Welcome to Simplyhealth - HEALTH CASH PLANS
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Welcome
to Simplyhealth
ALTH CASH PLANS
HE
1203089-b.indd 1 11/04/2012 15:43We wish you the very best of health and
by choosing a cash plan from Simplyhealth
Contents
it’s clear that you do too. Introduction 4
Your table of cover 6
This booklet sets out the benefits available
to you and what you can claim. In a separate Your benefits in more detail 7
booklet accompanying this one you will also Claiming couldn’t be simpler 14
find the terms and conditions which outline
exactly what is and isn’t covered. How to fill out your claim form 16
Your questions answered 18
At Simplyhealth, we’re committed to helping you
feel better every day. So if you have any queries
or questions we’d like you to bother us.
Customer Services
0800 980 7890
www.simplyhealth.co.uk
2 3
1203089-b.indd 2-3 11/04/2012 15:43Simply covered Our commitment to you
You can now claim up to 100% immediately on dentist and optician bills as Simplyhealth is here to make life easier for you. It’s why we pay claims directly
well as up to 75% towards the cost of physiotherapy, osteopathy, chiropractic to you usually within a few days. It’s why all Simplyhealth customer documents
treatment, acupuncture, homeopathy, chiropody/podiatry1 and consultations, will be sent within five days and it’s why we have real people on the other end
all up to an annual limit. of the line – no answer phones or automated calls. We provide all services from
within the UK.
For example, if you are on the £16.25 per month option, you can claim up to
£115 money back towards your dental bills every year. So if a dental bill comes
to £50 we’ll refund you the total bill, leaving you £65 to use towards other
dental fees. Simply flexible
If you are an in-patient or a day case on the NHS or being treated privately, The following table shows your annual entitlement for each benefit under each
we can help cover the cost of everyday bills too. payment option. Please refer to the column which represents your selected
1
Please note that chiropody/podiatry, hospitalisation and the new child payment monthly payment to see how much you can claim.
are not covered under level 1.
If you’d like to increase your cover, just call us on 0800 980 7890.
There are a few things you should be aware of before you increase your
We can be bothered payment option. Please see section 4 of the terms and conditions for more
information.
Your membership benefits include access to health and wellbeing advice as
well as telephone counselling. If you’re feeling stressed or would like advice on
health or lifestyle issues, call our 24 hour free advice helpline at any time on
0800 975 3345 and talk to one of our trained professionals.
Simply claim
We take the bother out of claiming so you can start right away (with the
exception of new child payment and pre-existing conditions under the
hospital benefit).
• Ask for a receipt when you pay for your treatment
• Send us your completed claim form (enclosing your receipt)
within six months of treatment
• Receive money back from Simplyhealth
To make life easier for you, we even pay the funds directly into your bank.
4 5
1203089-b.indd 4-5 11/04/2012 15:43Your table of cover Your benefits in more detail
Here is an easy guide to all the benefits your Simply Cash Plan offers. Please
Your table of cover Level 1 Level 2 Level 3 Level 4
remember that Simplyhealth will only pay for treatment by registered health care
Monthly premium for you £10.85 £16.25 £21.70 £32.50
Payback
professionals that we recognise, where applicable. For more information about
Monthly premium for you and your partner £21.70 £32.50 £43.40 £65.00
level exactly what is and isn’t covered, please refer to section 2 of the terms and
Monthly premium for up to four of your children under
Free Free Free Free
the age of 18 who live with you conditions.
Annual limit for each person
Dental
Includes check-ups, hygienist’s fees, fillings, dentures, 100%
£90 £115 £140 £190
Acupuncture
crowns and bridges
Optical Acupuncture can be particularly helpful in treating arthritic and rheumatoid
Includes sight tests and fitting fees, prescription glasses, 100% £90 £115 £140 £190
sunglasses and contact lenses pain in joints, chronic muscle strains and sports injuries. It can also help relieve
Physiotherapy, osteopathy, chiropractic, headaches, period pains, allergic symptoms and insomnia. Simplyhealth will
acupuncture and homeopathy
75% £50 £100 £150 £200 pay up to 75% of your acupuncture bills up to your annual entitlement.
Treatment carried out by a qualified practitioner that we
recognise
Chiropody / podiatry There is currently no government legislation in the UK covering acupuncture.
75% - £50 £100 £150
Treatment for your feet carried out by a qualified
practitioner that we recognise
This means that anyone can provide acupuncture treatment without any
Diagnostic consultation cover professional acupuncture training. Until the introduction of compulsory
75% £150 £200 £300 £400
Diagnostic consultations with a specialist, including allergy
testing and blood tests
registration for this profession, Simplyhealth will continue to pay claims for
Hospital benefit treatment from professionals who provide acupuncture treatment.
Cash amount for each day or night to help towards 20 days/
everyday expenses if you need to stay in hospital, nights max - £10 £15 £20 For more information or to find your nearest acupuncturist contact
including day-case, in-patient and parental stay. Pre- per year
existing conditions are excluded for the first 12 months the following:
New child payment (12 month qualifying period)
Single payment for each child that you or your partner give Per child - £100 £200 £300 The British Acupuncture Council
birth to or adopt
Tel: 020 8735 0400, www.acupuncture.org.uk
Free helpline Your plan gives you access to a free confidential helpline to advise you on health and lifestyle issues, as well as an over
the phone counselling service. This service is available 24 hours a day, 7 days a week and can be accessed by calling 0800 975 3345.
European Cover You’ll receive these benefits for stays up to and including 28 days, on business or pleasure, wherever you are in the The Acupuncture Association of Chartered Physiotherapists
EEA and Switzerland.
Tel: 01733 390007, www.aacp.uk.com
The joining age for this policy is from 18 years old up to 69. If you or anyone on the policy are aged 70 or over you will not be able to
increase the level of cover.
Premiums include Insurance Premium Tax.
The British Medical Acupuncture Society
For full details of the plan please refer to the Policy Document.
Tel: 01606 786782, www.medical-acupuncture.co.uk
dCashPlan-post-0412
6 7
1203089-b.indd 6-7 11/04/2012 15:43Chiropody/Podiatry Dental
Chiropody/podiatry deals with the care of the feet. Simplyhealth will pay up We all know how hard it is to find a dentist on the NHS these days, so there’s
to 75% of your chiropody/podiatry bills up to your annual entitlement. Please no need to suffer with toothache or put off going to the dentist because of
note that chiropody/podiatry treatment is not covered under payment level 1. the cost. Simplyhealth pays up to 100% of your dental bills up to your yearly
The chiropodist or podiatrist must be qualified and registered with the Health entitlement, whether you are treated privately or on the NHS. This includes
Professions Council. regular check-ups as well as treatment such as fillings.
For more information please contact the following: To find your nearest dentist visit www.nhs.uk/servicedirectories
The Health Professions Council NHS Direct
Tel: 020 7582 0866, Tel: 0845 4647 (England & Wales),
www.hpc-uk.org Tel: 08454 242424 (Scotland)
www.nhsdirect.nhs.uk
Chiropractic British Dental Health Foundation
By manipulating and adjusting the vertebrae of the backbone a therapist can Tel: 01788 546365 / 0845 063 1188
correct malfunctioning nerves and muscles throughout the body. You can claim www.dentalhealth.org
up to 75% money back for chiropractic treatment with a chiropractor who is
British Dental Association
registered with The General Chiropractic Council, up to your annual limit.
www.bda-findadentist.org.uk
For more information or to find your nearest registered chiropractor contact the
following: Diagnostic consultation cover
The General Chiropractic Council If you are unwell and need to find out what’s wrong, this benefit helps you to
Tel: 020 7713 5155, see a private consultant fast, without the long, uncomfortable wait. Simplyhealth
www.gcc-uk.org enables you to claim up to 75% towards a diagnostic consultation up to an
annual limit.
If you think something’s wrong, your GP will be able to refer you to the
appropriate consultant.
To find your nearest GP visit www.nhs.uk/servicedirectories
NHS Direct
Tel: 0845 4647 (England & Wales),
Tel: 08454 242424 (Scotland)
www.nhsdirect.nhs.uk
8 9
1203089-b.indd 8-9 11/04/2012 15:43European Cover Hospital Cover
Simplyhealth cover applies anywhere in the European Economic Area including If you need to go into hospital either as an in-patient or a day case, whether
Switzerland. Any trip up to and including 28 days in duration is covered, be it you are treated privately or by the NHS, Simplyhealth will pay you money for a
business or pleasure. Please refer to section 5.21 of the terms and conditions maximum of 20 days/nights in a claiming year. This could help cover the cost of
for more details. everyday bills. Please note pre-existing conditions are not covered for the first
12 months of your cover.
Homeopathy Simply refer to the benefit table to see how much you can claim. Please note
Homeopathy works by using extremely small quantities of drugs that create that hospitalisation is not covered under payment level 1.
the symptoms for which the patient is being treated, in order to build up the
immune system. You can claim up to 75% of your homeopathic bills, up to your New child payment
yearly entitlement.
When you have a child we’ll say ‘congratulations’ with a cash sum, as long as
There is currently no government legislation in the UK covering homeopathy. you’ve been with us for at least 12 months! New child payment is not covered
This means that anyone can provide Homeopathic treatment without any under payment level 1.
professional training. Until the introduction of compulsory registration for
this profession, Simplyhealth will continue to pay claims for treatment from Optical
professionals who provide homeopathic treatment.
Whether working with computers or driving a car, everyone should still get their
For more information or to find your nearest homeopath contact eyes tested regularly. Simplyhealth will give up to 100% money back towards
the following: your optician bills, including sight tests, new glasses or contact lenses, up to
your annual entitlement.
The Society of Homeopaths
Tel: 0845 450 6611, To find your nearest optician visit www.nhs.uk/servicedirectories
www.homeopathy-soh.org
NHS Direct
The Homeopathic Medical Association Tel: 0845 4647 (England & Wales),
Tel: 01474 560336, Tel: 08454 242424 (Scotland)
www.the-hma.org www.nhsdirect.nhs.uk
Alliance of Registered Homeopaths
Tel: 01825 714506,
www.a-r-h.org
10 11
1203089-b.indd 10-11 11/04/2012 15:43Osteopathy Physiotherapy
This treatment provides relief for many disorders of the bones and joints, If you have a strenuous job, suffer from backache or are a sports enthusiast,
especially back pain. Treatment includes palpation, manipulation and massage. you’ll appreciate this benefit. Physiotherapy uses physical methods to promote
With Simplyhealth you can claim up to 75% towards osteopathy with an healing. The therapist may use a combination of light, infrared and ultraviolet
osteopath who is registered with The General Osteopathic Council up to an rays, heat and electric current. You can claim up to 75% of your physiotherapy
annual limit. bills up to your yearly entitlement. The physiotherapist must be qualified and
registered with the Health Professions Council.
For more information or to find your nearest registered osteopath contact the
following: For more information or to find your nearest physiotherapist contact
the following:
The General Osteopathic Council
Tel: 020 7357 6655, The Health Professions Council
www.osteopathy.org.uk Tel: 020 7582 0866,
www.hpc-uk.org
12 13
1203089-b.indd 12-13 11/04/2012 15:43Claiming couldn’t be simpler Hospital claims
• Turn to the ‘Hospital claims’ section on the back of the claim form
There are three types of claim:
• Fill in the ‘Patient’s details’ yourself
Claims with receipts • A
sk a hospital representative to complete the ‘Admission details’ section or
send your discharge letter from the hospital
• Pay
your bill – to the physiotherapist, dentist etc. as normal. Simplyhealth will
only pay claims for treatment provided by registered healthcare professionals • Sign and date the ‘Declaration’ on the front of the form
• Keep your receipt – see the receipt requirements below • Send your claim form back to Simplyhealth in the reply envelope provided
within six months of discharge
• Fill in the ‘Claims with receipts’ section of the claim form, following the guide
on the following pages. Don’t forget to sign and date the ‘Declaration’ section Pre-existing conditions are not covered for the first 12 months.
• You can make four claims per form, if you need more claim forms
or need assistance, please call Simplyhealth Customer Services
New child claims
on 0800 980 7890 • Fill in the ‘New child payment’ section on the back of the claim form
• Send your claim form and receipt back to Simplyhealth in the reply envelope • If you stayed in hospital for over 14 nights following the birth of your baby,
provided within six months of treatment please also complete the ‘Hospital claims’ section as instructed above
• Sign and date the ‘Declaration’ on the front of the form
Receipt requirements
• S
end your claim form and your child’s birth certificate to Simplyhealth in the
A completed claim form is required together with a receipt confirming payment.
reply envelope provided within six months of giving birth
The receipt must show:
There is a 12 month qualifying period for new child payment.
• The full name, address and telephone number of the practice
• The patient’s full name and address
• A description of the treatment given, including dates and amounts settled by
the patient
Simplyhealth does not accept receipts which have been altered, nor do we
accept invoices, credit card receipts or photocopies of any accounts. (Please
note receipts cannot be returned.)
14 15
1203089-b.indd 14-15 11/04/2012 15:43How to fill out your claim form
The front – for healthcare claims with a receipt The back – for hospital claims
We’ve already included a claim form in this welcome pack. When making a The reverse of the form is for hospital and new child payment claims only.
claim, please complete your form in blue or black ink, and remember to enclose Please remember to sign and date the declaration on the front of the form.
the original receipt for your treatment.
78725_1 SHCFV1:72053 ALL CFPV10 1007 13/08/2009 13:42 Page 1 For a new child 78725_1 SHCFV1:72053 ALL CFPV10 1007 13/08/2009 13:42 Page 2
payment, fill in
this section,
704 A / 0 Claim Form enclose your
child’s birth
Please note that you may only claim for cover that is specified in the
Policy Document of your Plan
certificate, then New-child payment
If we’ve got your sign and date the
Policy no. 123456789 For New-child payment just complete below and enclose each child’s birth certificate/adoption papers, then simply sign the declaration overleaf. New child
details wrong, declaration If a hospital stay of more than 14 nights was needed, also ask a hospital representative to complete the ‘Hospital claims’ section below.
payment only
please correct
I wish to claim for New-child payment (4) Number of birth certificates/adoption papers enclosed
them in this box Mr & Mrs Sample
Sample address For all hospital Hospital claims
Sample Road Customer Services
claims, fill in your
Hambleden House To assist the hospital in completing this form, please complete the ‘Patient’s details’ yourself, then ask the hospital representative to complete
Sample Town details, then sign the ‘Admission details’ where appropriate.
Waterloo Court
Postcode Andover and date the Patient’s details
Hampshire
SP10 1LQ declaration
Please provide your current contact details below First name Personal code (see front of form)
Minicom service: 0800 0725840
E mail: (For hearing or speech impaired members only) Surname Date of birth D D M M Y Y
Opening hours: 8 am to 9pm weekdays9am to
Tel No: 5pm weekends
Admission details
Each person
covered under Your personal details I certify that the above patient was admitted to this establishment for the period and reason shown below:
your plan The codes shown below are for use when completing your claim form. If you need any help with your claim or any of your personal information
Your establishment (4) Hospital Establishment stamp and details of representative
has their own shown is incorrect, just call us free on the number above.
Convalescent Home
personal code PERSONAL PERSON COVERED
CODE
DATE OF BIRTH TREATMENT TREATMENT DESCRIPTION
CODE
TREATMENT TREATMENT DESCRIPTION
CODE
Nursing Home
100 Mrs Sample 03/10/1959 045 Optical 085 Chiropody/Podiatry
Each benefit has 201 Mr Sample 05/06/1961 052 Dental Your details Duration of admission As a day case: admitted on D D M M Y Y
its own benefit 302 Charlie Sample 11/10/2000 080 Physiotherapy
As an in-patient: admitted on D D M M Y Y
081 Chiropractic
code
082 Osteopathy discharged on D D M M Y Y
083 Acupuncture Hospital claims
number of nights
(Excluding home visits)
For all claims,
except hospital or The relevant
Claiming details (See overleaf for claims not listed above) hospital
Reason for admission (4) Care for the elderly
new child payment,
please
Please complete a separate line below for each treatment, selecting the PERSONAL CODE and the TREATMENT CODE from the above lists. authorities Mental/Psychiatric
Then enter the treatment date and if applicable the amount paid from your receipt. Please use black or blue ink and complete the form in
enter the personal BLOCK CAPITALS and always submit your claim within 6 months of treatment. must complete Signature:
Ante/Post natal
code and the this section Position:
PERSONAL CODE TREATMENT CODE TREATMENT DATE FULL AMOUNT PAID
treatment code EXAMPLE 1 0 0 0 8 0 0 9 0 1 0 8 5 0 . 9 5 EXAMPLE Other Date:
(The example above shows a claim for physiotherapy for the person coded 100 who received treatment on 9th January 2008 and paid £50.95) All claims (except Please always confirm nature of condition/procedure below
hospital or new
Enter the D D M M Y Y . child payment)
treatment date D D M M Y Y .
and the full If a parent stayed with a child
amount paid D D M M Y Y .
Parent’s first name Personal code (see front of form)
D D M M Y Y .
Parent’s surname
Please enclose your original receipts in the envelope provided (do not staple them to the claim form).
Please note that receipts will not be returned, only scanned images are retained on our records.
Declaration Stayed from D D M M Y Y to D D M M Y Y Number of nights
For all claims, I consent to Simplyhealth seeking medical information in respect of this application and any subsequent claim under this membership, from any
the policy holder relevant doctor, professional or hospital representative. I consent to Simplyhealth processing sensitive information about me (and anyone
Simplyhealth Data Protection Notice: We will keep information about you confidential and as the data controller we will store and process your data in accordance with the Data Protection
covered under my policy) including health information. I understand that any charges levied for completing this form are my responsibility and
must sign and are not refundable by Simplyhealth. I declare that the information given is to the best of my knowledge and belief, true and complete. I Your signature
Act 1998. However, we may give information about you and how you use our products to fraud prevention agencies, regulatory bodies or other specified groups as set out in our Terms and
Conditions.
date here understand that any false statements may disqualify me from membership and/or reimbursement of any claim. Simplyhealth is a trading name of Simplyhealth Access, registered and incorporated in England and Wales, No. 183035. Registered office: Hambleden House, Waterloo Court, Andover,
Hampshire SP10 1LQ. Authorised and regulated by the Financial Services Authority. Your calls may be recorded and monitored for training and quality assurance purposes.
Customer’s signature: Date:
SHCFV1 09/09
16 17
1203089-b.indd 16-17 11/04/2012 15:43Your questions answered When will I receive money back from my claim?
We normally settle claims within a few days.
When can I claim? What if you’ve printed my details incorrectly on my claim form?
You can claim immediately. Simply use the claim form provided or request If any of your pre-printed details on the form are incorrect, please update them
another form by calling us on 0800 980 7890. The only exceptions are the new clearly in blue or black pen before sending the form back to us.
child payment which has a 12 month qualifying period and hospital cover which
excludes pre-existing conditions for the first 12 months. Please refer to section What happens if my personal details change?
2 of the terms and conditions. So that your cover remains appropriate for your needs, it is important that
you review it regularly and let us know about any significant changes to your
When do my annual benefits start and end?
healthcare requirements.
Your annual benefits commence from your policy start date and begin again on
the same day every year. Please refer to your enclosed Summary of Cover to Where can I get more information or additional help when making a claim?
find your claiming year details. If you have any queries, please call Simplyhealth Customer Services on
0800 980 7890 who will be pleased to help you.
What is the duration of my cover?
The cover under your plan is monthly and runs from month to month until it is What do I do if I have changed my mind?
cancelled or otherwise comes to an end. You have 14 days from receipt of your welcome pack in which to change your
mind and receive a full refund from Simplyhealth, provided no claims have been
Are existing conditions covered?
made. Simply call Customer Services on 0800 980 7890. After this period our
The great thing about Simplyhealth is that you can start claiming straight standard cancellation rights apply – please refer to section 8 of the terms and
away, even if you already have a problem that needs treatment when you join. conditions for full details.
However, hospital cover excludes pre-existing conditions for the first 12 months.
Once you have been with us for 12 months then you can claim for these How do I make a complaint?
pre-existing conditions. At Simplyhealth we aim to provide you with the very highest levels of customer
service and care at all times. In order to maintain this service standard, we
Does cover continue when I reach 69?
encourage feedback from our customers and have put in place a procedure
Yes, cover doesn’t cease when you reach a certain age. You can keep your that you can use to raise any concern or complaint that you may have. In the
policy for as long as you wish, however, you cannot increase your cover after first instance you should write to: Customer Services, Simplyhealth, Hambleden
your 70th birthday. There are some circumstances where cover will end. Please House, Andover, Hampshire SP10 1LQ or contact customer services direct
refer to section 8 of your terms and conditions for full details. on 0800 980 7890.
How are my claims paid? If you are not satisfied with our response, or we have not replied within eight
To make life easier for you, Simplyhealth provides a service which pays your weeks, you have the right to refer your complaint to: Financial Ombudsman
money directly into your bank account via direct credit, sending Service.
you confirmation in the post. You will need to provide us with your Please refer to section 9 of the terms and conditions for full details.
bank account details if you haven’t done so already.
18 19
1203089-b.indd 18-19 11/04/2012 15:43About us and our insurance services
Simplyhealth is a trading name of Simplyhealth Access which is authorised and
regulated by the Financial Services Authority (FSA). Our FSA register number is
202183. You can check this on the FSA’s Register by visiting the FSA website at
www.fsa.gov.uk/register or by telephoning the FSA directly on 0845 606 1234.
We can only provide you with information on our own products and you will not
receive any advice or a personal recommendation from us for our health plans.
We may ask you some questions to narrow down the product option on which
we provide you with information, but you will then need to make your own
choice about how to proceed.
If you have any questions please call us on
0800 980 7890 from landlines
0370 908 3481
from mobiles1
8am to 8pm Monday to Friday, 9am to 5pm Saturday
or visit www.simplyhealth.co.uk
1203089-dCashPlan-WB-03/12
¹Some mobile networks charge for calls to 0800 numbers. Our 0370 number is free if you have mobile
inclusive minutes available. If not it’s still no more expensive than calling numbers starting 01 or 02.
Simplyhealth is a trading name of Simplyhealth Access, registered and incorporated in England
and Wales, No.183035. Registered office: Hambleden House, Waterloo Court, Andover,
Hampshire SP10 1LQ. Authorised and regulated by the Financial Services Authority. Your calls
may be recorded and monitored for training and quality assurance purposes.
1203089-b.indd 20 11/04/2012 15:43You can also read
