wide approach to physical health, mental health and well-being. It is about EY supporting you to take
responsibility for your own physical and mental health. Health EY provides tools, knowledge, understanding and support on all areas of
physical and mental health
What does Health EY include?
Being Health EY Thinking Differently
Health EY is EY’s firm-wide approach to health, mental health and EY’s forward thinking approach to mental health and well-being.
wellbeing. It supports EY employees to take responsibility for their It is designed to embrace all aspects of it; preventing problems
own health by providing tools, knowledge, understanding and from arising, increasing awareness, understanding and acceptance
support on all areas of health and mental health. and more effectively supporting people with problems by
providing easier access to treatment.
Thrive Nurture
Because prevention is better than cure Health EY includes a The nature of being human is to have periods where physical
monthly health education programme. The programme includes and mental health is not at optimum levels. A big part of Health
monthly webinars run by health experts which are recorded and EY is ensuring EY has the right health services and pathways in
saved in our E-Thrive library where you can access information place to support employees in times of need and making it easy
on all areas of mental and physical health, nutrition and lifestyle to find and access these. This is achieved by working closely with
topics. healthcare providers such as Aviva.
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AV122410_GEN5026_0918.indd 10 05/11/18 7:59 AMHealth EY
How does Health EY fit into your Private Health Scheme?
EY has collaborated with Aviva to develop clear, joined-up, clinical care pathways for employees who need support or help. These
make it easier to access our health services and show how all are linked. Through your health scheme with Aviva you can get quick
access to musculoskeletal treatment via BacktoBetter, details are available on page 6.
Also as part of your policy you have access to Aviva's mental health care pathway which allows someone to be referred for a clinical
assessment without the delay of getting a GP referral, further details can be found on page 7.
For further information on the branches of Health EY please visit the Health EY SharePoint site or alternatively please call EYHelp HR.
11
AV122410_GEN5026_0918.indd 11 05/11/18 7:59 AMMyAviva
Welcome to MyAviva
MyAviva brings together the products and services that help our customers protect their health, loved ones,
future and possessions in one secure and simple-to-use online place.
There’s a whole host of benefits available at your fingertips:
view details of your policies online, including cover and benefit information and your hospital list
track any policy excess or out-patient limit spend - helping you stay in control
onitor a wealth of details about your claim such as all invoices paid, the name of the treatment provider (for
m
example, the specialist) and the total value of any claim
start a claim online or update an existing claim all online at a time that suits you
arrange a callback to speak to the customer service helpline
find frequently asked questions, helpful guidance and contact information when you need it most
enjoy discounts on a range of Aviva products and services with multi product discounts available.
Lets get started – log
in to MyAviva today at
aviva.co.uk/myaviva or download
the app to your tablet or
smartphone by searching for
'MyAviva' in your app store.
MyAviva is free to download.
Data charges may apply.
12
AV122410_GEN5026_0918.indd 12 05/11/18 7:59 AMCover guide
Cover guide
Private health scheme from Aviva
This cover guide has been designed to provide you with the key information about your scheme, and it’s
important that you read this section. The cover guide doesn’t, however, contain the full terms, conditions,
benefits and exclusions that apply to your scheme. These are contained in the policy wording, a copy of which
is available at aviva.co.uk/healthzone/ey.
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AV122410_GEN5026_0918.indd 13 05/11/18 8:00 AMCover guide What’s covered
What’s covered – summary
Benefit limits shown below apply per member per scheme year and all treatment
must be on referral by, and under the care of, a specialist unless otherwise stated.
As a member of the EY scheme you have your medical history disregarded which
means that any pre-existing conditions you have will be covered providing they fall
within the terms and conditions of the scheme.
See the ‘Making a claim’ section for full details of the claims process.
In-patient or day-patient treatment of acute conditions at a facility recognised by us as part of a
network, a hospital on your list or an NHS hospital recognised by us for your treatment or condition
• Hospital accommodation charges
• Prescribed medicines, drugs and dressings
• Operating theatre fees
• Nursing care including intensive/high dependency care
Specialists’ fees including surgeons’, anaesthetists’ and physicians’ fees
•
• Radiotherapy and chemotherapy
• Diagnostic tests including blood tests, X-rays, scans and ECG’s.
Out-patient treatment of acute conditions at a facility recognised by us as part of a network or at
a hospital recognised by us
• Consultations with a specialist
• Treatment by a specialist as an out-patient
• CT, MRI and PET scans at a diagnostic centre recognised by us
• Radiotherapy and chemotherapy
• Diagnostic tests for example X-rays, blood tests and ECG’s
• Physiotherapy, osteopathy, acupuncture and chiropractic treatment is limited to 10 sessions in
combined total if referred by your GP (for non-musculoskeletal conditions).
Mental health benefits at a hospital or clinic within the clinical provider's network consisting of:
• In-patient and day-patient psychiatric treatment up to 28 days
• Out-patient treatment by a psychiatric specialist or psychiatric therapist
There’s no need to see your GP to claim for a mental health condition. All you need to do is call us and we’ll
refer you through the mental health pathway.
BacktoBetter – In-patient, day-patient or out-patient treatment of acute musculoskeletal
conditions, at a hospital or clinic within the clinical providers’ networks
There’s no need to see your GP to claim for these conditions. All you need to do is call us and we’ll refer
•
you through the BacktoBetter service to access the most appropriate treatment for your condition.
14
AV122410_GEN5026_0918.indd 14 05/11/18 8:00 AMCover guide What’s covered
What are musculoskeletal For mental health symptoms,
conditions? you'll need to use the mental health
pathway. You'll receive a detailed
Musculoskeletal conditions are any
clinical assessment by a mental
conditions relating to back, neck,
health practitioner who will be
muscle or joint pain, also commonly
able to guide you down the most
referred to as orthopaedic conditions. appropriate treatment pathway.
Additional benefits Hospitals
• ursing at home immediately following eligible
N You can access any hospital on Aviva's Extended
in-patient or day-patient treatment list. You can see which hospitals are in your area by
Private ambulance where medically necessary for
• downloading the hospital list from: aviva.co.uk/
transportation to the nearest available hospital hospital-list or by accessing MyAviva.
for the purpose of eligible treatment You can also benefit from our networks if we
• P arent accommodation costs when staying with have any for your condition or suspected condition.
a child of 11 or under receiving eligible treatment; A list of the conditions or suspected conditions for
one parent only which we have networks in place can be found at
• inor surgery by a GP up to £100 per procedure;
M aviva.co.uk/health-network
payable to the GP. To see what procedures are
covered visit: aviva.co.uk/gp-minor-surgery NHS amenity beds
• ospice donation of £70 per day up to 10 days
H If you receive treatment as an NHS in-patient or
maximum day-patient whilst occupying an NHS amenity bed
(a bed paid for by you in a single room or side ward
• ash benefit of £100 per night where eligible
C
in an NHS hospital where you receive NHS in-patient
treatment as an NHS in-patient takes place
or day-patient treatment), and that treatment would
without charge. Maximum of 35 nights. NHS cash
have been covered by the scheme if you had chosen
benefit is not available for the first three nights
to receive it as a private patient, we’ll reimburse you
following an accident or emergency admission,
for the cost of the amenity bed.
psychiatric treatment, cancer treatment (please
see the ‘Benefit for cancer treatment’ section) or Excess
if you claim for the cost of an NHS amenity bed
A £75 excess applies per member per scheme year.
for the same treatment
Benefits will only be paid once the excess amount
• aby bonus of £100 per baby born or adopted
B has been exceeded and this should be settled
within a year of birth; payable once per baby directly with the relevant provider, for example a
• T reatment for complications of pregnancy hospital or specialist.
and childbirth as detailed in the policy The excess does not apply to treatment received
wording. See the ‘Common terms’ section for through the mental health pathway or to
further information physiotherapy for pain in the back, neck, muscles or
• Investigations into the causes of infertility joints (musculoskeletal conditions) managed by the
• S urgical procedures on the teeth performed in a BacktoBetter service.
hospital.
24 hour stress counselling helpline
This is a summary of the scheme benefits.
If you’re a little stressed and just want someone
Full details of standard cover and exclusions are
to talk to, whatever the reason, just call the stress
given in the policy wording, a copy of which is
counselling helpline on 0800 158 3349.
available at aviva.co.uk/healthzone/ey.
It doesn’t matter what’s on your mind – work
issues, relationships, social strains, bereavement,
money worries, anything at all. Experienced
counsellors are there for you 24 hours a day, 7 days
a week. The stress counselling helpline is available
for members aged 16 and over.
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AV122410_GEN5026_0918.indd 15 05/11/18 8:00 AMCover guide Benefit for cancer treatment
Benefit for cancer treatment
We understand the importance of providing extensive cover and
Extensive c support at every stage of your cancer treatment. Our cancer pledge
means we’ll cover the cancer treatment and palliative care you need,
ov
Our
er
canc as recommended by your specialist.
er p
ledg We also want to make things as comfortable as possible for you
e following your cancer treatment, so we’ll provide extensive cover
an
d for your aftercare, including consultations with a dietician, as well as
su p p ort
money towards prostheses and a wig.
What’s covered
• Hospital charges for surgery and medical admissions at a • Bone strengthening drugs (such as bisphosphonates) that
network facility or hospital recognised by Aviva are being used to treat metastatic bone disease
• Specialists’ fees • Treatment prescribed by your specialist for side effects
• NHS cancer cash benefit. This is payable where eligible
while you are receiving chemotherapy or radiotherapy
treatment as an NHS patient takes place for cancer without • Stem cell and bone marrow transplants. This includes
charge collection, storage and implantation
We’ll pay £100 for each day you receive treatment: • Monitoring for up to ten years after your treatment for cancer
- as an in-patient has finished. We don’t pay for monitoring after treatment for
non-melanoma skin cancer
- as a day-patient.
• Up to £100 towards a wig if you suffer hair loss caused by
We’ll pay £100 for each day you:
cancer treatment. We’ll pay £100 in total whilst you are a
- receive out-patient radiotherapy or chemotherapy
member of the scheme, not per scheme year
- undergo out-patient surgical procedures.
• Up to £5,000 towards the cost of the first external
We’ll also pay £100 for: prosthesis following an amputation for cancer
- each day you receive intravenous (IV) chemotherapy at
• Ongoing needs, such as regular replacement of tubes or
home
drains, for up to five years after your treatment for cancer
- each week whilst you are taking oral chemotherapy has finished
drugs at home.
• Preventative surgery, only if you’ve already had treatment
You won’t be able to claim more than £100 in any one day, for cancer that we’ve paid for. For example, we’ll pay for a
but there’s no limit on the amount of days you can claim. mastectomy to a healthy breast in the event that you have
NHS cancer cash benefit isn’t available for psychiatric been diagnosed with cancer in the other breast. (We won’t
treatment or if you claim for the cost of an NHS amenity pay for surgery where you have no symptoms of cancer, for
bed for the same treatment. example where you have a strong family history of cancer)
We may need to contact your GP or specialist for details of • End of life care:
your treatment before we can pay your claim. - we’ll pay for end of life care in a hospital if this is
We may also ask for the discharge summary from the hospital medically necessary
• Post surgery services - includes specialist services - hospice donation of £100 per night, up to £10,000 if
immediately following surgery such as consultations with a you’re admitted to a hospice
dietician or stoma nurse, and insertion and replacement of - donation of £50 per day to a registered charity if you’re
a tube for artificial feeding visited at home by one of their nurses, up to £10,000.
• Radiotherapy and chemotherapy, including targeted drug
therapies for cancer. Hormone therapy is only covered if you
need it to shrink a tumour before surgery or radiotherapy
16
AV122410_GEN5026_0918.indd 16 05/11/18 8:00 AMCover guide Benefit for treatment overseas
Guide to limited emergency
overseas cover
Your healthcare scheme includes an overseas benefit Assistance company services
which is available for the first 90 days spent overseas
We have an emergency assistance provider who
on a temporary basis in any one scheme year. The
deals with all aspects of overseas claims.
90 days are accrued on a cumulative basis. If you
are outside the UK for more than 90 days during Before you travel you should give your scheme
any scheme year there is no cover under the limited number and the emergency assistance provider’s
emergency overseas benefit. telephone number to a family member or a travelling
companion who can contact them on your behalf
should you become involved in an emergency and
Cover is restricted to the treatment be unable to contact them directly.
of emergency conditions serious
The telephone number is: +44 (0)2381 247290
enough to require immediate
admission to hospital as an Calls may be monitored and/or recorded.
in-patient or day-patient. The
medical emergency must arise In an emergency – members should
incidental to the intended purpose go immediately to the nearest
of the visit. physician or hospital without
delay, then contact the emergency
assistance provider.
In the event that the country of incident doesn’t
have adequate facilities to treat the condition, Aviva
The overseas emergency assistance provider is
will evacuate the patient only, to the nearest available
available 24 hours a day. When you call, please
facility, which may not be the UK. After release from
give them your name, scheme number and brief
hospital following evacuation, Aviva will meet the
description of the problem.
cost of the journey either to the country evacuated
from, or the UK, if this is of comparable cost. Please note this is not travel insurance and cover
is restricted to the treatment of emergency conditions
Cover doesn’t extend to costs incurred on behalf of
that are serious enough to need an immediate
any person who accompanies the patient.
admission to hospital as an in-patient or day-patient.
This is a summary of the overseas benefit available The medical emergency must arise incidental to the
under your corporate healthcare scheme. Full details intended purpose of the visit. If you feel this level of
are given in the scheme wording. cover is not appropriate for you or that you may need
more cover, you should consider taking out a travel
insurance policy.
You may also want to consider the European Health Insurance Card (EHIC)
scheme which allows you to benefit from the reciprocal health arrangements
when travelling to countries covered by the EHIC scheme. Application forms
can be obtained from the post office or online and should be completed and
validated before you travel. You should take steps to use these arrangements
where possible.
17
AV122410_GEN5026_0918.indd 17 05/11/18 8:00 AMAviva Wellbeing
Aviva Wellbeing
With Aviva Wellbeing, a healthier you is just around the corner. Our web and mobile app can help you reach your
wellbeing goals through small, easy steps. So whether you want to sleep more, lose weight, worry less, get fitter
or simply eat better Aviva Wellbeing can help.
What are the benefits? How do I get started?
Choose a challenge
• When Aviva Wellbeing is activated for your company
There are challenges to help you stick to your scheme, you'll receive an invitation email, inviting
goals and they're designed for all fitness levels. you to set up your account.
So whether you're a marathon runner or a
All you need to do is activate your account with
Sunday stroller there is always a challenge for you.
MyAviva. If you don't have an account, don't worry
Get hints and tips personalised for you
• we will send you details of how to set one up. Once
Aviva Wellbeing is packed with information from you're in MyAviva, look for the Aviva Wellbeing icon
experts in nutrition, fitness, sleep and stress to start your wellbeing journey. You'll need to use
management. your work email, which you can change later if you
want to.
Set plans
•
To create positive habits for specific areas you Once you've done that, download the MyAviva app
want to improve. to your phone and connect your wearable devices
and any other wellbeing apps you have to start
Earn rewards
•
tracking your progress through Aviva Wellbeing.
You’ll also earn reward points, giving you
access to all kinds of exciting offers, discounts
and freebies, including discounts on wearable
trackers and lots more.
Track your goals
•
It's compatible with most popular wearable
devices and wellbeing apps. So you can track
things like sleep, calories, distance and steps all
in one place, giving you tailored insights into
the small steps you can make to improve your
wellbeing.
18
AV122410_GEN5026_0918.indd 18 05/11/18 8:00 AMAviva Digital GP
Aviva Digital GP
Get free around the clock access to GP consultations, including video, chat features, pharmacy services and repeat
NHS prescriptions with free delivery, all at the touch of a button.
Powered by Now Healthcare Group, the largest digital and telehealth service provider in Europe, the Digital GP
app effectively gives customers a GP in their pocket.
You can look forward to the following benefits:
Unlimited access to GP consultations – prompt access
to a GP 24/7, 365 days a year with no limit to the number
of GP video consultations you can have
Choose your GP – you can choose your GP by gender
and language and rebook with a GP you've seen previously
epeat NHS prescriptions/medication with free
R
delivery – request prescriptions at the same price
you'd pay on NHS and get free delivery (90% of NHS
prescriptions are dispensed free of charge in the UK –
including those with pre-payment certificates)
edication reminder service – use reminders for your
M
NHS medication and automatically notify a family member
when you have taken your medicine(s)
Chat to a GP or pharmacy – ask an NHS registered GP or
a member of the pharmacy team a question
Paediatric GP consultations – add your children under
16 to your account for GP video consultations.
Aviva Digital GP is powered by Now Healthcare Group. Sign up is subject to the terms & conditions of the Aviva
Digital GP service which can be found at drnow.co.uk/avivatandc.htm
Downloading Aviva Digital GP is simple and it’s free*
Keep your eye out for your invitation email and activate your account through MyAviva. The email will make it
clear how to register. Once you're in MyAviva you’ll be prompted to download the Aviva Digital GP app from the
Apple App Store or Google Play and login using your MyAviva credentials.
Please note, we’ll ask you to upload your photo and provide some personal details for security and screening
purposes before you can start using the app.
* Data charges may apply
19
AV122410_GEN5026_0918.indd 19 05/11/18 8:01 AMCover guide What’s not covered
What’s not covered – summary
There are some things which aren’t covered by your scheme so it’s important
you speak to the customer service helpline before receiving any treatment.
Some examples of what isn’t covered by the scheme include:
• Long term or chronic conditions. This • Treatment for pregnancy or childbirth
exclusion does not apply to treatment other than the complications specified Chronic conditions explained
for cancer in the policy wording. See the ‘Common A chronic condition is a disease, illness
terms’ section for further information or injury which has one or more of the
• Treatment undertaken by a specialist
following characteristics:
without GP referral (except through • Overseas treatment other than as
BacktoBetter or the mental health provided for in the limited emergency • it needs ongoing or long-term
monitoring through consultations,
pathway) overseas benefit
examinations, check-ups and/or tests
• Any musculoskeletal or mental health • Surgical or medical appliances such as
• it needs ongoing or long-term control
treatment that has not been neurostimulators (e.g cochlear implants)
or relief of symptoms
pre-authorised by us and crutches
• it requires your rehabilitation or for you
• Seeing a GP privately • Alcoholism, alcohol abuse, solvent to be specially trained to cope with it
• Prescription charges abuse, drug abuse and other addictive
• it continues indefinitely
conditions
• Charges by a GP, medical practitioner • it has no known cure
or specialist for completion of a claim • Treatment for psycho-geriatric conditions
• it comes back or is likely to come back.
form unless the claim is confirmed by us • Treatment required as a result of war,
• Take home drugs and dressings terrorism, contamination by radioactivity,
biological or chemical agents Psychiatric cover explained
• HIV/AIDS and related conditions
• Varicose veins of the leg, unless For psychiatric treatment, we cover
• Treatment received in a health hydro or
they meet the criteria detailed in the treatment that aims to lead to your full
similar establishment
policy wording. See the ‘Common recovery. We don’t cover:
• Cosmetic treatment (except following
terms’ section for further information • treatment that is given solely to
an accident or surgery for cancer)
• Sleep disorders and sleep problems, alleviate symptoms, or
• Routine medical examinations including
such as snoring and sleep apnoea • chronic psychiatric conditions.
eye tests and health screens etc. (If we’ve
• Treatment for warts, verrucas and We consider a psychiatric condition to
paid for you to have treatment for cancer,
skin tags be chronic if:
this exclusion won’t apply with regard
• Treatment by a practitioner, specialist • it meets the definition of a chronic
to cancer)
or other healthcare professional who is condition, or
• Sports injuries where you are paid or
not recognised by us •w
e’ve paid for treatment for that
individually sponsored condition or a related psychiatric
• Treatment at a hospital, facility or any
• Convalescence condition during three separate
other treatment centre that is not
• Experimental treatment (limited benefit scheme years. This applies to acute
recognised by us flare-ups of a chronic condition, it will
may be available - please contact us)
• Weight loss surgery also apply if the treatment was not in
• Incidental hospital expenses such as consecutive scheme years.
• Treatment for lipoedema.
newspapers and telephone calls
We don’t cover treatment, including
This is a summary of the scheme
• Kidney dialysis diagnostic tests to treat or assess
exclusions. Full details of standard cover
• Routine dental treatment learning difficulties or developmental
and exclusions are given in the policy
or behavioural problems such as
• Treatment for infertility wording, a copy of which is available at Attention Deficit Hyperactivity Disorder
aviva.co.uk/healthzone/ey. (ADHD) and Autistic Spectrum disorders.
20
AV122410_GEN5026_0918.indd 20 05/11/18 8:01 AMYour questions answered
Your questions answered
Can I use a hospital or facility not on the We’ve every reason to believe that you’ll be totally
hospital list? satisfied with your Aviva scheme, and with our service.
It’s very rare that matters cannot be resolved amicably.
If you have treatment as an out-patient at a hospital not
However, if you’re still unhappy with the outcome after
on your list but recognised by us for the treatment you
we’ve investigated it for you and you feel that there’s
need, we’ll pay in full. However, if you receive treatment
additional information that should be considered, you
as a day-patient or in-patient in a hospital that isn’t
should let us have that information as soon as possible
included on your hospital list but recognised by us for
so that we can review it. If you disagree with our
the treatment you need, we’ll calculate the average cost
response or if we’ve not replied within eight weeks,
of equivalent treatment across all hospitals on your list,
you may be able to take your case to the Financial
and that average cost is the maximum we’ll pay.
Ombudsman Service to investigate. Their contact
This could leave you with a shortfall that the scheme details are:
doesn’t pay for. If the actual cost of the treatment is
The Financial Ombudsman Service
less than the average cost, we’ll pay the hospital costs
Exchange Tower
in full. We’ll pay for specialists’ fees in full.
London
Remember, if you use our networks for your treatment, E14 9SR
whether as an in-patient, day-patient or an out-patient Telephone: 0300 123 9123 or 0800 023 4567
we'll pay in full. Email: complaint.info@financial-ombudsman.org.uk
The Financial Services Compensation Website: financial-ombudsman.org.uk
Scheme (FSCS) The Financial Ombudsman Service will only consider
We’re covered by the FSCS. You may be entitled to your complaint if you’ve given us the opportunity to
compensation from the FSCS if we become insolvent resolve the matter first. Making a complaint to the
and cannot meet our obligations. This depends on the Ombudsman won’t affect your legal rights.
type of business and the circumstances of the claim. Clinical complaints
Where you’re entitled to claim, insurance advising and Clinical complaints are not regulated by the Financial
arranging is covered for 90% of the claim, with no Conduct Authority (FCA) and are not subject to our
upper limit. Further information about compensation complaint process set out above.
scheme arrangements is available from:
For clinical complaints relating to the conduct or
Financial Services Compensation Scheme competency of your specialist or the facilities at which
10th Floor, Beaufort House they practise, these need to be directed to the specialist
15 St Botolph Street and hospital or clinic directly.
London
EC3A 7QU For your information, the responsibility for investigating
Website: fscs.org.uk and responding to clinical complaints is as follows:
Telephone: 020 7741 4100 or 0800 678 1100 • If your complaint is about a hospital/clinic
or specialist, whether through a network or
Can I leave the scheme? otherwise, it will be investigated in accordance
You’ll only be entitled to leave the scheme during with the complaints process in force at the relevant
the annual flexible benefits window or following an hospital/clinic, please contact the hospital directly.
appropriate lifestyle event. For more information please • If your complaint relates to a third party clinical
contact EYHelp HR on 0141 226 9555 or your HR contact. case manager, this will be investigated by the
If you have any cause for complaint clinical provider who employs that case manager.
Our aim is to provide a first class standard of • If your complaint is about a network therapist (e.g.
service to our customers, and to do everything we can physiotherapist, counsellor, psychologist) this will
to ensure you’re satisfied. However, if you ever feel be investigated by the independent clinical provider
responsible for the therapist network.
we’ve fallen short of this standard and you’ve cause to
make a complaint, please let us know. Once you have contacted the provider who is
Our contact details are: responsible for investigating and responding to your
Aviva Health UK Ltd clinical complaint, they should advise you of the
Complaints Department full complaints process which will also include any
escalation details should you require these.
PO Box 540
Eastleigh While Aviva do not have a role in investigating and
SO50 0ET responding to clinical complaints, Aviva do record clinical
Telephone: 0800 051 7501 complaint volumes and investigation outcomes. If you
Email: hcqs@aviva.com would like to inform us of a clinical complaint outcome
please contact us using the details provided before.
21
AV122410_GEN5026_0918.indd 21 05/11/18 8:01 AMUse of personal information
Use of personal information
Personal Information If you are providing information about another
We collect and use personal information about person we expect you to ensure that they know
you so that we can provide cover for your company you are doing so. You might find it helpful to
private health scheme. This notice explains the show them this privacy notice and if they have
most important aspects of how we use your any concerns please contact us in one of the
information but you can get more information about ways described below.
the terms we use and view our full privacy policy The personal information we collect and use will
at aviva.co.uk/privacypolicy or request a copy include name, address, date of birth, current state
by writing to us at Aviva, Freepost, Mailing Exclusion of health and any existing conditions of each person
Team, Unit 5, Wanlip Road Ind Est, Syston, Leicester, included in the application (if medical underwriting
LE7 1PD applies to your scheme). If a claim is made we will
also collect personal information about the claim
The data controller(s) responsible for this personal
from you and any relevant third parties. We recognise
information is Aviva Insurance Limited as the insurer
that information about health is particularly sensitive
of your company’s scheme. Additional controllers are
information. Where appropriate, we will ask for
Aviva Health UK Limited who administers the scheme
consent to collect and use this information.
and your company’s intermediary (if applicable),
who are responsible for the sale and distribution of If we need your consent to use personal information,
the scheme and any applicable reinsurers. we will make this clear to you when you complete an
application or submit a claim. If you give us consent to
Personal information we collect and how using personal information, you are free to withdraw
we use it this at any time by contacting us. Please note that if
We will use your personal information: consent to use information is withdrawn we may not
be able to continue to process your claims and we
• to provide you with the benefit of your company’s
may need to cancel your benefit under the scheme.
insurance cover: we need this to decide if we can
offer insurance and if so, on what terms and also Of course, you don’t have to provide us with any
to administer the scheme, handle any claims and personal information, but if you don’t provide the
manage any renewal; information we need we may not be able to proceed
with your application or any claim you make.
• to support legitimate interests that we have as a
business: we need this to manage arrangements Some of the information we collect may be provided
we have with reinsurers, for the detection to us by a third party. This may include information
and prevention of fraud and to help us better already held about you within the Aviva group,
understand our customers and improve our including details from previous quotes and claims,
customer engagement (this includes marketing, information we obtain from publicly available records,
customer analytics and profiling), our trusted third parties and from industry databases,
including fraud prevention agencies and databases.
• to meet any applicable legal or regulatory
obligations: we need this to meet compliance How we share your personal information
requirements with our regulators (e.g. Financial with others
Conduct Authority), to comply with law We may share your personal information:
enforcement and to manage legal claims; and
• with the Aviva group, our agents and third
• to carry out other activities that are in the public parties who provide services to us, your company’s
interest: for example we may need to use personal intermediary (if applicable) and other insurers
information to carry out anti-money laundering (either directly or via those acting for the insurer
checks. such as loss adjusters or investigators) to help us
As well as collecting personal information about administer our products and services;
you, we may also use personal information about • with clinicians, including hospitals, and third party
other people, for example your eligible dependants case managers from whom you and others covered
who you wish to benefit from your company’s under the scheme receive insured treatment or
scheme. who manage your care or treatment pathway;
22
AV122410_GEN5026_0918.indd 22 05/11/18 8:01 AMUse of personal information
• With regulatory bodies and law enforcement bodies, Contacting us
including the police, e.g. if we are required to do If you have any questions about how we use personal
so to comply with a relevant legal or regulatory information, or if you want to exercise your rights, please
obligation; contact our Data Protection Team by either emailing
• With other organisations including insurers, public them at dataprt@aviva.com or writing to the Data
bodies and the police (either directly or using shared Protection Officer, Level 4, Pitheavlis, Perth PH2 9NH.
databases) for fraud prevention and detection If you have a complaint or concern about how we use
purposes; your personal information, please contact us in the
Some of the organisations we share information with first instance and we will attempt to resolve the issue
may be located outside of the European Economic as soon as possible. You also have the right to lodge a
Area (“EEA”). We’ll always take steps to ensure complaint with the Information Commissioners Office
that any transfer of information outside of Europe at any time.
is carefully managed to protect your privacy rights.
For more information on this please see our Privacy
Policy or contact us.
How long we keep your personal
information for
We maintain a retention policy to ensure we only keep
personal information for as long as we reasonably need
it for the purposes explained in this notice. We need to
keep information for the period necessary to administer
your insurance and deal with claims and queries on
the scheme. We may also need to keep information
after our relationship with you has ended, for example
to ensure we have an accurate record in the event of
any complaints or challenges, carry out relevant fraud
checks, or where we are required to do so for legal,
regulatory or tax purposes.
Your rights
You have various rights in relation to your personal
information, including the right to request access your
personal information, correct any mistakes on our
records, erase or restrict records where they are no
longer required, object to use of personal information
based on legitimate business interests, and data
portability. For more details in relation to your rights,
including how to exercise them, please see our full
privacy policy or contact us.
23
AV122410_GEN5026_0918.indd 23 05/11/18 8:01 AMYou can also read
