A bother free guide to Care for Corporates Health CoverYour Group Policy Document

Effective from 1 December 2009

Your PolicyThis Policy Document tells you what you need to know about the benefits, terms and conditions of your policy. It also gives you information about making changes to your membership and how to make a claim. Please read it in conjunction with your Membership Certificate.

Certain words used in the Policy have special meanings. Where those meanings apply, the words and phrases start with capital letters. The words have the same meaning in the plural or singular.

The special meanings are defined on page 10.

Claims Helpline: 0800 980 6248Your Group number is: S...........

Congratulations. In selecting Care for Corporates Private Health Cover from Simplyhealth, your employers have demonstrated that they can be bothered about you.

We believe that your health is the most important thing of all. And we want to help more of you to feel better every day. So we’d like you to know that we are always available to listen, to chat about your policy and to offer you all the practical help and support you need – whenever you need it.

And that’s because (just like your employer) we can be bothered.

Contents How to make a claim 3

Your health cover benefits explained 4

What is NOT covered by your policy 5

What is a chronic condition? 6

Cancer treatment – what is covered? 6

Dental treatment – what is covered? 7

If you have an accident 7

If you have other insurance policies 7

How any excess on your policy is applied 7

Membership

Including family members within your policy 8

Leaving your group 8

Additional Services 8

Advice Lines/Counselling Services 8

Overseas Assistance 8

Cancellation rights 9

How we use information about you 9

Definitions 10

Important notes 11

About Simplyhealth 11

How to contact us 11

2

How to make a claimFor your peace of mind, we aim to make claiming on your policy as easy as possible – just follow the four steps below.

For in-patient treatment your scheme includes a ‘Six Week Rule’. This means that cover for eligible in-patient treatment will only be available when the NHS is unable to provide treatment within six weeks of your Specialist’s recommendation. In-patient treatment under London Scale and out-patient or day-patient treatment on either scale is not affected. Your Group Secretary will confirm your scale of cover.

Making a claim Step 1: Visit your GP and, if you need private treatment, call our Claims Helpline on 0800 980 6248 quoting reference S……..

Step 2: Your treatment is authorised and arranged over the phone. In most cases it’s as simple as that. In some cases, however, we may need more medical information. Please note that we will only pay for treatment which has been authorised and arranged through the Claims Helpline.

If you have an excess on your policy we are able to take this over the telephone using a credit or debit card. We will then forward payment for the excess amount, along with our contribution to the treatment provider. We will confirm to you in writing the payments that we have made and that the excess has been paid on your behalf.

Step 3: Once you’ve had your consultation, please call the Helpline on 0800 980 6248 and let us know if your treatment has been completed, or if you need any further treatment. If you need to undertake a prolonged series of treatments, we’ll provide you with a personal contact who can help you every step of the way.

Step 4: We pay invoices directly and we’ll send you details of any payments we make. If you receive any invoices, please send them to us along with your membership details, and we’ll settle the account. If you are asked to pay for your treatment immediately, please send us the receipted invoice, along with your membership details, and we’ll refund you directly.

What do I do in an emergency?If you need emergency treatment, please go to your nearest NHS Emergency department. If you have received emergency treatment in an NHS Hospital and then require further non-urgent treatment, you may be eligible to be transferred to a private hospital. Please call us on 0800 980 6248 to check whether your transfer and treatment is covered.

Claims – important notes1 In some cases, a claim form and medical report may

need to be submitted. We do not meet fees for the completion of claim forms or medical reports.

2 All claims must be confirmed and accepted by Simplyhealth. No one else has any power or authority to act on our behalf, or to change any of the policy rules.

3 Authorisation is valid for three months from the date given to you for your first appointment. If your first appointment is cancelled and is not rearranged within three months, the authorisation will lapse. You must call us for new authorisation to proceed further.

4 If we have made an appointment on your behalf, we will not be responsible for any charges made for an appointment that you fail to attend unless you notify us, the hospital, clinic and/or Specialist at least 48 hours in advance of the appointment. These charges may include costs that would have been incurred for diagnostic procedures.

5 Premiums are payable in advance. We will only pay benefits during a period for which premiums have been paid.

6 We select your treatment provider and will only pay for treatment arranged through the Claims Helpline.

3

4

Your health cover benefits explainedThe table shows the benefits included under your policy. The maximum benefit payable is £100,000 for each person in any one year. You must call the Claims Helpline before arranging any treatment.

Benefit Level of cover Notes

1 Hospital charges for in-patient and day-patient treatment

Full cover Cover provided for accommodation and nursing (including intensive care); operating theatre charges; drugs and dressings prescribed for use while an in-patient or day-patient; pathology, physiotherapy and diagnostic tests; prostheses when implanted as an integral part of a surgical procedure.

2 Parent accommodation charges Full cover For one parent while their child receives in-patient treatment. The child must be under the age of 12 and enrolled in their parents’ membership.

3 ‘Out of Scale’ benefit Provincial Scale – up to £230/day

London Scale – not applicable

Paid if treatment received in a hospital classed within a higher scale than the scale on which you are covered. The benefit is likely to fall short of expenses incurred for accommodation and nursing (including intensive care) and you will be responsible for paying the balance. Other hospital charges will be paid under Benefit 1.

4 Surgeons’ and Anaesthetists’ fees Full cover Fees and other expenses must be reasonable. We may refuse to pay any expenses that we consider to be in excess of those normally charged for similar treatment in the UK.

5 Specialist Physicians’ fees for in-patient and day-patient treatment

Full cover You must be under the regular care of a Specialist. For in-patient treatment, benefit would not normally be paid unless the Specialist attends you on at least five days each week. Paid for up to 91 days in any one Year.

6 High cost scans Full cover Includes CT, MRI and PET scans.

7 Psychiatric benefits

Out-patient consultations In-patient and day-patient treatment

Full cover Paid when treatment is carried out under the care of a recognised Specialist and has been agreed in advance. In-patient treatment must be in a hospital room within your scale, or a lower scale of cover. Maximum of 28 days cover per year for in-patient and day-patient treatment.

8 Oncology including radiotherapy and chemotherapy

Full cover Please refer to ‘Cancer treatment – what is covered?’

9 Private ambulance Full cover Paid when required out of medical necessity and in connection with eligible in-patient or day-patient treatment.

10 NHS cash benefit £100/night Paid when you receive in-patient treatment free of charge under the NHS, up to 91 nights in any one Year. Paid for procedures carried out free of charge under the NHS on a day-patient basis.

11 Hospice benefit £100/night A payment to the hospice, up to 91 nights in any one Year.

12 Maternity cash benefit Provincial Scale - £125/birth

London Scale - £150/birth

Paid once per child.

13 Home nursing Full cover Paid for the full time services of qualified nurses on a resident or daily basis, following an in-patient stay, when prescribed by a Specialist solely for medical reasons.

14 Out-patient services

Specialist Acupuncture Consultations Podiatry/ Radiology Chiropody Pathology Chiropractic Physiotherapy Osteopathy

Full cover Where referral to an acupuncturist, podiatrist/chiropodist, chiropractor or osteopath is by a GP, benefit is limited to a maximum of £500 per Year. Full cover is available when referral is made by a Specialist.

15 Emergency in-patient treatment overseas

Overseas Assistance

Available to UK residents while travelling abroad. Payment of benefits outside the UK is made in Sterling. Claims for benefits will be converted to Sterling at the exchange rate prevailing on the date we receive the claim.

5

Important notes1 We select your treatment provider and will only pay

for treatment we have arranged, so you must call the Claims Helpline before arranging treatment.

2 The maximum benefits payable for each person in any one Year is £100,000.

3 Expenses must, in our opinion, be reasonable and exclusively to treat an eligible Acute Condition.

4 Benefits are available if you are resident in the UK, Channel Islands or Isle of Man, or if you are resident abroad provided that you have notified us in writing before you take up residence abroad and we have written to you giving our consent to continuing entitlement to benefit.

5 Benefits may be adjusted from time to time. Changes will only apply to your policy from the renewal date.

6 Maximum limits of benefit apply to each person included in your policy.

7 Except in an emergency, all treatment for which benefit is claimed must be arranged with the knowledge and approval of your GP, or a Specialist that you have been referred to by your GP.

8 All treatment must be given by a Specialist or a qualified Physiotherapist.

9 We may refuse to pay expenses in excess of those normally charged for similar treatment in the UK. We may require full itemisation of charges giving rise to a claim. We will not pay more than the actual expenses incurred (except for payment of NHS, Hospice and Maternity benefit).

10 Benefit is only payable for treatment received, by an enrolled member, during a period for which premiums have been paid. Treatments are limited to those shown in the benefit table.

11 For assessment of in-patient claims, the days of admission and discharge shall count as one day.

12 Surgical operations are classified in accordance with a schedule of operations approved by our medical advisers.

What is NOT covered by your policy Any treatment that has not been arranged by us.

Treatment not normally provided under the NHS.

Pre-existing medical conditions which have not been disclosed to us and accepted for benefit.

Charges which are not customary and reasonable in the UK - please refer to ‘Important notes’ above.

Treatment received abroad where the purpose of being abroad is wholly or partly to obtain treatment.

Repatriation to the UK or transfer to a hospital abroad from a ship, oil rig, or similar off-shore location.

Any dental, periodontal or orthodontic treatment, other than an oro-surgical operation which is included in our schedule of operations. See ‘Dental treatment – what is covered?’ for further details.

Chronic conditions. See ‘What is a chronic condition?’ for further details.

Consumables and appliances, including medical, dental and surgical appliances, prostheses (except as included in the benefits table), drugs and dressings for use whilst an out-patient, spectacles, contact lenses and hearing aids.

Cosmetic surgery – whether or not for psychological reasons.

Any alcohol related illness, drug or solvent abuse or any associated psychiatric condition.

HIV infection, AIDS or any associated condition.

Preventative treatment or investigations, including sight testing, vaccination, inoculation, routine medical or dental examinations or other investigations or treatment taken as a preventative measure.

Genetic testing.

Treatment of low fertility or infertility, or pregnancy, or childbirth resulting from such treatment.

Pregnancy or childbirth, including any medical conditions relating to childbirth.

Termination of pregnancy.

Regular or long-term renal dialysis.

Transplantation operations or procedures - for example autologous plasmapharesis, transplants of bone marrow or stem cells, autologous blood transfusions or similar procedures.

Removal of non-diseased tissue.

Self-inflicted non-accidental conditions.

Accommodation without treatment, including stays in hospital wholly or partly for domestic reasons; when the patient is not undergoing active regular treatment by a Specialist or where treatment could be provided elsewhere; or where the Hospital has become the patient’s permanent abode. We also exclude stays in a convalescent home/hospital, health hydro or nature cure clinic or similar establishments.

GP or Dentists’ fees.

Unlicensed drugs – or the use of drugs outside the scope of the licence issued by the European Medicines Agency (EMEA) or the National Institute of Health and Clinical Excellence (NICE).

Treatment for injuries or illness arising out of war, invasion, act of foreign enemy, nuclear or chemical contamination, hostilities (whether war be declared or not), civil war, riot, civil commotion, rebellion, revolution, insurrection or military or usurped power.

Any exclusions specific to your cover as shown on your Membership Certificate.

6

What is a chronic condition?This is a disease, illness or injury that has at least one of the following characteristics:

it continues indefinitely and has no known cure;

it comes back or is likely to come back;

it is permanent;

you need to be rehabilitated or specially trained to cope with it;

it needs long-term monitoring, consultations, check-ups, examinations or tests.

It is not always clear that you have a chronic condition when you visit your GP so we will pay for referral to a Specialist and any eligible tests, investigations and consultations to make a diagnosis. The aim of any treatment must be to return you to the state of health you were in immediately before suffering the disease, illness or injury, or lead to your full recovery.

What does this mean in practice? If your condition has or acquires characteristics detailed in the description of a chronic condition, we will not pay any benefit unless agreed in advance of treatment. Even if we have paid for previous treatment, it does not mean that we will continue to cover that condition if we think it has become chronic. If your diagnosis is for a chronic condition, we will confirm that we will not pay for further investigations or treatments.

We select your treatment provider and will only pay for treatment we have arranged, so you must call the Claims Helpline before arranging treatment.

What if your condition gets worse?We do not pay for on-going treatment or investigations to maintain a chronic condition in a stable state. Depending on individual circumstances, and any other guidance we have given you on your claim, we may pay benefit for an acute flare up of symptoms related to a chronic condition. The aim of the treatment should be to return you to a stable condition. We would not pay benefit for frequent reoccurrences of an acute flare up of a chronic condition. To establish whether we could consider an acute flare up of symptoms related to your chronic condition to be eligible for benefit you must call the Helpline for pre-authorisation of treatment. We would not pay benefit for an acute flare up of a chronic condition unless the cost of treatment has been pre-authorised by us.

Cancer treatment – what is covered?Cancer as a condition does not fit easily into the acute and chronic definitions used to categorise other illnesses. We want you to have a clear understanding of what is covered (eligible treatment) and what is not covered (non-eligible treatment) for cancer treatment under your policy.

If treatment for cancer is ever necessary, then you will have the personal support of your own nurse adviser. We will authorise your claims, guide you through your treatment programme and explain what treatment is covered under your policy.

Your nurse adviser will be there to support your care whether this is given privately or through the NHS. Remember, we are always here to help.

We will pay for:

Surgery, chemotherapy, radiotherapy and support services that are administered to achieve cure or to reach remission. Treatment plans and surgery must be widely recognised as safe and effective treatments.

Chemotherapy for drugs licensed by the European Medicines Agency (EMEA). They must be used for the purpose for which they are currently licensed and widely available within the NHS. Combination drug therapies will only be considered if widely recognised for use within the NHS.

Hormonal and biological therapies eg. monoclonal antibodies, such as Herceptin, if licensed with the EMEA. They must be approved by the National Institute of Health and Clinical Excellence (NICE) and be used for the purpose for which they are currently licensed and widely available within the NHS. If used in combination with other drugs, hormonal and biological therapies will only be considered if these combinations are widely recognised for use within the NHS.

Benefit for follow-up consultations and monitoring for a period of five years once treatment to achieve cure or to reach remission has ceased.

Breast reconstruction and surgery to improve symmetry, following a mastectomy or lumpectomy. We will pay for such operations for a period of up to 18 months following initial surgery.

A donation to a hospice to the value of the ‘Hospice benefit’ when a patient receives hospice care.

NHS cash benefit for day-patient or in-patient cancer treatment received under the NHS.

We will not pay for:

Drugs that are still under trial or trials of combination drug therapies.

Surgical and non-surgical treatment of cancer that is not recognised for treating that particular type of cancer.

Maintenance or long-term therapies where the condition is stable, remains in remission, or remission cannot be achieved. At this time your nurse adviser can help with the smooth transition of care into the NHS. We will continue to support you during this transition period.

7

Dental treatment – what is covered?We do not cover routine treatment from your Dentist. There are a limited number of surgical treatments to the teeth and jaw for which benefit is available. These treatments must be carried out by an oral maxillofacial surgeon in a hospital.

We will pay for:

Reimplantation of original tooth/teeth immediately following trauma.

Surgical removal of impacted/buried or unerupted tooth/teeth.

Surgical removal of complicated buried roots.

Apicectomy of tooth/teeth (removal of the tip of the root).

Enucleation of cyst of jaw (surgical removal of cyst lining from the jaw bone).

We will not pay for:

Any dental, periodontal or orthodontic treatment other than an oro-surgical operation listed above.

Treatment of gum conditions (periodontal treatment) and malocclusion (orthodontic treatment).

Treatment which is usually carried out in general dental practices by a General Dental Practitioner, even though it may be recognised as treatment of a highly specialised nature.

If you have an accidentIn many accidents, someone or something is at fault and the accident victims have a right to claim compensation. Simplyhealth has a legal right to recover any medical expenses if you make a claim for treatment resulting from an accident or illness which was someone else’s fault.

When claiming for treatment you must notify us that you have a personal injury claim against another party as a result of an accident. We will ask for your solicitor’s details. You, or your solicitor, then need to keep us informed of the claim’s progress. You need to:

Pursue your personal injury claim at your own personal expense.

Tell your solicitor that you are insured by Simplyhealth for medical expenses.

Include all the medical expenses which you have claimed, or will claim from Simplyhealth, in your personal injury claim.

Ask your solicitor to provide assistance to Simplyhealth and provide copies of any pleadings, expert reports, witness statements, court documents or other legal documents concerning your personal injury. We will pay reasonable photocopying charges.

Ask your solicitor not to agree any final settlement of your claim or waive our right to recover expenses paid out for medical treatment without consulting us first.

Ask your solicitor to repay your medical expenses direct to us from any settlement of your claim.

If you have other insurance policiesIf you make a claim and you have insurance with another insurance company or provident association that covers you for any of the same benefits under your policy, you must tell us and provide the other company’s details. We may well need to contact these other companies, since we will not be liable to pay more than our proportionate share when split between the various insurance companies.

Scales of CoverThe hospitals in the Hospital Directory are split into two ‘scales’, depending on their overall charges, not the quality of treatment. London scale covers hospitals listed with London postcodes. Provincial scale covers all other hospitals. London scale hospitals are more expensive than Provincial scale hospitals. Members with London scale can also use Provincial scale hospitals. Your Group Secretary will advise you of your scale of cover.

What if you receive treatment in a hospital outside your chosen scale of cover?We recommend that any in-patient or day-patient treatment you receive falls within your scale of cover so that you do not incur additional costs. If you do receive treatment in a hospital with a higher scale classification, you will not be eligible for cover for accommodation as listed under Benefit 1 in the table on page 4. Instead you will be paid Out of Scale benefit – a fixed amount of £230 towards the room charge only, which will more than likely fall short of the expenses incurred.

How any excess on your policy is appliedThere is a claims excess of £x per person per policy year. We start to apply the excess to the first claim or claims for treatment. If treatment begins in one membership year and then continues into the next, the excess will apply twice. The excess does not apply to any cash benefits.

8

Membership Underwriting terms The underwriting terms that apply to your cover can be found on your Membership Certificate.

Including family members within your policyYou may, with the agreement of your employer, include a spouse or partner and unmarried dependant children under the age of 21, or 24 if they are in full-time education. Your family members must be resident in the UK, Channel Islands or Isle of Man. The cost of including dependants may have to be borne by you. If you wish to add dependants to your policy please contact your Group Secretary.

Leaving your groupIf you leave the group policy due to retirement or leaving the company, you can apply for personal membership of Simplyhealth. There are a number of options available.

Unmarried children, who are already on your policy, remain covered by family membership until the renewal date following their 21st birthday, or their 24th birthday if they are in full-time education. They may then apply for a Simplyhealth policy in their own right on specially low rates for young people.

Additional servicesThe following additional services are automatically included within your policy.

Advice Lines – Available 24 hours a day, 365 days a year by calling 0800 975 3360. Our experts provide help on matters such as: health and lifestyle issues, childcare, care of the elderly and hospital procedures. To ensure standards of service are maintained, calls may be recorded.

Counselling Services – Available 24 hours a day by calling 0800 975 3360. The service gives you access to highly experienced and professionally-trained counsellors who are able to help resolve issues such as: relationship or family difficulties, emotional problems, work related issues, bereavement and debt. At times, further assistance might be appropriate. Any costs incurred resulting from onward referral would be at the caller’s own expense. All counsellors uphold the British Association of Counselling and Psychotherapy (BACP) Code of Ethics and Practice for Counsellors. Simplyhealth accepts no responsibility for any advice you receive from this service.

Advice Lines and Counselling Services are provided by FirstAssist Services Limited.

Overseas AssistanceOverseas Assistance offers help in an emergency 24 hours a day, seven days a week, providing valuable support if you become unexpectedly ill or injured when travelling abroad.

We will pay for:

In-patient treatment whilst abroad.

Transfer to an alternative hospital abroad by any means necessary if the facilities at the original hospital are medically unsatisfactory.

Repatriation to the UK following discharge from hospital if you cannot return by the means originally planned.

We will not pay for:

Any treatment related to personal exclusions that apply to your policy.

Consultations with the overseas equivalent of a GP.

Drugs, medicines and dressings prescribed as an out-patient.

The costs of extra hotel accommodation and other related costs.

Out-patient treatment.

To access this service call for authorisation.

Emergency Telephone and Fax Number for Simplyhealth Assistance

From the UK

T 01737 815389 F 01737 815057

From the USA

T 0144 1737 815389 F 0144 1737 815057

From the rest of the world

T 0044 1737 815389 F 0044 1737 815057

Any personal underwriting exclusions will apply. Please make sure you have your membership details ready when you call.

Overseas Assistance is provided by AXA Assistance UK Limited.

Cancellation rights Our right to cancel the policyWe may cancel the policy if:

The premium (or any part of it) due is more than 30 days in arrears.

Your Group Secretary cancels the group policy.

We decide to discontinue the Care for Corporates product or any part of it, in which case we will offer alternative arrangements for cover.

A resolution is passed, or an order made, for the winding up of Simplyhealth.

You knowingly claimed benefits which are not provided for under the policy.

You, or the Group Secretary, misled us by mis-statement or concealment.

You, or the Group Secretary, attempted to obtain an unreasonable financial advantage to our detriment.

You, or the Group Secretary, failed to act in good faith.

How we use information about youAs the Data Controller, we will store and process your personal data in accordance with the Data Protection Act 1998 (DPA). We will use your information to provide our services, for assessment and analysis, for underwriting and claims handling, to improve our services, and to protect our interests.

We may use your information to keep you informed by post, telephone, email or other means about products and services, which may be of interest to you. If you do not wish your information to be used for these purposes please write to: The Data Protection Co-ordinator, Simplyhealth, James Tudor House, 90 Victoria Street, Bristol BS1 6DF.

We will keep information about you confidential. However we may give information about you and how you use our products to the following:

Fraud prevention agencies and other organisations who may record, use and give out information to other insurers.

People who provide a service to us, or act as agents on the understanding that they will keep the information confidential.

Anyone to whom we may transfer our rights and duties under this agreement.

We may also give out information about you if we have a duty to do so (such as regulatory bodies), or if the law allows us to do so, or if the person requesting the information has in our opinion, a legitimate interest in the disclosure.

Sensitive dataTo assess the terms of the insurance contract, including any specific medical exclusions or administer claims, we may collect data, including medical information, which the DPA defines as sensitive.

Medical information will be kept confidential and only disclosed to those involved in providing the patient’s treatment or care, including their General Practitioner or Dentist, or their agents. Only in exceptional circumstances will we disclose medical information to other third parties or family members, without the patient’s explicit consent.

If an insurance broker or intermediary has been appointed by your employer, we may disclose to them the personal information that they need to deal with your cover. Details of medical information will not be disclosed to the intermediary unless we have the specific consent of the patient.

Accuracy of personal informationTo help us ensure that your personal information remains accurate and up to date, please inform us of any changes.

You have the right to see personal information which is held by us. There may be a charge if you want to do this. For more details please write to: The Data Protection Co-ordinator, Simplyhealth, James Tudor House, 90 Victoria Street, Bristol BS1 6DF.

9

DefinitionsCertain words and phrases sometimes occur with special meanings. Where those special meanings apply the words and phrases start with capital letters. The special meanings of those words and phrases are defined below.

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.

Cancer: a malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chronic Condition: a disease, illness, or injury that 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.

Day-patient: A patient who is admitted to hospital or day-patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.

Dependant: (i) your wife, husband or civil partner.

(ii) a person who resides with you on a permanent basis as if your legal spouse.

(iii) unmarried children up to the annual renewal date following their 21st birthday or 24th birthday if in full-time education.

Diagnostic Tests: investigations, such as x-rays or blood tests, to find or to help to find the cause of your symptoms.

General Practitioner: a registered medical practitioner in general practice.

Group Secretary: the person responsible for taking out your group policy with Simplyhealth.

Home Nursing: the full time services of Qualified Nurses, on a resident or daily basis, following an in-patient stay, when prescribed by a Specialist solely for medical reasons.

Hospital: any hospital in the current Simplyhealth Hospital Directory.

In-patient: A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.

Member: the individual nominated by the Group Secretary and accepted by Simplyhealth as a Member, including each nominated eligible Dependant.

Membership Certificate: provides details of your chosen form of medical underwriting and any personal restrictions that apply to your policy.

Nurse: a qualified nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Out-patient: A patient who attends hospital, consulting room or out-patient clinic and is not admitted as a Day-patient or In-patient.

Physiotherapy: treatment given by a State Registered Physiotherapist.

Policy: our contract of insurance with your group.

Policy Document: the full terms and conditions that relate to your Policy including your Membership Certificate and personal underwriting exclusions.

Pre-existing Condition: any disease, illness or injury for which:

you have received medication, advice or Treatment; or

you have experienced symptoms; whether the condition has been diagnosed or not in the five years before the start of your cover.

Simplyhealth: a division of Simplyhealth Access.

Specialist: a registered medical or dental practitioner who holds or has held an appointment as a consultant in a National Health Service Hospital or has a Certificate of Higher Specialist Training from the appropriate Royal College.

Treatment: surgical or medical services (including Diagnostic Tests) that are needed to diagnose, relieve or cure a disease, illness or injury.

Year: the period of 12 calendar months from the date of your enrolment or renewal of enrolment as a member.

10

If you have a complaintWe aim to provide you with the highest levels of customer service and care. In order to maintain this service standard we encourage feedback from our members. That’s why we’ve put in place a procedure that you can use to raise any concern or complaint you may have.

In the first instance you should write to Simplyhealth Customer Services at James Tudor House, 90 Victoria Street, Bristol BS1 6DF or contact our Customer Services team on 0800 294 7302.

If you are unhappy with the response you receive then we will refer your complaint to the Simplyhealth Quality Assurance team for a final decision.

Should you remain dissatisfied with our final response, you have the right to refer your complaint to the Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR, telephone 0845 080 1800. Full details of our complaints procedure are available on request.

Important notesThe terms and conditions of Care for Corporates Private Health Cover:

(i) Shall not confer rights upon any third party and any third party rights are specifically excluded.

(ii) May be changed without reference to and without the consent of any third party.

No verbal communication can override or vary the written terms or conditions of Care for Corporates Private Health Cover unless confirmed by us in writing.

You have a choice of contract law. We propose to apply the Laws of England to the contract.

You are protected by the Financial Services Compensation SchemeYou are protected by the Financial Services Compensation Scheme (FSCS) – in the unlikely event that we go out of business or into liquidation the FSCS protects you. Should this happen, the scheme will pay any valid outstanding claims you have at the appropriate level applicable to the scheme at the time of the claim. For more details on the scheme please visit www.fscs.org.uk or contact the FSCS direct on 0207 892 7300.

About SimplyhealthPart of the Simplyhealth Group, BCWA and Simplyhealth are trading names 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.

How to contact us We are always happy to hear from you.

Call our Claims Helpline on: 0800 980 6248

Alternatively you can contact us at:

Simplyhealth James Tudor House 90 Victoria Street Bristol BS1 6DF

Tel: 0800 980 6046 Fax: 0117 929 5539 Email: cfcadmin@simplyhealth.co.uk View our website: www.simplyhealth.co.uk

Your calls may be recorded and monitored for training and quality assurance purposes.

11

Simplyhealth, James Tudor House, 90 Victoria Street, Bristol BS1 6DFPart of the Simplyhealth Group. BCWA and Simplyhealth are trading names 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.

CFC

001/

0909