Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover

 
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
Universities & Colleges
Personal Healthcare Scheme

                        Working with
                     to offer employees
                        of niversities
                      Colleges access to
                private healthcare cover
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
Private medical insurance for
you and your family
The University & Colleges Personal Healthcare Scheme offers university and
college employees access to private medical insurance to help ensure you and
your family have access to the eligible treatment you need – when you need it.
The scheme is managed by JLT Benefit Solutions Limited, part of the Jardine Lloyd
Thompson Group, and is underwritten by us, at AXA PPP healthcare. We are one of
the UK’s most experienced private medical insurance providers and have been
providing access to private healthcare cover for over 70 years.
We currently have over two million members that put their trust in us when
it comes to their healthcare cover.

Call our Personal Advisers on
0800 0321 950
quoting reference 96369
Lines are open 8am-8pm weekdays and 9am-1pm
Saturdays. Calls may be recorded and/or monitored
for training, quality assurance and evidential
purposes.
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
What are the benefits of private
medical insurance?
Nothing is quite as important as looking after our
health, and knowing that we can get the care we need,                     Joining is simple
when we need it.                                                          Available exclusively to university and college
Private medical insurance provides you with prompt                        employees, this scheme offers you healthcare cover
access to eligible medical treatment when you need it.                    that is simple to join:
It gives you choices too. You can usually decide where                     No medical examination is required.
                                                                           Open to all employees, their partners and
you want to be treated, from a national network of over
250 quality-assessed hospitals, including day-patient
                                                                            dependants (up to 25 years old if in full time
units and scanning centres. More importantly, you can
                                                                            education).
choose a time that is convenient for you. All you need
to do is decide what level of cover you want and                           Automatic acceptance onto the scheme if you join
choose from the products in our range to suit your                          within six weeks of joining your current employer.
                                                                           A range of underwriting methods are available (see
needs and your budget.

With private medical insurance from AXA PPP healthcare                      page 6 for more information).
you can rest assured that you’ll receive:

 Prompt access to eligible diagnostic tests to find out
  what the problem is.
 The eligible treatment you need – when you need it.
 Comfortable facilities, usually in private rooms with
  en-suite and TV.
 Access to Health at Hand, our 24 hour confidential
  health information line.
 Cover for cancer treatment.
 Dedicated Nurse telephone helpline for members
  who have been diagnosed with cancer
 Parent accommodation if your child is under 14 and
  covered under the policy
 Cash benefit if you stay overnight in a NHS hospital
  receiving free eligible treatment.                                         The Universities & Colleges
                                                                             Personal Healthcare Scheme is
The scheme is open to all employees, their partners and
                                                                             explained in detail in this
dependents (up to 25 years if in full time education).
                                                                             brochure. If you have any
                                                                             questions, please feel free to
                                                                             contact our team of expert
                                                                             advisers on:

                                                                             0800 0321 950
                                                                             Lines are open 8am-8pm weekdays and
                                                                             9am-1pm Saturdays. Calls may be recorded
                                                                             and/or monitored for training, quality
                                                                             assurance and evidential purposes.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                      2
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
Our range of plans

    We provide a
    range of plans to
    suit your needs:
       Assure
       Key
       Ideal
       Premier                                                              Help when you’re abroad
                                                                             Immediate emergency in-patient
    In-patient and day-patient treatment                                     treatment abroad
    explained                                                                The plan you choose with the Universities &
    In-patient treatment is treatment for a patient who is                   Colleges Personal Healthcare Scheme will
    admitted to hospital and who occupies a bed overnight                    provide you with limited medical cover when
    or longer, for medical reasons. We normally settle all                   you’re travelling abroad. You’ll have up to
    eligible bills for this type of care directly with the                   £40,000 of cover for emergency in-patient
    hospital or specialist, so you will not be out of pocket.                hospital treatment in an overseas hospital.

    As an in-patient, you are covered for all your essentials                Please note, this cover is only available
    during your hospital stay: accommodation, meals,                         when it immediately precedes or follows
    nursing care, drugs and dressings. You will usually have                 an emergency evacuation or repatriation
    your own private room, with an en-suite bathroom,                        we have arranged for you and providing
    television and telephone. We will also pay your                          you haven’t travelled abroad against
    specialists’ fees in full, up to the level published in our              medical advice, or gone abroad specifically
    schedule of procedures and fees.                                         for treatment.

    Day-patient treatment is treatment for a patient who is                  Under normal circumstances there is no cover on
    admitted to a hospital or day-patient unit because they                  the policy for medical treatment received outside
    need a period of medically supervised recovery but                       the United Kingdom and therefore this cover
    does not occupy a bed overnight.                                         should not be relied on in place of adequate
                                                                             travel insurance which we strongly recommend
    Out-patient treatment explained                                          you take out whenever you travel abroad.
    All our plans include cover for out-patient surgical                     Visit www.jlttravelinsurance.co.uk for details
    procedures, radiotherapy, chemotherapy, magnetic                         of such an arrangement.
    resonance imaging (MRI), computerised tomography
    (CT) and positron emission tomography (PET) scans.                       Evacuation or repatriation service
    All of our plans excluding Assure also cover specialist                  If you can’t get suitable or adequate emergency
    referred out-patient consultations, diagnostic tests and                 in-patient treatment, we’ll arrange for you to be
    treatment by a clinical practitioner, including                          transported to the nearest suitable medical
    physiotherapy.                                                           facility – or even bring you home for treatment,
    Complementary therapies – acupuncture, homeopathy,                       if necessary. If a member is under 18, or
    osteopathy and chiropractic treatments by recognised                     where it is appropriate for the condition
    complementary practitioners – are also covered on all                    involved, we will arrange and pay for
    of our plans excluding Assure when you are referred by                   someone to accompany them.
    your GP or specialist (subject to the annual limits on
    each plan).

                                                                         Call   0800 0321 950 quoting reference 96369
3                                               We may record and/or monitor calls for training, quality assurance and evidential purposes.
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
A summary of the cover available

 Benefits                                                              Assure                 Key             Ideal            Premier
 In-patient and day-patient treatment
 Hospital charges for treatment in a hospital listed in the
                                                                           ✔                  ✔                 ✔                   ✔
 Directory of Hospitals.
 Hospital charges for treatment in a hospital not listed in
                                                                           ✘                  ✘                  ✘                  ✘
 the Directory of Hospitals.

 Consultant/specialist fees.                                               ✔                  ✔                 ✔                   ✔
 Diagnostic tests.                                                         ✔                  ✔                 ✔                   ✔
 Radiotherapy/chemotherapy.                                                ✔                  ✔                 ✔                   ✔
 Psychiatric treatment.                                                    ✘                  ✘                 ✔                   ✔
 Out-patient treatment
 Surgical procedures.                                                      ✔                  ✔                 ✔                   ✔
 Radiotherapy/chemotherapy.                                                ✔                  ✔                 ✔                   ✔

 Computerised tomography (CT), magnetic resonance
                                                                           ✔                  ✔                 ✔                   ✔
 imaging (MRI) and positron emission tomography (PET).

                                                                                       The 4 benefits     The 4 benefits
                                                                                                                              The 4 benefits
                                                                                       detailed below     detailed below
                                                                                                                              detailed below
                                                                                      have a combined    have a combined
                                                                                                                                 have no
                                                                                        limit of £400      limit of £900
                                                                                                                               annual limit
                                                                                           per year           per year

 Consultations with a consultant/specialist.                               ✘                  ✔                 ✔                   ✔
 Diagnostic tests.                                                         ✘                  ✔                 ✔                   ✔
                                                                                      Within the above Within the above Within the above
                                                                                         limit up to a      limit up to a      limit up to a
                                                                                           combined           combined           combined
 Physiotherapy and complementary practitioners’ charges.                   ✘            maximum of         maximum of         maximum of
                                                                                       10 GP referred     10 GP referred     10 GP referred
                                                                                      sessions per year. sessions per year. sessions per year.

 Psychiatric treatment.                                                    ✘                  ✘                 ✔                   ✔
 Additional benefits
 NHS cash benefit of £50 per night up to £2,000 a year.                    ✔                  ✔                 ✔                   ✔
 Day-patient and out-patient NHS radiotherapy and
 chemotherapy cash benefit of £50 a day up to                              ✔                  ✔                 ✔                   ✔
 £2,000 a year.
 Parent accommodation for one parent to stay with
                                                                           ✔                  ✔                 ✔                   ✔
 a child under 14 covered by the policy.

 Private ambulance.                                                        ✔                  ✔                 ✔                   ✔
 Hospital-at-home – the cost of a nurse to administer
 intravenous chemotherapy for the treatment of cancer                      ✔                  ✔                 ✔                   ✔
 or intravenous antibiotics at home.

When you join, all claims will be assessed against the terms and conditions of your chosen plan, and any exclusions
placed on your policy when joining. Private medical insurance is designed to cover the costs of medical treatment of –
what are known as – acute conditions (a disease, illness or injury that is likely to respond to treatment in the near
future). Please see page 11 for more information.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                                      4
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
What are the main exclusions and
    limitations?
    As with industry standards, general exclusions apply.
    The following is a summary of the main exclusions and              Other important
    limitations of the policy.
     Treatment of medical conditions that existed, or you             information
      had symptoms of, before joining (unless joining on
      medical history disregarded underwriting terms).                 How long will my cover last?
     Ongoing, recurrent or long-term treatment of                     Your policy will be arranged for 12 months from the
      long-term illnesses (usually referred to as chronic              effective date on your membership statement.
      conditions).
                                                                       What do I do if I want to make a claim?
     General dental procedures.                                       If you need to make a claim simply call our team of
     Routine pregnancy and childbirth.                                Personal Advisers on 0800 454 080.

     If you choose either the Assure or Key plans;                    Full details of how to make a claim are included in
      psychiatric treatment.                                           the membership handbook which you will receive

     Treatment of injuries sustained from engaging in or
                                                                       when you join.

      training for any sport for which you receive a salary            What do I do if I want to make a
      or monetary reimbursement, including grants or
                                                                       complaint?
      sponsorship (unless you receive travel costs only).
     In-patient or day-patient treatment or MRI, CT or
                                                                       We aim to provide you with the highest possible
                                                                       standards of service but accept there may be occasions
      PET scans, oral surgical procedures or cataract                  when you feel that things have gone wrong for you and
      surgical procedures not received in a hospital or                you are unhappy with us. If you have a complaint about
      scanning centre listed in the Directory of Hospitals.            any matter please contact us and we will do our best to
     We will pay eligible fees in full when a specialist,             address your concerns. Your feedback is vital to helping
      complementary practitioner or clinical practitioner              us improve. Further details on how to complain can be
      charges up to the level within our published                     found in the ‘Complaint and regulatory information’
      schedule of procedures and fees.                                 section of your membership handbook which you will

     Emergency and urgent treatment
                                                                       receive when you join. If you are dissatisfied with the
                                                                       outcome of our investigation, you can ask the Financial
    Please remember, this is only a summary and full                   Ombudsman Service to consider your complaint.
    details of cover including terms and conditions will be
    contained in your membership handbook when you                     If you have a claim against
    join, or can be obtained from us.                                  AXA PPP healthcare
                                                                       In the unlikely event that AXA PPP healthcare becomes
                                                                       insolvent and is unable to pay the benefits under your
                                                                       policy, you are protected by the Financial Services
                                                                       Compensation Scheme (the FSCS). Further information
                                                                       about the operation of the scheme is available on the
                                                                       FSCS website: www.fscs.org.uk.

                                                                       What if I change my mind?
                                                                       You have a 14 day cancellation period. During this
                                                                       period you have the right to cancel your policy and have
                                                                       your premium returned in line with the terms for
                                                                       cancellation at renewal, as detailed in the ‘Complaint
                                                                       and regulatory information’ section of your membership
                                                                       handbook which you will receive when you join. The
                                                                       cancellation period begins on the day your contract is
                                                                       agreed or the day you received your full policy terms and
                                                                       conditions if this is later and will also apply from each
                                                                       renewal date.

                                                                       Call   0800 0321 950 quoting reference 96369
5                                             We may record and/or monitor calls for training, quality assurance and evidential purposes.
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
What am I covered for?

You can join us on any of the policies available to you on the Universities & Colleges Personal Healthcare Scheme on a
moratorium or a fully underwritten basis. If you choose either the Premier or Key plan, you may join on a medical
history disregarded (MHD) basis. Details of these different underwriting terms are provided below.

Moratorium underwriting                                                   the last five years, and in some cases certain related
A moratorium is a set period of time during which you                     conditions, will be excluded from cover for the first two
will not be covered for treatment for any medical                         years. However, as long as you are completely free of
conditions that you had suffered from before you took                     any form of treatment or advice for that condition for a
out the policy. There’s no need to have a medical                         consecutive two year period once you join, we will look
examination or provide information about your medical                     at covering it for you in the future. You will be provided
history when you join. Medical conditions you’ve had in                   with more information about this when you join.

Example

                                   Joined
                              AXA PPP healthcare
                                in March 2009                                                       Now covered from
            Back                                             No cover for                         March 2011 for this
         operation in                                       back condition                       pre-existing condition
          April 2008                                    for a two year period                   as two continuous years
                                                                                                  have passed trouble
                                                                                                  free of the condition
            2009                                                2010                                     2011

If you have been diagnosed with diabetes, are currently undergoing treatment for raised blood pressure or are
currently under investigation, having treatment or undergoing monitoring as a result of a prostate specific antigen
(PSA) test, we will exclude the following:

 If you:                                                               You will not be covered for treatment of:

                                                                       • diabetes • ischaemic heart disease • cataract
 Have been diagnosed with diabetes                                     • diabetic retinopathy • diabetic renal disease
                                                                       • arterial disease • stroke

 Are currently undergoing treatment for raised                         • hypertension • ischaemic heart disease • stroke
 blood pressure (hypertension)                                         • hypertensive renal failure

 Are under investigation, having treatment or undergoing
 monitoring as a result of a prostate specific antigen                 • any disorder of the prostate
 (PSA) test.

Please note If you are over 74 years of age, Moratorium underwriting is not available to you and you will be required
to declare your full medical history. For further information, please refer to the range of underwriting options explained
in the ABI guide enclosed in your pack.

Fully underwritten                                                        Medical history disregarded
We ask for you to declare your medical history on your                    If you choose either the Premier or Key plans, you may
application form. This means that we will tell you which                  be able to join on a medical history disregarded basis,
conditions will be excluded from your cover.                              provided your application is received within six weeks of
                                                                          joining your current employer, and providing you can
                                                                          confirm that neither yourself or anyone else covered on
                                                                          the policy, has any on-going claims or treatment
                                                                          planned or pending within three months of the start
                                                                          date of the policy.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                            6
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
How can I reduce my premiums?

    The 6 Week Option
    If you are comfortable using the NHS but
    worry about potentially long waiting times,
    then the 6 week option could be for you. If
    treatment is available on the NHS within six
    weeks from the date it should take place, then
    you will use the NHS. However, if the wait for
    treatment is more than six weeks from when it
    should take place, then you can go private straight
    away.

    Excess options
    Assure, Key, Ideal and Premier come with a £100
    excess as standard. This means you will pay the first
    £100 of eligible claims – once per policy year – for
    each person covered. To reduce your premium even
    further, you can add an excess of £200 or £500.

                                                                   Call   0800 0321 950 quoting reference 96369
7                                         We may record and/or monitor calls for training, quality assurance and evidential purposes.
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
Care and convenience – hand in hand

Health at Hand information helpline                                       with one-to-one support whenever you need information
                                                                          about your condition, treatment options available to you
Health at Hand is a 24-hour telephone health
                                                                          or if you simply need emotional support. Your family can
information service for our members. It provides
                                                                          also benefit from the helpline if they have concerns or
you with immediate access to a qualified team of
                                                                          need guidance about your care.
healthcare professionals when you need it most.
The team includes trained nurses, pharmacists,
counsellors and midwives. They can give you                               Our team of Personal Advisers
information on specific illnesses, treatments and                         The AXA PPP healthcare ‘personal touch’ begins from
medications and provide details of local and national                     the moment you join. Our Personal Advisers are on
organisations that can help you. They can also arrange                    hand to help you:-
to send you free fact sheets and leaflets on a wide                        To discuss the benefits and limitations of your policy.
                                                                           To change your personal details.
range of medical issues, conditions and treatments,

                                                                           To give you guidance when arranging treatment.
and will happily phone you back to discuss any further
questions you may have.
                                                                           To help you fill out a claim form.

                       You can also email Health at Hand                   To confirm a claims payment.
                       via our website
                       www.axappphealthcare.co.uk

Dedicated Nurse telephone helpline
for cancer patients
Dealing with cancer treatment can be difficult and so
our aim is to provide you with as much support as
possible. If you are diagnosed with cancer, we will offer
you immediate access to our Dedicated Nurse
telephone helpline. A trained nurse will provide you

                                                                          be healthy
                                                                          If you’re looking for one central place for health
                                                                          information to help keep your body in tip top condition
                                                                          – you need look no further than be healthy. This
                                                                          valuable online resource offers a wealth of useful
                                                                          health tips, articles and tools including fitness
                                                                          programs that you can build to your personal
                                                                          requirements; with videos to help you fully
                                                                          understand the exercises and routines. We have a
                                                                          delicious recipe index for you to browse and
                                                                          there’s a section to help keep your mind healthy
                                                                          too with games and memory tips.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                           8
Universities & Colleges Personal Healthcare Scheme - Working with to offer employees of niversities Colleges access to private healthcare cover
Why choose AXA PPP healthcare?

     More benefits of being an AXA PPP healthcare member
     From health and fitness to books and magazines, you can make great savings with our member offers.*
     These include:-

         10% discount off health and wellbeing assessments

         Substantial eyecare discounts for you and your family

         10% off Denby products

         10% off fair-trade and organic hampers

         18% discount on bikes and accessories

         Amazing value breaks around England

         and many more...

         You’ll also receive our free be magazine
         The magazine is packed with health features, case studies from
         AXA PPP healthcare members, and a whole range of member offers
         and competitions.

         *Correct at the time of going to print.

                                                                    Call   0800 0321 950 quoting reference 96369
9                                          We may record and/or monitor calls for training, quality assurance and evidential purposes.
Choose from over 250 quality assessed
hospitals
We have a national network of over 250 hospitals, selected for their quality, value and range of services. You can be
assured of receiving prompt treatment in comfortable facilities usually in a private room with television, telephone and
en-suite bathroom.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                10
Chronic conditions

     In common with other annual insurance policies,                      What does this mean in practice?
     medical insurance is designed to cover eligible claims               For pre-authorised claims, we will tell you if we think your
     for expenses incurred as a result of unexpected events.              condition is now a chronic condition under our rules.
     Therefore, it is important to understand when buying
                                                                          We may then (with your permission) contact your
     medical insurance that policies are designed to cover
                                                                          specialist or GP who knows your particular
     treatment of medical conditions that respond quickly
                                                                          circumstances. We may ask them for confirmation
     to treatment, referred to by us as ‘acute conditions’.
                                                                          of the diagnosis of your condition and details of the
     Medical insurance is not intended to cover you
                                                                          treatment you are currently receiving and to give us
     against the cost of recurrent, continuing or long-term
                                                                          a future prognosis for the condition.
     treatment of chronic medical conditions since these
     treatments become a series of predictable, rather than               In line with other medical insurance policies, our plans
     unexpected, events.                                                  are designed to cover claims for expenses incurred as
                                                                          a result of unexpected events and we stop paying for
     This section is designed to help you understand more                 recurring or continuing treatment of medical conditions
     about what we mean by a chronic condition and                        that will continue indefinitely or that keep recurring.
     provide practical examples of when we will or will not               Should the information we have indicate that you have
     cover treatment of those conditions.                                 a chronic condition we will write to tell you we will stop
                                                                          paying benefit for the continuing or recurrent treatment
     What is a chronic condition?                                         of the chronic condition.
     A chronic condition is a disease, illness or injury that
     has one or more of the following characteristics:                    What if your condition gets worse?
      it needs ongoing or long-term monitoring through                   We will pay for the treatment of acute exacerbations or
       consultations, examinations, check-ups, and/or tests               complications (flare-ups) in order to bring the condition
                                                                          quickly back to its controlled state (for instance in-patient
      it needs ongoing or long-term control or relief of                 treatment needed to re-stabilise a chronic condition such
       symptoms                                                           as diabetes). There are certain other chronic conditions

      it requires your rehabilitation or for you to be
                                                                          such as Crohn’s disease which because of their nature,
                                                                          require management of recurrent episodes during which
       specially trained to cope with it
                                                                          the symptoms of the condition worsen. Because of the
      it continues indefinitely                                          ongoing or continuing nature of such conditions, we will

      it has no known cure
                                                                          write to tell you when there is no further benefit available
                                                                          for the treatment of that medical condition.
      it comes back or is likely to come back.
                                                                          Examples of chronic conditions
     At AXA PPP healthcare we cover the cost of treatment                 The following are examples of chronic conditions and
     for acute conditions. That is, treatment which aims to               how we usually deal with them. In all of the following
     return you to the state of health you were in before                 examples we may need to write to you or your doctor
     suffering the condition, or which leads to your full                 to obtain further information, as explained above.
     recovery. This includes short-term medical intervention              Important note – certain plans have specific
     to treat unexpected complications or exacerbations of                restrictions to benefits such as out-patient treatment,
     a chronic condition.                                                 for treatment that could have been received on the
     If your illness or medical condition requires recurring              NHS within six weeks and other specific exclusions
     consultations over a long period, checks on your                     covered in the customer’s policy terms. The cover for
     medication, long term therapy or treatment to ease                   cancer also varies by product with some products
     symptoms, your condition may fall within the definition              having higher levels of cover than those described in
     of a chronic condition. If you have been receiving                   this document while others have lower or no cover for
     ongoing or continuing treatment or treatment that is                 cancer. The examples overleaf are designed to show
     intended to manage your condition or keep your                       our general policy on chronic conditions and how we
     symptoms in check, we will review your treatment to                  would deal with them for a customer on a
     assess whether it remains eligible for benefit.                      comprehensive policy. Please read your handbook
                                                                          carefully to establish what cover you have as all the
                                                                          other terms of your policy (including any limits) will
                                                                          continue to apply to your cover.

                                                                          Call   0800 0321 950 quoting reference 96369
11                                               We may record and/or monitor calls for training, quality assurance and evidential purposes.
Example 1 – Angina and heart disease                                      We would agree to cover the cost of hospital treatment
Alan has been with AXA PPP healthcare for many years.                     until her condition has been stabilised. We would also
He develops chest pain and is referred by his GP to a                     pay for one further consultation following discharge
specialist. He has a number of investigations and is                      from hospital.
diagnosed as suffering from angina. Alan is placed on
medication to control his symptoms.                                       Example 3 – Diabetes
                                                                          Deidre has been with AXA PPP healthcare for two years
We would pay for the initial consultation and tests to
                                                                          when she develops symptoms that indicate that she
diagnose the condition and further consultations with
                                                                          may have diabetes. Her GP refers her to an
the specialist to allow the medication to bring the
                                                                          endocrinology specialist who organises a series of
condition under control. At this point we would advise
                                                                          investigations to confirm the diagnosis and she then
Alan that further regular review consultations to monitor
                                                                          starts on oral medication to control the diabetes. After
the condition would not be covered, but we would allow
                                                                          several months of regular consultations and some
one further consultation to allow Alan to discuss
                                                                          adjustments to the medication regime the condition is
alternative arrangements should he wish to do so.
                                                                          now well controlled and the specialist explains he would
Two years later, Alan’s chest pain recurs more severely                   like to see her every four months to review the condition.
and his specialist recommends that he has a heart
                                                                          We would explain that we cannot continue to provide
by-pass operation. We would confirm to Alan that we
                                                                          benefit for the review consultations but, would agree
will cover that operation as it will stabilise his condition
                                                                          to provide benefit for one more to allow Deidre the
and substantially relieve his acute symptoms. We would
                                                                          opportunity to discuss alternative arrangements for
then explain to Alan that although his policy would not
                                                                          follow up.
normally cover regular check-ups, in this particular
circumstance we would allow for a further ten years of                    One year later Deidre’s diabetes becomes unstable and
annual postoperative check-ups with the specialist to                     her GP arranges for her to go into hospital for in-patient
ensure that his condition remains stabilised. This                        treatment.
benefit would only be available on policies with
                                                                          We would provide benefit for this admission and for a
out-patient cover and while the policy remains in force.
                                                                          short period after her discharge.

Example 2 – Asthma                                                        Example 4 – Hip pain
Eve has been with AXA PPP healthcare for five years
                                                                          Bob has been with AXA PPP healthcare for three years
when she develops breathing difficulties. Her GP refers
                                                                          when he develops hip pain. His GP refers him to an
her to a specialist who arranges for a number of tests.
                                                                          osteopath who treats him every other day for two
These reveal that Eve has asthma. Her specialist puts
                                                                          weeks and then recommends that he return once a
her on medication and recommends a follow-up
                                                                          month for additional treatment to prevent a recurrence
consultation in three months, to see if her condition
                                                                          of his original symptoms.
has improved. At that consultation Eve states that her
breathing has been much better, so the specialist                         We would explain that the monthly visits are not
suggests she have check-ups every four months.                            covered by Bob’s policy but that, if he should have
                                                                          further problems or if his condition should worsen to the
We would agree to cover Eve’s initial tests and
                                                                          point where a hip replacement is needed, this would be
consultation to establish the diagnosis and also the
                                                                          covered if his GP refers him to a suitable specialist.
subsequent consultation to see if there was an
improvement. However, we would then advise Eve that
                                                                             If you would like to discuss any of this with
regular check-ups are outside the scope of her cover.
                                                                             us, please call us on the number below.
Eighteen months later, Eve has a bad asthma attack.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                            12
Frequently asked questions
Frequently asked questions

                             The following are questions that are frequently asked about our healthcare plans. If you
                             would like any more information please call us on 0800 389 7911.

                                There are lots of medical insurers in the market; why should I choose
                                AXA PPP healthcare?
                                We are one of the largest UK medical insurers with 70 years’ experience. We want our members to feel confident
                                and secure when they take out our healthcare policies, so customer satisfaction is at the core of everything we
                                do. We are proud to have been awarded ‘Best Private Medical Insurance Provider’ by Your Money readers in 2010.

                                How often can I claim?
                                There is no limit to the number of times you can claim for new conditions that arise after you join, as long as it is
                                within your policy limits, and you can start claiming from when you join.

                                Are my dental costs covered under the plan?
                                Generally no, as this treatment is not a medical condition. However, a small number of oral procedures are
                                covered, so please ask our Personal Advisers for more information.

                                What happens if I have to spend a night in an NHS hospital?
                                For each night you spend in an NHS hospital receiving free treatment that would have been eligible under your policy,
                                you will receive a cash benefit of £50, up to a maximum of £2,000 per year.

                                Do I have to pay for treatment and then claim the money back?
                                No, as we normally receive invoices directly from the specialists or hospitals and will settle them directly within
                                policy limits.

                                How can I be sure that I’m covered before I go ahead with treatment?
                                That’s simple. Just ring our team of Personal Advisers with the details of your proposed treatment and specialist.
                                They will confirm if your treatment is eligible, so you may go ahead with the peace of mind that you are fully covered.

                                What happens if I have hospital treatment without checking with
                                a Personal Adviser first that it is covered?
                                We would strongly recommend that you obtain authorisation for your proposed treatment before it is undertaken
                                so you can be sure that it is covered. However, if you don’t pre-authorise treatment with us we will pay for the
                                claim provided it is eligible under the terms of your policy.

                                What is the 6 week rule and why should I add it to my policy?
                                It’s a good way to reduce your premium. If you are comfortable using the NHS but worry about the long waiting
                                times, then the 6 week option could be for you. If the eligible treatment you need is available on the NHS within
                                six weeks of the date the treatment should take place, then you will be treated under the NHS. However, if the
                                wait for treatment is more than six weeks then you can go private straight away.

                                Can you help if I need medical information?
                                When you join, you will have access to Health at Hand, our 24 hour telephone based medical information service.
                                We have a wide range of medical professionals on hand to give you information about medicines, pain relief,
                                pregnancy, cancer, stress, menopause, and much more.

                                                                                               Call   0800 0321 950 quoting reference 96369
      13                                                              We may record and/or monitor calls for training, quality assurance and evidential purposes.
We want to make it easy
to understand your policy
Glossary: Medicine seems to have a language all of its own. Here are
some terms that we use in this brochure and in your policy with which you
may not be familiar.

Clinical practitioner                                                     Medical underwriting
A dietician, nurse, orthoptist, physiotherapist,                          The process by which we assess your application and
psychologist, psychotherapist or speech therapist who                     decide on what terms we may offer to cover you.
we recognise for benefit purposes.
                                                                          Member
CT scans                                                                  You and any family member covered by your policy.
Computerised tomography scans. A form of X-ray
                                                                          MRI scans
examination. It is particularly useful for making
                                                                          Magnetic resonance imaging scans. A way of medically
diagnoses in the head, chest and abdomen.
                                                                          mapping the body's tissues. It helps with non-invasive
Complementary practitioner                                                diagnosis and treatment planning of a wide range of
A practitioner in acupuncture, homeopathy, osteopathy                     diseases, including cancer. It doesn't use potentially
and chiropractic treatment who we recognise for                           harmful ionising radiation such as X-rays.
benefit purposes.
                                                                          Out-patient
Day-patient                                                               A patient who attends a hospital, consulting room, or
A patient who is admitted to a hospital or day-patient                    out-patient clinic and is not admitted as a day-patient
unit because they need a period of medically supervised                   or an in-patient.
recovery but does not occupy a bed overnight.
                                                                          PET scan
Diagnostic tests                                                          Positron emission tomography scan. A way of
Investigations, such as x-rays or blood tests, to find or                 diagnosing and monitoring many serious medical
to help to find the cause of your symptoms.                               conditions, including heart problems and cancer. A very
                                                                          small radioactive injection is given to the patient and a
Directory of Hospitals
                                                                          PET camera is used to measure radioactivity in various
A document we publish which lists private hospitals,
                                                                          parts of the body.
day-patient units and scanning centres in the UK that
we cover.                                                                 Physiotherapy
                                                                          Physical treatment such as massage or exercises.
Excess
Choosing an excess on your policy may help to reduce                      Pre-existing conditions
your premiums. An excess is the amount of money that                      A medical condition, and conditions relating to it, which
you have to pay towards the cost of treatment each                        existed before your cover with us started.
year and applies to each person covered by the policy
                                                                          Radiotherapy and chemotherapy
in each year.
                                                                          Treatments for cancer.
Family member
                                                                          Specialist
The policyholder’s current spouse or civil partner or any
                                                                          A senior and experienced medical practitioner who has
person (whether or not the same sex) living permanently
                                                                          attained the status of an NHS consultant or equivalent.
in a similar relationship with the policyholder and any of
their or the policyholder’s unmarried children.                           Surgical procedure
                                                                          An operation or other invasive procedure.
In-patient
A patient who is admitted to hospital and who occupies                    Treatment
a bed overnight or longer, for medical reasons.                           Surgical or medical services (including diagnostic tests)
                                                                          that are needed to diagnose, relieve or cure a disease,
Medical condition
                                                                          illness or injury.
Any disease, illness or injury, including psychiatric illness.

Call   0800 0321 950 quoting reference 96369
We may record and/or monitor calls for training, quality assurance and evidential purposes.                                           14
JLT Benefit Solutions Limited.
                                                          Authorised and regulated by the Financial Services Authority.
                                                                A member of the Jardine Lloyd Thompson Group.
                                                            Registered Office: 6 Crutched Friars, London EC3N 2PH.
                                                          Registered in England No 02240496. VAT No. 244 2321 96

                                            For more information on our private medical
                                            insurance, call us at AXA PPP healthcare on:

                                            0800 0321 950
                                            quoting reference 96369

                                            www.axappphealthcare.co.uk/jlt

                                                                                                                          PB40248/04.11

                                ISO14001

AXA PPP healthcare, Phillips House, Crescent Road, Tunbridge Wells, Kent TN1 2PL.
AXA PPP healthcare limited. Registered Office: 5 Old Broad Street, London EC2N 1AD,
United Kingdom. Registered in England No. 3148119.
Authorised and regulated by the Financial Services Authority. © AXA PPP healthcare 2011.
Calls may be monitored and/or recorded for training, quality assurance and evidential purposes. .
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