National Oilwell Varco member guide. Making the most of your private medical insurance. Effective from 1 April 2018.

Transcription

1 National Oilwell Varco member guide Making the most of your private medical insurance Effective from 1 April 2018 Extensive cover Our cancer pledge and support

2 Contents About your cover 4 MyAviva and your Aviva Digital GP 7 BacktoBetter 8 Mental health pathway 9 Making a claim 10 Talk to the experts 12 Cover guide 13 - What s covered 14 - Benefit for cancer treatment 16 - Benefit for treatment overseas 17 - What s not covered 18 Your questions answered 19 Use of personal information 20 Common terms 22 About Aviva Aviva is the largest insurer in the UK and provides 33 million customers with insurance, savings and investment products worldwide as well as expertise in administering private medical insurance and trust schemes. Your private medical insurance with Aviva provides you with the peace of mind that you ll receive prompt access to diagnostic tests and eligible medical treatment, should you need it. Along with your comprehensive healthcare cover, we also provide you with additional benefits to help you look after your health and wellbeing. 2

3 Welcome to your Aviva policy This member booklet contains information about your policy. Within these pages you ll find details about your cover, including your cover guide and contact information, should you need to make a claim. Please keep this information somewhere safe you may need it in the future, especially if you make a claim. A copy of the policy wording containing full details of the definitions, benefit terms, conditions and exclusions that apply to your cover is available upon request. If you ve any questions about your policy or want to make a claim, call the customer service helpline: :00am - 8:00pm Monday to Friday 8:00am - 1:00pm Saturday Calls to and from Aviva may be monitored and/or recorded. Did you know? You can ask a range of questions as well as start a claim or arrange a callback with the customer service helpline using MyAviva. See the 'MyAviva' section of this booklet for further information Aviva are proud winners of: Health Insurance Awards Health Insurance Company of the Year 2010, 2011, 2012, 2013, 2014, 2015, 2016 and 2017 Best Group Private Medical Insurance Provider 2010, 2011, 2012, 2013, 2014, 2015, 2016 and 2017 Best Customer Service 2012, 2013, 2016 and 2017 Most Innovative New Product - GuideWell 2014 Money Marketing Awards Company of the Year 2017 Cover Excellence Awards Best Group PMI Provider 2014 and 2015 Defaqto 5 Star Rating 5 Star rating for quality of cover by independent financial researcher Defaqto. Defaqto have given our Optimum product their highest rating, 5 Star, meaning that it is one of the most comprehensive products in its class within the private health insurance market Private Medical Insurance 3

4 About your cover About your cover Your policy is designed to cover acute symptoms and conditions. An acute condition is a disease, illness or injury that s likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery. Where to find your hospital list We offer a range of hospitals that are conveniently located and provide access to top-class facilities. Our hospital lists are updated frequently as we work to ensure we get the best possible service for our customers. National Oilwell Varco members are covered under Aviva s Key hospital list. We recommend you check your hospital list before you see your GP, so you know which hospitals you can be referred to. Details of the hospitals available to you under the terms of your healthcare policy are provided online at aviva.co.uk/hospital-lists. Alternatively you can call the customer service helpline to find out which hospitals are covered. Networks To help manage costs and drive consistent quality of care, we re developing a number of networks of facilities, specialists and other practitioners for specific conditions. If we have a network for your condition or suspected condition, we ll tell you where you can have your treatment which may not be at a hospital on your hospital list. We will only pay for that treatment if it is carried out within our networks. A list of the conditions or suspected conditions for which we have networks in place can be found at aviva.co.uk/health-network Your policy includes our BacktoBetter service and mental health pathway This means that if you need to claim for pain in the back, neck, muscles or joints (commonly referred to as musculoskeletal conditions) or need some support with your mental health, you don t need to see your GP. Call the customer service helpline and, providing it s an eligible claim, we ll facilitate contact with our independent clinical case management providers who will assess your symptoms and arrange the most appropriate treatment. Please see the 'BacktoBetter' and 'Mental health pathway' sections of this booklet for more information about these services. The claims process is explained in more detail in the Making a claim section of this booklet. Your policy excess An excess of 100 applies per person per policy year. Benefits will only be paid once the excess amount has been exceeded and this should be settled directly with the relevant provider, for example a hospital or specialist. The excess does not apply to treatment received through the mental health pathway or to physiotherapy for pain in the back, neck, muscles or joints (musculoskeletal conditions) managed by the BacktoBetter service. 4

5 About your cover Points to remember Claims for children Children aged 12 and older can use our BacktoBetter service and our mental health pathway without seeing their GP. Please see the 'BacktoBetter' and 'Mental health pathway' sections of this booklet for further information. Change of personal details Please advise your company immediately should any of your personal details change, e.g. address, name, etc. If you have family cover and wish to add new dependants, for example, a newborn baby, please notify your HR team as soon as possible. Income tax liability Under current UK tax rules, the contribution that s paid to us for your inclusion on the policy arises from your employment and is therefore a taxable benefit. Please contact your HR team if you require further information. If you leave your company If you leave your company, your membership of the policy will cease immediately, even if treatment was pre-authorised by Aviva. However, having been a member of a company policy, you re entitled to benefit from continued medical cover on an individual policy without further medical underwriting. Benefits, exclusions, terms and conditions on an individual policy may be different to those on this policy. If you d like to discuss this further, please contact our sales advice line on: (calls to and from Aviva may be monitored and/or recorded). To qualify for continued cover you need to apply within 45 days from the date your cover ceases. If more than 45 days elapse, you ll be required to complete a member health declaration which may affect your underwriting. Benefits outside the UK Your healthcare policy provides benefit for treatment in the United Kingdom with only limited cover for emergency treatment overseas (more detail is available in the Benefit for treatment overseas section). If you need to travel outside of the United Kingdom, you should consider taking out a travel insurance policy. Member offers Did you know that because your company provides medical benefit through Aviva, you could save on your first year s home, car and annual travel insurance when you buy direct from Aviva? To find out more about car, home and travel insurance visit aviva.co.uk/healthy-discount 5

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7 MyAviva and your Aviva Digital GP Welcome to MyAviva MyAviva brings together the products that help our customers protect their life, health, loved ones, future and possessions in one secure and simple-to-use online place. There s a whole host of benefits available at your fingertips: view details of your policies online, including cover and benefit information track any policy excess and out-patient benefit - helping you stay in control start a claim online, update an existing claim, or arrange a callback to speak to us get access to frequently asked questions, helpful guidance and contact information when you need it most enjoy discounts on a range of Aviva products and services. Log in to MyAviva today at aviva.co.uk/myaviva - safe, secure and tailored to use on all devices. Your Aviva Digital GP Everyone needs to see a doctor at some point. You can arrange a video consultation with a GP from the comfort of your own home, or work, at a time that s convenient to you. With Aviva Digital GP, you ll have the reassurance that you can access a network of over 1,000 NHS qualified GPs at the touch of the button. prompt access to a GP 24/7, 365 days of the year. With the ability to book a video consultation with a GP within seconds comprehensive pharmacy network offering convenient access to a next-day private medicine delivery service (2-4 hours in central London). Top-up medicines can also be ordered qualified GPs provide an online chat service, giving peace of mind that questions will be answered directly by a qualified medical professional choose whether your consultations are with a male or female GP. The network also includes GPs conversant in 12 different languages - giving you more choice continuity of support by enabling you to book the same GP for consultations, helping you build a long-term relationship get FREE access for your policy year, which includes up to 7 FREE GP consultations. Aviva Digital GP is powered by Now Healthcare Group. Sign up is subject to the terms & conditions of the Aviva Digital GP service which can be found at drnow.co.uk/avivatandc.htm Download now and register using the code: NOVDGP 7

8 BacktoBetter BacktoBetter We know that back, neck, muscle and joint pain (otherwise known as musculoskeletal pain) can stop you in your tracks and prevent you from enjoying life to the full. BacktoBetter is Aviva s independent clinical case management service for musculoskeletal conditions. It gives you access to a clinical case manager who will help guide you down the right treatment pathway. There s no need to see a GP, just call the customer service helpline to access BacktoBetter. Members aged 11 and under will need to get a GP referral before contacting the customer service helpline. Telephone clinical assessment This is an in depth assessment of your symptoms and medical history by a clinical case manager from one of our carefully selected independent clinical providers, to determine the most appropriate treatment pathway for you. The assessment will include questions about the nature and duration of your symptoms, the impact they are having on your daily activities, and the presence of any serious symptoms which require emergency treatment. Providing advice and support If you need face-to-face physiotherapy or to be seen by a specialist, you ll be referred to an appropriate facility or clinic close to your work or your home. Even if you don t need a course of treatment after your assessment, a clinical case manager will ensure that you have all the tools to manage your recovery yourself, including a detailed exercise and advice programme. You ll receive follow up calls from a clinical case manager to ensure that your recovery remains on track and that you have the support you need. The benefits of BacktoBetter BacktoBetter offers quick access to a telephone clinical assessment with one of our carefully selected clinical providers, who can help you deal with the pain of a musculoskeletal injury Getting you the right treatment at the right time, which can lead to a faster recovery There s no need to see a GP, and that means less time to wait before accessing treatment and/or advice It s an end-to-end service that delivers best clinical practice no matter how complicated the problem Remember: There s no need to see a GP first Your excess won t apply to physiotherapy provided through the BacktoBetter service. The excess will apply at the point you need to see a specialist. 8

9 Mental health pathway Mental health pathway As we're all unique, with individual needs, we believe that mental health treatment should be tailored to your personal requirements. That's why we ve introduced a clinical, results-driven approach to mental health treatment. Our innovative mental health pathway enables us to tailor the support you receive - ensuring that your treatment is guided by clinical need. Members aged 11 and under will need to get a GP referral before contacting the customer service helpline. Telephone clinical assessment If you want some support with your mental health, call the customer service helpline in the first instance you don t need to see your GP. If your claim is eligible, our claims team will facilitate contact with our independent case management provider for a clinical assessment. The pathway provides a detailed clinical assessment with a mental health practitioner, before making recommendations on the most appropriate treatment for you. Your bespoke treatment plan Following your clinical assessment, the dedicated case manager will arrange the most appropriate treatment. This could be online Cognitive Behavioural Therapy, remote (telephone or video link) or face-to-face talking therapies, or psychiatrist assessment. Where clinically appropriate, they can offer a relapse prevention programme, giving you access to up to 12 months online self-help support. The benefits of the mental health pathway Offers quick access to a telephone clinical assessment with our carefully selected clinical provider Getting you the right treatment at the right time, which can lead to a faster recovery There s no need to see a GP, and that means less time to wait before accessing treatment and/or advice It s an end-to-end service based on clinical need; guided by clinical expertise and insight Remember: There s no need to see a GP first Your excess won t apply to any treatment provided through the mental health pathway. 9

10 Making a claim Making a claim BacktoBetter for musculoskeletal claims The following outlines how a claim for a musculoskeletal condition works in three simple steps: 1 Step 1 If you re unwell with any back, neck, muscle or joint pain The BacktoBetter service is your first port of call with no need to contact your GP. Just call the customer service helpline. If you ve already seen your GP, you can move to step 2 of the standard claim process overleaf, if: your GP has recommended osteopathy or chiropractic treatment, or your condition does not relate to your back or neck (spine), and your GP has recommended radiology, pathology, or referral to a specialist. Otherwise you must continue to follow the BacktoBetter pathway. Mental health pathway The following outlines how a claim for a mental health condition works in three simple steps: 1 Step 1 If you need some support for your mental health If you re worried about your mental wellbeing, our clinical case management approach can help. There s no need to contact your GP, just call the customer service helpline. If you've seen your GP, you must still follow the mental health pathway to access assessment and treatment covered by your policy. 2 Step 2 Calling the customer service helpline Calls to and from Aviva may be monitored and/or recorded. Please have the following information to hand when you call: your policy number 961BCX to help us to confirm your identity details of your symptoms and when they started. One of our advisers will assess your claim and if eligible, arrange for a clinical case manager from one of the independent clinical providers to contact you at a convenient time to assess your symptoms. In some instances we may require more information before confirming cover but we ll talk this through with you when you call. 2 Step 2 Calling the customer service helpline Calls to and from Aviva may be monitored and/or recorded. Please have the following information to hand when you call: your policy number 961BCX to help us to confirm your identity details of your symptoms and when they started. One of our advisers will transfer you to our independent clinical provider, where a therapist will conduct a thorough assessment with you. Or, if you prefer, we can arrange a suitable time to call you back. 3 Step 3 Telephone clinical assessment Using evidence-based medical guidelines, a clinical case manager will conduct a thorough assessment of your problem and recommend the most effective course of treatment. If clinically appropriate, this will include being referred to an approved physiotherapist from one of the clinical providers networks for treatment within two working days and/or onward referral to a specialist. The clinical case manager will provide advice to help you manage symptoms and pain, how best to remain active with a tailored home exercise programme and will continue to monitor your progress throughout your claim. 3 Step 3 Telephone clinical assessment From a range of treatment options, the therapist will agree what s the most appropriate help for you, these options include: self-directed online services remote therapy (telephone or video link) face-to-face treatment further assessment by a psychiatrist, if clinically necessary. All treatment is led by experienced mental health therapists working in conjunction with our independent clinical provider. At the end of treatment you ll be provided with a plan to help manage your symptoms in the longer term. 10

11 Making a claim For all other claims For any other symptoms, you ll need to follow the standard claims process: 1 Step 1 Consult your GP If you feel unwell, go and see your GP in the usual way. If your GP recommends you need to see a specialist for further assessment or treatment, they ll give you a referral. This may either be: a named referral - where the GP recommends a particular specialist and/or hospital an open referral - where the GP just states which type of specialist you need to see or the type of treatment you need, without stating a specialist s name or hospital. If you have a named referral, you ll need to ring us to confirm whether the specialist is recognised by us and whether they work out of a hospital on your list. If you have an open referral, the customer service team can help to find a specialist in your area who works out of a hospital on your list. All claims have to be authorised in advance by Aviva. Payment of bills All eligible bills will be settled by us directly with the treatment provider. If you do receive a bill for your treatment, please send us a copy together with your policy number, so that we can arrange payment. Please send this to: Bill Payment Team Aviva Health UK Limited Chilworth House Hampshire Corporate Park Templars Way Eastleigh Hampshire SO53 3RY We ll contact you to advise if you need to pay any part of the bills for example, your 100 excess. 2 Step 2 Calling the customer service helpline Calls to and from Aviva may be monitored and/or recorded. Please have the following information to hand when you call: your policy number 961BCX to help us to confirm your identity medical specialism and sub-specialism of the specialist you need to see details of your condition, including symptoms, dates and diagnosis if known. If we have a network for your condition or suspected condition, we'll tell you where you can have your treatment. This may or may not be at a hospital included on your hospital list. If we don't have a network in place: if you ve been given a named referral, we ll check to make sure the specialist is recognised by us, and works within Aviva s fee guidelines, if it s an open referral, we ll use our specialist finder database to select an appropriate specialist and/or hospital. To view our fee guidelines for specialists visit aviva.co.uk/pmifees Where possible we'll let you know whether your claim is authorised, there and then over the phone. The more information you're able to give us at this point, the easier it'll be for us to make the decision. 3 Step 3 Diagnosis, treatment or surgery If your specialist recommends hospital treatment please ask for a description of the treatment and a procedure code, if there is one. Once you ve called us again with these details, we can confirm whether or not your treatment is covered. Once you ve called us with this code, we can confirm whether or not your treatment is covered. If we have a network in place, we will also confirm at which facility you can receive treatment. If we do not have a network in place, we will confirm if your recommended hospital is recognised by us. If you don t contact the customer service helpline and you continue with any recommended diagnostics or treatment, you may have to pay the costs for these services yourself if they re not covered by your healthcare policy. To make the process as quick and easy as possible, most claims will be telephone assessed by our experienced claims advisers. This means we can take all the necessary medical information from you over the telephone to assess your claim and no claim form will be required (some situations will require more information from your specialist or GP). Private Healthcare Information Network You can find independent information about the quality and cost of private treatment available from doctors and hospitals from the Private Healthcare Information Network: phin.org.uk Please call us so that we can confirm: the details of your membership the treatment you require is eligible under the terms of your policy if we have a network in place for your condition or suspected condition if there are any limits that apply to your benefit which you should be aware of for symptoms requiring GP referral, that your recommended specialist and hospital are recognised by us. 11

12 Talk to the experts Talk to the experts Just a simple call away We know that sometimes you just can t get to see your doctor, the waiting list is too long or you re not sure whether or not to bother them with your symptoms. When this is the case, don t spend your time worrying just call the 24 hour GP helpline on and you ll be put through to a qualified GP. Or if you just want some general healthcare information like what sort of jabs you ll need before going on holiday then you can always talk to one of the trained nurses. If you re a little stressed and just want someone to talk to, whatever the reason, just call the stress counselling helpline on It doesn t matter what s on your mind work issues, relationships, social strains, bereavement, money worries, anything at all. Experienced counsellors are there for you 24 hours a day, 7 days a week. The stress counselling helpline is available to members aged 16 and over. Calls to the GP helpline may be recorded for quality and training purposes. 24 hour GP helpline Call us on Calls to the GP helpline may be recorded for quality and training purposes. 24 hour stress counselling helpline Call us on Calls to the stress counselling helpline are available for members aged 16 and over. 12

13 Cover guide Cover guide Private medical insurance from Aviva This cover guide has been designed to provide you with the key information about your policy, and it s important that you read this section. The cover guide doesn t, however, contain the full terms, conditions, benefits and exclusions that apply to your policy. These are contained in the policy wording, a copy of which is available on request. 13

14 Cover guide What s covered What s covered summary Benefit limits shown below apply per member per policy year and all treatment must be on referral by, and under the care of, a specialist unless otherwise stated. Members of the policy have their medical history disregarded which means that any pre-existing conditions you have will be covered providing they fall within the terms and conditions of the policy. See the Making a claim section for full details of the claims process. In-patient or day-patient treatment of acute conditions at a facility recognised by us as part of a network, a hospital on your list or an NHS hospital recognised by us for your treatment or condition Hospital accommodation charges Prescribed medicines, drugs and dressings Operating theatre fees Nursing care including intensive/high dependency care Specialists fees including surgeons, anaesthetists and physicians fees (subject to Aviva s fee guidelines for specialists) Radiotherapy and chemotherapy Diagnostic tests including blood tests, X-rays, scans and ECG s. Out-patient treatment of acute conditions Consultations with a fee approved specialist Treatment by a specialist as an out-patient (subject to Aviva s fee guidelines for specialists) CT, MRI and PET scans at a diagnostic centre recognised by us Radiotherapy and chemotherapy Diagnostic tests for example X-rays, blood tests and ECG s. Mental health benefits at a hospital or clinic within the clinical provider's network consisting of: In-patient and day-patient psychiatric treatment up to 28 days Out-patient treatment by a psychiatric specialist or psychiatric therapist There s no need to see your GP to claim for a mental health condition. All you need to do is call us and we ll refer you through the mental health pathway. BacktoBetter In-patient, day-patient or out-patient treatment of acute musculoskeletal conditions, at a hospital or clinic within the clinical providers networks There s no need to see your GP to claim for these conditions. All you need to do is call us and we ll arrange the most appropriate treatment for your condition, managed through the BacktoBetter service. 14

15 Cover guide What s covered What are musculoskeletal conditions? Musculoskeletal conditions are any conditions relating to back, neck, muscle or joint pain, also commonly referred to as orthopaedic conditions. For mental health symptoms, you'll need to use the mental health pathway. You'll receive a detailed clinical assessment by a mental health practitioner who will be able to guide you down the most appropriate treatment pathway. Additional benefits Nursing at home immediately following eligible in-patient or day-patient treatment Private ambulance where medically necessary for transportation to the nearest available hospital for the purpose of eligible treatment Parent accommodation costs when staying with a child of 11 or under receiving eligible treatment; one parent only Minor surgery by a GP up to 70 per procedure; payable to the GP Hospice donation of 70 per day up to 10 days maximum Cash benefit of 100 per night where eligible treatment as an NHS in-patient takes place without charge. Maximum of 35 nights. NHS cash benefit is not available for the first three nights following an accident or emergency admission, psychiatric treatment, cancer treatment (please see the Benefit for cancer treatment section) or if you claim for the cost of an NHS amenity bed for the same treatment Treatment for complications of pregnancy and childbirth as detailed in the policy wording. See the Common terms section for further information Investigations into the causes of infertility Hospitals If we don't have a network for the treatment you need, you can access any hospital on Aviva's Key list. You can see which hospitals are in your area by downloading the hospital list from: aviva.co.uk/hospital-list NHS amenity beds If you receive treatment as an NHS in-patient or day-patient whilst occupying an NHS amenity bed (a bed paid for by you in a single room or side ward in an NHS hospital where you receive NHS in-patient or day-patient treatment), and that treatment would have been covered by the policy if you had chosen to receive it as a private patient, we ll reimburse you for the cost of the amenity bed. Excess A 100 excess applies per member per policy year. Benefits will only be paid once the excess amount has been exceeded and this should be settled directly with the relevant provider, for example a hospital or specialist. The excess does not apply to treatment received through the mental health pathway or to physiotherapy for pain in the back, neck, muscles or joints (musculoskeletal conditions) managed by the BacktoBetter service. Surgical procedures on the teeth performed in a hospital. This is a summary of the policy benefits. Full details of standard cover and exclusions are given in the policy wording, a copy of which is available upon request. 15

16 Cover guide Benefit for cancer treatment Benefit for cancer treatment Extensive cover Our cancer pledge and support We understand the importance of providing extensive cover and support at every stage of your cancer treatment. Our cancer pledge means we ll cover the cancer treatment and palliative care you need, as recommended by your specialist. We also want to make things as comfortable as possible for you following your cancer treatment, so we ll provide extensive cover for your aftercare, including consultations with a dietician, as well as money towards prostheses and a wig. What s covered Hospital charges for surgery and medical admissions at a hospital recognised by Aviva. If your treatment (whether as an in-patient, day-patient or out-patient) is for a condition or suspected condition for which we have a network, we ll only pay for that treatment if it is carried out at a facility and/or under the care of a specialist (or other practitioner) recognised by us as part of that network Specialists fees (subject to Aviva's fee guidelines for specialists') NHS cancer cash benefit. This is payable where eligible treatment as an NHS patient takes place for cancer without charge We ll pay 100 for each day you receive treatment - as an in-patient - as a day-patient We ll pay 100 for each day you - receive out-patient radiotherapy or chemotherapy - undergo out-patient surgical procedures We ll also pay 100 for - each day you receive intravenous (IV) chemotherapy at home - each week whilst you are taking oral chemotherapy drugs at home You won t be able to claim more than 100 in any one day, but there s no limit on the amount of days you can claim NHS cancer cash benefit isn t available for psychiatric treatment or if you claim for the cost of an NHS amenity bed for the same treatment We may need to contact your GP or specialist for details of your treatment before we can pay your claim We may also ask for the discharge summary from the hospital Post surgery services - includes specialist services immediately following surgery such as consultations with a dietician or stoma nurse, and insertion and replacement of a tube for artificial feeding 16 Radiotherapy and chemotherapy, including targeted drug therapies for cancer. Hormone therapy is only covered if you need it to shrink a tumour before surgery or radiotherapy Bone strengthening drugs (such as bisphosphonates) that are being used to treat metastatic bone disease Treatment prescribed by your specialist for side effects while you are receiving chemotherapy or radiotherapy Stem cell and bone marrow transplants. This includes collection, storage and implantation Monitoring for up to ten years after your treatment for cancer has finished. We don t pay for monitoring after treatment for non-melanoma skin cancer Up to 100 towards a wig if you suffer hair loss caused by cancer treatment. We ll pay 100 in total whilst you are a member of the policy, not per policy year Up to 5,000 towards the cost of the first external prosthesis following an amputation for cancer Ongoing needs, such as regular replacement of tubes or drains, for up to five years after your treatment for cancer has finished Preventative surgery, only if you ve already had treatment for cancer that we ve paid for. For example, we ll pay for a mastectomy to a healthy breast in the event that you have been diagnosed with cancer in the other breast. (We won t pay for surgery where you have no symptoms of cancer, for example where you have a strong family history of cancer) End of life care: - we ll pay for end of life care in a hospital if this is medically necessary - hospice donation of 100 per night, up to 10,000 if you re admitted to a hospice - donation of 50 per day to a registered charity if you re visited at home by one of their nurses, up to 10,000.

17 Cover guide Benefit for treatment overseas Guide to limited emergency overseas cover Your healthcare policy includes an overseas benefit which is available for the first 90 days spent overseas on a temporary basis in any one policy year. The 90 days are accrued on a cumulative basis. If you are outside the UK for more than 90 days during any policy year there is no cover under the limited emergency overseas benefit. Cover is restricted to the treatment of emergency conditions serious enough to require immediate admission to hospital as an in-patient or day-patient. The medical emergency must arise incidental to the intended purpose of the visit. In the event that the country of incident doesn t have adequate facilities to treat the condition, Aviva will evacuate the patient only, to the nearest available facility, which may not be the UK. After release from hospital following evacuation, Aviva will meet the cost of the journey either to the country evacuated from, or the UK, if this is of comparable cost. Cover doesn t extend to costs incurred on behalf of any person who accompanies the patient. This is a summary of the overseas benefit available under your corporate healthcare policy. Full details are given in the policy wording. Assistance company services We have an emergency assistance provider who deals with all aspects of overseas claims. Before you travel you should give your policy number and the emergency assistance provider s telephone number to a family member or a travelling companion who can contact them on your behalf should you become involved in an emergency and be unable to contact them directly. The telephone number is: +44 (0) Calls may be monitored and/or recorded. In an emergency members should go immediately to the nearest physician or hospital without delay, then contact the emergency assistance provider. The overseas emergency assistance provider is available 24 hours a day. When you call, please give them your name, policy number and brief description of the problem. Please note this is not travel insurance and cover is restricted to the treatment of emergency conditions that are serious enough to need an immediate admission to hospital as an in-patient or day-patient. The medical emergency must arise incidental to the intended purpose of the visit. If you feel this level of cover is not appropriate for you or that you may need more cover, you should consider taking out a travel insurance policy. You may also want to consider the European Health Insurance Card (EHIC) scheme which allows you to benefit from the reciprocal health arrangements when travelling to countries covered by the EHIC scheme. Application forms can be obtained from the post office or online and should be completed and validated before you travel. You should take steps to use these arrangements where possible. 17

18 Cover guide What s not covered What s not covered summary There are some things which aren t covered by your policy so it s important you speak to the customer service helpline before receiving any treatment. Some examples of what isn t covered by the policy include: Long term or chronic conditions. This exclusion does not apply to treatment for cancer Treatment undertaken by a specialist without GP referral (except through BacktoBetter or the mental health pathway) Any musculoskeletal or mental health treatment that has not been pre-authorised by us Seeing a GP privately Prescription charges Charges by a GP, medical practitioner or specialist for completion of a claim form unless the claim is confirmed by us Take home drugs and dressings HIV/AIDS and related conditions Treatment received in a health hydro or similar establishment Cosmetic treatment (except following an accident or surgery for cancer) Routine medical examinations including eye tests and health screens etc. (If we ve paid for you to have treatment for cancer, the exclusion for routine medical examinations won t apply with regard to cancer) Professional sports injuries Convalescence Experimental treatment (limited benefit may be available - please contact us) Incidental hospital expenses such as newspapers and telephone calls Kidney dialysis Routine dental treatment Treatment for infertility Treatment for pregnancy or childbirth other than the complications specified in the policy wording. See the Common terms section for further information Overseas treatment other than as provided for in the limited emergency overseas benefit Surgical or medical appliances such as neurostimulators (e.g cochlear implants) and crutches Alcoholism, alcohol abuse, solvent abuse, drug abuse and other addictive conditions Treatment for psycho-geriatric conditions Treatment required as a result of war, terrorism, contamination by radioactivity, biological or chemical agents Varicose veins of the leg, unless they meet the criteria detailed in the policy wording. See the Common terms section for further information Sleep disorders and sleep problems, such as snoring and sleep apnoea Treatment for warts, verrucas and skin tags Weight loss surgery Treatment outside of a network (for any condition or suspected condition for which we have a network). This is a summary of the policy exclusions. Full details of standard cover and exclusions are given in the policy wording, a copy of which is available upon request. Chronic conditions explained A chronic condition is a disease, illness or injury which has one or more of the following characteristics: it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests it needs ongoing or long-term control or relief of symptoms it requires your rehabilitation or for you to be specially trained to cope with it it continues indefinitely it has no known cure it comes back or is likely to come back. Psychiatric cover explained For psychiatric treatment, we cover treatment that aims to lead to your full recovery. We don t cover: treatment that is given solely to alleviate symptoms, or chronic psychiatric conditions. We consider a psychiatric condition to be chronic if: it meets the definition of a chronic condition, or we ve paid for treatment for that condition or a related psychiatric condition during three separate policy years. This will apply even if the treatment was not in consecutive policy years. We don t cover treatment, including diagnostic tests to treat or assess learning difficulties or developmental or behavioural problems such as Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum disorders. 18

19 Cover Guide Your questions answered Your questions answered Making a claim Once a GP has recommended you see a specialist and provided you with a referral, all you need to do is call the customer service helpline on Calls may be monitored and/or recorded. Further details can be found in the Making a claim section of this booklet. Remember for pain in the back, neck, muscles or joints (musculoskeletal conditions) or for mental health symptoms, you don t need to see your GP. Providing your claim is eligible, you can use the BacktoBetter service or mental health pathway to start treatment as soon as possible - just call the customer service helpline on the number above. Can I use a hospital or facility not on the hospital list? If we don t have a network for your condition or suspected condition and you have treatment as an out-patient at a hospital not on your list, we ll pay in full. However, if you receive treatment as a day-patient or in-patient in a hospital that isn t included on your hospital list and recognised by us for the treatment you need, we ll calculate the average cost of equivalent treatment across all hospitals on your list, and that average cost is the maximum we ll pay. This could leave you with a shortfall that the scheme doesn t pay for. If the actual cost of the treatment is less than the average cost, we ll pay the hospital costs in full. We ll pay for specialists fees up to the limits in our fee schedule. To view our fee guidelines for specialists visit aviva.co.uk/pmifees The Financial Services Compensation Scheme (FSCS) We re covered by the FSCS. You may be entitled to compensation from the FSCS if we become insolvent and cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Where you re entitled to claim, insurance advising and arranging is covered for 90% of the claim, with no upper limit. Further information about compensation scheme arrangements is available from: Financial Services Compensation Scheme 10th Floor, Beaufort House 15 St Botolph Street London EC3A 7QU Website: fscs.org.uk Telephone: or If you have any cause for complaint Our aim is to provide a first class standard of service to our customers, and to do everything we can to ensure you re satisfied. However, if you ever feel we ve fallen short of this standard and you ve cause to make a complaint, please let us know. Our contact details are: Aviva Health UK Ltd Complaints Department PO Box 540 Eastleigh SO50 0ET Telephone: hcqs@aviva.com We ve every reason to believe that you ll be totally satisfied with your Aviva policy, and with our service. It s very rare that matters cannot be resolved amicably. However, if you re still unhappy with the outcome after we ve investigated it for you and you feel that there s additional information that should be considered, you should let us have that information as soon as possible so that we can review it. If you disagree with our response or if we ve not replied within eight weeks, you may be able to take your case to the Financial Ombudsman Service to investigate. Their contact details are: The Financial Ombudsman Service Exchange Tower London E14 9SR Telephone: or complaint.info@financial-ombudsman.org.uk Website: financial-ombudsman.org.uk The Financial Ombudsman Service will only consider your complaint if you ve given us the opportunity to resolve the matter first. Making a complaint to the Ombudsman won t affect your legal rights. Can I leave the policy? You ll only be entitled to leave the policy during the annual benefits window or following an appropriate lifestyle event. For more information please contact your HR team. 19

20 Use of personal information Use of personal information Personal Information We collect and use personal information about you so that we can provide cover for your company private medical insurance policy. This notice explains the most important aspects of how we use your information but you can get more information about the terms we use and view our full privacy policy at aviva.co.uk/privacypolicy or request a copy by writing to us at Aviva, Freepost, Mailing Exclusion Team, Unit 5, Wanlip Road Ind Est, Syston, Leicester, LE7 1PD The data controller(s) responsible for this personal information is Aviva Insurance Limited as the insurer of your company s policy. Additional controllers are Aviva Health UK Limited who administers the policy and your company s intermediary (if applicable), who are responsible for the sale and distribution of the policy and any applicable reinsurers. Personal information we collect and how we use it We will use your personal information: to provide you with the benefit of your company s insurance cover: we need this to decide if we can offer insurance and if so on what terms and also to administer the policy, handle any claims and manage any renewal; to support legitimate interests that we have as a business: we need this to manage arrangements we have with reinsurers, for the detection and prevention of fraud and to help us better understand our customers and improve our customer engagement (this includes marketing, customer analytics and profiling), to meet any applicable legal or regulatory obligations: we need this to meet compliance requirements with our regulators (e.g. Financial Conduct Authority), to comply with law enforcement and to manage legal claims; and to carry out other activities that are in the public interest: for example we may need to use personal information to carry out anti-money laundering checks. As well as collecting personal information about you, we may also use personal information about other people, for example your eligible dependants who you wish to benefit from your company s policy. If you are providing information about another person we expect you to ensure that they know you are doing so and are happy to have their information shared with us. You might find it helpful to show them this privacy notice and if they have any concerns please contact us in one of the ways described below. The personal information we collect and use will include name, address, date of birth, current state of health and any existing conditions of each person included in the application. If a claim is made we will also collect personal information about the claim from you and any relevant third parties. We recognise that information about health is particularly sensitive information. Where appropriate, we will ask for consent to collect and use this information. If we need your consent to use personal information, we will make this clear to you when you complete an application or submit a claim. If you give us consent to using personal information, you are free to withdraw this at any time by contacting us. Please note that if consent to use information is withdrawn we may not be able to continue to process your claims and we may need to cancel your benefit under the policy. Of course, you don t have to provide us with any personal information, but if you don t provide the information we need we may not be able to proceed with your application or any claim you make. Some of the information we collect may be provided to us by a third party. This may include information already held about you within the Aviva group, including details from previous quotes and claims, information we obtain from publicly available records, our trusted third parties and from industry databases, including fraud prevention agencies and databases. How we share your personal information with others We may share your personal information: with the Aviva group, our agents and third parties who provide services to us, your company s intermediary (if applicable) and other insurers (either directly or via those acting for the insurer such as loss adjusters or investigators) to help us administer our products and services; with clinicians, including hospitals, and third party case managers from whom you and others covered under the policy receive insured treatment or who manage your care or treatment pathway; 20

21 Use of personal information With regulatory bodies and law enforcement bodies, including the police, e.g. if we are required to do so to comply with a relevant legal or regulatory obligation; With other organisations including insurers, public bodies and the police (either directly or using shared databases) for fraud prevention and detection purposes; Some of the organisations we share information with may be located outside of the European Economic Area ( EEA ). We ll always take steps to ensure that any transfer of information outside of Europe is carefully managed to protect your privacy rights. For more information on this please see our Privacy Policy or contact us. How long we keep your personal information for We maintain a retention policy to ensure we only keep personal information for as long as we reasonably need it for the purposes explained in this notice. We need to keep information for the period necessary to administer your insurance and deal with claims and queries on the policy. We may also need to keep information after our relationship with you has ended, for example to ensure we have an accurate record in the event of any complaints or challenges, carry out relevant fraud checks, or where we are required to do so for legal, regulatory or tax purposes. Your rights You have various rights in relation to your personal information, including the right to request access to your personal information, correct any mistakes on our records, erase or restrict records where they are no longer required, object to use of personal information based on legitimate business interests, and data portability. For more details in relation to your rights, including how to exercise them, please see our full privacy policy or contact us. Contacting us If you have any questions about how we use personal information, or if you want to exercise your rights please contact our Data Protection Team by either ing them at dataprt@aviva.com or writing to the Data Protection Officer, Level 4, Pitheavlis, Perth PH2 9NH. If you have a complaint or concern about how we use your personal information, please contact us in the first instance and we will attempt to resolve the issue as soon as possible. You also have the right to lodge a complaint with the Information Commissioners Office at any time. 21

22 Some common terms Some common terms used in your policy Your policy wording will provide a full list of definitions and terms that apply to the policy, we have however provided a selection below. Should you have any questions about the information included in this booklet, please contact the customer service helpline. Acute condition A disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery. Chronic condition A disease, illness or injury which has one or more of the following characteristics: it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and/or tests it needs ongoing or long-term control or relief of symptoms it requires your rehabilitation or for you to be specially trained to cope with it it continues indefinitely it has no known cure it comes back or is likely to come back. Complications of pregnancy and childbirth The policy covers the following conditions once diagnosed: ectopic pregnancy miscarriage (but not investigations into the cause of repeated miscarriages) still birth hydatidiform mole retained placenta eclampsia caesarean sections - in specific clinical circumstances (we require full clinical details from your specialist before we can make a decision about your cover). Dependants An employee s spouse, partner, civil partner and/or children under 24 years of age. Medical history disregarded This means that any pre-existing conditions you have will be covered providing they fall within the terms and conditions of the policy. Open referral A referral for tests or treatment that details the type of specialist you need to see, but doesn t name a specific specialist or hospital. An open referral should include: your medical condition/symptoms the specialism and sub-specialism of consultant that you need to see degree of urgency required for the appointment. Varicose veins Treatment of varicose veins is excluded other than where the varicose veins are greater than 3mm in diameter and any of the following also applies: there s established lipodermatosclerosis or progressive skin changes there have been recurrent episodes of superficial thrombophlebitis there s active or healed venous ulceration. We ll need to contact your GP or specialist for details of your condition before we can confirm your claim. 22