IMPORTANT INFORMATION AND CHANGES TO YOUR PLAN

Transcription

1 IMPORTANT INFORMATION AND CHANGES TO YOUR PLAN FROM VITALITYHEALTH PRUHB21545 VITALITY.CO.UK/HEALTH

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3 IMPORTANT INFORMATION AND CHANGES TO YOUR ESSENTIAL PLUS PLAN As part of our commitment to constantly improve the products we offer our customers, we re moving all of our existing members onto our Business Healthcare plan. Many of the benefits are the same as you had on the Essential Plus plan, but there are some important changes you need to know about which are set out on the following pages. The changes will take effect from your plan renewal date. Some of the changes may not be applicable to your plan, so please take some time to read through this document alongside your new Your plan terms and conditions document, and your certificate of insurance which shows which benefits are included in your plan. You can find these documents by logging in to your secure inbox on the Member Zone at member.vitality.co.uk and clicking on the envelope icon at the top right hand corner of the screen.

4 CONTENTS YOUR PLAN NUMBER 1 NEW BENEFITS 2 Introducing Vitality GP primary care 2.1 Out-patient surgical procedures 2.2 NEW COVER OPTIONS 3 Vitality GP Select 3.1 Vitality Status Linked Excess (formerly Vitality-linked Excess) 3.2 CHANGES TO YOUR EXISTING BENEFITS AND EXCLUSIONS 4 Treatment at a hospital not eligible under your plan what you will have to pay 4.1 Lifestyle Surgery 4.2 Private Ambulance 4.3 NHS Hospital Cash Benefit 4.4 Childbirth Cash Benefit 4.5 Parent Accommodation 4.6 Oral Surgery 4.7 Home Nursing 4.8 Assistance at Home 4.9 Cancer Cover 4.10 Rehabilitation 4.11 Out-patient Cover 4.12 Out-patient scans and diagnostic tests 4.13 Out-patient physiotherapy 4.14 Psychiatric Cover 4.15 Therapies Cover 4.16 The Personal Health Fund (PHF) 4.17 Changes to the Premier and Countrywide Hospital Lists 4.18 Changes to Excess 4.19 OTHER CHANGES TO YOUR PLAN TERMS AND CONDITIONS 5 Acceptance terms 5.1 Changes to exclusions 5.2 Cashback 5.3 Discounts, cashback & rewards 5.4 Policy terms and conditions, general conditions, policy administration 5.5 Changes to membership 5.6 Changes to definitions 5.7 Appendices 5.8

5 1. YOUR PLAN NUMBER Your company s plan number has now changed and you ll find your new number on your renewal certificate of insurance. Please have this number ready if you need to contact us. Your Vitality membership number, which is used to register on our secure Member Zone and with our health and reward partners, will remain the same and is also displayed on your certificate. 2. NEW BENEFITS 2.1 INTRODUCING VITALITY GP PRIMARY CARE We have introduced a new service called Vitality GP. This service puts a GP at the heart of your healthcare using our FREE app. You ll need an Apple (ios7 or above) or Android (4.4 or above) device to download the Vitality GP app from the App Store or Google Play. The Vitality GP app lets you book a private video consultation with a GP within 48 hours at a time convenient for you. Opening hours are Monday Friday 8am to 7pm and Saturday 9am 1pm, excluding bank holidays. You can speak to our Vitality GP s about most aspects of men s, women s, and children s health and you can even upload images from your Smartphone. The Vitality GP will be able to provide clinical advice and guidance, and, if they re able to diagnose straightaway, they can issue a private prescription, refer you for minor diagnostic tests and, if necessary, refer you for the most appropriate further treatment. The benefit also includes up to 100 per member to help pay for any private prescriptions and minor diagnostic tests. This new benefit is included as standard in your plan. For more information and to find out what is covered under the Vitality GP benefit, please refer to page 10 of your new plan terms and conditions. Further details can also be found at vitality.co.uk/ health. 2.2 OUT-PATIENT SURGICAL PROCEDURES Out-patient surgical procedures are now included in your plan. Please refer to page 12 of the Your plan terms and conditions document for details of this benefit. 1

6 3. NEW COVER OPTIONS Please refer to your certificate of insurance to see if either of these benefits are included in your plan. 3.1 VITALITY GP SELECT In addition to our hospital list options we have introduced Vitality GP Select. This new way of accessing treatment offers cover at hospitals arranged by a Vitality GP. The Vitality GP will arrange for your treatment to take place in a hospital within our network of private healthcare providers. If you don t have an Apple or Android device, you can visit your own GP, gain an open referral from them, and then contact us when you need to make a claim. You re covered up to the limits specified on your plan. As with our hospital list options, if any treatment or MRI, CT or PET scans do not take place in a facility arranged by a Vitality GP or agreed by VitalityHealth, you will need to pay 40% of the treatment cost (excluding consultants fees). Your certificate of insurance will indicate if this benefit is included in your plan, and you can refer to page 40 of your new Your plan terms and conditions document for more details. 3.2 VITALITY STATUS LINKED EXCESS This benefit links the excess you pay to your Vitality status. There are now two options available. You start off with an excess of either 250 or 150. The excess may be per claim or per person per plan year and you will need to check your certificate of insurance to see if this benefit applies to your plan and if so, which one of these two options applies. This excess then reduces as you improve your Vitality status, meaning that you could end up not having to pay any excess at all if you need to make a claim, as the following table shows: EXCESS LEVEL Excess option selected Bronze Silver Gold Platinum Vitality status linked excess (max 250) No excess No excess Vitality status linked excess (max 150) No excess Details can be found in Appendix 4 on page 68 of your new Your plan terms and conditions document. 2

7 4. CHANGES TO YOUR EXISTING BENEFITS AND EXCLUSIONS 4.1 TREATMENT AT A HOSPITAL NOT ELIGIBLE UNDER YOUR PLAN WHAT YOU WILL HAVE TO PAY If you have our Vitality GP Select option, you should only go to a hospital that a Vitality GP or VitalityHealth have arranged for you to attend, as you are only covered for treatment at those hospitals. If you have one of our hospital list options, you should only go to a hospital on your list, as you are only covered for treatment at those hospitals. We have clarified that if a member decides to go to a hospital that s not on your list or, if they are using Vitality GP Select and the hospital has not been arranged by a Vitality GP or agreed by VitalityHealth, then the member will have to pay 40% of the costs of their treatment. This includes any in-patient and day patient treatment as well as out-patient scans and/or surgical procedures, excluding consultants fees. Consultant s fees will be covered in full, providing the consultant is recognised by us. To avoid incurring these costs, we would always recommend that members go to a hospital that s included on their hospital list. In the rare circumstances where eligible treatment is unavailable in a hospital that is near where the member lives and available under their plan, we will help them find another hospital where it can take place. Sometimes this may mean the member has to travel further than would normally be the case. You should refer to your certificate of insurance along with page 8 of your new Your plan terms and conditions document for further details and to ensure that you understand what this means for you. 4.2 LIFESTYLE SURGERY Previously this benefit had only been available to groups with 20 or more insured employees; this restriction has now been removed and this is now available to all groups. Details of this benefit can be found in Appendix 5 on page 69 of the Your plan terms and conditions document. 4.3 PRIVATE AMBULANCE Insured members will now be covered in full for the use of a private ambulance for transfer between hospitals, whether NHS or private, if a consultant recommends it as medically necessary. Previously, cover was limited to 60 per trip. 3

8 4.4 NHS HOSPITAL CASH BENEFIT We ve increased the amounts we ll pay if an insured member chooses to have eligible in-patient or day-patient treatment under the NHS rather than going to a private hospital. We ll now pay 250 each night (up to a maximum of 2,000 per person, per plan year) for in-patient treatment, and 125 each day (up to a maximum of 500 per person, per plan year) for day-patient treatment. Previously this was limited to 50 per day up to a limit of 2,000 per person, per plan year. 4.5 CHILDBIRTH CASH BENEFIT We have increased the waiting period required before being able to claim on this benefit for the birth of a child from 9 months to 10 months from the insured member s cover start date. The waiting period does not apply to adoption and can include cover with the insured member s previous insurer if their underwriting terms are continued personal medical exclusions (switch). 4.6 PARENT ACCOMMODATION This benefit enables one insured parent to stay in the same hospital as their insured dependent child when their child is admitted as an in-patient to a private hospital or an NHS private ward within an NHS Private Patient Unit (PPU). The insured child must be under 14 years of age in order for the insured parent to claim under this benefit. Previously, the age limit was under ORAL SURGERY The re-implantation of teeth is no longer covered as part of the Oral Surgery benefit. Please refer to page 15 of your new Your plan terms and conditions document to see what s covered. 4.8 HOME NURSING We ve increased the cover available under our Home Nursing benefit from up to 3,000 per person, per plan year to Full Cover. 4

9 4.9 ASSISTANCE AT HOME We have further defined the terms and conditions of our Assistance at Home benefit. Where required, the benefit is arranged by Intana, and applies following a period of eligible in-patient treatment authorised by us that lasts at least 3 nights. If a member has hip or knee replacement surgery, they will be eligible following an in-patient stay that lasts at least 2 nights. Cover is limited to a maximum of 28 hours care per claim (minimum of 1 hour per visit) for a maximum period of 30 days immediately following discharge from hospital. Where more than one claim for this benefit is made in a plan year, cover is limited to 84 hours in total. For a full list of the services available under our Assistance at Home benefit please see page 16 of the new Your plan terms and conditions document CANCER COVER We have added a number of benefits to your Cancer Cover benefit including end-of-life home nursing care and cover for wigs and external prostheses. We have also renamed this benefit as Extended Cancer Cover. Please refer to your new Your plan terms and conditions document for details on what is and isn t covered. Appendix 3 on page 61 titled Our cancer cover explained provides more information REHABILITATION We have reduced the number of days for which we would normally provide cover for rehabilitation following a stroke or injury from 30 days to 21 days. Please refer to section 1.7 of the Your plan terms and conditions document for further details about this benefit OUT-PATIENT COVER Osteopathy and chiropractic treatment are no longer included within the Out-patient Cover benefit. They will now be included within the new Therapies Cover benefit which has a combined limit of up to 350 per person, per plan year. Refer to section 4.16 of this document for details of your Therapies Cover benefit. 5

10 4.13 OUT-PATIENT SCANS AND DIAGNOSTIC TESTS We have confirmed, on page 18 of your new Your new plan terms and conditions document that we will not cover any out-patient scans or diagnostic tests that are ordered by anyone other than the member s consultant OUT-PATIENT PHYSIOTHERAPY When your plan renews, the way in which we pay for physiotherapy sessions will change. All physiotherapy is managed by our physiotherapy network partners, and providing you see a physiotherapist within the network, each session will be covered in full and will not be subject to any limits on your Out-patient Cover. All in-network physiotherapy must follow our claims process. However, any physiotherapy undertaken outside of the network will only be covered up to 35 per session and this will count towards your Out-patient Cover limit of 1,000 per person per plan year. You will also have to pay any shortfall yourself. Full details can be found on page 18 of the new Your plan terms and conditions document PSYCHIATRIC COVER We have increased the out-patient psychiatric treatment sub-limit from up to 1,000 per person, per plan year, to up to 1,500 per person, per plan year. The overall limit of up to 15,000 per person, per plan year for in-patient, day-patient and out-patient treatment will remain. We have further defined what is covered under our Psychiatric Cover option. You are covered for the following talking therapies where treatment is agreed as clinically appropriate by a consultant psychiatrist, or arranged through our mental health panel: cognitive behavioural therapy (CBT) eye movement desensitisation reprocessing therapy (EMDR) counselling For further details on what is and isn t covered under this benefit, please see page 19 of the new Your plan terms and conditions document. 6

11 4.16 THERAPIES COVER You can now claim up to a combined limit of 350 per person per plan year for chiropody/podiatry; acupuncture; homeopathy and up to two consultations with a dietician, after a referral by a GP or consultant. Your existing out-patient osteopathy and chiropractic treatment benefits will also be included within this combined limit for Therapies Cover. For full details of what s covered and any exclusions that may apply, please refer to pages 20 and 30 of the new Your plan terms and conditions document THE PERSONAL HEALTH FUND (PHF) If you have access to this benefit, you will now be able to use your Personal Health Fund to pay for medical aids, activity tracking and health measurement devices. Due to in-network physiotherapy being covered in full as part of our Out-patient Cover option, you will no longer be able to claim physiotherapy expenses on the PHF. A maximum balance of 1,000 per adult member can be retained. Once a member s PHF reaches this level, no further additions to their fund will take place, until such time as their PHF reduces below this level. For more information on this benefit, please refer to Appendix 4 on page 66 of the new Your plan terms and conditions document. You can see your current PHF balance by logging into the Member Zone at member.vitality.co.uk CHANGES TO THE PREMIER AND COUNTRYWIDE HOSPITAL LISTS The Hospital of St John & St Elizabeth, which was previously only available on the Premier list, is now included on the Countrywide list. What was formerly known as the Premier hospital list has been renamed the Countrywide Plus hospital list CHANGES TO EXCESS If your plan was subject to our rolling excess, this has now ended and you will be moved onto our per person, per claim excess instead. This means that for every new claim you make, an excess will be applicable. You won t have to pay an excess again for any existing claims until that claim reaches its anniversary. 7

12 Your certificate of insurance will show if you have an excess applied to your plan. For full details, please refer to pages 28 and 50 of the new Your plan terms and conditions document. 5. OTHER CHANGES TO YOUR PLAN TERMS AND CONDITIONS 5.1 ACCEPTANCE TERMS Moratorium Underwriting Your certificate of insurance will display Medical History Disregarded as the underwriting terms for any insured members, including dependants, who joined the plan on Moratorium underwriting before the plan renewal date in This means that, subject to the terms and conditions of the plan, pre-existing conditions are not excluded from cover. Your certificate of insurance will display Moratorium as the underwriting terms for any insured members, including dependants, who joined the plan on Moratorium underwriting on or after the plan renewal date in 2013, and our Moratorium clause will continue to apply to their cover. Please refer to the Acceptance terms section on page 38 of the Your plan terms and conditions document for a full explanation of what these terms mean. 5.2 CHANGES TO EXCLUSIONS We have made some changes to the exclusions under the section, Exclusions what s not covered. For full details of the exclusions that apply to your cover, please refer to page 24 of the new Your plan terms and conditions document. 5.3 CASHBACK We have clarified that if a member has not provided their bank details they have 12 months from their calculation date to claim their cashback, otherwise it will expire. More information on cashback can be found on pages 32 to 34 of the new Your plan terms and conditions document. 5.4 DISCOUNTS, CASHBACK & REWARDS We have clarified that the limits associated with the discounts and rewards we offer will not be multiplied by the number of insurance plans you may have with VitalityHealth and VitalityLife. 8

13 We have added additional terms to clarify that if you do have more than one insurance plan with VitalityHealth and VitalityLife, your discounts, cashback and rewards will be based on the plan that, in our view, gives you the most comprehensive package of benefits. More information on discounts, cashback and rewards can be found on pages 35 to 37 of the new Your plan terms and conditions document. 5.5 POLICY TERMS AND CONDITIONS, GENERAL CONDITIONS, POLICY ADMINISTRATION We have updated the wording for this section of the new Your plan terms and conditions document. For ease of use, we have also divided it into the following sections and we recommend that you read each of these sections in detail: Claims conditions General conditions Membership 5.6 CHANGES TO MEMBERSHIP Who can be covered under your plan? We have clarified that your dependent children can continue to remain on the plan after the age of 25. We have also clarified that subject to agreement from your Group Secretary, you can apply to add dependants to your plan at any time by completing an additional member application form. They should apply to join as soon as they are eligible to do so, and they must join the appropriate employee category based on the agreed eligibility criteria. Please refer to the Membership section on page 45 of your new Your plan terms and conditions document for full details. What happens if I leave the company? Your cover ends on your leaving date which means we won t pay for any more treatment you have after that date. Depending on your age and how long you ve been covered under the company scheme, you may be eligible to apply to continue your cover with us on an individual plan with the same underwriting terms. You will be subject to the rules and eligibility criteria defined in your new Your plan terms and conditions document. We do not offer continuation of cover to insured dependants alone. 9

14 For full details about how you can continue your cover with us please refer to the Membership section on page 45 of the new Your plan terms and conditions document. If you die or become divorced or separated We have introduced two new sections in the Your plan terms and conditions document that define what happens in the event of your death or if you become divorced or separated. Please refer to the Membership section on page 45 of the Your plan terms and conditions document. 5.7 CHANGES TO DEFINITIONS We have revised the list of defined terms applicable to your plan. Please refer to the Definitions section on page 48 of the Your plan terms and conditions document for the updated definitions. 5.8 APPENDICES We have added the following Appendices to the new Your plan terms and conditions document and recommend that you take some time to read them: Appendix 2 Chronic conditions information Appendix 3 Our Cancer Cover explained 10

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16 FIND OUT MORE To find out more, visit member.vitality.co.uk VitalityHealth is a trading name of Vitality Corporate Services Limited. Registered number Registered in England and Wales. Registered office at 3 More London Riverside, London, SE1 2AQ. Vitality Corporate Services Limited is authorised and regulated by the Financial Conduct Authority. Trust administration business is handled by Vitality Corporate Services Limited and this activity is not regulated by the Financial Conduct Authority. PRUHB21545_PHL_SME_ESSPLUS_MIG_MEM_0815_J0233 Part of the Discovery Group