Client update. For plans with a start date on or after 1 January 2014

Transcription

1 Client update For plans with a start date on or after 1 January 2014

2 Client update 2014 Welcome to your Client update which tells you about the changes to our individual and family plans from 1 January We are delighted to announce that our insurance partner, InterGlobal, has won Best International Private Medical Insurance Provider at the 2013 Cover Excellence awards for the fifth year in a row. It s testament to their product and service proposition that their brokers have nominated them in such high numbers year-in and year-out. We would like to take this opportunity to thank you for your continued custom. If you have any questions about our plans or would like a quotation, please contact your advisor or us. Product range changes We have consolidated our five UltraCare plans to a range of four to make it easier for you to distinguish the step-change in benefits from UltraCare Standard through to UltraCare Elite by merging the UltraCare Plus and Elite plans. The Travel add-on plan is now available free of charge to our UltraCare Elite planholders. If you previously held an UltraCare Plus plan, you will be contacted about your renewal terms to allow you to make a choice based on your personal needs. We have renamed our International Schools plans as UltraCare International Schools. Premium changes After a thorough review and taking into account medical inflation, the overall inflationary increase applied to our 2014 UltraCare plans will be 5%. We have been able to minimise increases through continued focus on efficient claims management and cost containment strategies as well as wanting to provide a value for money product. Some plans will have a different premium adjustment as a result of changing age bands, no-claims discounts and product type. The changes in your plan will be explained to you before your plan renewal. An inflationary increase of 5% applies to the Maternity add-on plan. There are no premium increases on the Travel and Personal accident add-on plans. The location loading no longer applies to Bahrain. Cancellation fees We have updated the Cancellation section in the Plan guides. An administration fee of $170 will be charged for the cancellation of UltraCare and UltraCare International Schools plans. We reserve the right to make an additional charge if we incur any further or unexpected costs as a result of the cancellation. If more than one plan is cancelled, any pro-rata refund or outstanding premium due on each plan will be combined. There is still no administration fee if a plan is cancelled within the 30-day cooling off period. Changes to the Table of benefits for UltraCare and UltraCare International Schools plans Overall plan limit benefit section 1 We have increased the overall plan limits on all of our plans for See the Table of benefits for more information. Cancer care benefit section 2 We have increased cover for the treatment of cancer. All cancer care is now covered in full on all plans. We have also removed the excess from this benefit. In-patient and daycare treatment benefit section 3 The separate nursing at home benefit has been removed, and the following has been incorporated in this section: Medical services of a nurse as part of your in-patient or daycare treatment when these are received in your home instead of in hospital. Accidents and emergencies are no longer specified in this section. However in-patient and daycare treatment needed for accidents and emergencies continues to be covered by this section, based on the treatment and services received. Dental treatment for natural teeth following an accident is no longer specified in this section. However dental medical conditions that are caused by an accident and require in-patient or daycare treatment continue to be covered by this section, based on the treatment and services received. In-patient physiotherapy and psychiatric treatment have been separated from this section. See the updates for benefit sections 6 and 7 for details. Out-patient post-hospitalisation treatment benefit section 4 Treatment is now paid in full on all of our plans for a period of 90 days following in-patient or daycare treatment related to the same acute medical condition. This benefit covers medical practitioners and specialists fees, surgical procedures, prescribed drugs and dressings, MRI, PET and CT scans, X-rays, pathology and other diagnostic tests and procedures. Out-patient treatment benefit section 5 Out-patient surgical procedures are now paid in full on the UltraCare Standard and UltraCare International Schools Bronze plans. Increased cover of $1,000 is now available for out-patient pre-operative tests on the UltraCare Standard and UltraCare International Schools Bronze plans. Cover on all plans is for tests up to 72 hours before in-patient or daycare treatment. The benefit limits for out-patient pre-operative tests are shared with outpatient medical practitioners and specialists fees, prescribed drugs and dressings, X-rays, pathology and diagnostic tests and procedures on the UltraCare Select and Comprehensive plans, and have changed as follows: UltraCare Select plan: the limit has reduced to $5,000. UltraCare Comprehensive plan: the limit has increased to $10,000. Out-patient physiotherapy and psychiatric treatment have been separated from this section. See the updates for benefit sections 6 and 7 for details. Physiotherapy and complementary medicine benefit section 6 Post-hospitalisation out-patient physiotherapy has been specified separately, and now provides cover for a period of 90 days following in-patient or daycare treatment related to the same medical condition. Cover has been introduced on the UltraCare Standard and UltraCare International Schools Bronze plans as follows: UltraCare Standard plan: a new limit of $750. UltraCare International Schools Bronze plan: a new limit of $300. Post-hospitalisation out-patient physiotherapy continues to share a benefit limit with all other out-patient physiotherapy on all other plans. The shared benefit limit has increased as follows: UltraCare Select plan: the limit has increased to $1,500. UltraCare Comprehensive plan: the limit has increased to $2,000. UltraCare International Schools Silver plan: the limit has increased to $450. $850. The benefit limits on the UltraCare Select and Comprehensive plans are also shared with complementary medicine and treatment. 2

3 Updates Where cover is included on your plan, referral is no longer required from your medical practitioner for acupuncture or homeopathic treatment. Psychiatric treatment benefit section 7 In-patient psychiatric treatment has been introduced on the UltraCare Comprehensive plan for up to 30 days after you have completed a 12 month waiting period from the date that the benefit is first introduced on your plan. This new benefit has a limit of $10,000. Out-patient psychiatric treatment has been given a separate benefit limit on the following plans: UltraCare Select plan: a limit of $1,000. UltraCare Comprehensive plan: a limit of $2,000. Out-patient psychiatric treatment continues as a separate benefit on the UltraCare Elite and UltraCare International Schools Silver and Gold plans, with increased limits on the following plans: UltraCare Elite plan: the limit has increased to $10,000. $2,600. Maintenance of chronic medical conditions benefit section 8 The lifetime limits have increased on the following plans: UltraCare Select plan: the lifetime limit has increased to $75,000. UltraCare Comprehensive plan: the lifetime limit has increased to $150,000. UltraCare Elite plan: the lifetime limit has increased to $300,000. UltraCare International Schools Silver plan: the lifetime limit has increased to $75,000. UltraCare International Schools Gold plan: the lifetime limit has increased to $150,000. Kidney dialysis for the maintenance of chronic medical conditions is now mentioned specifically in this section to make it clear that cover is included. Stabilising acute episodes of chronic medical conditions is no longer referred to in this section. This is now included specifically in benefit sections 3 and 5. Congenital abnormalities benefit section 9 A new benefit has been introduced on the UltraCare Comprehensive and Elite plans and the UltraCare International Schools Gold plan. This benefit is for all congenital abnormalities that: are not inherited; the member did not have signs or symptoms of before their date of joining; and were not diagnosed before the member s date of joining; and covers treatment aimed to cure congenital abnormalities, treatment of congenital abnormalities that are diagnosed as chronic medical conditions, palliative treatment and care of congenital abnormalities that are diagnosed as terminal, and treatment for any related medical condition. The benefit limits are as follows: UltraCare Comprehensive plan: a lifetime limit of $35,000. UltraCare Elite plan: a lifetime limit of $50,000. UltraCare International Schools Gold plan: a lifetime limit of $35,000. Terminal care benefit section 10 We have removed the lifetime limits and increased cover to Paid in full on the UltraCare Select, Comprehensive and Elite and UltraCare International Schools Silver and Gold plans. Medical evacuation and repatriation benefit section 11 Cover has been extended on the UltraCare Standard and UItraCare International Schools Bronze plans to include costs to transport you to the nearest location within your area of cover for out-patient cancer treatment. Out-patient dental treatment benefit section 13 The benefit limits have increased on the following plans: UltraCare Comprehensive plan: the limit has increased to 75% of $1,000. UltraCare Elite plan: the limit has increased to $1,500 with no co-insurance. 75% of $1,300. Dental checkups have been moved from this section. See the updates for benefit section 14 for details. Wellness benefit section 14 The benefit limits for routine health checks, well-child tests and vaccinations have increased on the following plans: UltraCare Comprehensive plan: the limit has increased to $700. UltraCare Elite plan: the limit has increased to $1,000. Preventative dental services have been introduced on the UltraCare Comprehensive plan. This covers checkups to include scraping, cleaning and polishing only, with a limit of $100. The benefit limit for preventative dental services has also increased to $200 on the UltraCare Elite plan. Cover for one sight examination and one hearing examination has been introduced on the UltraCare Elite plan with a limit of $100. Organ transplants benefit section 15 The benefit limits have increased on all of our plans as follows: UltraCare plans: the limit has increased to $500,000. UltraCare International Schools plans: the limit has increased to $500,000. Maternity care UltraCare International Schools only benefit section 17 The shared benefit limits for birth defects and congenital abnormalities for newborns have increased on the following plans: UltraCare International Schools Bronze plan: the limit has increased to $35,000. UltraCare International Schools Silver plan: the limit has increased to $35,000. The standard and voluntary excess amounts now apply to congenital abnormalities for newborns, benefit section The benefit limit for birth defects for newborns is no longer shared with congenital abnormalities for newborns on the UltraCare International Schools Gold plan, and the limit has increased to $35,000. Congenital abnormalities for newborns are no longer covered in this benefit section on the UltraCare International Schools Gold plan, instead all eligible treatment is covered under the new congenital abnormalities benefit. See the updates for benefit section 9 for details. Hormone replacement therapy UltraCare benefit section 17 and UltraCare International Schools benefit section 18 This benefit has been removed from the UltraCare Standard and Select plans and the UltraCare International Schools Bronze plan. The benefit limits have increased on the following plans: UltraCare Comprehensive plan: the limit has increased to $500. UltraCare Elite plan: the limit has increased to $500. UltraCare International Schools Silver plan: the limit has increased to $260. $500. 3

4 Hospital cash UltraCare benefit section 18 and UltraCare International Schools benefit section 19 This benefit limit has increased to $450 each night on all UltraCare and UltraCare International Schools plans. Compassionate emergency visit UltraCare benefit section 19 and UltraCare International Schools benefit section 20 This benefit has been removed from the UltraCare Select plan. The benefit wording has been updated to the following: Costs you have to pay for an economy class return travel ticket from a country within your area of cover to visit a close family member if their medical condition is critical, or for you to attend their burial or cremation following their death. You are limited to one return journey in each plan year. Mortal remains UltraCare International Schools benefit section 21 This benefit has increased to Paid in full on all plans. Emergency treatment outside area of cover UltraCare benefit section 21 and UltraCare International Schools benefit section 22 The benefit limits have increased on the following plans: UltraCare Select plan: the limit has increased to $40,000. UltraCare Comprehensive plan: the limit has increased to $70,000. UltraCare Elite plan: the limit has increased to $100,000. UltraCare International Schools Silver plan: the limit has increased to $70,000. $100,000. Deductibles UltraCare benefit section 22 The standard out-patient excess has increased to $45.00 for each medical condition in each plan year on the UltraCare Standard, Select and Comprehensive plans. Voluntary excess options are now available on the UltraCare Elite plan. Changes to the Table of benefits for add-on plans Maternity add-on plan UltraCare only The congenital abnormalities benefit for newborns is no longer included in this add-on plan, instead all eligible treatment is covered under the new congenital abnormalities benefit in the UltraCare Comprehensive and Elite plans. See the updates for UltraCare plan benefit section 9 for details. Birth defects for newborns continue to be included in the Maternity add-on plan as follows: Area 2: a limit of $34,000. Area 3: a limit of $51,000. Travel add-on plan Benefit section F - to make it clear which items are covered up to the maximum amount of $510 in total, this section now refers to the new valuables definition in the Plan guide. See the Definitions section in the Plan guide for more information. Full medical underwriting We are pleased to announce that Full Medical Underwriting (FMU) terms are now available on UltraCare International Schools plans. These terms continue to be available on UltraCare plans. Information about FMU underwriting terms can be found in the Plan guide. UltraCare and UltraCare International Schools Plan guides Unless otherwise stated: all updates apply to both UltraCare and UltraCare International Schools 2014 Plan guides; and all references to 2013 Plan guides are in respect of the UltraCare, UltraCare FMU and International Schools 2013 Plan guides collectively. Adding or removing dependants For ease of reading, we have now split this section into two parts: Adding dependants; and Removing dependants. General conditions and benefit conditions We have rearranged the order of the general conditions and benefit conditions so that they are grouped together in a more consistent format. To reflect the revised order, the majority of the general conditions and benefit conditions have been given new GC and BC references. We have also added, changed and removed some general conditions, and added, updated and changed some benefit conditions. The following general condition has been added: General condition GC9 GC9 If an eligible claim is submitted at any time and it relates to a plan year for which a no-claims discount was previously given, the no-claims discount amount must be returned before your claim can be paid. The following general conditions have been changed: General condition GC12 (was BC12) has been changed to say: GC12 We will not return the original claim documents to you after payment has been made to you or the provider. General condition GC15 (was BC5) has been changed to say: GC15 If your area of cover is Area 3 and you are a citizen of the USA, we will cancel your cover if you have spent more than 180 continuous days in the USA in any one plan year. The following general condition has been removed: General condition GC18 The following benefit condition has been added: Benefit condition BC8 BC8 If you move to a plan where a lifetime limit applies to a benefit, any amount previously paid under the same, or equivalent benefit: on any one or more plans; regardless of any previous benefit limit; and whether or not there has been a break in your cover; will be deducted from the current lifetime limit on the benefit. The following benefit conditions have been updated: 4 Benefit condition BC2 BC2 You or your personal representative must request pre-authorisation

5 Updates for any in-patient treatment, daycare treatment, medical evacuation, compassionate emergency visit, or preparation or transportation of your body or mortal remains, before it takes place. Once you or your personal representative have received our approval, we will settle all covered costs directly with the providers. If you or your personal representative do not receive our approval before it takes place, we will only approve the costs we would have negotiated if we had been involved and given our approval. Benefit condition BC5 (was BC4. Not included in the 2013 UltraCare FMU Plan guide) BC5 If we have not been given details of your medical practitioner on your application and a claim is made that we believe is for a pre-existing medical condition: we will reject the claim if your underwriting terms are moratorium or CPME previously moratorium; we will reject the claim if your underwriting terms are FMU or CPME previously FMU and you did not tell us about the medical condition when we asked about it on the application, or we have not accepted it. This benefit condition does not apply if your underwriting terms are MHD. The following benefit conditions have been changed: Benefit conditions BC11 and BC14 (BC4 and BC11 in the 2013 UltraCare FMU Plan guide) have merged to become benefit condition BC10 BC10 Complementary treatment must be referred by a medical practitioner or specialist. If more than four osteopathic, chiropractic, homeopathic, podiatry, Chinese traditional medicine or acupuncture sessions are needed for any medical condition, your therapist must provide the reasons in the Claim form so we can consider cover. Benefit exclusions The following benefit exclusions have been added: Benefit exclusion BE2 (was BE1 in the 2013 UltraCare FMU Plan guide) BE2 (This benefit exclusion applies if your underwriting terms are FMU or CPME previously FMU, as shown on your Certificate of insurance. See benefit exclusion BE1 if your underwriting terms are moratorium or CPME previously moratorium, as benefit exclusion BE2 does not apply to these underwriting terms. Benefit exclusions BE1 and BE2 do not apply if your underwriting terms are MHD.) A medical condition or symptom that you were aware of before your start date unless we were given all the information we asked for in the application and we have not specifically excluded the medical condition or symptom as shown on your Certificate of insurance. Benefit exclusion BE5 BE5 A benefit not included on your plan at the time the costs are incurred, even if the benefit was included in any previous plan year. The following benefit exclusion has been updated: Benefit exclusion BE31 (was BE29) BE31 Developmental disorders of the brain, learning disorders, learning difficulties, speech problems and voice problems. The following benefit exclusion has been changed: Benefit exclusions BE44 and BE45 have merged to become benefit exclusion BE46 BE46 Any costs relating to in-patient, daycare or out-patient treatment in a hospital: received at the time of your start date; or that you were aware of at your start date; whether the treatment was planned or not, unless you have told us about it and we have accepted it. The following benefit exclusion has been moved: Benefit exclusion BE56 (was BEM3 in the 2013 UltraCare Plan guide and BEM4 in the 2013 UltraCare FMU Plan guide) has moved from the add-on plan section BE56 Treatment of birthmarks. Maternity add-on plan benefit conditions and benefit exclusions UltraCare Plan guide only The following benefit conditions have been removed: Benefit condition BCM1, as this is now incorporated in the Individual eligibility section. Benefit condition BCM3 from the 2013 UltraCare FMU Plan guide, as benefit condition BC5 applies. The following benefit exclusions have been removed: Benefit exclusion BEM1 from the 2013 UltraCare FMU Plan guide, as benefit exclusion BE1 applies. Benefit exclusion BEM1 (BEM2 in the 2013 UltraCare FMU Plan guide), as benefit exclusion BE6 applies. Benefit exclusion BEM2 (BEM3 in the 2013 UltraCare FMU Plan guide). Benefit exclusion BEM3 (BEM4 in the 2013 UltraCare FMU Plan guide), as benefit exclusion BE56 applies. Personal accident add-on plan benefit conditions and benefit exclusions The following benefit conditions have been removed: Benefit condition BCPA12, as this is now incorporated in the eligibility sections. Benefit condition BCPA13 from the 2013 UltraCare FMU Plan guide. The following has been updated: The Personal accident add-on plan benefit exclusion references have been updated to exclude claims for, arising from or connected with the benefit exclusions, BE3 to BE4, BE11 to BE14, BE23 to BE27, BE29, BE43, BE44, BE47, BE52 and BE53 listed in the Benefit exclusions section in addition to benefit exclusions BEPA1, BEPA2 and BEPA3. Travel add-on plan benefit conditions and benefit exclusions The following benefit condition has been added: Benefit condition BCT11 BCT11 When making a claim because your transport was hijacked you must provide us with a police report giving the details. The following benefit conditions have been updated: Benefit condition BCT4 (was BET34, BET35 in the 2013 UltraCare FMU Plan guide) BCT4 Any loss of, or damage to, an item or items when in the custody of an airline or other carrier: must be reported to the airline or other carrier immediately upon discovering the loss or damage; and must be supported by a written report from the airline or other carrier. 5

6 Benefit condition BCT5 (was BET39, BET40 in the 2013 UltraCare FMU Plan guide) BCT5 Any theft, suspected theft or loss must be reported to the local police within 24 hours of discovery and supported by a police report. The following benefit conditions have been removed: Benefit condition BCT3 Benefit condition BCT10 from the 2013 UltraCare FMU Plan guide The following benefit exclusions have been updated: Benefit exclusion BET2 (was BET3 in the 2013 UltraCare FMU Plan guide) BET2 A medical condition that: clearly showed itself; you had signs or symptoms of; you asked for advice about; you received treatment for; to the best of your knowledge, you were aware you had; within the 24-month period before: the date of booking a trip; or your date of joining as shown on your Certificate of insurance; whichever is later. Benefit exclusion BET5 (was BET18, BET29 in the 2013 UltraCare FMU Plan guide) BET5 Leaving your baggage: with a person you have not previously met; in a public place where it can be taken without your knowledge; or at a distance from which you cannot prevent it from being taken. The following have been updated: The benefit exclusion references for Section A of the Travel add-on plan have been updated to exclude claims for, arising from or connected with benefit exclusions BE3 to BE5, BE9 to BE27, BE29 to BE45, BE47 to BE53 and BE56 listed in the Benefit exclusions section in addition to benefit exclusions BET1 to BET35. The benefit exclusion references for Sections B to I of the Travel add-on plan have been updated to exclude claims for, arising from or connected with benefit exclusions BE3 to BE5, BE11 to BE17, BE22 to BE35, BE37, BE39, BE43 to BE49, BE52, BE53, BE56, BET2 in addition to benefit exclusions BET5 to BET19. Some of the benefit exclusions now apply to different benefit sections. Section A: No changes. The following benefit exclusions now apply to benefit sections B to I: BET5 (was BET18, BET28 in the 2013 International Schools Plan guide and BET29 in the 2013 UltraCare FMU Plan guide). BET7 (was BET26, BET25 in the 2013 International Schools Plan guide). BET8 (was BET27, BET26 in the 2013 International Schools Plan guide). BET9 (was BET20, BET19 in the 2013 International Schools Plan guide). BET10 (was BET21, BET20 in the 2013 International Schools Plan guide). BET13 (was BET38, BET39 in the 2013 UltraCare FMU Plan guide). BET18 (was BET19, BET18 in the 2013 International Schools Plan guide). Sections B, D, G and H: BET20 (was BET11, BET12 in the 2013 UltraCare FMU Plan guide). BET21 (was BET12, BET13 in the 2013 UltraCare FMU Plan guide). 6 Sections F, G, H and I: BET26 (was BET15, BET16 in the 2013 UltraCare FMU Plan guide). The following benefit exclusions have been removed: Benefit exclusion BET1 from the 2013 UltraCare FMU Plan guide. Benefit exclusion BET6 (BET7 in the 2013 UltraCare FMU Plan guide). Benefit exclusion BET16 (BET17 in the 2013 UltraCare FMU Plan guide). Benefit exclusion BET25. Definitions The following plan definitions have been added: Card Visa debit, Visa credit or MasterCard. CPME previously FMU continuation of your full medical underwriting terms with a previous insurer. You will not be subject to any new personal underwriting terms. Cover will still be governed by the benefits, terms and conditions of your plan with us, including benefit exclusion BE2. Benefit exclusion BE1 will not apply. CPME previously moratorium continuation of your moratorium start date if you had moratorium underwriting terms with a previous insurer. You will not be subject to any new personal underwriting terms. Cover will still be governed by the benefits, terms and conditions of your plan with us, including benefit exclusion BE1. Benefit exclusion BE2 will not apply. Deductibles any co-insurance or excess that applies to your plan. Inherited a medical condition which is hereditary. Lifetime limit the total amount that will be paid for any eligible costs incurred during any time you are covered on any one or more plans with the same, or equivalent benefit, even if there is a break in your cover. See benefit condition BC8 for more information. UltraCare plan the healthcare plan. Valuables photographic, audio, video, computer or electrical equipment of any kind, mobile phones, glasses, sunglasses, binoculars, telescopes, musical instruments, antiques, fine art, furs, leather goods, animal skins, watches, jewellery, and any items made of, or containing, gold, silver, precious metals, precious or semi-precious stones. The following plan definitions have been updated: Continuation of Personal Medical Exclusions continuation of the same underwriting terms, including any special exclusions, that applied to you with a previous insurer. The underwriting terms with us can be CPME previously moratorium or CPME previously FMU. You will not be subject to any new personal underwriting terms. Cover will still be governed by the benefits, terms and conditions of your plan with us. See the Transfers or Group member transfers section and the CPME previously moratorium and CPME previously FMU definitions in this Plan guide for more information. Excess the amount you must pay towards the cost of a covered claim as shown on your Table of benefits. The different types of excess are: Excess for each visit you must pay this excess for each consultation with a medical practitioner or specialist, no matter how many medical conditions are treated by them during one consultation. Excess for each medical condition this excess applies to each medical condition claimed in each plan year. For example, if you make four claims for two medical conditions, you must pay two excesses in the plan year. Excess for each member this excess applies to you once every plan year, no matter how many claims you make in each plan year. Excess for each claim you must pay this excess for each claim you make. Full Medical Underwriting the process that we use to assess your medical history and decide the special terms we offer you. Cover will still be governed by the benefits, terms and conditions of your plan with us except for benefit exclusion BE1.

7 Updates Moratorium a waiting period of 24 months from your date of joining, or the date shown on the special terms section of your Certificate of insurance, that must have passed before claims for pre-existing medical conditions or related medical conditions may be eligible under the UltraCare plan. See benefit exclusion BE1 for more information. The moratorium also applies to the Maternity add-on plan. Plan the contract between the planholder, you and us. Reasonable the average cost of treatment, expertise or services given by similar types of provider: within the same country or geographical region; and based on our experience and knowledge. Terminal the end stages of a medical condition where life expectancy is considered to be days or weeks and only palliative treatment is given. The following plan definitions have been removed: Cancer Consultant Hospice IPT Insurance premium tax Nursing at home Rehabilitation Unattended baggage 7

8 Policies are underwritten by Bahrain National Life Assurance BSC. All claims and claims related activity occurring outside of Bahrain will be administered by InterGlobal Limited. InterGlobal Limited is licensed to administer policies in Dubai Healthcare City. M017-89E