Dental and Optical

Help towards the cost of all dental treatment including check-ups, and the cost of a sight test and optical appliances, up to the maximum shown.This benefit may be used flexibly according to requirements for both categories. It is payable between all eligible registered persons in any 12 consecutive calendar months. 

Qualifying period – 3 months.

The cost of Eye LaserTreatment, Implantable Contact Lenses (to correct long or short sightedness) and assessments is included in Schemes 3, 4, 5 and the Extra Cover Schemes. 

Qualifying period – 12 months    

Dental Trauma 

For details on DentalTrauma, please refer to the Personal Accident Section. 

General Practitioner and Emergency Department 

An amount payable towards the cost of a visit to a General Practitioner (Family Doctor) or an attendance at an Accident and Emergency Depart- ment in a public or private hospital. Limited to 10 visits in any 12 consecutive calendar months, regardless of which eligible insured person is the pa- tient.

The maximum repaid per visit is as shown or actual charges if less. 

Prescription  

An amount payable towards prescription charges. Limited to 6 prescriptions in any 12 consecutive calendar months, regardless of which eligible insured person is the patient. 

The maximum repaid per prescription is as shown or actual charges if less. 

Practitioner: Physiotherapy, Physical Therapy, Osteopathy, Chiropractic  

Help towards the cost of consultation and treatment (not including medication or appliances) by a qualified and registered practitioner in the categories above up to the maximum shown. This benefit may be used flexibly according to requirements for all categories. Payable between all eligible insured persons in any 12 consecutive calendar months. 

Wellbeing & Alternative Treatments: Acupuncture, Homoeopathy, Chiropody / Podiatry, Reflexology  

Help towards the cost of consultation and treatment (not including medication or appliances) by a qualified and registered practitioner in the categories above up to the maximum shown. This benefit may be used flexibly according to requirements for all categories. Payable between all eligible insured persons in any 12 consecutive calendar months. 

Consultations  

Help towards the cost of specialists’ consultation fees listed in the rules, all undertaken on an outpatient basis, up to the maximum shown. Payable between all eligible insured persons in any 12 consecutive calendar months. 

Medical Tests  

Help towards the cost of medical tests including, initial allergy testing, vaccination, health screening, pathology tests, x-rays, scans, electrocardiograms and other investigations listed in the rules, all undertaken on an outpatient basis, up to the maximum shown. Payable between all eligible insured persons in any 12 consecutive calendar months. 

Birth and Adoption Grant  

Payable to the policyholder, whether the mother or father of the baby, for each registered birth in hospital or at home. Hospital benefit is payable for the mother in addition to the grant from the sixth night onwards. The grant is also payable for a registered adoption up to the age of 10.

Claims for this benefit can only be accepted at least 10 months after policy start date. 

General and Hospice: For an inpatient admission to a hospital or hospice to receive medical treatment. Payable to each eligible insured person for up to 40 nights in any 12 consecutive calendar months. (See page 15 for full details).

Accident: For an inpatient admission to a hospital immediately following an accident. Payable to each eligible registered person for up to 40 nights in any 12 consecutive calendar months. (See page 15 for full details). No waiting period, if an Accident admission. 

Elderly and Mental Illness: For an inpatient admission to a hospital for elderly medical care / long stay / rehabilitation / respite or for a mental illness. Payable to each eligible registered person for up to 50 nights elderly and 50 nights mental illness from first registration, but not for more than 40 nights in a 12 month period. (See page 15 for full details). All amounts shown are per night. 

Recuperation  

Following each stay in a hospital or hospice for which benefit has been paid for a minimum of 7 nights, a recuperation grant is payable for each eligible insured person. 

Day Case Surgery and Treatment 

For a planned admission to occupy a bed for a day in a public or private hospital to undergo surgery, treatment or a procedure. Limited to 8 occasions within any 12 consecutive calendar months for each eligible insured person.

All amounts shown are per day. 

Surgical Appliances and Hearing Aids 

An amount payable towards the cost of purchasing a surgical appliance or hearing aid,
prescribed or recommended by a doctor (or a practitioner, eg. a physiotherapist, who has treated the policyholder or dependant, and the appli- ance forms part of that treatment), up to the maximum shown. Payable between all eligible insured persons in any 12 consecutive calendar months. 

Personal Accident Benefit

All Claims must be submitted within 6 months of the accident occurring.

If an Accident results in Permanent Disability or death the financial consequences can be enormous. Even less serious injuries can result in a lengthy period off work or confinement to the house. Whilst you may be able to cope in the short term, a longer period of disability can put severe pressure on your finances.Lump sum cash payments (shown opposite) when they are needed most could ease the financial burden. Policyholders and dependent children are covered 24 hours a day, every day of the year, whether at work, at home or at play.

Permanent Disability: A lump sum cash benefit depending upon the type and degree of Permanent Disability following an Accident.

Facial Disfigurement: A lump sum payment for Permanent facial disfigurement as a result of an accident.

Accidental Death: A lump sum payment if the Accident is fatal

Dental Trauma: A lump sum payment for dental treatment required as a direct result of a blow to the head.

Temporary Disability: (not applicable to children under 16 years of age) A weekly sum payable (normally by direct credit, monthly in arrears) if following an Accident, you are: a) unable to take up your normal paid occupation or any other paid employment; or b) confined to the home (applicable only if you are not in paid employment at the time of the Accident) as certified by a qualified medical practitioner. Payable from the 31st day of your disability for up to 52 weeks. Odd days will be paid at 1 ⁄ 7 of the weekly rate.

Although there is no waiting period under this section, the Temporary Disability benefit is not payable for the first 30 days (Deferment Period) of each period of temporary disablement. 

Fracture Benefits: A lump sum payment for a fracture or fractures to one or more bones of the arm or leg following an Accident.